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Poster 161: Increasing Compliance with Using the Standardized Patient Admission Report Through Email Communication
S184
Abstracts / PM R 9 (2017) S131-S290
Poster 161: Increasing Compliance with Using the Standardized Patient Admission Report Through Email Communication Ellia Ciammaichella (University of Texas Health Science Center, Houston, TX, USA), Tomasz K. Podobinski, DO, Kelly Cameron, MD, Abana F. Azariah, MD, Tony Nguyen, MD, Elham Cohen, MD, Christopher M. Falco, MD Disclosures: Ellia Ciammaichella: I Have No Relevant Financial Relationships To Disclose Objective: To optimize transition of care with admissions at one acute inpatient rehabilitation facility by increasing overall nursing compliance with the “Patient Admission Report” (Report) by 25%. Design: To determine whether compliance improved after the intervention, pre- and post-intervention compliance were assessed as follows: Pre-intervention compliance was determined by collecting data over a random but consecutive two-week period in Spring 2016. Ten days after the intervention was provided, post-intervention data was collected for two weeks. During each of these two weeks, the Investigator reviewed all new admissions for the presence or absence of the completed Report. Setting: Acute inpatient rehabilitation facility. Participants: Long Le, MD, Kelly Cameron, MD, Elham Cohen, MD, Abana Azaria, MDh, Tomasz Podobinski, DO, Ellia Ciammaichella, DO, Tony Nguyen, MD, Siddarth Thakur, MD, Christopher Falco, MD Interventions: An email was sent out to all nursing staff with detailed explanation to complete and how to complete the Report. In addition, the nursing floor managers were emailed with a reminder. A copy of the Report was also included in the email. Main Outcome Measures: The main outcome measure was compliance, which was measured by inspecting the physical chart for the completed Report. The presence of a completed Report in the chart was considered compliant and the absence of a completed Report was considered noncompliant. Results: Overall compliance pre-intervention was 45% and postintervention was 56%. With p-.001 no significant difference was found. Conclusions: The study showed compliance improved with the intervention but this finding was not statistically significant. This may be due to: the type of intervention (one email), lack of impact of the email, the possibility that it was not read, lack of incentive to encourage compliance, or loss or misplacement of any completed Report. Level of Evidence: Level II
Poster 162: A Practice Improvement Project to Decrease Falls in Patients Discharged from Acute Rehabilitation Jamal Khan, DO (SUNY At Stony Brook, Valley Stream, NY, United States), Karen I-Kemper, OT, Michael Scicchitano, PT, Jun Zhang, MD, Jennifer Semel, MD Disclosures: Jamal Khan: I Have No Relevant Financial Relationships To Disclose Objective: Practice improvement project to decrease falls after discharge from acute rehabilitation. Design: Patients discharged from acute rehabilitation were surveyed via MedTel 3 months after discharge beginning in January 2015. They were asked whether they had sustained a fall since being discharged. A fall education class was implemented in October 2015 and data were collected through July 2016. Setting: Community rehabilitation hospital. Participants: All patients discharged from acute rehabilitation, including patients who went home or to another facility. The survey had an 80% response rate.
