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QIPSS #5 - Shared screen with speaker view
Javier Lorenzo (he/him)
01:47
Dr. Ahuja as well!
Javier Lorenzo (he/him)
03:13
Josh will you provide a 2 minute warning.. or any warning before 7 mins are up?
Rahim Nazerali
03:59
can you make the screen bigger?
Lee White
10:11
What’s your experience been with working with epic to improve the template?
Neera Ahuja
10:52
thanks Sofia! would be great to share this with incoming housestaff! :)
lauren eggert
11:18
So is the problem that the teams are not updating the handoffs daily?
Sofia Gomez
12:55
@Lauren Yes, exactly. Handoffs are often quite outdated. Looking at daytime event inclusion in handoffs is the best way, we felt, to quantify whether or not handoffs are updated on a daily basis.
Javier Lorenzo (he/him)
18:06
@Adrian What exactly is the problem statement you are trying to address? Low patient satisfaction with virtual visits? Understanding drivers of low satisfaction? Unclear what the scope is here.
Kaniksha Desai
18:42
what are you interventions to improve the scores?
Kaniksha Desai
18:55
were your
Natalie Lui
19:42
Thanks, Adrian. Very interesting how many patients prefer virtual visits to in person, considering we rarely offered this before Covid.
Neera Ahuja
19:48
very nice, Arian. Nice to see innovation in the time of covid
Caleb Seufert
19:55
In your analysis, did you find patient satisfaction corresponded to any significant clinical outcomes?
Michael Zhang
20:01
Great job, Adrian!
Kaniksha Desai
25:14
Thanks Adrian, great presentation! I was typing that question while you were answering the one before. :) very useful information to see what patients find important out of the televisits
Neera Ahuja
25:28
Nice presentation, Lee. Were there certain sites amongst your list that received an overwhelming number of hits (eg. medical vs. amion)?
Javier Lorenzo (he/him)
25:44
Great work from hitec.
Natalie Lui
25:59
Hi Lee, has the website required a lot of time to keep up to date?
Jay Shah
26:22
this is fantastic, Lee. I wish this existed when I was in residency!
josh jaramillo
37:31
Thank you Joy for your presentation
Natalie Lui
38:03
Great presentation, Joy. Do you know the denominator of patients seen at Stanford for those symptoms? Do some physicians already skip the EMG if low clinical concern, or would this be a major change in practice?
Javier Lorenzo (he/him)
38:50
@Lee Great use of a SMART Goal. I have a sense of a baseline, the target, and the time to reach target. Strong work
Joy Lin
41:14
great question! in the cohort of 56 patients, 15 were felt to clinically have motor neuron disease, and 41 were not. So while the selected cohort was patients with cramps/fasics who underwent EMG/NCS, the majority had EMG/NCS ordered despite low clinical concern
Neera Ahuja
41:29
This is like an ERAS approach... were you just looking at 30 day readmissions for urologic issues or were readmissions for all cause assessed?
Kaniksha Desai
41:42
@lee- what did you feel was the most important intervention
Javier Lorenzo (he/him)
41:44
@Lee, any idea on how Stanford benchmarks with other peer institutions?
Javier Lorenzo (he/him)
41:54
with RC readmissions?
lauren eggert
42:51
Who emails the APP for follow up at discharge? Do you have a dedicated APP for this?
Jay Shah
43:18
lee, is each element of the bundle considered a unique intervention or is the whole bundle considered one intervention. (eg, if patient has all but one of the elements done, are they considered as having had the intervention or not?)
Eila Skinner
43:20
this intervention is actually on top of a standardized ERAS perioperative approach and a care pathway.
Caleb Seufert
43:57
@Dr.Lorenzo - Our RC readmission numbers are similar to national averages.
Jay Shah
44:00
@Neera - this is beyond ERAS :-)
Caleb Seufert
44:16
Nice job Lee!
lauren eggert
44:20
Nice Job!
Rahim Nazerali
44:27
Nice job, good use of all the tools from CELT!
Javier Lorenzo (he/him)
44:28
Thanks Caleb. Good to have the aim to lead the pack. Nice Job.
Kaniksha Desai
44:49
Thank you Lee! great project, high cost saving
Lee White
45:07
Thank you!
Javier Lorenzo (he/him)
47:55
@Jared. Great use of pchart with annotations! Congratulations on reaching 0% TRPIs in the last 2 quaters.
Rahim Nazerali
49:00
Very nicely organized and diagrammed. Not overwhelming in text and easy to follow! Really nice and important QI project.
