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| CONFERENCE ABSTRACTS AND REPORTS |
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| Year : 2016 | Volume
: 2
| Issue : 3 | Page : 79-95 |
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The 2016 St. Luke's university health network annual research symposium: Event highlights and scientific abstracts
| Date of Web Publication | 19-Aug-2016 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2455-5568.188740
How to cite this article:
. The 2016 St. Luke's university health network annual research symposium: Event highlights and scientific abstracts. Int J Acad Med 2016;2, Suppl S1:79-95 |
How to cite this URL:
. The 2016 St. Luke's university health network annual research symposium: Event highlights and scientific abstracts. Int J Acad Med [serial online] 2016 [cited 2023 Jun 5];2, Suppl S1:79-95. Available from: https://www.ijam-web.org/text.asp?2016/2/3/79/188740 |
Guest Editor
Jill C. Stoltzfus
Director, The Research Institute, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Background Information and Event Highlights: The Annual St. Luke's University Health Network (SLUHN) Research Symposium was created in 1992 to showcase research and quality improvement projects by residents and fellows. The Research Institute Director is responsible for planning and organizing the event, with collaboration and consultation provided by the Chief Academic Officer, the Graduate Medical Education leadership, residency, and fellowship faculty, and the Director of Media Production Services. Residents and fellows submit an application for oral and/or poster presentation along with an accompanying abstract describing their project. Three physician judges not affiliated with any residency or fellowship program are selected to evaluate the presentations for the first and the second place cash prizes awarded in both oral and poster presentation categories.
For the first time in SLUHN history, the 2016 Research Symposium for Resident and Fellows was combined with the Nursing Research and Scholarship Celebration into an institutional-wide SLUHN “Research Day” that also included two keynote speakers. This year's distinguished keynote speakers were Dr.Susan Moffatt.Bruce, MD, PhD, MBOE, FACS, FRCP.(C), and Dr.Timothy Huerta, PhD, MS. Dr.Moffatt-Bruce, Professor of Surgery, serves as an Associate Director of the Center for Lean Healthcare Research at the Fisher College of Business.(The Ohio State University) and is the Chief Quality and Patient Safety Officer at The Ohio State University Medical Center. Dr.Huerta is an Associate Professor in the Departments of Family Medicine and Biomedical Informatics at The Ohio State University College of Medicine. Dr. Moffatt-Bruce and Dr. Huerta presented a captivating talk on multidisciplinary approaches to research, describing their pioneering projects that intersect the areas of patient safety, health-care quality, clinical research, biomedical informatics, and numerous other disciplines. Significant portions of their keynote addresses focused on the most important aspects of the art and science of grant writing, interacting with funding agencies, and building teams that are able to effectively compete for opportunities offed by the National Institutes of Health and the National Science Foundation. Please see the Future Trends commentary (Pages S2-S5 of this Supplement) by Dr. Moffat-Bruce and Dr. Huerta, for highlights of their Keynote session.
The Nursing Research and Scholarship Celebration featured original research and quality improvement projects by nurses from all six hospital campuses and the Visiting Nurses Association of St. Luke's University Health Network. The event was coordinated by Peter Deringer, RN, MA, NE-BC, and Joan Snyder, MSN, RN. Presenting nursing scholars discussed projects aimed at enhancing patient safety, optimizing care delivery, and improving quality of care. In addition, the 3rd Annual Robin E. Haff Award, given to a nurse showing exceptional interest in nursing research, was presented to Deborah Martin, MSN, RN, CCRN, by Dr.Vincent Lucente, an internationally recognized academic urogynecologist and medical researcher.
The following core competencies are addressed in this article: Practice-based learning and improvement, medical knowledge, patient care, systems-based practice.
Keywords: Nursing Research and Scholarship Celebration, Resident and Fellow Research Competition, St. Luke's University Health Network
| Oral Presentation Abstracts | |  |
| Oral Presentation Abstract Number 1 | | |
Month to month trauma volume variations affecting mortality: a multicenter study
Keith Habeeb, James Cipolla, David Evans, Charles Cook, Alok Gupta, Noelle Saillant, William Hoff, Peter Thomas, Stanislaw Stawicki
Surgical Critical Care Fellowship Program, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: This study examined the relationship between monthly trauma volumes and patient mortality at three Level 1 trauma centers located in the Eastern United States. We hypothesized that significant differences in mortality patterns would be noted at the reporting centers across a spectrum of monthly trauma volume ranges, without predetermined directionality.
Methodology and Statistical Approach: Monthly trauma volume data were collected from three Level 1 trauma centers. Additional information included monthly mortality, mean monthly injury severity score (ISS), and blunt versus penetrating trauma mechanism. The primary study outcome was average mortality. Additional outcomes included mortality and volume trends corrected for ISS, and institutional volume characteristics were analyzed using analysis of covariance (ANCOVA) with statistical significance set at α < 0.01.
Results: When examining the primary end-point of monthly volume versus mortality, we found that for all three institutions, higher monthly volumes were associated with significantly lower mortality even after correcting for ISS and center-specific volume characteristics. Mean mortality was 3.7% for months with volumes <80, progressively decreasing to 2.5% for months with >240 trauma contacts. Results of the ANCOVA for key study outcomes are shown in [Figure 1]. | Figure 1: (Left) adjusted monthly mortality (shown as mean ± standard error); (top right) adjusted yearly mortality over the entire study period (1998–2015, mean ± standard error); (bottom right) descriptive characteristics for each contributing Level I trauma center
Click here to view |
Discussion and Conclusion: Our data showed that trauma mortality, corrected for ISS and center-specific volume variability, was lowest during months with >240 contacts. Progressive increases in mortality were seen as monthly volumes decreased, with absolute mortality 1.2% higher for months with <80 contacts. This translates to a 48% increase in relative mortality. These observations suggest that a system-wide opportunity might exist to further reduce trauma mortality in the United States. Further research is warranted in this important area, focusing specifically on ways to optimize trauma patient flow across growing regional trauma networks and within consolidated hospital systems. The effect of further increases or decreases in average monthly volumes remains to be elucidated.
| Oral Presentation Abstract Number 2 | | |
Computed tomography-based outcome prediction tool for older patients with traumatic brain injury
Ronnie Mubang, Thomas Wojda, William Hoff, Brian Hoey, Peter Thomas, Steven Falowski, Stanislaw Stawicki
General Surgery Residency Program, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Advanced age has been traditionally associated with worse traumatic brain injury (TBI) outcomes. Although prompt neurosurgical intervention (NSI, craniotomy or craniectomy) may be lifesaving in the older trauma patient, it does not guarantee survival and/or return to preinjury functioning levels. The aim of this study was to determine whether a simple score, based entirely on the initial cranial computed tomography (CCT), is predictive of morbidity, mortality, and other outcome measures in the older (age 45+) NSI patient subset. We hypothesized that increasing number of discrete CCT findings might independently predict the need for NSI and mortality in older patients with severe TBI.
