Quality Improvement

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  Admission Rates, Healthcare Utilization, and Economic Burden of Radiation Cystitis (RC) in the United States

  Sohrab Arora, Chandler Bronkema, Akshay Sood, Deepansh Dalela, Alex Borchert, Lee Baumgarten, Quoc-Dien Trinh, Craig G. Rogers, James O Peabody, Mani Menon, and Firas Abdollah

  INTRODUCTION AND OBJECTIVES: Radiation cystitis (RC) is a major cause of morbidity after radiotherapy for pelvic cancers. In the absence of a definite cure, patients may require repeated admissions, undergoing multiple - often morbid - urological procedures. Our aim was to study the inpatient economic burden and healthcare utilization associated with RC in the United States (US).

  METHODS: We focused on 13,272 records of adult (age >= 18) patients... Read More

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  Comparing the Rate of Positive PHQ-2 in Self-administered Paper versus Provider-administered Verbal Screening Tools

  Rachel Carolan, Diahann Marshall, Pooja Kulkarni, Pamela Castro-Camero, Benjamin Abraham, Berta Rezik, Sam Islam, and Andrea Smith

  Comparing the rate of positive PHQ-2 in self-administered paper versus provider administered verbal screening tools. The USPSTF recommends screening adults for depression in clinical practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up. While there are many studies validating the self -administration of PHQ-2, research comparing this with provider administration of PHQ-2 is limited. We designed a retrospective study over a 3 year time... Read More

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  A Microbiological Assay of Common Operating Room Tapes: Developing a Culture for Patient Safety

  Gaurav Chauhan, Aman Upadhyay, Samvid Dwivedi, and Robert J. Tibbetts

  Introduction: A medical adhesive tape is a ubiquitous and essential piece of equipment that is used in almost all of the patients admitted to the hospital. As a medical equipment, adhesive tapes are unique as it is almost never washed or sterilized after the initial opening of the package. Current literature reports that 74% of specimens of tape collected in one hospital were colonized by pathogenic bacteria. Primary Objective:... Read More

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  Improving Quality in Breast Cancer Treatment

  Samfee Doe and Monique Swain

  Objectives: The goal of this study is to evaluate and compare care received following implementation of the multidisciplinary care tumor board at a community hospital in Detroit, MI. Methods: This is a retrospective chart review of patients who were newly diagnosed with invasive breast cancer one year prior to and one year following the implemenation of the MDC tumor board. Demographic information including race, age, insurance type (private vs... Read More

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  EHR Visual Overlay Promises to Improve Hypertension Guideline Implementation

  Raef Fadel, Joseph B. Miller MD, Hanan Ibrahim, Rawan Hammoudeh, Guneet Ahluwalia, Tamara Roumayah, Megan Scott, Nitesh Gandhi, John France, Thomas Theoharis, and Jacob Ross

  Background: Primary care management of essential hypertension (HTN) has become increasingly challenging since recently published guidelines integrate atherosclerotic cardiovascular disease (ASCVD) risk stratification into decision making. Our objective was to measure whether overlay of visualdecision support (VDS) with standard electronic health record (EHR) platform improves guideline-based treatment, and reduces time burden associated with EHR use, in management of essential HTN. Methods: This was a quality improvement project. We interviewed... Read More

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  Reducing Culture Reporting Errors in the Microbiology Laboratory

  Kathryn Hogan, Beena U. Ahsan, Kathy Callahan, Robert J. Tibbetts, and Linoj Samuel

  Introduction: To date, there are few papers that characterize the types of errors in microbiology laboratories, and there is scant research demonstrating the effects of interventions on microbiology lab errors. This study aims to categorize the types of culture reporting errors found in a microbiology lab as well as document the error rates before and after interventions designed to reduce errors and eradicate a blame culture. Methods: To increase... Read More

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  Impact of Hospital Teaching Status on Healthcare Utilization, Length of Stay (LOS), and Cost of Hospitalization of Radiation Cystitis (RC) in the United States

  Marcus Jamil, Sohrab Arora, Jacob Keeley, Akshay Sood, Alex Borchert, Lee Baumgarten, Craig G. Rogers, James O Peabody, and Firas Abdollah

  Background: Limited data exist regarding in-hospital use of resources, LOS, and cost of RC-associated admissions in teaching hospital (TH) versus nonteaching hospital (NTH) settings. The goal of this study was to address the above void in literature. Methods:We focused on 13,272 admissions for RC between 2008-2014 within the National Inpatient Sample. Patients with concurrent diagnosis of other bladder conditions (n=914) were excluded. ICD-9 diagnosis and procedure codes were used... Read More

