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25 Fellows QI 2020v3
September 2, 2020

Meet the 25 fellows making huge strides in GI patient care

These fellows showcase their commitment to advancing our field through their quality improvement projects.
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Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” This year 25 quality improvement (QI) initiatives were selected — you can review these abstracts in the August issue of Gastroenterology in the “AGA Section” or review a presenter’s abstract by clicking their image. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.

  • Ali Aamar, MD
    h2

    Ali Aamar, MD

  • Abdelhai Abdelqader, MD
    h2

    Abdelhai Abdelqader, MD

  • Mohamed Barakat, MD
    h2

    Mohamed Barakat, MD

  • Jessica Bernica, MD
    h2

    Jessica Bernica, MD

  • John Blackett, MD
    h2

    John Blackett, MD

  • Michael Blanco, MD
    h2

    Michael Blanco, MD

  • Adam Bledsoe, MD
    h2

    Adam Bledsoe, MD

  • Daniel Bushyhead, MD
    h2

    Daniel Bushyhead, MD

  • Naueen Chaudhry, MD
    h2

    Naueen Chaudhry, MD

  • Patrick Chen, MD
    h2

    Patrick Chen, MD

  • Thomas Cotter, MD
    h2

    Thomas Cotter, MD

  • Sonya Dasharathy, MD
    h2

    Sonya Dasharathy, MD

  • Cassandra Fritz, MD
    h2

    Cassandra Fritz, MD

  • Seifeldin Hakim, MD
    h2

    Seifeldin Hakim, MD

  • Jason Heffley, MD
    h2

    Jason Heffley, MD

  • Elizabeth John, MD
    h2

    Elizabeth John, MD

  • Blake Jones, MD
    h2

    Blake Jones, MD

  • Kevin Kline, MD
    h2

    Kevin Kline, MD

  • Brandon Kuiper, MD
    h2

    Brandon Kuiper, MD

  • Kishore Kumar, MD
    h2

    Kishore Kumar, MD

  • Sarabdeep Mann, MD
    h2

    Sarabdeep Mann, MD

  • Sonali Palchaudhuri, MD
    h2

    Sonali Palchaudhuri, MD

  • Vijeta Pamudurthy, MD
    h2

    Vijeta Pamudurthy, MD

  • George Salem, MD
    h2

    George Salem, MD

  • Chung Sang Tse, MD
    h2

    Chung Sang Tse, MD

Ali Aamar, MD

Brooklyn Hospital

Selection of an Appropriate Helicobacter Pylori Eradication Regimen in an Urban Population: A Quality Improvement Project

We found clarithromycin based triple therapy failure rate was > 15 % in a NYC population and suggest quadruple therapy should be preferred for H. pylori eradication in populations with a > 15% triple therapy failure rate.

Abdelhai Abdelqader, MD

West Virginia University Hospital

Improving Prophylactic Antibiotic use in Patients with Cirrhosis and Gastrointestinal Hemorrhage: A Quality Improvement Study

By implementing quality improvement initiatives including brief didactic sessions, a customized order set, and concise handouts at physician workstations, we improved use of prophylactic antibiotics and the time to infusion for cirrhotics admitted with non-variceal bleeding.

Mohamed Barakat, MD

The Brooklyn Hospital Center

Overutilization Of Fecal Occult Blood Test In The Acute Hospital Setting and its Impact On Clinical Management And Outcomes

We decided to explore the rationale behind inpatient FOBT which led us to discover the inappropriate overutilization of this test and its impact on the health care system.

Jessica Bernica, MD

Baylor College of Medicine

Improving Helicobacter Pylori Testing in Patients with Acute Upper GI Bleeding due to Peptic Ulcer Disease

We demonstrated an increase in the testing for H. Pylori in patients with upper GI bleeding due to peptic ulcer disease from 68% to 100% by instituting a comprehensive H. Pylori order set and shifting the burden of testing to the diagnosing endoscopist.

John Blackett, MD

Columbia University Medical Center

Inappropriate Discharge on Proton Pump Inhibitors After Intensive Care Unit Hospitalization

Among ICU patients started on a PPI for stress ulcer prophylaxis without a long-term indication, 27% were nonetheless discharged on a proton pump inhibitor (PPI), with risk factors for inappropriate PPI prescription including surgical admission and increased length of stay.