Methodology and Statistical Approach: After the Institutional Review Board approval, a retrospective study of patients aged 45 years and older was performed using registry data from Level 1 trauma center between June 2003 and December 2013. Abstracted data included patient demographics, injury severity score (ISS), Abbreviated Injury Scale (AIS)-head, brain injury characteristics on CCT, Glasgow Coma Scale (GCS), Intensive Care Unit (ICU) and hospital length of stay (LOS), all-cause morbidity and mortality, Functional Independence Measure scores, and discharge disposition. A novel CCT scoring tool (CCTST, scored from 1 to 8+) was devised with one point given for each of the following findings: subdural hematoma, epidural hematoma, subarachnoid blood, intraventricular blood, cerebral contusion/intraparenchymal blood, skull fracture, brain edema/herniation, midline shift, and external (skin/face) trauma. Descriptive statistics and univariate analyses were subsequently conducted with mortality as the primary end-point. Secondary end-points included all-cause morbidity, ICU LOS, and postdischarge destination. Variables achieving statistical significance of P < 0.20 were subsequently included in a multivariate logistic regression model, with statistical significance set at α = 0.05. Data were presented as either mean ± standard deviation or adjusted odds ratios (AORs) with 95% confidence intervals (CIs).
Results: A total of 620 patients were included in the analysis (310 patients who underwent NSI and 310 age- and ISS-matched non-NSI controls). Average patient age was 72.8 ± 13.4 years (64.1% male, 99% blunt trauma, mean ISS 25.1, mean AIS-head 4.63, mean GCS 10.9). The CCTST was inversely proportional to initial GCS score and discharge functional outcomes [Figure 1]a and [Figure 1]f. Increasing CCTST was associated with greater mortality, morbidity, hospital and ICU LOS, and ventilator days [Figure 1]b,[Figure 1]c, [Figure 1]d, [Figure 1]e. On multivariate analysis, independent predictors of mortality included AIS-head (AOR 2.698, 95% CI 1.21–5.99), initial GCS (AOR 1.14, 95% CI 1.07–1.22), and CCTST (AOR 1.31, 95% CI 1.09–1.58). Neither ISS nor the presence of preinjury anticoagulation independently predicted mortality. The only independent predictor of the need for craniotomy was CCTST (AOR 1.225, 95% CI 1.06–1.42). | Figure 2: Total amount of estrogen receptor and progesterone receptor as represented by their category (1, 2, or 3) added together. All tumors with <33% of each estrogen receptor and progesterone receptor are high risk on MammaPrint
Click here to view |
Discussion and Conclusion: This study demonstrated that the number of discrete findings on CCT significantly correlates with nearly every TBI outcome measure, including NSI and mortality. The CCTST is easy to calculate, and this preliminary investigation of its predictive utility in patients undergoing NSI warrants further validation, focusing on the potential for prognostic synergy between CCTST, GCS, and AIS-head.
| Oral Presentation Abstract Number 3 | | |
The comorbidity-polypharmacy score: An alternative measurement of frailty for medical-surgical patients
Julia Tolentino, Riley Harris, Amanda Mazza, Dan Foltz, Jill Stoltzfus, Peter Deringer, Donna Sabol, Stanislaw Stawicki
General Surgery Residency Program, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: The current patient frailty indices are limited by their complexity and lack of translatability across clinical settings. The comorbidity-polypharmacy score (CPS) is a simple sum of preadmission medications and comorbid conditions. Previous studies have demonstrated that CPS was correlated with morbidity, mortality, readmissions, and postemergency department triage in various patient populations. However, earlier studies of CPS were limited due to small sample sizes and narrow age ranges (i.e., 45 years and older) across study populations. The aim of the study was to determine the behavior of CPS across a large sample of medical-surgical patients of all age ranges. We hypothesized that CPS would be significantly associated with readmissions, mortality, and hospital length of stay.
Methodology and Statistical Approach: We conducted a retrospective review of patients admitted to our network's hospitals between July 1, 2014, and December 31, 2014. This study was deemed exempt by the Institutional Review Board. Variables collected for each patient included demographics (age, gender), polypharmacy data (number of preadmission medications), comorbid conditions (all conditions listed as “preexisting” on admission), hospital length of stay, need for Intensive Care Unit (ICU), postdischarge destination (home vs. nonhome discharge), and mortality. Descriptive and univariate analyses were conducted across sequential 3-point CPS ranges, with mortality and readmissions as primary end-points. Subsequent multivariate logistic regression was conducted for variables reaching a significance level of P < 0.10 in univariate analyses. Statistical significance set at α < 0.01 due to the multiple comparisons.
Results: A total of 20,644 medical-surgical patients were included in our study. On univariate analysis, CPS was significantly associated with patient age, gender, length of stay, readmission, discharge destination, ICU requirement, and mortality [all, P < 0.001; [Figure 1]. On multivariate analyses, independent predictors of mortality included age (adjusted odds ratio [AOR] 1.03 per year); CPS (AOR 1.05 per unit); and ICU requirement (AOR 21.9). Independent predictors of readmission included age (AOR 1.01 per year) and CPS (AOR 1.04 per unit). ICU requirement was not a significant predictor of readmission after correcting for index admission mortality.
Discussion and Conclusion: In the acute setting, challenges in medical management of the aging patient are related to frailty. CPS is easily calculated as a sum of preexisting comorbidities and prehospital medications. Investigators had previously described the correlation between a CPS of >15 with poor hospital outcomes in older trauma patients. The CPS score has also been shown to predict readmission in trauma patients, as well as inpatient morbidity and discharge to extended care facilities in burn patients <45 years of age.