Interventions: A comprehensive fall prevention and home safety education class was implemented in October 2015. It was offered to all inpatient rehabilitation patients and their family members. The class addressed topics such as client factors, environmental factors and additional preventive strategies. Patients were educated on their risk of falling based on factors such as medication side effects or visual problems, and were given specific fall prevention interventions to complete in their homes. Patients were also given community resource information to help them and their family members prevent falls after discharge. Main Outcome Measures: Telephone survey conducted 3-months post discharge by MedTel. Results: For 2015, 131 out of 572 total patients (22.90%) reported falling at 3 month follow up. Between January and June 2016, 103 out of 602 patients (17.11%) reported falling at 3 month follow up. Since beginning the fall prevention class in October 2015, nine of the ten following months have had a fall average below the facility’s historical average of 23%. There has also been a downward trend in patients reporting falls after discharge during this time. Conclusions: Implementation of a fall prevention and education class has led to a decrease in patient falls post discharge. Class offerings are held biweekly for rehabilitation patients and their family members. Reinforcement of preventative practices by the entire staff improved adherence to the program. Level of Evidence: Level IV
Poster 163: Calf Measurements as Indicator for Deep Vein Thrombosis: A Quality Improvement Project Amy H. Ng, MD MPH (University of Texas MD Anderson Cancer Center) Disclosures: Amy Ng: I Have No Relevant Financial Relationships To Disclose Objective: We aim to implement a nursing driven physical assessment during the initial admission encounter in cancer patients admitted to inpatient rehabilitation that will improve documented DVT screening assessment to 75% within 1 year. Additionally, we aim to see if calf circumference measurements at admission to inpatient rehabilitation unit will have an impact on DVT detection at admission to the rehabilitation unit. Design: Prospective Study and Retrospective Chart Review. Setting: Cancer rehabilitation patients admitted to inpatient rehabilitation unit at a tertiary cancer center. Participants: A total of 373 patients were admitted to the inpatient cancer rehabilitation unit from 4/1/15 to 4/1/16. Interventions: Not Applicable. Main Outcome Measures: Collected measurements included compliance (if calf measurement were recorded), if there was a difference of greater than 3 cm between the two calves, and if a venous Doppler was ordered for the affected leg and if the outcome of the Doppler study was positive for DVT. Results: A total of 373 patients were admitted to the inpatient cancer rehabilitation unit. Only 6 patients or 1.6% did not have calves measured. We achieved a good compliance rate, with 98.4% compliance to measurement of calves by the admitting nursing staff. Only 1 patient had difference in calf measurement and clinical exam significant to warrant a venous Doppler ultrasound. No positive identification of DVT resulted in the use of calf measurement technique. Conclusions: This quality improvement project increased surveillance of clinical detection of DVT. It also increased awareness of clinical staff, nurses, and therapists to appropriately identify leg swelling as an earlier indicator of DVTs. Level of Evidence: Level IV
Abstracts / PM R 9 (2017) S131-S290
Poster 161: Increasing Compliance with Using the Standardized Patient Admission Report Through Email Communication Ellia Ciammaichella (University of Texas Health Science Center, Houston, TX, USA), Tomasz K. Podobinski, DO, Kelly Cameron, MD, Abana F. Azariah, MD, Tony Nguyen, MD, Elham Cohen, MD, Christopher M. Falco, MD Disclosures: Ellia Ciammaichella: I Have No Relevant Financial Relationships To Disclose Objective: To optimize transition of care with admissions at one acute inpatient rehabilitation facility by increasing overall nursing compliance with the “Patient Admission Report” (Report) by 25%. Design: To determine whether compliance improved after the intervention, pre- and post-intervention compliance were assessed as follows: Pre-intervention compliance was determined by collecting data over a random but consecutive two-week period in Spring 2016. Ten days after the intervention was provided, post-intervention data was collected for two weeks. During each of these two weeks, the Investigator reviewed all new admissions for the presence or absence of the completed Report. Setting: Acute inpatient rehabilitation facility. Participants: Long Le, MD, Kelly Cameron, MD, Elham Cohen, MD, Abana Azaria, MDh, Tomasz Podobinski, DO, Ellia Ciammaichella, DO, Tony Nguyen, MD, Siddarth Thakur, MD, Christopher Falco, MD Interventions: An email was sent out to all nursing staff with detailed explanation to complete and how to complete the Report. In addition, the nursing floor managers were emailed with a reminder. A copy of the Report was also included in the email. Main Outcome Measures: The main outcome measure was compliance, which was measured by inspecting the physical chart for the completed Report. The presence of a completed Report in the chart was considered compliant and the absence of a completed Report was considered noncompliant. Results: Overall compliance pre-intervention was 45% and postintervention was 56%. With p-.001 no significant difference was found. Conclusions: The study showed compliance improved with the intervention but this finding was not statistically significant. This may be due to: the type of intervention (one email), lack of impact of the email, the possibility that it was not read, lack of incentive to encourage compliance, or loss or misplacement of any completed Report. Level of Evidence: Level II
Poster 162: A Practice Improvement Project to Decrease Falls in Patients Discharged from Acute Rehabilitation Jamal Khan, DO (SUNY At Stony Brook, Valley Stream, NY, United States), Karen I-Kemper, OT, Michael Scicchitano, PT, Jun Zhang, MD, Jennifer Semel, MD Disclosures: Jamal Khan: I Have No Relevant Financial Relationships To Disclose Objective: Practice improvement project to decrease falls after discharge from acute rehabilitation. Design: Patients discharged from acute rehabilitation were surveyed via MedTel 3 months after discharge beginning in January 2015. They were asked whether they had sustained a fall since being discharged. A fall education class was implemented in October 2015 and data were collected through July 2016. Setting: Community rehabilitation hospital. Participants: All patients discharged from acute rehabilitation, including patients who went home or to another facility. The survey had an 80% response rate.
