QIPSS #4 - Shared screen with speaker view
Sam Shen
Apologize in advance but will only be able to stay for a few of the presentations as i will be working a clinical shift soon
Topher Sharp
Thank you for presenting a great case, Sam. Your goal appears to be a more easily measured process metric (% aware). Did you consider an outcome (further downstream) metric, and if so what?
Sam Falkson
I think one interesting outcome would be to measure the amount of patients that transfer care to Stanford that end up needing re-biopsies at Stanford on account of difficulty obtaining original specimens at the original hospital they were taken. Hopefully, this number would decrease if the process were improved. I have heard instances of this happening, and it nearly happened with the patient that motivated me to look into this further.
Topher Sharp
Thank you, Sam!
Stacy Serber, CNS L5/L6/B1/C1/G2S
With such a high per-dose cost, even small reductions can make a big difference!
Topher Sharp
@Dr. Linfield - great poster and work! Was there any review of potential (unintentional) risks and monitoring for such?
Rebecca Linfield
I'm on CCU and on call, going to admit a patient, thank you so much for your time!
Topher Sharp
Thank you, Dr. Linfield! Appreciate your team's work!
Topher Sharp
@Dr. Centkowski - wonderful work! Thank you for studying the value of this novel approach. What do you know of frequency of need/use?
Cliff Schmiesing
Sierra, can you group meds like antibiotics or analgesics or antiemetics?
Topher Sharp
Thank you, Dr. Centkowski & team!
Anisia Dugala
Dr. Chen - thank you for sharing your great work. Increasing psychological safety is so critical to improvement. I'm wondering how you plan to collect data across all inpatient units ?
Neil Schwartz
great work Jenny
Topher Sharp
Dr. Chen - thank you for the work on this important topic!
Jenny (Jingjing) Chen
Hi Anisia, we are still actively working on how to collect data. We're tentatively planning on piloting a feedback process on a single inpatient service first and asking medical students, residents, and faculty to report the frequency of feedback given and received at end of each two week period. If successful, we can broaden our scope to the rest of the inpatient teams (neurology has stroke, consult, wards, and neurocritical care inpatient services).
Topher Sharp
@Kush - terrific work, thank you! Very important and relevant in clinical care.
Ron Li
Outstanding job Kush!
Kush Gupta
Thank you! Very grateful to have a strong team working on this (Ron, Dr. Chen, and Dr. Shieh)
Barb Mayer, Exec Dir Prof Prac/Improvement
Thank you Kush. Would love to explore nursing's role in obtaining and recording allergy information.
Kush Gupta
Thank you Barb, I’ll follow up with you over email - looking forward to discussing further
Topher Sharp
@Dr. Weia - very important work! 30k/month for a single unit is a huge improvement opportunity. Even a small % change can be meaningful. Great use of control charts to show measurement.
Benjamin Weia
thanks Dr. Sharp!
Ann Weinacker
@Ben — Am I reading it correctly on your chart that there were ~7000 pages per day on B3?
Jenny (Jingjing) Chen
Thanks Ben for your work on Voalt. Voalt messages are now labeled with names and they make a huge difference to us residents
Benjamin Weia
@Ann, that's right
pedram fatehi
@ben. agree with jenny. I've found recent use of voalte easier to direct my messages.
Ann Weinacker
@Ben — wow. That’s a lot of pages — 210,000/month! That really points up the importance of your work. Thank you for doing this.
Barb Mayer, Exec Dir Prof Prac/Improvement
@Ben, thanks for continuing this work. Am anxious to see next steps. It might be interesting to look at # Voalte messages per resident/nurse to explore qualitatively underlying decision-making process.
Benjamin Weia
@Barb -- yeah I agree
Stacy Serber, CNS L5/L6/B1/C1/G2S
@CW: Excellent point about the Ceribell - may have saved some delay time!
Topher Sharp
@Dr. Wu - great work by your team! I was also surprised to see the results, but reassured. Your drill-down in this project is an important area of focus.
@Dr. Sharp. Thank you!
@Stacy: Indeed! Ceribell is definitely a win
Katie Kvam
Congratulations Connie on this great and interesting project! What a testament to our amazing residents that there were no delays in stroke care even in the throes of the pandemic.
Thank you Dr. Kvam! Team Brain held down the fort.
Stacy Serber, CNS L5/L6/B1/C1/G2S
Very impactful difference between the "convenience" of the kits vs. the increased waste they contribute!
Barb Mayer, Exec Dir Prof Prac/Improvement
@Anita - love this project! Any thoughts on the trade-off between pre-packaged kit and time to collect necessary items?
Topher Sharp
@Dr. Lowe - wonderful work and broadens our usual view of quality and health. Hope that this area of focus can continue forward. Thanks!
anita lowe
@Barb Mayer- sure, I personally have found that once you get the hang of things the pre-fab kits aren’t that much faster. Of course this isn’t the case when learning the set up
anita lowe
@ Topher Sharp, thank you! I am also hoping this project continues on. I’ve recruited a few residents to take over once I graduate next year so fingers crossed
Ann Weinacker
@Anita — I’ll keep my fingers crossed with you!
Topher Sharp
@Dr. Lowe - would love to see SHC request of our suppliers to have a metric of waste (e.g. packaging) per kit. I can imagine this isn't available today, but creating the data to measure and advocate as you are doing is very forward-looking.
anita lowe
@Ann Weinacker, thanks so much! And @Topher Sharp, I love the idea of putting the onus on the supplier. One of our attendings is planning to approach the supplier to try to reduce the kit components based on this data, but it would be much more impactful if SHC required a waste metric.
Topher Sharp
@Dr. Villegas - appreciate the clinically relevant operationally impactful work. Great points about the challenges in working with these data.
Topher Sharp
Greening of clinic = "visionary and transformational"
Stacy Serber, CNS L5/L6/B1/C1/G2S
Greening = exemplar for the 5th Magnet submission!!
Topher Sharp
more winners! ;-)
Topher Sharp
everyone wins!
Topher Sharp
#1 = Penicillin Allergies in the EMR cause Unnecessary, Clinically Harmful Antibiotic Changes including Significantly greater exposure to Vancomycin#2 = Improving Multi-directional, Real-time Feedback in Neurology Residency#3 multi-disc = Improving Effectiveness and Satisfaction of Communications with Voalte#4 honorable mention = Greening the Clinics: Improving Environmental Sustainability at the Stanford Redwood City Outpatient Center
Ann Weinacker
@Topher — agree!