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.
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Ali Aamar, MD
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Abdelhai Abdelqader, MD
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Mohamed Barakat, MD
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Jessica Bernica, MD
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John Blackett, MD
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Michael Blanco, MD
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Adam Bledsoe, MD
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Daniel Bushyhead, MD
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Naueen Chaudhry, MD
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Patrick Chen, MD
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Thomas Cotter, MD
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Sonya Dasharathy, MD
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Cassandra Fritz, MD
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Seifeldin Hakim, MD
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Jason Heffley, MD
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Elizabeth John, MD
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Blake Jones, MD
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Kevin Kline, MD
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Brandon Kuiper, MD
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Kishore Kumar, MD
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Sarabdeep Mann, MD
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Sonali Palchaudhuri, MD
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Vijeta Pamudurthy, MD
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George Salem, MD
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Chung Sang Tse, MD
Ali Aamar, MD
Brooklyn Hospital
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
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
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
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
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
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
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
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
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
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
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
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 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
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 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
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
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
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.
