2022 QIPSS - Group 1 - Shared screen with speaker view
Katherine Xiong
Anu Phadke
@ Julia + Arman, Great presentation! Can you please share more information about the linkage between poor communication and readmission? How was that link established? Thanks!
Arman Sharma
Excellent question! The link was established primarily by literature review as well as the work by past groups in Stanford Healthcare Consulting Group. The literature review found that of all the technologies that have changed/updated in post-acute care setting in the last decade or so, the one area that has remained relatively static is communication (i.e. pipelines are still largely reliant on fax, paper transfer, and personal communication between physicians and SNFs). Given that it hasn't been updated, it was the natural suspect for inefficiencies contributing to readmissions.
Roxanne Hyke
Great project, appreciate the addition of both process and outcome metrics in the target statement.
Carl Preiksaitis
Video review has given us much more nuanced and detailed feedback than is traditionally available to learners in the immediate post-procedure time period
Larry Katznelson
Jonathan, Great and important project. Can you say more on how you standardize assessment by the judges?
Johnathan Clevinger, MSN - Director of Clinical Trial Operations
Great project. Are there plans to implement in Critical Care areas?
Anu Phadke
Jonathan, great presentation! Has this approach been studies in the EM literature or is it novel? If previously reported, are there any key takeaways from similar programs?
Nathalie Cheng
Agree, great project! Same question as Jonathan. How do you plan to expand the projects to other areas?
Jonathan Hootman
Thanks Larry! We developed a check-list based on expert opinion, prior airway management research, and internally validated.
Carl Preiksaitis
@larry We have developed and internally validated checklists for specific intubation modalities. There are previous checklists, but they don't address details to the level we are able to assess with our videos. Our checklist is based on objective assessments that can be made on video review
Topher Sharp
@Dr. Hootman - thx for the great work! I'm wondering about your capture rate: how important is this to your outcomes? (e.g. what % of all potential opportunities are being captured) Also, curious how many total videos have you captured to date?
Jonathan Hootman
Johnathan, thank you! Yes, myself and several other critical care bound EM residents are eager to expand to the ICU.
Johnathan Clevinger, MSN - Director of Clinical Trial Operations
That's great to hear. Thanks, Jonathan!
Carl Preiksaitis
One of our outcome goals is to generate educational materials that can be shared with ICU and anesthesia programs as well as ED programs outside of stanford.
Larry Katznelson
Thanks Carl.
Jonathan Hootman
Anu, we know that other EM programs do record their intubations, but to our knowledge, none have released data on the impact of this video review on resident education or patient safety outcomes.
Carl Preiksaitis
How many recordings do we have to date Jonathan?
Barbara Mayer
Jonathan, it would be interesting to see how your evaluation of practice might translate to other high risk procedures.
Jonathan Hootman
We have approximately 75 recordings thus far
Carl Preiksaitis
@topher although our goal is to capture 100% of intubations on video, the bias is currently towards more challenging intubations captured as these are more closely supervised by senior residents and faculty
Jonathan Hootman
@Topher, since a good deal of our intervention is based on providing feedback based on video review, capture rate is important. We currently have a capture rate of about 50% (already improved from 38% at the outset of this project in September).
Topher Sharp
@Carl & Jonathan - that's an amazing start and lofty goal. Congrats on the important work!
Carl Preiksaitis
@Barabara, there have been several studies looking at video review for QI of codes and trauma resus with good outcomes. Agreed that video review of other critical procedures would be great
Ashok Krishnaswami
Got to jump off to handle some clinical issues. Please email me if any questions come up? Thanks for the opportunity !
Katherine Xiong
As a reminder to all the judges, you can also share additional feedback with our presenters using the qualtrics link: https://stanforduniversity.qualtrics.com/jfe/form/SV_a5CYWwPPwXt8elE
Barbara Mayer
@Ashok, how do you perceive the primary nurse contributing to this discussion - particularly as part of discharge planning?
Anu Phadke
@ Rob, great project! From what you hear from your colleagues, how have resident perceptions of the model changed with the interventions you've tested?
Rob Gallo
@Anu, that is a great question, and one we hope to investigate with further surveys in the future!
Topher Sharp
@Rob, great work. What have you discovered about accountability between stakeholders in the process given this is a team-based response?
Rob Gallo
@Topher Sharp, we've found that it is really important to have sustainable roles that involve the whole care team in the pathway. Originally we had the residents perform part of the huddle documentation, but with residents changing services frequently it is difficult to make that role sustainable. Now we are shifting to a model driven by our nursing colleagues to empower them to contribute their important perspective in discussion with clinicians
Topher Sharp
Thanks Rob!
Jonathan DeLong
I am sorry but I will have to run back to the OR, thank you so much for the opportunity to present. I would be happy to answer any questions by email jcdelong@stanford.edu if any additional questions arise!
Nathalie Cheng
Great presentation Dr. Pal, am I understanding correctly that your baseline is 47%? How did you determine your goal of 75% by 2023?
Roxanne Hyke
@Ria - great presentation and incredibly impactful.
ria pal
Correct, our baseline was 47%. 75% is a bit under what we're getting in the inpatient (LPCH) stroke codes, which we used as a goal -- understanding that an inpatient won't have the same challenges of coordinating across hospitals
ria pal
Thank you for your time and bearing with my audio issues, all!
Nathalie Cheng
Ok, great. thank you!
Topher Sharp
No questions, but thanks for a great improvement-led effort to bring in latest care advancements!
Inna Kaplan
Do you see this expanding to heme/BMT service lines that perform frequent multiple LPs ? If so, what avenue would you recommend?
Dave Rogawski
Yes, we would love to expand to the heme/BMT service. I will be the incoming neuro-oncology fellow this year and am planning on implementing in our clinic. Please send me an email as I'd love to work with anyone in the heme/onc clinic.
Anu Phadke
Thanks, everyone for letting me joined! Barb has my votes. Great session!