This study included the largest patient population in which CPS has been investigated. Our study found CPS to be predictive of mortality and readmissions for medical-surgical patients across all age groups. Given the fact that CPS incorporates the “intensity” of management required to medically control all associated comorbidities, we believe that this score is a strong candidate for measuring patient frailty, independent of chronological age. CPS may also have utility in identifying patients at high risk for in-hospital mortality and readmission, serving a role in triage and risk quantification and stratification.
| Oral Presentation Abstract Number 4 | | |
A novel use of estrogen receptor and progesterone receptor percentages to assess risk of tumor recurrence compared to MammaPrint
Brian Wernick, Thomas Wojda, Elisabeth Paul, Melissa Mao, Lee Riley
General Surgery Residency Program, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Over the past decade, the treatment of breast cancer has changed immensely. Today, therapy is tailored not only to the presence or absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) but also to the use of the genetic risk profile of individual tumors. MammaPrint (MP) is a Food and Drug Administration-approved genetic test that uses a 70-gene microarray to estimate the risk of breast cancer recurrence (either low or high). However, this test is expensive and sometimes unnecessary. It has been shown that lower ER and PR percentages reflect a worse prognosis. With this in mind, we set out to determine if the additive ER-PR relationship reflects patients' risk of recurrence as compared to their MP score. This sort of analysis has never been performed and may provide an opportunity to assess breast cancer risk of recurrence without the need for expensive genetic tests. We hypothesized that low-risk tumors based on the MP score would have a higher total amount of ER and PR compared to high-risk tumors.
Methodology and Statistical Approach: This was a retrospective, single-institution study analyzing all breast cancer patients who had an MP test performed and documented during their treatment between 2010 and 2015. Demographics and tumor data were collected, including age, sex, percentage of ER and PR, presence of HER2, stage, and tumor grade. The MP score was then compared to receptor status, grade, and stage of tumor. ER and PR totals were stratified into three different categories: 0–33% = 1, 34–66% = 2, and 67–100% = 3. A Chi-square test was conducted to determine the association for ER, PR, and the combined ER-PR group with MP score (low risk = 0, high risk = 1). Patients' ER and PR category was added and plotted against their MP score, with percentages depicted on a bar graph.
Results: A total of 246 patients were included in this study, with 133 low-risk and 113 high-risk MP scores. All patients were female, and the average age was 58.7 years. The average ER percentage for low risk and high risk was 95.1% and 66.8%, respectively, and the average PR was 76.2% and 43.7% for low risk and high risk, respectively (P < 0.05). There were more Grade I tumors in the low-risk category (46 vs. 16) and more Grade III tumors in the high-risk category (38 vs. 14) (P < 0.05). There was also a significantly greater number of high-risk MP scores in category 1 (0–33%), with both ER (100%, n = 31) and PR groups (80%, n = 75) (P < 0.005). Categories 2 (34–66%) and 3 (67–100%) for both ER and PR were associated with lower-risk MP scores [Figure 1]a and [Figure 1]b. For the sum of ER and PR, 100% of category 2 (n = 31) and category 3 (n = 2) were associated with high-risk tumors (P < 0.005) as demonstrated by [Figure 2].
Discussion and Conclusion: This study identified novel trends in the ER and PR relationship, demonstrating that the greater the sum of ER and PR, the higher the likelihood of having a low-risk MP score. Furthermore, tumors containing <33% of each ER and PR had a high-risk MP score 100% of the time. Although the clinical significance of this information is still in its preliminary stages, we believe that these new findings will help clinicians evaluate the risk of recurrence for a particular tumor without the need for an expensive genetic test.
| Poster Presentation Abstracts | | |
| Poster Presentation Abstract Number 1 | | |
Impact of CHA 2DS 2-VASC Score on atrial fibrillation detection in patients with cryptogenic stroke
Ajay Abichandani, David Signarovitz, Kevin Branch, David Prutzman, Sahil Agrawal, Lindsay Sadowski, Steve Stevens, Darren Traub, Jamshid Shirani, Sudip Nanda
Cardiology Fellowship Program, The Heart and Vascular Center, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Atrial fibrillation (AF) is a leading cause of ischemic stroke. The advent of insertable loop recorders has allowed detection of occult AF in patients with ischemic stroke. The CHA2 DS2-VASc scoring system, an indicator of progressive endothelial dysfunction, is shown to be superior to the CHADS2 score in the assessment of thromboembolic risk. We hypothesized that systemic causes of endothelial dysfunction are more often responsible for ischemic stroke than occult AF.
Methodology and Statistical Approach: From October 2009 to September 2015, 202 loop recorders were implanted at our institution, of which 74 (37%) were inserted for detection of occult AF in patients with cryptogenic stroke (mean age 66 years, 51% women). Medtronic LINQ was implanted in sixty patients, and Medtronic REVEAL XT was implanted in the remaining 14 patients. Cryptogenic stroke was defined as stroke of undetermined etiology after extensive testing, including 12-lead electrocardiogram; ≥24-h of electrocardiographic monitoring; transesophageal echocardiography; absence of thrombophilic state (in patients <55 years of age); and magnetic resonance, computed tomographic, or invasive angiography of the head and neck. The CHA2 DS2-VASc risk score was calculated, with trends examined using the Student's t-test for continuous variables and Chi-square test for categorical variables.
Results: At a mean follow-up duration of 12 months, occult AF was detected in 15 patients (20%) with an average time to detection of 8 months. CHA2 DS2-VASc scores were 5.13 ± 1.84 and 4.97 ± 1.56 in patients with and without occult AF (P > 0.05), respectively. There were no statistically significant differences in congestive heart failure (20% vs. 5.1%), hypertension (66.7% vs. 67.8%), age >65 years (33% vs. 22%), age >75 years (47% vs. 29%), diabetes (13% vs. 32%), or vascular disease (40% vs. 59%) (P > 0.05 for all comparisons) among patients with and without occult AF.
Discussion and Conclusion: In our study, risk factors comprising the CHA2 DS2-VASc score (congestive heart failure, age, hypertension, diabetes, and vascular disease) were highly prevalent among patients with cryptogenic stroke regardless of the presence of occult AF. This finding has implications regarding optimal long-term management of cryptogenic stroke.
| Poster Presentation Abstract Number 2 | | |
Natural evolution of human papilloma virus series completion and interdose interval
Stephanie Guido, Phelps Lambert, Helaine Levine
Family Medicine Residency - Warren Hospital Program, St. Luke's University Health Network, Phillipsburg, NJ
Introduction/Background: The human papilloma virus (HPV) is responsible for the most cervical cancers and genital cancers but is preventable through a three-dose vaccination series, with interdose intervals of 2 and 4 months. Despite the current recommendations, a Center for Disease Control study in 2014 revealed that only 34% of girls and 21% of boys completed the series in New Jersey. Furthermore, there are little-published data on the effectiveness of intervention programs in improving both vaccine completion rates and interdose intervals in either gender.