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  Determining Effects of Delayed Discharges and Pain Medication Administration on Patient Satisfaction

  Ernesto Juarez, Raymond Chahoud, and Kevin Brody

  Studies have shown that there has been significant increases in Emergency Department visits throughout the United States over the past decade. Increased healthcare demands have precipitated increased wait times in the ED and increased turnaround time for physicians to provide care. We sought to determine the effects of actual versus perceived delays in discharge and pain medication administration on patient satisfaction after their visits to the ED. In regards... Read More

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  The Efects of Harm Events on the Rate of 30-day Readmissions in Surgical Patients

  Pridvi Kandagatla, Wan-Ting Su, Indra Adrianto, Christina Shabet, Jessica Hauesler, Jack Jordan, and Ilan Rubinfeld

  Background: Readmissions are an increasingly important focus for improvement regarding quality, value and patient burden in our surgical patient population. Predictive strategies to-date have focused on patient demographics and comorbidities with some hospital data added to the mix. We hypothesized that inpatient harm events would increase the likelihood of readmission in surgical patients.

  Methods: We created a system-wide inpatient registry within the Henry Ford Health System, Detroit, MI, with... Read More

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  Acute Myeloid Leukemia: The Race to Diagnosis and Treatment!

  Leila Khaddour, Vijayalakshmi Donthireddy, and Vrushali Dabak

  Introduction: Acute myeloid leukemia (AML) is one of the hematologic emergencies that require prompt treatment. Advanced changes in the molecular pathogenesis has been emerging with major impact on prognosis and treatment. FLT3 mutation is associated poor prognosis and early relapse in AML. Midostaurin is a multi-kinase inhibitor, when combined with induction 7+3 chemotherapy, improves the response rate and disease-free survival. Purpose: To evaluate our institution efficiency obtaining the appropriate... Read More

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  Case Conference: Care Coordination Continuum Task Force

  Mohammed Khalid and Everett Kalcec

  Problem Issue: Patients that have frequent use of health care is often complicated by socioeconomic related factors. Process to Improve: Targeted multidisciplinary intervention to coordinate care; done with a Case Conference format. Metric to Change: Implementation of Case Conference. Target of Performance: Decrease rates of healthcare use and hospital re-admission. Analysis of Causes: Patient are increasingly affected by influences surrounding their healthcare. No current process for identifying and following... Read More

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  Solving the Logistical Issues of Rapid MSK MR Scanning

  Nicholas C. Laucis, Chad L Klochko, and Daniel Siegal

  Object or Purpose of Study: State of the art sequences and specialized hardware are beginning to allow for the reduction of the acquisition time of musculoskeletal (MSK) Magnetic Resonance (MR) scans. Shorter acquisition times should allow for more patients to be scanned in a day; however, implementing these rapid scans into the imaging workflow required changing the whole MR scheduling system. We report the challenges and benefits after incorporating... Read More

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  A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs

  Mohamed Macki, Sharath K. Anand, Mohamed Fakih, Jaafar Elmenini, and Victor Chang

  The North American Spine Section (NASS) published the Evidence-Based Clinical Guide for the use of antithrombotics in spine surgery. Many of the 14 clinical questions lacked clinical studies to establish evidence-based recommendations, as such expert consensuses were arrived at via a modified nominal group technique. On the clinical inquiry of chemoprophylaxis, the study published that “Unfortunately, scientific scrutiny of chemoprophylaxis in elective spinal surgery has been limited to case... Read More

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  Assessment of Provider Compliance Using an ED Protocol to Improve Care of COPD

  Tyson McKechnie, Ali A Dabaja, Zach Illg, Joanna Fourtounis, Ben Stoyak, Katie Biringer, Tarandeep Singh, and Thomas McKeown

  Introduction: COPD is a chronic, irreversible disease that, when poorly controlled, is associated with high patient morbidity and mortality as well as a significant financial burden on the healthcare system. Although the management of this disease is multifactorial and complex, preliminary data from a comprehensive multi-disciplinary Emergency Department (ED) care plan specific to COPD patients has demonstrated improved patient outcomes and reduced hospital admissions. In the ED at Henry... Read More

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  Utility of Statin in Patients Listed for Liver Transplant

  Kajali Mishra, Sandra Naffouj, Carina Dagher, Sunjay Modi, and Deepak Venkat

  Introduction: Current guidelines recommend statin use in high risk patients based on the ASCVD (atherosclerotic cardiovascular disease) score, diabetes, or LDL levels. Despite several trials showing safety and potential cardiovascular and liver related benefits, statin use has been limited in liver disease due to theoretical concerns of hepatotoxicity. We aimed to determine the current rate of statin use in patients listed for liver transplant. Methodology: In a single center... Read More

