Lost in Translation: A Standardized, Interdepartmental Approach to Improve the Safety of Inpatient Transitions of Care

AIM: During the 2016-2017 academic year physician perception of favorability regarding inpatient interunit handoffs will meet the national HSOPS benchmark without negatively impacting patient bed flow. All ACGME training programs at Thomas Jefferson University Hospital will expose their new trainees to standardized handoff training during orientation in June 2017 as well as adapt a framework for monitoring trainee compliance and proficiency.https://jdc.jefferson.edu/patientsafetyposters/1028/thumbnail.jp

Understanding Differences in Medical Versus Surgical Patients Alerted by the Modified Early Warning Score (MEWS) at Jefferson Hospital

An Early Warning Score (EWS) is a risk-management tool to identify patients experiencing clinical deterioration early, therefore allowing timely treatment to occur. Although EWS scores are recommended for all in-patients, more data is available for patients under general medical services compared to surgical services. This study aims to understand differences between medical versus surgical in-patients who receive a red alert from the Modified Early Warning Score (MEWS) at Jefferson hospital. Patients who received a red MEWS alert during admission and discharged between June 2017 to March 2018 (N=812) were categorized as medical or surgical patients. Patient characteristics were compared using an independent samples t-test (age, alert count) or chi-square test (sex, race, admission source, insurance). Patient outcomes were compared using a binary logistic regression (in-hospital mortality, RRT, sepsis diagnosis, ICU transfer, intubation, discharge to hospice) or a Cox regression model (length of stay), controlling for age, sex, and race. Compared to medical patients, surgical patients were younger by 2.7 years (p=0.026) and more likely to have a Commercial and/or Medicare category of insurance (OR=1.568, p=0.005). Surgical patients were more likely to have ICU transfer (OR=1.487, p=0.013) and intubation post-alert (OR=2.470, p=0.006), while less likely to be discharged early (HR=0.675,

To Fib or Not to Fib: Misdiagnosis of Atrial Fibrillation on Telemetry Case Presentation and Root Cause Analysis

Case presentation, current practices of telemetry management, root cause analysis, goals for improvement, proposed intervention and next steps

Norman Jaffe, MD, Oral History Interview, April 20, 2012

Major Topics Covered: Personal and educational background Working with Dr. Sidney Farber at the Sidney Farber Cancer Institute in Boston Cancer in pediatric patients; “total care” of pediatric patients; special challenges Research: solid tumors, osteosarcoma, eradicating metastasis with methotrexate The Department of Pediatric Oncology: history and evolution Pediatrics and survivorship Long-Term Surveillance Clinic Ski Rehabilitation Program International collaborationshttps://openworks.mdanderson.org/mchv_interviewsessions/1161/thumbnail.jp

Norman Jaffe, MD, Oral History Interview, August 31, 2012

Major Topics Covered: Personal and educational background Working with Dr. Sidney Farber at the Sidney Farber Cancer Institute in Boston Cancer in pediatric patients; “total care” of pediatric patients; special challenges Research: solid tumors, osteosarcoma, eradicating metastasis with methotrexate The Department of Pediatric Oncology: history and evolution Pediatrics and survivorship Long-Term Surveillance Clinic Ski Rehabilitation Program International collaborationshttps://openworks.mdanderson.org/mchv_interviewsessions/1163/thumbnail.jp

Norman Jaffe, MD, Oral History Interview, August 17, 2012

Major Topics Covered: Personal and educational background Working with Dr. Sidney Farber at the Sidney Farber Cancer Institute in Boston Cancer in pediatric patients; “total care” of pediatric patients; special challenges Research: solid tumors, osteosarcoma, eradicating metastasis with methotrexate The Department of Pediatric Oncology: history and evolution Pediatrics and survivorship Long-Term Surveillance Clinic Ski Rehabilitation Program International collaborationshttps://openworks.mdanderson.org/mchv_interviewsessions/1162/thumbnail.jp

Iliac Compression Syndrome Treated with Stent Placement.

Iliac compression syndrome is usually diagnosed during the third and fourth decades of life when the patient has iliofemoral deep vein thrombosis. Catheter-directed thrombolytic therapy is an accepted method of treatment for iliofemoral deep vein thrombosis, which has been reported to afford greater success with clot dissolution than with system therapy. Although this method is not new, this is the first case, to our knowledge, reporting successful treatment of computerized tomographically demonstrated iliac compression syndrome with stent placement after lysis and insufficient response to balloon angioplasty

Troponin Elevations After Electroconvulsive Therapy: The Need for Caution

BACKGROUND: Electroconvulsive therapy is used to treat patients with severe or resistant depression. Troponin elevations are associated with an adverse prognosis, and it is well known that central nervous system insults can cause biochemical evidence of cardiac injury. No study previously has studied this with electroconvulsive therapy. METHODS: Patients scheduled for electroconvulsive therapy were enrolled. Clinical information, an electrocardiogram, and a baseline sample for cardiac troponin I and T (cTnI and cTnT) were obtained. Electroconvulsive therapy was done with standard techniques. Subsequently, electrocardiograms and additional samples were obtained. cTnT was measured with the Roche assay and cTnI with the Dade Stratus equipment. Values above the 99th percentile were considered abnormal. RESULTS: Seventy patients completed the study. Four patients had elevated levels of cTn before treatment. In 3 patients, the elevations persisted. Four additional patients developed elevated cTn levels during electroconvulsive therapy. Two of the patients with cTn elevations died. No other events occurred during follow-up. CONCLUSIONS: Elevations of cTn occurred in 11.5% of patients treated with electroconvulsive therapy. Some of the elevations preceded therapy and some occurred during treatment. Given the adverse prognostic importance of cTn elevations in general, in addition to additional studies, an increased degree of medical scrutiny may be appropriate for this group of patients and for those receiving electroconvulsive therapy