Methodology and Statistical Approach: This retrospective cohort study explored HPV series completion rates and interdose intervals at a residency-based family medicine practice in consecutive 18-month periods: Period A (January 1, 2013, to June 31, 2014) and Period B (July 1, 2014, to December 31, 2015). Patients in both time periods received a paper or electronic alarm reminder for the next dose at the time of vaccination. Bill dates for the HPV vaccine for patients <19 years of age were obtained by querying for the HPV CPT code. A registry of HPV dose dates was created by auditing charts of patients billed to collect all doses ever given. Interdose intervals were calculated to the nearest month. “On time” was defined as an interdose interval for dose 1–2 of <4 months and for dose 2–3 of <6 months. The Chi-square test was used to compare dosing rates between the time periods.
Results: We found statistically significant and generally increasing HPV on-time completion rates in both of our study periods across both genders [Figure 1] and [Figure 2]. In addition, we found increasingly shorter intervals between doses among noncompliant patients. The average interval to receive doses 2 and 3 each decreased by 2 months.
Discussion and Conclusion: The addition of an inexpensive and minimally time-consuming reminder to patients resulted in higher and sustainable HPV completion rates compared to those in New Jersey as a whole. To build on our current success, we will create additional interventions that not only continue decreasing interdose intervals and increasing series completion rates but also further decrease our missed opportunities in initiating this potentially lifesaving vaccine.
| Poster Presentation Abstract Number 3 | | |
Evaluation of the use of three-factor prothrombin complex concentrate in the treatment of bleeding due to target-specific oral anticoagulants
Yvonne Labram, Neha Civic, Daniel Longyhore
Pharmacy Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Vitamin K antagonists (VKAs) are the mainstay for chronic anticoagulation until the recent development of target-specific anticoagulants (TSOACs), which gained favor due to their specific mechanisms of action and lack of routine testing. Nevertheless, reversal of anticoagulation is better defined with VKA than with TSOAC. Four-factor prothrombin complex concentrate (PCC4) is recommended in the 2012 American College of Clinical Pharmacy guidelines for the reversal of VKA, but it is used clinically in the treatment of bleeding due to TSOAC. The objective of this study was to evaluate the use of PCC3 for the treatment of bleeding due to TSOAC.
Methodology and Statistical Approach: A retrospective chart review was performed on all patients admitted to St. Luke's University Health Network from January 1, 2013, to November 30, 2015, who received orders for PCC3. Patients were categorized into groups based on whether they received warfarin or one of the TSOACs before PCC3 administration. The primary end-points were units of fresh frozen plasma (FFP) and packed red blood cells (PRBCs) administered after PCC3 administration. The secondary end-points were total units of FFP and PRBC received during treatment, percentage of patients re-dosed with PCC, and thromboembolic adverse events. Descriptive outcomes were reported for baseline characteristics, percentage of patients re-dosed, and thromboembolic adverse events. Separate Mann–Whitney rank sum tests were used for exploratory purposes only to assess the primary outcome and the total units of FFP and PRBC received.
Results: Baseline characteristics were similar between the two treatment groups. There were more units of FFP and PRBC administered after PCC3 administration in the TSOAC arm, but this was not statistically significant (P = 0.11). Total units of FFP administered throughout the bleeding treatment was significantly higher in the TSOAC arm (P = 0.03). Overall, three patients were re-dosed with PCC3, and no thromboembolic events were documented in the charts during the hospitalization.
Discussion and Conclusion: The results of this study suggest that PCC3 is an acceptable treatment agent to use in patients with life-threatening bleeds who were on TSOAC before admission. However, further studies are warranted to evaluate the effect of PCC3 on life-threatening bleeds due to the newer oral agents.
| Poster Presentation Abstract Number 4 | | |
Is placental abruption still a clinical diagnosis?
Melissa Chu Lam, Angel Gonzalez Rios, Jonathan Hunt, James Anasti, James Airoldi, Jill Stoltzfus
Obstetrics and Gynecology Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Placental abruption (PA) complicates 1% of pregnancies and is a leading cause of perinatal morbidity and mortality. Patient presentation varies widely, making the diagnosis sometimes challenging. Although many tests are obtained in PA patients, their clinical relevance is uncertain. We sought to review the incidence of abnormal findings in common hematologic markers in patients diagnosed with PA.
Methodology and Statistical Approach: This is a retrospective chart review of patients who had PA confirmed by pathology, patients with clinical suspicion of abruption but no pathology supporting PA, and patients with clinical and pathology diagnosis of PA at our institution from 2010 to 2015. Available white blood count (WBC), hemoglobin (Hgb), red blood cell distribution width (RDW), coagulation studies, Kleihauer–Betke (KB) test, platelets (PLT), and umbilical artery Doppler (UAD) were compared to normal references. We also analyzed the incidence of abnormal values in each group.
Results: During the 5-year review period, the incidence of pathology-confirmed PA was 0.87% (167/19,100). Of these patients, 74.5% had Hgb <11.5 g/dL; 4.9% had WBC >10.1K/µL; 10.8% had PLT <149 K/µL; and 45.1% had elevated RDW >15.1%. From coagulation profiles obtained, 16.1% had prolonged activated partial thromboplastin time (aPTT); 45.2% had prolonged prothrombin time (PT); and 82.1% had fibrinogen <227 mg/dL. Of the KB tests performed, 1.4% were positive. UADs were abnormal in 9.6% of patients, with 65% clinically diagnosed before delivery.
Of patients with clinical suspicion, but no abruption, 74.4% had Hgb <11.5 g/dL; 6.4% had WBC >10.1 K/µL; and 11.5% had PLT <149 K/µL compared to 61.5%, 10.8%, and 27.7%, respectively, in the group of patients with both clinical suspicion and pathology diagnosis of abruption. In addition, 6.4% of patients had prolonged aPTT; 52.2% had prolonged PT; 66.7% had low fibrinogen; and 5.6% had + KB compared to 13%, 41.7%, 66.7%, and 16.7%, respectively, in the patients with only clinical suspicion.
Discussion and Conclusion: The above markers did not assist substantially in making a diagnosis of PA. While 35% of the PAs were missed using individual clinical acumen, it appears to be one of the most accurate tools at this time.
| Poster Presentation Abstract Number 5 | | |
The effect of an orthopedic surgeon's attire on patient confidence and trust in a suburban setting
Vince Lands, Ajith Malige, Chinenye Nwachuku, Kristofer Matullo
Orthopedic Surgery Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Previous studies have demonstrated that patients are more likely to exhibit trust and confidence in physicians who dress in formal attire, with the white coat acting as a major source of patients' perceived trust and confidence. This study sought to explore potential associations between an orthopedic surgeon's attire and its influence on patients' perceptions of surgeon competence and trustworthiness in a suburban setting.