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  Seeing a Difference: A Visual Aid Tool for Topical Medication Selection

  David M. Oberlin, Jesse Veenstra, Allison Zarbo, and Holly Kerr

  Topical medications are the mainstay of many common dermatologic conditions. There are many factors that contribute to patient adherence to topical regimens with medication vehicle playing a role in usage. Due to lack of familiarity with topical vehicle nomenclature, patients often have difficulty selecting the appropriate vehicle when discussing their therapy plan, leading to unsatisfactory results and potentially medication discontinuation. To assist the patient in topical medication vehicle selection,... Read More

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  Urologic Care of a Multiple Sclerosis Patient Population: Single Provider Experience

  Samantha Raffee, Philip Wong, Isaac Palma, Vicki Irish, and Humphrey Atiemo

  INTRODUCTION AND OBJECTIVES: Multiple sclerosis (MS) is a demylinating neurologic condition affecting approximately 2 million people worldwide. Lower urinary tract dysfunction is common with 50-90% having voiding symptoms. If lower urinary tract symptoms are recognized and a urological referral is made, little is known regarding the outcomes of these patients within a urology practice. The objective of this study was to evaluate the MS population of a single provider... Read More

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  A Systematic Way of Ordering Hyaluronic Acid for Knee Injections in the Primary Care Setting

  Jacob Russell, Aaron Cloutier, and Kyle Casadei

  Background: Osteoarthritis (OA) is one of the most common forms of arthritis affecting a significant population worldwide potentially leading to long term disability. Osteoarthritic joints contain synovial fluid that has become less concentrated and viscous over time which often leads to less absorption and protection. Synovial fluid also contains Hyaluronic Acid (HA), although the mechanism is unclear this seems to inhibit inflammation, decrease cartilage degradation, and promote cartilage development.... Read More

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  Provider Knowledge and Comfort with the Use of HIV Pre-exposure Prophylaxis (PrEP) Therapy in High-Risk Patient Populations

  Megan Scott, Indira Brar, Monica Kole, and Roopina Sangha

  HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection and when taken consistently, reduces HIV transmission via sexual intercourse more than 90% in serodiscordant couples, and more than 70% in intravenous drug users. In United States, men who have sex with men (MSM) remains the highest risk group for HIV transmission accounting for 82% of all newly diagnosed infection. Consistent condom use remains the most effective... Read More

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  Surgical Feedback Evaluation Tool for Resident Physicians

  Matthew Turanovic, Abdurrahman Kabani, Bilal Kharbutli, Saif Ahmed, Fallon Dimaano, Vanessa Majeski, and Alexander Turfe

  Currently, residents of surgical specialties lack effective and efficient feedback assessment tools to improve surgical performance after surgical cases. Our aim is to increase the rate of attending surgeon assessments of resident surgical performance to at least 75% of cases for the Podiatric Surgery and General Surgery residency programs at Henry Ford Wyandotte Hospital using the Surgical Performance Evaluation Tool (SPET), with at least 70% perceived positive impact in... Read More

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  Attempts to Improve Hepatitis C Screening Rates in a Gastroenterology Fellows' Clinic: A Quality Improvement Initiative

  Alexander Weick, Andrew Watson, and Reena Salgia

  Introduction: The CDC recommends one-time birth cohort HCV testing for individuals born between 1945-1965. Previous quality improvement (QI) projects aiming to improving HCV screening have largely focused on increasing education of screening guidelines. We conducted a QI initiative focusing on improving the rates of HCV birth cohort screening in the Gastroenterology Fellows’ (GI) continuity clinic at an urban tertiary care center. Methods: The baseline rates of HCV birth cohort... Read More

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  Characterization of Wound Misclassification in Common Surgical Procedures

  Andrew Worden, Pridvi Kandagatla, Ilan Rubinfeld, and Amalia Stefanou

  Introduction: Wound class helps predict wound related complications and is useful for stratifying surgical site infection (SSI) reporting. Misclassification could be significant as report cards increasingly affect reimbursement and publicly reported data. We sought to evaluate misclassification among commonly performed surgeries that are defined to be clean-contaminated or higher. We hypothesized that rates of misclassification are increasing, and this increasing trend may be correlated with laparoscopic approaches. Methods: The... Read More

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  Early Ambulation After Lumbar Spine Surgery

  Hesham M. Zakaria, Michael Bazydlo, Lonni R Schultz, David Nerenz, Muwaffak M Abdulhak, Victor Chang, and Jason M. Schwalb

  Introduction: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality improvement collaborative. Using the MSSIC database, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-day adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility.

  Material and Methods: A total... Read More