We Are What We Pre-Attend To Be: Piloting a Pre-Attendingship Rotation in Hospital Medicine

Problem Definition New-to-practice attendings (NPTAs) lack readiness for independent practice Graduated autonomy – understood but not structurally enforced in residency training Curricular expectations not explicitly defined despite experiential differences between graduate training levels of PGY2 and PGY3 internal medicine residents Although residents achieve competencies established by the ACGME prior to graduation, NTPAs feel unprepared suggesting opportunities to change the clinical learning environment to increasehttps://jdc.jefferson.edu/medposters/1022/thumbnail.jp

Improving Rates of Nephrology Referral for Patients with Chronic Kidney Disease in Resident Clinic

According to the KDIGO (Kidney Disease Improving Global Outcomes), evaluation by a nephrologist is recommended for patients with CKD stage 4 or higher (corresponding to a GFR of 30 or lower). Studies have shown that patients who are not referred to a nephrologist or referred later suffer from increased complications of renal disease, accelerated progression to ESRD, and have an increased overall mortality rate. At Jefferson Hospital Ambulatory Practice (JHAP), we noted decreased rates of nephrology follow-up in our patients with chronic kidney disease stage 4 and 5. We identified that the most prevalent reason for the decreased referral rates is due to the lack of knowledge of the KDIGO guidelines. Our goals were to implement an intervention to educate our internal medicine residents and improve the referral rates for advanced chronic kidney disease in our practice

Improving Inpatient Management of Opioid Use Disorder

Research Question: What aspects of successful OUD treatment teams are most needed at Thomas Jefferson

Use of Naltrexone for Alcohol Use Disorder: Closing The Gap in Inpatient Initiation

Project AIM: increase the prescribing of this medication as an inpatient to ideally provide more support to patients with alcohol use disorde

Increasing Awareness for the Opioid Aftercare Coordination Service (OACS)

Background The United States is in a crisis of opiate related adverse events. From 1999 2017, more than 700,000 people in the U.S. died from drug related overdose; 68% of those involved opioids Admissions at Jefferson Hospital for opioid abuse complications are common among the medicine services. Treating patients for their opiate addiction is essential to prevent future opioid overdoses and other complications Jefferson has initiated an Opioid Aftercare Coordination Service (OACS) consult system in response to this crisis in order to increase the number of patients who receive medications for opioid use disorder on discharge OACS serves both Jefferson Hospital and Methodist and aims to: – Link patients with medications for opioid use disorder after discharge – Provide access to ancillary resources inpatient and outpatient – Provide in hospital counselinghttps://jdc.jefferson.edu/patientsafetyposters/1122/thumbnail.jp

Medication Initiation, Patient-directed Discharges, and Hospital Readmissions Before and After Implementing Guidelines for Opioid Withdrawal Management

OBJECTIVES: Rising rates of hospitalization for patients with opioid use disorder (OUD) result in high rates of patient-directed discharge (PDD, also called discharge against medical advice ) and 30-day readmissions. Interdisciplinary addiction consult services are an emerging criterion standard to improve care for these patients, but these services are resource- and expertise-intensive. A set of withdrawal guidelines was developed to guide generalists in caring for patients with opioid withdrawal at a hospital without an addiction consult service. METHODS: Retrospective chart review was performed to determine PDD, 30-day readmission, and psychiatry consult rates for hospitalized patients with OUD during periods before (July 1, 2017, to March 31, 2018) and after (January 1, 2019, to July 31, 2019) the withdrawal guidelines were implemented. Information on the provision of opioid agonist therapy (OAT) was also obtained. RESULTS: Use of OAT in patients with OUD increased significantly after guideline introduction, from 23.3% to 64.8% ( P \u3c 0.001). Patient-directed discharge did not change, remaining at 14% before and after. Thirty-day readmissions increased 12.4% to 15.7% ( P = 0.05065). Receiving any OAT was associated with increased PDD and readmission, but only within the postintervention cohort. CONCLUSIONS: A guideline to facilitate generalist management of opioid withdrawal in hospitalized patients improved the process of care, increasing the use of OAT and decreasing workload on the psychiatry consult services. Although increased inpatient OAT has been previously shown to decrease PDD, in this study PDD and readmission rates did not improve. Guidelines may be insufficient to impact these outcomes