Michael Blanco, MD

Vanderbilt University Medical Center

Biopsy and Empiric Dilation Practices in Veterans with Dysphagia and Normal Appearing Esophagus

Despite ACG and ASGE guidelines, biopsy is not routinely performed in veterans at our center with dysphagia and normal appearing esophagus, while empiric dilation is.

Adam Bledsoe, MD

Mayo Clinic-Rochester

Improving venous thromboembolism prophylaxis in patients hospitalized with inflammatory bowel disease: A quality improvement initiative

Hospitalized patients with inflammatory bowel disease are at elevated risk for venous thromboembolic events, but pharmacologic prophylaxis is often held given concerns for bleeding. This study shows that an education intervention improves prescribing of these agents.

Daniel Bushyhead, MD

University of Washington School of Medicine

Comparison of Low Versus High Volume Bowel Preparation Efficacy and Tolerability For Colonoscopy: A Quality Improvement Study

Utilization of low versus high volume preparation for colonoscopy was associated with comparable bowel cleaning and superior patient experience.

Naueen Chaudhry, MD

University of Florida

Tracking Colonoscopy Quality Measures in GI Fellows

We created a user-friendly, uniform data collection tool that is successful in tracking colonoscopy quality indicators and measuring endoscopic skills for first year fellows and provides ongoing formative feedback to GI trainees and the program director.

Patrick Chen, MD

Wright State University

Veterans with Hepatitis B, Who is Being Missed and Why?

Our study was able to identify the major factor for lack of hepatitis B treatment was due to noncompliance with follow up as well as re-establish 85% of patients, who were successful contacted, back into the gastroenterology clinic.

Improving Vaccination Rates in Veterans with Inflammatory Bowel Disease

The goal of our study was to improve vaccination rates of veterans affected by IBD by having a dedicated nurse to track vaccinations and involve the primary care providers in contacting these veterans and administer the required vaccinations.

Thomas Cotter, MD

The University of Chicago Medicine

An Automated Inpatient Split-dose Bowel Preparation Improves Colonoscopy Preparation Quality

Recurrent suboptimal inpatient colonoscopy preparations were a source of frustration for us. We developed and implemented a successful an automated inpatient split-dose bowel preparation, improved inpatient colonoscopy preparation quality and reduced hospital stay.

Sonya Dasharathy, MD

UCLA Vatche and Tamar Manoukian Division of Digestive Diseases

Pneumococcal Vaccination Recommendation and Completion Rates Among Inflammatory Bowel Disease Patients Within A Large Academic Health System

Based on our data, we are administering surveys to gastroenterologists, primary care providers and patients with IBD to better understand the overall knowledge of pneumococcal vaccines and barriers to receiving them. We hope to develop an intervention to improve pneumococcal vaccination rates among patients with IBD at UCLA.

Cassandra Fritz, MD

Washington University in STL – Barnes Jewish Hospital

Charlson Comorbidity Index is a Useful Predictor of Patients Death Prior to Interval Colonoscopy

Charlson Comorbidity Index (CCI) outperformed age in predicting death prior to next screening/surveillance interval and CCI could be used to better determine which patients would most benefit from further screening or surveillance colonoscopy.

Seifeldin Hakim, MD

The University of Texas Health Science Center

Dedicated Cytopathologists vs Community Pathologist Significantly Affects Overall Diagnostic Accuracy of Endoscopic Ultrasound Guided Sampling of Solid Pancreatic Lesions: Outcomes From a Large Healthcare System

Rapid on-site evaluation improved diagnostic accuracy of pancreatic solid lesion specimen obtained through endoscopic ultrasound guided technique. Dedicated cytopathologist evaluation of pancreatic tissue specimen obtained though fine needle aspiration or biopsy is associated with increased diagnostic accuracy.

Jason Heffley, MD

University of Vermont Medical Center

Improving H. Pylori Testing in Inpatients with Peptic Ulcer Disease: A Quality Improvement Initiative

Anecdotally we were finding that testing for H. pylori was happening less than anticipated for our consults with peptic ulcer disease. Figuring out our true testing rate was the first step in making eventual improvements.

