Residents Think Outside The Box To Improve Patient Care

Released on 06.26.2017

Their projects included ways to improve osteoporosis screening in male veterans, increasing the number of pregnant women who get the flu vaccine and reducing wait time in clinics. And UCF residents in internal medicine, pharmacy, emergency medicine and OB/GYN specialties showcased such innovations for improving patient care quality and safety at the 3rd Annual Quality and Patient Safety Forum on June 15.

As part of their training, residents conduct a yearlong research project on a range of patient safety issues, examine current practices to identify areas that need improvement and recommend solutions for these problems. At the end of the year, they present their projects for judging to a panel of faculty physicians and compete for awards including “Most Innovative” and “Most Likely to Improve Patient Care.”

This year’s forum included a keynote Address from Dr. Jonathan Perlin, president of clinical services and chief medical officer of the Hospital Corporation of America (HCA) and past undersecretary of health at the Veterans Health Administration.  Dr. Perlin spoke about using big data to create opportunities for learning and improving safety, citing examples from his landmark REDUCE MRSA (“Randomized Evaluation of Decolonization vs. Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus”) study that demonstrated a 44 percent reduction in the serious bloodstream infection that is often caught in hospitals.

“What our organizations have the capacity to do is to use data at scale and to learn from every clinical encounter,” Dr. Perlin said. “We need to not just collect data, but also channel that data as knowledge that can be reapplied for the best of personalized, precision care and more generally for the improvement of quality and safety assurance.”

“The opportunity to achieve the best possible outcome is not what we know, or what we used to know,” he added.  “The best possible outcomes are always what we’re going to find in the future. It’s part of a learning cycle of patient care — curating data and transferring it to knowledge and reapplying it for higher levels of performance is what healthcare is all about.”

That philosophy is part of UCF’s partnership residency programs that are growing across the state. The medical school’s first residency in internal medicine began in 2014 with the Orlando VA and Osceola Regional medical centers. Since then, UCF has formed a consortium with HCA that has begun 14 new residencies and one fellowship across Central and North Central Florida in the last two years. Research and a focus on patient quality and safety are integral parts of the curriculum at each residency.

“The forum is an unbelievable accomplishment for a partnership this young to be thinking about patient safety at this level so early,” said Dr. Abdo Asmar, director of the internal medicine residency and vice chair of internal medicine.   “I want to commend all the partners involved for instilling a culture of quality improvement and patient safety in such a meaningful and powerful way. These are real dilemmas and situations that have been identified and the residents have developed proper solutions and actions plans to make them better.”

For their research project, internal medicine residents Drs.  Jeremy Agostinho, Patricia Guzman Rojas, Chirin Orabi and Asad Sattar developed a project to help reduce unnecessary lab draws at Osceola Regional.   Their project was voted “Most Likely to Impact Patient Care.”

“When patients get admitted to the hospital they have a lot of labs drawn every day,” Dr. Agostinho said.  “We found that many of these labs really weren’t helping their care or their management, so we wanted to find a way to reduce this.”

Their research found that unnecessary lab tests were were ordered largely from a lack of proper training and uniform guidelines. So the team developed a set of guidelines which will be placed in a handbook and given  to all residents. Residents will be able to consult the guidelines to assess whether their patient would benefit from having a blood test done. The team is also presenting the guidelines to attending physicians at their staff meetings so they can establish protocols for ordering blood tests.

“So the change we’re trying to make is really focused on education for the residents as well as the teaching attending physicians, so that the next generation of residents coming in understand when it’s not appropriate to order these type of blood tests,” Dr. Agostinho added.   “We hope that these will reduce hospital costs as well as reduce the risk of evasive testing, such as hospital acquired anemia, if the patient doesn’t need a lab done.”

Other projects were centered on patient education. Dr. Samantha Bunting, an OB/GYN resident, developed an educational program to teach woman the importance and safety of getting the flu vaccine during pregnancy.

“We see a lot of patients that come into our hospitals and are admitted with the flu, and it’s a problem because we don’t want our other pregnant patients getting the flu,” Dr. Bunting said. “So the goal is just to educate our patients about receiving the vaccine and to see if this education results in an increase.”

Dr. Bunting said pregnant women are usually hesitant to get the flu vaccines dues to safety concerns. For her project, she developed handouts and patient-counseling programs to assure expectant mothers that the flu shot is safe at all points in pregnancy and even while breastfeeding.

In October, when the next flu season begins, Dr. Bunting will assess the impact of her project to see if there is a marked increase in the number of flu vaccinations for pregnant women.

Research winners were:

Best Poster

Drs. Abeer AlMajali, Giorgio Guiulfo, Poonam Kalidas, and Vishal Patel

“The Inappropriate Use of Acid Suppressive Therapy for the Purpose of GI Stress Ulcer Prophylaxis in patients on the Osceola Regional Medical Ward Resident Service”

Best Presentation

Tie

Drs. Israel Acosta-Sanchez, Esra Gucuk Ipek, Hiren Patel, and Zhabiz Solhjou

“Improvement of Transition of Care from ICU to Primary Ward Teams at ORMC”

Drs. Natalia Castillo, Arfa Faiz, Nway Ko Ko and Wael Sankar

“CIWA Implementation in the Teaching Wards in a Community-Based University Affiliated Hospital”

 

Most Likely Lasting Change

Drs. Sreyasi Bhattacharya , Abed Madanieh, Jorge Restrepo, and Luis Sanchez

“PADUA Score for Assessment of Inpatient Prophylactic Anticoagulation”

Most Innovative

Drs. Lori Weinberg, Emmanouil Papagiannakis, Sara DeNardis, and Nnenna Maduforo

“CIN2+ Detection on ASC-US/hrHPV+ Patients: Standard Colposcopy vs Digital Colposcopy with Dynamic Spectral Imaging”

Most Likely to Impact Patient Care

Drs.  Jeremy Agostinho, Patricia Guzman Rojas, Chirin Orabi, and Asad Sattar                            

“Reducing Unnecessary Lab Draws at Osceola Regional Medical Center”

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