Methodology and Statistical Approach: Patients older than 18 years who presented for outpatient evaluation in a suburban setting were asked to participate in this survey-based study. After patients' demographic information had been collected, they were shown images of male and female surgeons wearing different outfits (i.e., formal, business, casual, and scrubs) and asked to rate the following seven perceived characteristics of each surgeon using a Likert scale: confidence, perceived intelligence, technical prowess, willingness to discuss confidential information, trust, perceived safety, and empathy. Finally, patients were asked about their preferences regarding physician attire and physical attributes.
Results: A total of 85 surveys were fully completed. Participants were mostly female (65%), Caucasian (79%) and had completed higher education (52%). The age groups of 45–54 years (25%) and 55–64 years (26%) constituted the largest groups of participants. Patient confidence, perceived intelligence, and trust were higher for physicians pictured in a white coat or scrubs, compared to a lower approval of physicians wearing gender-specific professional or casual attire. When patients asked to directly compare physicians' attire, they were most confident in male surgeons wearing a white coat and in female surgeons wearing either white coats or scrubs.
Discussion and Conclusion: Combining strong clinical skills with appropriate clinical attire (specifically, physicians wearing a white coat) appears to be an effective way to enhance patients' trust and confidence in their orthopedic surgeon.
| Poster Presentation Abstract Number 6 | | |
The impact of a standardized checklist on transition of care during emergency department physician change of shift
Alyssa Milano, Philip Salen, Holly Stankewicz
Emergency Medicine Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Transition of patient care during physicians' change of shift introduces the potential for critical information to be missed or distorted, resulting in possible morbidity. Since 2009, the Joint Commission has encouraged improving transition of care as a national safety goal. Our study sought to determine if utilization of a sign-out checklist resulted in improved quality and standardization of patient care transitions among emergency medicine (EM) resident physicians.
Methodology and Statistical Approach: This prospective study assessed EM residents' transition of care during departmental group sign out. After the Institutional Review Board approval, residents of varying postgraduate years transferred their patients' care to the incoming physician team. For 2 months, residents gave their typical sign out. For the next 2 months, residents utilized a standardized sign-out checklist. Attending physicians assessed overall quality of transition of care using visual analog scores (VAS) and assessed whether specific issues were discussed (i.e.,, diagnosis, tasks to do, patient disposition, admitting team, code status, if patients were signed out multiple times, and the need for additional patient information from the attending). Continuous data were reported as medians and ranges, with separate Wilcoxon signed rank tests conducted as appropriate, while categorical data were reported as frequencies and percentages.
Results: Assessment of transition of care was performed for 77 days (38 days of status quo, 39 days utilizing a checklist). There were 548 assessments in the prechecklist cohort (PCL) and 697 in the postchecklist implementation cohort (CLI). Attending VAS assessment of sign out was 8 for the CLI (range 2.5–10) as compared to 7.5 for the PCL (range 0.05–0.95) (P < 0.0001). Important aspects of transition of care improved with implementation of checklist, including the to do list (PCL 578/686, 84.3%; CLI 482/493, 97.8%; P < 0.0001); disposition (PCL 683/703, 97.2%; CLI 518/521, 99.4%; P = 0.004); admitting service (PCL 392/584, 67.1%; CLI 321/421, 76.2%; P = 0.03); and necessity of attending clarification (PCL 100/427, 23.4%; CLI 39/345, 11.3%; P < 0.0001). See [Table 1] for detailed results.
Discussion and Conclusion: A standardized checklist improved the quality of transition of care of resident sign out based on assessment by attending observers, as well as facilitated discussion of important transition of care issues.
| Poster Presentation Abstract Number 7 | | |
Education on contraception: How much do patients know?
Ingrid Paredes, James Anasti, Jill Stoltzfus
Obstetrics and Gynecology Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: The rate of unwanted and unplanned pregnancy remains high among young and Hispanic women. Nearly half of pregnancies in the United States are unintended. The consequences of such pregnancies may be serious, including abortions at later gestations that compromise the life of the mother, as well as raising children in inadequate environments. We believe that lack of education among patients about the different contraceptive methods that are available is a contributing factor to the low rates of contraception use and subsequently, the increase in short-interval pregnancies. Lack of education may also result in failure to use the appropriate contraception method according to individual needs. Therefore, we sought to determine the impact of a brief educational intervention on patients' knowledge about contraception.
Methodology and Statistical Approach: We developed a 15-min contraceptive instructional video in both English and Spanish to be viewed by our day 2 postpartum (PPD2) patients. The video explained the various forms of contraception, including usage, efficacy, side effects, and contraindications. Before the video, PPD2 patients were given a simple seven-question survey to determine their understanding of postpartum contraception. They were then instructed to watch the video and retake the survey within 2 h of watching it.
Results: A total of 60 PPD2 patients viewed the video. The mean age was 22 ± 3 years and mean parity was 1 ± 0.5. Although not statistically significant, the pre- and post-survey results demonstrated trend toward increased knowledge about some methods. Of particular interest was the failure of the video to increase patients' understanding of what is required to insert an intrauterine device (IUD) as well as postpartum oral contraception use (OCP). The prevideo survey revealed that 13% thought one “needed to go to operating room for IUD insertion,” which was largely unchanged after viewing the video. Before the video, 52% of patients thought that OCPs were safe to use immediately after delivery, which dropped to 45% after the video.
Discussion and Conclusion: Information regarding IUDs and postpartum OCP use may require additional, if not separate, educational counseling to better inform patients about these contraceptive options.
| Poster Presentation Abstract Number 8 | | |
Utility of coronary artery calcium score testing
Abdullah Quddus, Francis Burt, Jamshid Shirani, Alex Smith, Michael McLane, David Prutzman
Cardiology Fellowship Program, The Heart and Vascular Center, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Coronary artery calcium scoring (CACS) is gaining recognition as a risk stratifying tool in coronary atherosclerosis. We aimed to evaluate community-based referral patterns for CACS and its potential immediate impact on statin therapy.
Methodology and Statistical Approach: We retrospectively reviewed records and images of consecutive patients who were referred for CACS from January 2014 to March 2015 at our facility. All patients referred for CACS were reviewed. Paired t-tests were used to compare continuous variables.
