Andrew Dunn, MD, MPH
Bedside Interdisciplinary Rounds
This trial investigates the impact of transforming standard daily interdisciplinary rounds from a conference room to a bedside model. An enhanced, structure, scripting, and a patient safety checklist is utilized. Outcomes include LOS, hospital-acquired complications, and patient satisfaction.
Peri-operative Management of Anticoagulation
Investigating whether peri-operative bridging with LMWH for patients on warfarin on arterial thromboembolism and bleeding.
Eric Barna, MD, MPH
An On the Go Curriculum for enhancing the Quality and efficiency of inpatient teaching
In this project we worked to create a teaching tool that hospitalists can use On the Go to deploy consistent and high quality teaching during time pressurized work rounds.
Jeremy Berman, MD
Hospitalist Comanagement with Vascular Surgery and Surgical Oncology/Otolaryngology
In this project, we have implemented a structured collaborative framework to improve outcomes and provide high value care to surgical patients in the perioperative period.
Dennis Chang, MD
Standardized Patients teaching hospitalists communication
In this study, hospitalists experienced 3 standardized patient encounters which challenged their abilities to communicate accurately and empathetically. The standardized patients then provided feedback to the hospitalist about their communication skills.
Mindfulness for Inpatient Physicians to help reduce burnout
In this study, any physicians who spend a majority of their clinical time on inpatient services will undergo six 90 minute sessions on mindfulness. Physician burnout, mindfulness and stress will be measured before, after and 3 months after the mindfulness sessions.
Neil Desai, MD and Olga Prystupa, MD
House staff education overnight
Few residency programs provide any house staff education overnight. In this project, the night hospitalists meet with residents overnight to discuss newly admitted, challenging cases and provides evidence-based education on the topic associated with this case.
Celine Goetz, MD
Application of a Stratification System for Patient with Acute Kidney Injury to Decrease Renal Ultra Sounds in Patients at Low-Risk for Hydronephrosis
Using a risk stratification scoring system for identifying patients at low risk and high risk of hydronephrosis, we hope to education ordering providers on the applicability to the MSH patient population and integrate into EPIC to decrease unnecessary renal ultra sounds.
Decreasing Head CTs in the work-up for Syncope
By chart reviewing all cases of syncope in our Observation Unit, we identified that over 40% of Heat CTs were unnecessary by guidelines developed by the American College of Emergency Physicians. We are working with Emergency Medicine Colleagues to develop an educational intervention with the aim of decreasing head CTs in low risk patients and increase the practice of orthostatics in patients who come in after syncope.
A Student-Developed Intervention to Reduce Ordering of Inpatient Folate Testing
One of the initiatives of MSH’s Student High Value Care Committee, this intervention was devised by medical students to educate Internal Medicine housestaff about the lack of utility of ordering folate as part of the work up for macrocytic anemia. Preliminary data shows impressive change in ordering behavior.
Eric Goodman, MD
Transitions of care for patients with acute venous thromboembolism
In this project we are developing and validating a novel transition of care bundle for patients with acute VTE. The bundle includes a smartphone app, new inpatient orders, and a social work-driven care coordination program. Our primary objective is to decrease recurrent VTE and major bleeding events, and secondary objectives are to improve measures such as cost, length of stay, and hospital readmission.
Improving inpatient handoffs
In this project we are developing a new standardized inpatient handoff protocol integrated into the EMR. We have shown that our handoff tool improves the subjective quality of inpatient handoffs. The tool is being revised based on resident feedback. Further work will evaluate the impact of this intervention on medical errors.
Improving Discharge Practices for Patients Discharged Against Medical Advice
In this project we are working to understand the practice patterns of providers who discharge patients against medical advice. Specifically, we are interested in the frequency of providing follow-up appointments. We are designing an intervention to improve the frequency of post-discharge follow-up among the inpatient population discharged against medical advice.
Michael Herscher, MD
Handheld ultrasound to aide fluid resuscitation and sepsis treatment
Examining the role of point-of-care ultrasound in the treatment of septic patients and whether this can affect patient-level outcomes.
