Using Electrolyte Repletion Guidelines to Improve the Rate of Oral Potassium and Magnesium Delivery

Introduction: Evidence-based guidelines for electrolyte replacement that safely encourage oral (PO) and/or intravenous (IV) dosing more successfully attain goal levels than standard care. However, the Thomas Jefferson University Hospital (TJUH) electrolyte replacement guidelines (JG 11-1296), approved in 2002 and last updated in 2008, provide guidance for IV repletion not PO. Between 5/2017-11/2017, TJUH dosed potassium and magnesium in a 2.30 and 4.24 IV:PO ratio, respectively. If 50% of doses were given PO, we anticipate ~$800,000 annual TJUH savings. Methods: We created a multidisciplinary team and completed a literature review to inform the creation of updated TJUH guidelines for potassium and magnesium repletion. We attained updated guideline approval from the TJUH Pharmacy & Therapeutics Committee followed by the Medical Executive Board. We are working on an Epic order-set to ease clinician use of guideline-based therapy; an institutional Epic build “Freeze” is delaying progress. We will study the impact of updated guidelines with a pre-post design; using a two-tailed Welch’s t-test to test for significance. Results: We hypothesize that the updated guidelines will reduce the ratio of IV:PO doses, increase the percent of patients within normal limits after repletion, decrease time to repletion, and reduce the average hospital cost for electrolyte repletion per patient/day. We additionally anticipate improved patient comfort and convenience of repletion though we will not study for significance. Conclusion: We anticipate that the creation of an easily-accessible evidence-based TJUH electrolyte repletion guideline will improve quality of repletion and patient comfort while decreasing TJUH electrolyte repletion cost

The “OK” Guideline: Implementing an Electronic Electrolyte Repletion Guideline for Improving Rates of Oral Potassium and Magnesium Delivery

Nearly 500,000 doses of potassium (K) and magnesium (Mg) are given at Thomas Jefferson University Hospital (TJUH) each year. More than 80% of these doses are given intravenously. Guidelines that encourage both intravenous and oral (PO) repletion options increase rates of PO dosing and more successfully attain goal levels than standard care. Our goal was to increase the percent of K and Mg doses delivered by oral route to \u3e50% of total doses distributed at TJUH within one year of implementation of an Epic-based electronic order set

Evaluating the reliability of the problem list for comorbidity

The problem list in EPIC provides a centralized source of patient medical conditions that informs medical decision making. This is especially important for COVID- 19 patients where risk scores such as the “4C score” inform care. The goal of this study was to identify the accuracy of the problem list and identify areas for future improvement

An Integrated, Evidence-Based Approach to Transitioning to Operations: Specifications for Future Replacement Lights on ISS

The International Space Station (ISS) currently uses General Luminaire Assemblies (GLAs) as its primary light source. These GLAs are composed of fluorescent lighting and are integrated into the electrical system on Station. Seventy seven of these units are distributed throughout the vehicle, and many of the lights, having reached their lifespan, are no longer functional; while backup panels are available on orbit, it is anticipated that the supplies of fluorescents on the station will be exhausted by 2015. The ISS vehicle office is therefore preparing to replace all of the GLAs, with Solid State Light Assemblies (SSLAs) composed of white Light Emitting Diodes (LEDs). In the Spring of 2010, an announcement for the replacement lights was released. The announcement specified that proposed lighting systems should use LED technology, given certain power draw restrictions and no changes to how the lights are currently controlled (a central on/off switch per node, and a dial to turn on/off and increase brightness on each lighting unit). The replacement lights are to follow current specifications for brightness levels (lux) and color temperature (degrees Kelvin, or K). Reportedly, the lighting on orbit is dim and suboptimal. The average brightness of the lights (given all lights within a node are operational) is 291 lux; by comparison, recommended office lighting ranges from 200 to 500 lux, and daylight ranges on a typical overcast day, consists of 10,000 to 25,000 lux. Representatives from NASA Behavioral Health and Performance Element (BHP) and Human Factors and Habitability identified that maintaining current brightness levels limits visual acuity, work space, and the use of light as a countermeasure for improving circadian entrainment, hastening phase shifting, evoking acute alertness and enhancing performance. Revised lighting specifications are therefore needed to optimize the replacement lights for the ISS

Initial Experience in Monitoring QT Intervals Using a Six-lead Contactless Mobile Electrocardiogram in an Inpatient Setting.