Results: Thirty-five adults (mean age 58 years, 51% men, 94% Whites, 8% diabetics, 45% hypertensive, 31% smokers, 70% family history of heart diseases, 69% overweight or obese) had CACS for cardiovascular risk estimation; 22 (62%) by cardiologists and 12 (37%) by primary care physicians. Overall, 25% of patients had chest pain and negative stress tests while 75% were asymptomatic.
Distribution of atherosclerotic cardiovascular disease (ASCVD) scores in 32 eligible patients was as follows: 46% were <5%; 43% were >7.5%; 9% were between 5 and 7.5%. CACS distribution was as follows: 28% =0; 31% =1–100; 26% =101–300; and 14% = >300. CACS of 0 was present in 40%, 33%, and 21% of patients with ASCVD scores of <5%, 5–7.5%, and >7.5%, respectively. Overall, ASCVD risk score was reclassified based on CACS in 13/32 patients (40%). This led to a change in management in 21/35 patients (60%), including initiation of statins in 17/29 patients (58%) who were not already on therapy; discontinuation of statins in 2/6 patients (33%) on prior therapy; and dose titration of statins in 2/6 patients (33%). CACS of 0 was present in ten patients with an ASCVD score of 1–19 (6.2 ± 5.5%); a multi-ethnic study of atherosclerosis (MESA) score of 0.3–5.3 (2.4 ± 1.4%); a Framingham risk score of <1–16 (7 ± 5.2%); and a MESA arterial age <1–5 (2.6 ± 1.5%) (P = 0.02 for ASCVD vs. MESA and P = 0.02 for Framingham vs. MESA arterial age).
Discussion and Conclusion: In this small retrospective study, wide heterogeneity was noted in the cardiovascular risk factor profiles of patients referred for CACS. Despite these differences, CACS provided important incremental information that impacted immediate cholesterol-lowering medication use.
| Poster Presentation Abstract Number 9 | | |
Tissue insufficient for diagnosis on endometrial biopsy: What's the next step?
Angel Gonzalez Rios, Melissa Chu Lam, Kelsey Sullivan, James Anasti, Jill Stoltzfus
Obstetrics and Gynecology Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Endometrial biopsy (EMB) has been the gold standard for diagnosing causes of postmenopausal bleeding (PMB) for the last 30 years. Occasionally, the EMB does not contain sufficient tissue to make a definitive diagnosis, which often leads to additional procedures. In an effort to improve patient care, we evaluated PMB patients whose initial EMB did not contain sufficient tissue for diagnosis.
Methodology and Statistical Approach: We reviewed EMBs performed at our institution for PMB during a single year that was read as tissue insufficient for diagnosis (TIS). We collected demographic data, ultrasound outcomes, and final pathology findings from a subsequent procedure (dilation and curettage or hysterectomy) within 12 months of initial EMB. We presented our results descriptively, given the exploratory nature of this study.
Results: There were 118 TIS results for 890 EMBs performed for PMB (13.2%). Mean age, body mass index (BMI), endometrial stripe, and uterine sound were 61.2 ± 2 years, 31 ± 8.5 kg/m 2, 7 ± 4 mm, and 7.6 ± 1.7 cm, respectively. Of the 74 patients for whom we had additional tissue, 45 were atrophic (61%), 22 had endometrial polyps (30%), six were proliferative (8%), and one had endometrial cancer (1.3%). PMB patients with the two most common diagnoses (atrophy or polyps) did not differ in age, BMI, endometrial thickness, or uterine length.
Discussion and Conclusion: Insufficient tissue on EMB in PMB patients rarely results in serious endometrial pathology. The ability to differentiate between the two most common pathologies using ultrasound and demographics is difficult. Thus, the inclusion of a sonohysteroscopy may be helpful in determining the need for additional procedures.
| Poster Presentation Abstract Number 10 | | |
Improving delirium detection in nursing home residents: A quality improvement project
Michael Sidhom, Ana Castellanos
Geriatric Medicine Fellowship Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Delirium is an unrecognized danger that is defined as an acute reversible and temporary state of cognitive disorientation due to multifactorial triggers. The ability to recognize those triggers and/or subsequent presentations of delirium is inconsistent among nursing and ancillary staff.
Many studies have demonstrated negative clinical outcomes and economic effects that delirium has on both the health-care system and society as a whole. Despite this reality, interventions to identify, prevent, and treat delirium remain suboptimal; therefore, nursing home residents are 3 times more likely to present to an emergency department with delirium than community-dwelling elderly patients. We implemented a quality improvement project to address this important issue.
Methodology and Statistical Approach: Preintervention – To assess baseline knowledge, a self-administered survey with ten questions addressing multiple aspects of delirium was administered to a convenience sample of clinical staff (LPNs, RNs, and CNAs) across all shifts in a skilled nursing facility. Intervention –
Our quality improvement initiative consisted of 15–20 min “in-service” training lectures to review and underscore the importance of delirium, identify triggers to recognize typical and atypical presentations, and discuss basic interventions. Postintervention –
We administered the ten-question survey to participants who attended the intervention. We analyzed data descriptively from the pre- and post-intervention surveys. Metrics measured included position, shift, and pre/post-survey scores.
Results: Among the 57 nursing participants who completed the study, there was a 10% improvement in survey scores after the intervention. The greatest improvement in delirium recognition and evaluation occurred within the CNA staff
Discussion and Conclusion: Ideally, the best management for delirium is prevention. Hence, early recognition of both organic and nonorganic causes of delirium, and subsequent presentations thereof, in high-risk nursing home residents may decrease adverse outcomes and unwanted complications associated with delirium. We hope to extend this quality improvement initiative to all health-care providers in the skilled nursing facility to improve the delirium-related outcomes of their residents.
| Poster Presentation Abstract Number 11 | | |
Systematic screening for cardiovascular disease in young sports participants
Archana Sinha, Kaitlen Nguyen, Amitoj Singh, Audrey Fedor, Kelly Mousely, Sahil Agrawal, Maheep Vikram, Steven Stevens, Darren Traub, Sudip Nanda, Jamshid Shirani
Cardiology Fellowship Program, The Heart and Vascular Center, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Sudden cardiac death (SCD) in a previously asymptomatic athlete is a rare but tragic event. The incidence in most studies ranges from 1:80,000 to 1:200,000. A comprehensive initial preparticipation physical evaluation (CIPPE) is mandated for junior, middle, and high schools by the Pennsylvania Interscholastic Athletic Association to reduce potential sports injuries and SCD. Athletes with positive screening for cardiac disease (including findings on the 12-item American Heart Association screening questionnaire) are referred for cardiac evaluation. We aimed to evaluate the yield of preparticipation cardiac screening in a group of athletes.
