2nd Annual
Master of Science Research Symposium Clinical Thesis Defense Building 517, Classroom 137 Friday, April 26, 2019 | 8:15 a.m.–3:40 p.m.
2nd Annual
Master of Science Research Symposium Clinical Thesis Defense Building 517, Classroom 137 Friday, April 26, 2019 | 8:15 a.m.–3:40 p.m.
Time
Presenter
8:15 a.m.–8:30 a.m.
Breakfast and Welcoming Remarks Dr. Anastasia Levitin, Professor of Practice in Translational Medicine and Director, Master of Science in Applied Life Sciences Program, Keck Graduate Institute
8:30 a.m.–9:00 a.m.
Assessing and Preventing Surgical Site Infections Issa Fakhouri, MS Student, Keck Graduate Institute
9:00 a.m.–9:30 a.m.
The Effects of Person-Centered Care on Patient Satisfaction Scores in the Labor & Delivery and Mother-Baby Care Units Raeven Chung, MS Student, Keck Graduate Institute
9:30 a.m.–10:00 a.m.
Telestroke Report Cards: Improving Treatment Times for Acute Ischemic Stroke Jocelyn Castro, MS Student, Keck Graduate Institute
10:00 a.m.–10:10 a.m.
Break
10:10 a.m.–10:40 a.m.
Study of Medicare Patient Length of Stay in Relation to Physician Practice Ifeanyichukwu Ndukwu, MS Student, Keck Graduate Institute
10:40 a.m.–11:10 a.m.
Increasing efficiency of tPA treatment for acute ischemic stroke Arjun Majithia, MS Student, Keck Graduate Institute
11:10 a.m.–11:40 a.m.
Implementation of ERAS in TJR surgeries at CVHP aims to reduce patient anxieties and promote home discharge at POD1 Harrison Manacsa, MS Student, Keck Graduate Institute
Time
Presenter
11:40 a.m.–12:10 p.m.
Preventing chronic disease with Healthcare Effectiveness Data Information Set (HEDIS) Measures Fatima Faisal, MS Student, Keck Graduate Institute
12:10 p.m.–12:40 p.m.
Lunch
12:40 p.m.–1:10 p.m.
Observing compliance and implementing best practices to lower the incidence of hospitalonset Clostridioides difficile infection Megan O’Leary, MS Student, Keck Graduate Institute
1:10 p.m.–1:40 p.m.
Impact of a Time-of-Triage Emergency Department Screening Tool on Ambulatory Patients with Suspected Sepsis Arthur Chang, MS Student, Keck Graduate Institute
1:40 p.m.–2:10 p.m.
Vancomycin Optimization at Queen of the Valley Hospital Melanie Valentin, MS Student, Keck Graduate Institute
2:10 p.m.–2:40 p.m.
Analyzing current benefits of increasing breastfeeding rates, skin-to-skin care after delivery, and couplet care prior to discharge on overall health of mothers and infants in both post-caesarean section and NICU conditions Ria Sara Yalamanchili, MS Student, Keck Graduate Institute
2:40 p.m.–3:10 p.m.
Diauxic-like Batch Multiplexing for Multiplexed Pathogen Identification of Urinary Tract Infections at the Point of Care Robert Grepo, MS Student, Keck Graduate Institute
3:10 p.m.–3:40 p.m.
MS Research Symposium Celebration
Issa Fakhouri Assessing and Preventing Surgical Site Infections Thesis Advisor: Loucine Kasparian, Infection Control Director, Citrus Valley Health Partners Presentation Abstract: A surgical site infection (SSI) is an infection that develops in the part of the body where a recent operation was performed. Currently, SSI’s are the most common health-care associated infections (HCI), accounting for about 31% of HCI’s among hospitalized patients. In order to address the issue of SSI’s, data from recent surgical patients will be collected and analyzed. Various circumstances of these procedures will be evaluated and compared, with emphasis on patients who subsequently developed a surgical site infection. The “Guideline for Prevention of Surgical Site Infection” written by the Center for Disease Control and Prevention (CDC) will be referred to for data analyzation.
Raeven Chung The Effects of Person-Centered Care on Patient Satisfaction Scores in the Labor & Delivery and Mother-Baby Care Units Thesis Advisor: Angela Bernacki, VP Talent Acquisition & Patient Experience, Citrus Valley Health Partners Presentation Abstract: Person-centered medicine is a model that stems from the caring and holistic view of patients. Within the last decade, hospitals have developed into a business strictly focused on the revolving flow of patients. This business model has dehumanized medicine by reducing patients down to bed numbers. This thesis will explore the implementation of various tactics on the Labor & Delivery and Mother-Baby Care units to facilitate a person-centered care model and determine its effects on patient satisfaction.