Standardized inpatient curriculumWe are developing a teaching curriculum to be used by hospitalists, teaching on the general internal medicine wards to teams that are comprised of internal medicine residents and medical students. We will track provider and learner perceptions of the material.
Diabetes care in an observation unit
We are evaluating glycemic control in our observation unit with an aim to implement an intervention to improve diabetic patients’ blood sugar and to reduce complications.
Asthma in older adults
We are examining age of onset of asthma in older adults and its effect on patient outcomes.
Saad Hussain, MD
Prevalence of Advanced Colorectal Neoplasia in Patients With Inflammatory Bowel Disease (IBD) Colitis Undergoing Colectomy in the Modern Era
The incidence of “surprise” advanced colorectal neoplasia in IBD has not been well described in the current era of improved IBD therapy and modern endoscopy. The aim of this study was to describe the rate of advanced colorectal neoplasia in patients with IBD colitis who underwent colectomy at our facility in the last decade.
Dilan Jogendra, MD
Impact of a House Staff Led Antibiotics Stewardship Program on Adherence to Treatment Guidelines for Community Acquired and Healthcare Associated Pneumonia
Studies show that quality improvement initiatives that focus solely on education of house staff do not change process or outcome measures. Reinforcement and change in culture are critical for successful QI projects. This project inserts discussion of antibiotics during morning rounds (i.e. "antibiotic timeout") by the house staff in order to stimulate awareness and broader cultural change.
Vinh-Tung Nguyen, MD
The Early Discharge Plan: A Multi-disciplinary approach
We use a multi-disciplinary approach to increase the number of early discharges from medical units that includes role-specific accountability and regular interdisciplinary staff review of data. Unlike previous studies, our data thus far has shown improvement in both teaching and non-teaching floors, and has not shown increased length of stay. Final data is being collected and analyzed for manuscript preparation.
Resident Engagement in the Mortality Review Process
Residents learn about the mortality review process through a didactic session and real-time review of a Teaching Service death with a faculty advisor. The formalized review process includes formal submission of write-up and presentation at the Department of Medicine Mortality Review Group.
Direct Care Model for Hospitalist
We investigate the use of a medical scribe to assist inpatient documentation and care on an attending-directed service. Quantitative measures including length of stay, discharge times, and patient volume will be analyzed, as well as qualitative data including physician satisfaction.
Evaluating necessity and safety of point-of-care glucose checks in the hospitalized patient
In this retrospective study, we examine glycemic control and insulin requirements in diabetic patients not on home insulin in the hospitalized setting. Pending the results of this analysis, we hope to clarify if it would be feasible to pilot a study to investigate decreasing or avoiding point-of-care glucose testing for these patients or a subset of these patients on a general inpatient ward.
The effect of mindfulness on physician burnout and well-being from those who provide inpatient care
We offer a 6-session mindfulness training course geared towards inpatient providers, led by a certified Mindfulness instructor. We measure physician well-being and burnout using validated scales to determine the effect of mindfulness training on these inpatient providers.
Medication Education Initiative
A multidisciplinary approach by the 9-West unit team to identify new medications initiated for each patient during hospitalization, and a simple indication as well as side effect taught by nursing to patients on a daily basis. The goal is to improve patient knowledge of new medications received during hospitalization, ultimately improving patient experience.
Masih Shinwa, MD
Student Led High Value Care Project: Think Before You Order
Through various students led interventions including educational posters our goal is to discourage use of serial orders to obtain daily labs on medicine units.
Surafel Tsega, MD
A Multidisciplinary Intervention to Reduce Routine Labs in Clinically Stable Patients
In this project, we identify patients stable for discharge that no longer require daily testing. During multidisciplinary rounds, providers (nurse practitioners and hospitalists) are prompted to consider discontinuing labs for patients stable for next-day discharge.
Tao Xu, MD
Discharge Hotline Initiative
Hospital Medicine answering service number is recreated in the form of a discharge hotline card to be dispensed personally by physicians to patients prior to discharge, encouraging patients to contact the Division of Hospital Medicine after discharge with any hospitalization and post-discharge-related issues or questions. The goal is to increase patient-physician communication after discharge, and ultimately reduce 30-day readmission.