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,

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

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

Taking the e out of Night MARe Rotation: Uncloaking Ghost Admissions via Teletracking and Reducing Paper Fatigue

Goal: To improve communication at admission for patients admitted from non-ED locations so that patient care delays are minimized and provider frustration decreases.https://jdc.jefferson.edu/patientsafetyposters/1015/thumbnail.jp

Protection or Punishment? Reimagining the Hospital Care Environment for People Who Use Drugs

Background Problem: Jefferson serves a large population of patients who use drugs (PWUD). As the opioid epidemic has evolved, our practice has adapted. Examples of Jefferson\u27s dynamic response include hospital-wide guidelines for withdrawal management and medications for opioid use disorder, establishment of a bridge clinic, and the JAMS service. However, there is little consensus on how to best support this population in the hospital, particularly if they are using or suspected of using non-prescribed substances during their admission. Aim: Development of accessible guidelines to manage and support PWUD in thehospital

Easy Identification of Missed DVT Prophylaxis-A Chance for Intervention

Goal: To minimize the number of missed or refused medications for inpatients so that adverse patient events such as PE or DVT are prevented SMART AIM: Within 3 months of initiating an EMR based electronic identification system for refused and missed medications, we will decrease the rate at which DVT prophylaxis was ordered however not eventually administered by 50%.https://jdc.jefferson.edu/patientsafetyposters/1014/thumbnail.jp

The TJUH Hospital Medicine COVID19 Emergency Taskforce: A guiding light during the surge of spring 2020

What’s the Problem? In mid March 2020 a highly infectious and deadly disease appeared in Philadelphia that no American physician had ever treated before. The challenge of disseminating reliable and relevant information about a novel and dangerous pathogen across practice areas cannot be understated. Usual practices for communication and leadership are not designed to manage this kind of challenge

At the Leading Edge of Change: Creation of the Housestaff Quality and Safety Leadership Council

Background: The ACGME Clinical Learning Environment Review (CLER) is driving a national re-evaluation of the engagement and alignment of housestaff in institutional Quality and Safety. In 2008, the concept of a housestaff quality and safety committee was born, as a means of driving practice change Our CLER data suggested that we need a similar councilhttps://jdc.jefferson.edu/patientsafetyposters/1004/thumbnail.jp