Javier Lorenzo (he/him)
49:22
@Jared. 2 questions: Sustainability Plan to keep these gains? Have you shared these trach care bundles with other services that performs tracheostomies (Interventional Pulmonology, ACS/SICU)?
Neera Ahuja
49:23
totally agree with Rahim....
Neera Ahuja
51:29
Thank you for incorporating into ValleyCare! The more integration of best practices as we can optimize, the better!
Natalie Lui
52:03
We are using this bundle in Thoracic Surgery! It requires minimal effort and has made such a big difference. This was a problem we did not recognize since we don’t generally follow patients after trach. Thanks, Jared!
Javier Lorenzo (he/him)
54:02
@Jared. Good work. Integration of the bundle in the EHR make for a more impactful and sustained practice.
Jared Shenson
55:22
Dr. Lui – thank you! Glad to hear things are going well with the Thoracic Surgery team’s experience.
Jared Shenson
56:31
Dr. Lorenzo – thank you for your comments and questions. Agree completely with the need to integrate into the EHR to sustain interventions where applicable. It’s often frustratingly slow to accomplish but highly valuable.
Lee White
58:51
Cayo: Was the Learning Assessment already present within Epic? Was it created for this project?
Lee White
59:51
How to you ensure the nurse completing the Learning Assessment is using appropriate language interpretation tools?
Lee White
59:55
Great job!
Rahim Nazerali
01:00:07
Very important area of improvement!
Kaniksha Desai
01:00:40
Cayo" What the baseline completion of the forms overall, are the nurses filling them out?
Javier Lorenzo (he/him)
01:04:16
@Jessica. Strong SMART Goal and your fishbone diagram is very easy to read.
Neera Ahuja
01:04:50
Jessica, very nice approach to the peds theme of "about me, then not without me". (We piloted this in Internal medicine a few years ago but it wasn't as effective because of lack of co-location)
Javier Lorenzo (he/him)
01:06:05
We have struggled with this in the ICU as well. Despite evidence that family engagement improves Post ICU outcomes (less anxiety, depression from caregivers). We should learn a few things from this project.
Javier Lorenzo (he/him)
01:06:55
@ Jessica, run chart y axis should be 0 to 100% for compliance.
Lee White
01:07:27
Is there a SCH/LPCH policy that prioritizes Family Centered Rounds?
Natalie Lui
01:08:46
Jessica, this is a great project. What time window are your rounds usually? This has been difficult in surgery as well. The team rounds 6-7am - before visiting hours and during nursing signout. We try to have a team member return later in the day when family is present.
Lee White
01:08:58
On surgical services, it is often difficult to wait at a patients room for the bedside nurse or a family member if they are not already present.
Larry Katznelson
01:08:59
Jessica, So important and well done!
amit singh
01:09:12
Great work Dr. Moriarty!
Javier Lorenzo (he/him)
01:09:17
Strong work Jessica.!
Lee White
01:09:21
Just finding the official bedside nurse is a challenge
Lee White
01:09:58
Great presentation, enjoyed flying around the poster. Slick!
Jessica Moriarty
01:10:08
@Natalie - we round from 8:50 - 11 (Ideal state). I do imagine this would be a challenge in the early morning hours.
Rahim Nazerali
01:10:20
Nice work Jessica.
Neera Ahuja
01:12:19
Nice outline of P-D-S-A
lauren eggert
01:12:48
What made you think of implementing this intervention? Have you found long delays with calling a cardiac code or delays in cannulation?
Javier Lorenzo (he/him)
01:15:51
@Alberto. Great job with addressing the supply of these kits in the units. Wondering if there is an opportunity to have them stocked in crash carts. As we improve our processes around E-CPR activation, consider the time from "ECMO activation" to "full flow" as a metric of interest.
Lee White
01:16:05
Alberto: great presentation. How hard was it to get the kit stocked in each ICU? Has this closer availability benefitted any patients who needed pVA-ECMO?
lauren eggert
01:17:31
Great idea!
Natalie Lui
01:17:37
Alberto, great project! Any plans for the CC fellows to use the micro puncture kit in advance instead of only once ECMO cannulation has been decided? Have you timed micro puncture insertion?
Natalie Lui
01:18:14
Josh, thanks for moderating!
Alberto Furzan
01:18:30
It was not difficult. We talked to the nurse manager and we found a place for the kit.
Javier Lorenzo (he/him)
01:18:31
Thanks for moderating Josh.
Lee White
01:18:32
Goo job Josh!
Javier Lorenzo (he/him)
01:18:37
Done on time!