Methodology and Statistical Approach: We conducted a retrospective chart analysis of the students who had presented to St. Luke's University Health Network Cardiology Department between June 2015 and February 2016. The data were analyzed descriptively, with continuous variables expressed as mean and standard deviation.
Results: Among 3174 students from 13 schools undergoing CIPPE, 100 (3%) were referred for cardiac evaluation (51 males; 53 Whites; mean age = 14.8 ± 2.2 years; mean height = 166 ± 12 cm; mean weight = 62 ± 17 kg). Overall, 98 students were engaged in moderate to high intensity sports activities. Marfanoid phenotype was present in six students, and six were clinically overweight. A heart murmur was present in 58 students, and one had systemic hypertension.
To obtain additional information, the following tests were performed: 12-lead electrocardiogram (ECG) with rhythm strip (100 students); transthoracic echocardiogram (93 students); treadmill exercise test (13 students); tilt-table test (1 student); cardiac magnetic resonance (CMR) imaging (2 students). ECGs showed minor abnormalities (likely normal variants) in 47 students (incomplete/complete right bundle branch block [9 students]; right axis deviation [2 students]; early repolarization [7 students]; and T-wave inversion [5 students]), with no major abnormalities identified. Echocardiogram showed one student with bicuspid aortic valve and dilated aortic root and another student with hypertrophic cardiomyopathy (both confirmed by CMR).
Discussion and Conclusion: A systematic approach to screening in junior, middle, and high school athletes can lead to identification of serious and primarily unsuspected genetic cardiovascular conditions in a small minority of individuals. Appropriate screening of first-degree relatives may broaden the overall impact of such programs.
| Poster Presentation Abstract Number 12 | | |
Osteomyelitic rate of positive proximal margins of partial ray amputations
Melody Stouder
Podiatric Medicine and Surgery Residency Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Submetatarsal wounds are a very common location for skin breakdown and subsequent bone infection. Standard of care for isolated metatarsal osteomyelitis is a partial ray amputation. Typically, the amputation is established proximally until noninfected bone is reached, and a “proximal margin” of bone is sent to pathology. If the proximal margin returns from pathology as positive, then proper treatment includes either a second revisional amputation or 6 weeks of intravenous antibiotics according to the Infectious Diseases Society of America guidelines – both of which have their own set of risks.
Retrospective studies have shown that approximately 35–40% of patients who received partial ray amputation have residual bone infection remaining in their foot after surgery as shown by pathology. This study sought to assess infection rates in a group of podiatric patients.
Methodology and Statistical Approach: This was a retrospective study of patient charts from December 2014 to October 2015 to determine the percentage of partial ray amputations with residual bone infection postoperatively at St. Luke's University Health Network. All patients included in the study presented with positive findings of osteomyelitis of a metatarsal, followed by a partial ray amputation, with a proximal bony margin sent to pathology.
Recorded data included age, comorbidities, location of partial ray amputation, bacteria grown from initial wound, imaging obtained preoperatively, and the pathologic result of the bony margin.
Results: Out of fifty charts reviewed, 15 patients (30%) had proximal metatarsal bony margins that were positive for osteomyelitis as confirmed by pathology.
The types of preoperative imaging, comorbidities, and bacteria were recorded for each patient. The most common location for ray amputations was the 1st ray (26% of patients), followed by the 5th ray (17% of patients). See [Figure 1] for microbiologic wound characteristics and [Figure 2] for amputation types.
Discussion and Conclusion: Of the fifty patients with a partial ray amputation, 15 had residual bone infection, meaning that 30% had a positive proximal margin. This rate is slightly lower than the average rate of 35–40% reported in the recent literature. However, it is unacceptable for 30–40% of patients to have bone infection remaining in their foot after a partial ray amputation as this puts patients at risk of increased complications and worsening comorbidities. A standard protocol or surgical guideline should be established to effectively resect all infected bones, thereby decreasing the overall positive proximal margin rate. If patients were to receive a magnetic resonance imaging preoperatively (which measures the distance that infection has spread along the bone), surgical resection might be accurate and less subjective.
| Poster Presentation Abstract Number 13 | | |
Safety and efficacy of transvenous extraction of pacemaker and cardioverter defibrillator leads
Huseng Vefali, Matthew Durkin, Darren Traub, Jamshid Shirani, Sudip Nanda
Cardiology Fellowship Program, The Heart and Vascular Center,St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Increasing implantable cardiac device use has led to a proportional increase in lead-related complications. Transvenous lead extraction (TLE) is commonly used to remove unwanted hardware. We sought to describe the safety and efficacy of TLE at a single center.
Methodology and Statistical Approach: This was a retrospective study assessing operative records for all scheduled permanent pacemakers and implantable cardioverter defibrillators from December 1, 2012, to May 15, 2015. All patients scheduled for an extraction procedure were included (i.e., elective, urgent, salvage) in the study. Operator and patient characteristics were collected, and each chart was reviewed for operative technique, procedural outcome, and complications. Variables of interest were summarized as percentages if categorical and as means with standard deviations or medians if continuous.
Results: A total of 78 patients (69% men; mean age 67 ± 14.5 years; mean body mass index 30.1 ± 6.7 kg/m 2) underwent TLE of pacemakers (31%) or defibrillators (69%). Leads were located in the right ventricle (RV 65%), right atrium (RA 26%), and left ventricle (9%) and were in situ for 2306 ± 1543 days, 1634 ± 1674 days, and 1692 ± 1069 days, respectively. Indications for TLE included infection (40%), lead failure (38%), manufacturer's recall (17%), and patient discomfort (5%).
Patients with infected systems (38% methicillin-sensitive Staphylococcus aureus) were commonly male (68%), diabetic (51%) and had chronic kidney disease (74%). The TLE success rate was 97.4%. Manual traction was more often successful in RA and RV active fixation leads. Adhesion and scarring of the superior vena cava (SVC) coil or SVC/RA junction were the most common triggers for laser use (21%). Minor and major complications occurred in 6 and 3 patients, respectively. The latter included an RA tear requiring surgical repair, a large pocket hematoma requiring evacuation, and a case of jugular vein thrombosis. One patient needed snaring to recover an RV lead tip. Only two patients needed to have their leads removed surgically, including the case with RA tear.