Interventions: A comprehensive fall prevention and home safety education class was implemented in October 2015. It was offered to all inpatient rehabilitation patients and their family members. The class addressed topics such as client factors, environmental factors and additional preventive strategies. Patients were educated on their risk of falling based on factors such as medication side effects or visual problems, and were given specific fall prevention interventions to complete in their homes. Patients were also given community resource information to help them and their family members prevent falls after discharge. Main Outcome Measures: Telephone survey conducted 3-months post discharge by MedTel. Results: For 2015, 131 out of 572 total patients (22.90%) reported falling at 3 month follow up. Between January and June 2016, 103 out of 602 patients (17.11%) reported falling at 3 month follow up. Since beginning the fall prevention class in October 2015, nine of the ten following months have had a fall average below the facility’s historical average of 23%. There has also been a downward trend in patients reporting falls after discharge during this time. Conclusions: Implementation of a fall prevention and education class has led to a decrease in patient falls post discharge. Class offerings are held biweekly for rehabilitation patients and their family members. Reinforcement of preventative practices by the entire staff improved adherence to the program. Level of Evidence: Level IV
Poster 163: Calf Measurements as Indicator for Deep Vein Thrombosis: A Quality Improvement Project Amy H. Ng, MD MPH (University of Texas MD Anderson Cancer Center) Disclosures: Amy Ng: I Have No Relevant Financial Relationships To Disclose Objective: We aim to implement a nursing driven physical assessment during the initial admission encounter in cancer patients admitted to inpatient rehabilitation that will improve documented DVT screening assessment to 75% within 1 year. Additionally, we aim to see if calf circumference measurements at admission to inpatient rehabilitation unit will have an impact on DVT detection at admission to the rehabilitation unit. Design: Prospective Study and Retrospective Chart Review. Setting: Cancer rehabilitation patients admitted to inpatient rehabilitation unit at a tertiary cancer center. Participants: A total of 373 patients were admitted to the inpatient cancer rehabilitation unit from 4/1/15 to 4/1/16. Interventions: Not Applicable. Main Outcome Measures: Collected measurements included compliance (if calf measurement were recorded), if there was a difference of greater than 3 cm between the two calves, and if a venous Doppler was ordered for the affected leg and if the outcome of the Doppler study was positive for DVT. Results: A total of 373 patients were admitted to the inpatient cancer rehabilitation unit. Only 6 patients or 1.6% did not have calves measured. We achieved a good compliance rate, with 98.4% compliance to measurement of calves by the admitting nursing staff. Only 1 patient had difference in calf measurement and clinical exam significant to warrant a venous Doppler ultrasound. No positive identification of DVT resulted in the use of calf measurement technique. Conclusions: This quality improvement project increased surveillance of clinical detection of DVT. It also increased awareness of clinical staff, nurses, and therapists to appropriately identify leg swelling as an earlier indicator of DVTs. Level of Evidence: Level IV