Process design for optimizing text-based communication between physicians and nurses

Background and Aim Communication between physicians and nurses is a cornerstone of high-quality inpatient care. HIPAA-compliant text-based methods offer an alternative to the pager for communication between nurses and physicians. While messaging is popular in the personal setting, text-based professional communication in hospitals may increase the number of messages without improving coordination between care providers. (1) In addition, urgent messages that are more appropriately calls could be missed by the physician, leading to a delay in action. Other institutions use triage systems to communicate a question or clinical change by the urgency of expected physician response, which have attempted to mitigate this issue. (2) We aimed to improve bidirectional communication between housestaff and nursing with a communication process developed jointly by both parties using QI methods such as stakeholder analysis and a structured Work-Out session to brainstorm solutions

Tenofovir Cons the Kidneys: A Case of Acquired Fanconi

INTRODUCTION Proximal (Type 2) renal tubular acidosis (RTA) is a relatively rare diagnosis, especially in adults. It is characterized by a reduction in proximal bicarbonate reabsorption resulting in urinary bicarbonate wasting. Proximal RTA can also be associated with additional defects in proximal tubular function including impaired reabsorption of phosphate, glucose, uric acid, and amino acids. Generalized proximal tubular dysfunction is termed Fanconi syndrome. While there are primary causes of Fanconi syndrome including sporadic and familial sources, this syndrome can also be acquired. Two major culprits include monoclonal gammopathies resulting in increased excretion of immunoglobulin light chains and drug-induced nephrotoxicity to the proximal tubules.1 Tenofovir disoproxil fumarate (TDF) is one such established nephrotoxic agent associated with Fanconi syndrome, likely because it is excreted through the kidney via active tubular secretion.2-4 This case demonstrates a classic presentation of tenofovir-induced Fanconi syndrome complicated by respiratory repercussions of hypophosphatemia, and also describes tenofovir alafenamide (TAF), a novel formulation with reduced renal toxicity. KEY POINTS This case illustrates the renal side effects of TDF-induced Fanconi syndrome, highlighting the manifestations of hypophosphatemia. Recognizing this potential side effect and switching patients to a TAF-containing regimen is important to prevent renal injury

Utilizing feedback as a mechanism to improve resident event reporting rates

Objectives Provide feedback to 100% of residents entering a report between December 2017 and March 2018 Evaluate the degree to which residents value the feedback we were able to provide Assess a pilot process for sustainability on a larger scalehttps://jdc.jefferson.edu/patientsafetyposters/1099/thumbnail.jp