Discussion and Conclusion: TLE for infection is more likely in men with diabetes and chronic kidney disease. The TLE success rate was high (97%) and independent of TLE indication, patient age, or chronicity of the lead. Procedure time was unrelated to the chronicity of the implanted leads or the nature of fixation (active/passive) in all patient subsets.
| Poster Presentation Abstract Number 14 | | |
Do provider-specific computed tomography usage patterns correlate with patient outcomes in trauma?
Thomas Wojda, John David Nuschke, Ken Zhang, Aliaskar Hasani, Brian Hoey, William Hoff,
Peter Thomas, Stanislaw Stawicki
Post-Doctoral Research Fellowship Program, Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Controversy continues regarding the practice of comprehensive computed tomography (CT), or “pan-scanning,” for trauma patients. Opponents of this practice frequently point out that this approach exposes patients to undue radiation risk and intravenous contrast toxicity, with only infrequent identification of clinically significant occult injuries. Proponents of this practice emphasize that despite the above-mentioned factors, consequences associated with missing a serious injury are both unacceptable and preventable in the era of readily available high-definition CT scanners. The aim of this study was to define the relationship between trauma provider-specific CT scan utilization and mortality. We hypothesized that underutilization of CT imaging correlates with increased patient mortality.
Methodology and Statistical Approach: This was a retrospective review of the patient registry at our Level I trauma center. After excluding patients who underwent emergency surgery or died in the trauma bay, we analyzed the following primary outcome variables: (a) mortality, (b) trauma provider experience, and (c) CT scan “tonnage” per provider. We also collected demographic and injury data (i.e., gender, age, injury severity score 3, revised trauma score (RTS), and mechanism). Provider-specific mortality and CT utilization data were corrected for ISS and patient age. De-identified traumatologist-specific mortality was used to create a third-degree polynomial model of mortality that was subsequently superimposed on provider-specific CT “tonnage.” We conducted analysis of covariance, with statistical significance at α = 0.05.
Results: Out of 32,026 records, we excluded 4346 patients who underwent emergent operative intervention or died before advanced trauma imaging was performed. The resulting sample of 27,372 patients consisted of 60.3% males, with median age of 45 years, 95% blunt mechanism of injury, median ISS of 5, median RTS of 7.84, and median length of hospitalization of 2 days. Seventy-nine Advanced Trauma Life Support (ATLS) certified traumatologists were examined. For the entire sample, median mortality per traumatologist was 2.3%, with the mean number of CT scans at 2.2 per traumatologist. There were no significant differences in the number of CT scans or rates of mortality per provider when attending physicians (n = 12) were compared to fellows (n = 67). However, the number of CTs per provider increased with provider experience.
When the third-degree polynomial model of mortality across all trauma providers was superimposed on the average number of CTs per traumatologist (in descending order), it is apparent that estimated mortality decreases as the number of CTs per traumatologist increases above the 2.2 threshold value [Figure 1].
Discussion and Conclusion: This study found an association between patient mortality and the average number of CT scans performed by traumatologists at our trauma center. Although cause-and-effect determination is not possible given the retrospective nature of this investigation, the observed trend strongly suggests that a more detailed initial radiographic workup may be associated with a mortality benefit to patients. This observation may be partly explained by greater utilization of CT imaging by more experienced traumatologists and the possible association between mortality and missed occult (but clinically significant) injuries. Further research in this important area is warranted, especially considering the existing controversies regarding risks and benefits of liberal CT imaging approaches in trauma.
| Poster Presentation Abstract Number 15 | | |
Empowering patients to take ownership of their diabetes care: A quality improvement project
Margaret Yoder, Nguyet-Cam Lam, Caitlin Dillon, Adam Kobialka, Emelia Perez
Familiy Medicine Residency-Bethlehem Program, St. Luke's University Health Network, Bethlehem, PA
Introduction/Background: Diabetes is one of the most common diagnoses encountered in the Family Medicine and causes significant patient morbidity and mortality. At St. Luke's Family Medicine Residency (Pennsylvania), we sought to optimize our comprehensive care of diabetic patients using a quality improvement initiative. Our aim was to exceed the national peer benchmarks in quality of care metrics, including 84% for annual lipid panel, 64% for annual monofilament foot examination, 46% for annual dilated eye examination, 67% for annual microalbumin measurement, 52% for pneumonia vaccination, and 57% for annual flu vaccination.
Methodology and Statistical Approach: Using our Electronic Health Records, we analyzed data from 225 diabetic patients seen in our office from October 2014 to October 2015 and again in February 2016 after the 3-month implementation period. Employing an integrated team approach involving the secretarial staff, nurses, residents, and attending physicians, we created diabetic packets to expand our provided care and to empower patients to take ownership of their health. In addition, to promote greater teamwork, we established a competition with awards for staff members who administered the most flu and pneumonia vaccinations.
Results: After the 3-month implementation period, we detected significant improvement in the following areas: annual lipid panel measurement (from 71% to 75%); annual eye examination (from 28% to 41%); annual foot examination (from 48% to 63%); pneumonia vaccination (from 39% to 60%); and flu vaccine (from 56% to 68%). We met our goal of exceeding national peer benchmarks for pneumonia and flu vaccinations and nearly met our goal for eye and foot examinations.
Discussion and Conclusion: By implementing a simple, low-cost, and effective intervention through an integrated team approach involving the secretarial staff, nurses, residents, attending physicians, and patients themselves, we were able to significantly improve the quality of care that we provide to our diabetic patients. It will be important to reassess our outcomes in 6 months to determine if the diabetic packets are a sustainable and effective intervention.
| Nursing Presentations: The 2016 Research and Scholarship Symposium | | |
The Nursing Research and Scholarship Celebration included presentations by nurses from each of the six St. Luke's University Health Network hospital campuses and the Visiting Nurses Association, all of whom conducted nursing research or quality projects aimed at improving patient care [Table 1]. In addition, the 3rd Annual Robin E. Haff Award, given to a nurse showing exceptional interest in nursing research, was presented to Deborah Martin, MSN, RN, CCRN, by Dr. Vincent Lucente. Dr. Lucente is an internationally recognized leader in Urogynecologic Surgery, Clinical Trials, and Research.
[Figure 1], [Figure 1], [Figure 1], [Figure 4], [Figure 2], [Figure 1], [Figure 2], [Figure 1], [Figure 1], [Figure 2], [Figure 1]
[Table 1], [Table 1]
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