Elizabeth John, MD

Methodist Dallas Medical Center

The Value Of Managing Acute Pancreatitis With Standardized Order Sets To Achieve Perfect Care

The Methodist Acute Pancreatitis Protocol (MAPP) standardized order set increased the value of care by improving clinical outcomes without increasing total costs as indicated by achieving perfect care.

Blake Jones, MD

University of Colorado

A Prospective System For Tracking Colonoscopy Performance Among Trainees Using Key Colonoscopy Quality Indicators

We developed a system to promote fellow tracking of colonoscopy quality metrics and analyzed milestone achievements between training years.

Kevin Kline, MD

University of Texas Medical Branch

Sustained Improvement in Antibiotic Stewardship in Acute Pancreatitis Mediated by Targeted Electronic Medical Record Based Communication- Lessons From a Quality Improvement Project

We effectively collaborated with our infectious disease colleagues to implement an intervention which led to the most substantial improvement in performance among our studied metrics, appropriate antibiotic use. This is a testament to the power multidisciplinary collaboration and the impact of targeted communication in the EMR.

Brandon Kuiper, MD

Brooke Army Medical Center

Instilling a Growth Mindset: A Quality Improvement Endeavor to Establish a Database to Track Adenoma Detection Rate in a Large Fellowship Program

Adenoma detection rate (ADR) is the single most important metric of comparison for quality endoscopy but our large fellowship was not tracking or reporting ADR until a QI endeavor created a systematic means of calculating and disseminating the ADR.

Kishore Kumar, MD

BronxCare Hospital Center

Efforts to eradicate Helicobacter Pylori in Hospitalized Patients: A Quality Improvement Project to Recognize and Overcome the Hurdles

Efforts were made to maximize H. Pylori treatment through phone calls after hospital discharge or by creating recall alert in EMR or by sending certified letters to indicate the need to follow up in clinic.

Sarabdeep Mann, MD

University of Arizona College of Medicine Phoenix

Better Prep Is Just One Phone Call Away: Quality Improvement in Colonoscopy Bowel Preparation Through Telephone Education

While most of us in the gastroenterology community understand that bowel preparation is vitally important to the quality of colonoscopy, the instructions and tools we give patients are often complex and confusing. We recognize that a brief telephone discussion with a nurse to simplify the process and answer questions is a valuable tool for patient education, and it is gratifying to show how effective it really is.

Sonali Palchaudhuri, MD

University of Pennsylvania

A Multimodal Interdisciplinary QI Intervention Is Associated with Reduced Variability in Finishing Inpatient Endoscopic Cases and Reduction in Cases after Hours

A multimodal intervention successfully reduced end-of-workday variability and the proportion of cases begun after 5 p.m., showing how QI tools and methods to design and implement interventions can improve inpatient endoscopic services.

Vijeta Pamudurthy, MD

Riverside Medical Center

In-Service Education and Changes to the Electronic Health Record System Improve Intravenous Fluid Hydration in the Emergency Department in Patients with a Diagnosis of Acute Pancreatitis

Providing in-service education and implementing changes to the electronic health record system had an improvement in the number of patients receiving adequate fluid infusions in patients diagnosed with acute pancreatitis in the emergency department.

George Salem, MD

Johns Hopkins Hospital

Bridges To Excellence (BTE) Quality Indicators in Inflammatory Bowel Disease (IBD) in Gastroenterology Fellows’ Clinic at the University of Oklahoma Health Sciences Center: A Quality Improvement Project

Using a provider-friendly note template may improve compliance with AGA quality metrics for the care including vaccination and smoking screening/counseling in patients with IBD in outpatient settings.

Chung Sang Tse, MD

Brown Universityl

Inflammatory Bowel Disease Patients Hospitalized for Flares are at Risk for Chronic Steroid Use due to Lack of Clear Instructions at Discharge: A 15-Month Retrospective Study at a Private, Not-For-Profit Academic Hospital

Individuals with inflammatory bowel disease (IBD) may be hospitalized for IBD flares, which may be treated non-surgically with high-dose steroids. However, the lack of a clear, predefined steroid tapering plan at the time of hospital may lead to prolonged steroid use.

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