Mobile electrocardiograms (ECGs) (mECGs) using smartphone applications are an emerging technology. In the coronavirus disease 2019 (COVID-19) era, minimizing patient contact has gained increasing importance. Additionally, increased QT/corrected QT (QTc) monitoring has concurrently been required. The KardiaMobile 6L ECG device, cleared by the United States Food and Drug Administration (FDA) for recording ECGs, along with the KardiaStation tablet application is a platform (AliveCor, Mountain View, CA, USA) that addresses these two issues. A team of residents, fellows, hospitalists, and cardiologists identified inpatients in need of QT/QTc interval monitoring to pilot the adoption of a system composed of a KardiaMobile 6L ECG device with the accompanying KardiaStation tablet application. Concurrent standard ECGs provided validation. Adoption and performance issues were recorded. Four patients agreed to participate in QT/QTc interval monitoring, three of whom were positive for severe acute respiratory syndrome coronavirus 2 viral infection. After basic instructions were given to the patients and their clinical nurses, all patients recorded mECGs successfully. Patients were able to record their own mECG tracings at least once without any assistance. The 12-lead ECGs and mECGs each showed the correct rhythm, and the measured QTc intervals on each modality were consistently acceptable (\u3c 500 ms). Contactless ECGs were successfully uploaded to KardiaStation for QT/QTc interval measurement and archiving. In this study, we showed that an FDA-cleared product, KardiaMobile 6L, has the ability to provide high-quality contactless ECGs for reliable QT/QTc interval measurements. Hospitalized patients were able to perform recordings when requested after receiving simple instructions at the time of first use. This technology has applications during the COVID-19 pandemic and beyond

Short-wavelength enrichment of polychromatic light enhances human melatonin suppression potency.

The basic goal of this research is to determine the best combination of light wavelengths for use as a lighting countermeasure for circadian and sleep disruption during space exploration, as well as for individuals living on Earth. Action spectra employing monochromatic light and selected monochromatic wavelength comparisons have shown that short-wavelength visible light in the blue-appearing portion of the spectrum is most potent for neuroendocrine, circadian, and neurobehavioral regulation. The studies presented here tested the hypothesis that broad spectrum, polychromatic fluorescent light enriched in the short-wavelength portion of the visible spectrum is more potent for pineal melatonin suppression in healthy men and women. A total of 24 subjects were tested across three separate experiments. Each experiment used a within-subjects study design that tested eight volunteers to establish the full-range fluence-response relationship between corneal light irradiance and nocturnal plasma melatonin suppression. Each experiment tested one of the three types of fluorescent lamps that differed in their relative emission of light in the short-wavelength end of the visible spectrum between 400 and 500 nm. A hazard analysis, based on national and international eye safety criteria, determined that all light exposures used in this study were safe. Each fluence-response curve demonstrated that increasing corneal irradiances of light evoked progressively increasing suppression of nocturnal melatonin. Comparison of these fluence-response curves supports the hypothesis that polychromatic fluorescent light is more potent for melatonin regulation when enriched in the short-wavelength spectrum

Implementation of Clinical Practice Guidelines for Hospitalized Patients With COVID-19 in Academic Medical Centers

This survey study assesses the rate at which US academic medical centers have adopted evidenced-based guidelines for the management of COVID-19 into practice

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

Trust the Process: A Templated, Centralized, and Protocolized Patient Safety Pilot Project to Improve Outside Admissions

Transfers are high-risk. Intra-hospital transfer processes research has improved protocols used nationally.1 Outside-hospital admissions remain without standards ensuring the transfer of the right information to the right clinician at the right time; presently, patients can arrive at a new hospital with limited-to-no information.2We trialed a novel process for outside (hospital, provider, or skilled nursing facility) admissions to a single academic medical center’s resident and- hospital-medicine-attending-based (“teaching”) medicine services.https://jdc.jefferson.edu/medposters/1015/thumbnail.jp