Jocelyn Castro Telestroke Report Cards: Improving Treatment Times for Acute Ischemic Stroke Thesis Advisor: Hedy Dizon, Hedy Dizon, Stroke Coordinator, Citrus Valley Health Partners Presentation Abstract: Alteplase is a time-dependent thrombolytic drug that when administered to patients within 4.5 hours of symptom onset has the ability to treat acute ischemic stroke (AIS). The American Heart Association/ American Stroke Association recommends that hospitals provide alteplase to eligible stroke patients within 45 minutes of their arrival in the hospital. To reach the objective of decreasing alteplase treatment time in a primary stroke center, a monthly telestroke report card was implemented as a quality improvement initiative. Methods: Report cards were sent to the neurologists that had telestroke consultations with patients treated with alteplase for stroke in the Emergency Department. The feedback included the rate of AIS treatment, number of patients treated with alteplase, median door to needle times, median consult to needle times, and median consult times. The report cards were sent to the neurologists electronically between the months MarchMay. Each report card sent out each month included the individual and collective data from the previous month. The door to needle time was measured pre- and post- intervention. Results: Stroke patient data from the months of February to March was reviewed to identify 4 patients treated with alteplase. The neurologist of each patient received feedback of their times during the following month. The median door to needle pre-intervention was 53.5 minutes. The median door to needle time post-intervention was 48.5 minutes. The median consult to needle time post-intervention was 20.5 minutes. Conclusion: The use of telestroke report cards to provide feedback to neurologists is feasible in a primary stroke center. The effectiveness in this feedback tool to reduce the door to needle time over time may be further explored in the future.
Ifeanyichukwu Ndukwu Study of Medicare Patient Length of Stay in Relation to Physician Practice Thesis Advisor: Leila Esmaili, Manager Care Coordination, CVHP-Queen of Valley Hospital Presentation Abstract: Due to a noticeable increase in patient length of stay, particularly in holders of Medicare, the Department of Care Coordination at Citrus Valley Health Partners - Queen of the Valley Hospital requests a study providing specific data on the delay in discharges and services for the Medicare patient population in correlation with physician practices including but not limited to the time the patient was initially seen by their physician, the time the patient was first consulted, how many consult orders were enacted during the patient’s stay, and the time elapsed between when the patient was admitted and when the patient was seen. Through navigating patients’ electronic charts, the variables causing delays will be trended and analyzed to promote the efficient provision of acute care and lower Medicare patient length of stay.
Arjun Majithia Increasing efficiency of tPA treatment for acute ischemic stroke Thesis Advisor: Michelle Jocson, Program Manager, Stroke, Adventist Health Glendale Comprehensive Stroke Center Presentation Abstract: Tissue plasminogen activator (tPA) is considered the gold standard in treating acute ischemic stroke. Every second counts in the treatment of stroke; delaying action heightens brain damage to the patient. Thus, prompt administration of tPA (within 4.5 hours) can drastically improve the outcomes of stroke victims. The goal of Adventist Health Glendale Hospital is to determine the setbacks in efficient delivery of this treatment upon the arrival of a stroke patient, and implement approaches to decreasing this time frame to 45 minutes or less.
Harrison Manacsa Implementation of ERAS in TJR surgeries at CVHP aims to reduce patient anxieties and promote home discharge at POD1 Thesis Advisor: Sajid Sindha, Vice President – Service Lines, Strategy & Decision Support, Citrus Valley Health Partners Presentation Abstract: Enhanced Recovery After Surgery (ERAS) is a peri-operative approach to surgeries, with the primary intention of reducing post-operative complications. Contemporary literature finds one successful endpoint to be length-of-stay (LOS), a determinant that encompasses successes in pain management and expedient recovery in the hospital; and, maintains key peri-operative approaches in such studies have subsequently been adopted as best practices.1 Pre-operative (pre-op) approaches find contingencies in educational resources that target typical patient stressors associated with surgery. Pre-op education demands active patient participation to address concerns with pain management and discharge planning. Intra-op and post-op interventions, however, often require mild restructuring to a facility’s protocols in anesthesia and post-surgical discharge planning. Citrus Valley Health Partners (CHVP) in Pomona, CA, is currently adopting some prominent ERAS protocols to bolster their Total Joint Replacement (TJR) clinical outcomes and reduce LOS in three ways: 1) The implementation of a Pre-Orthopedic Clinic will alleviate patient anxieties and better prepare themselves for home discharge, 2) the standardization of anesthesia protocols in three surgical sites will ensure timely patient ambulation immediately after waking up from surgery, and 3) expedient delivery of durable medical equipment (DME) immediately after surgery will equip patients with walkers that promote patient willingness for home discharge.
Fatima Faisal Preventing chronic disease with Healthcare Effectiveness Data Information Set (HEDIS) Measures Thesis Advisor: Guadalupe Herrera, VP of Strategy & Clinical Integration, Citrus Valley Health Partners Presentation Abstract: Quality healthcare is contingent upon the patient’s ability to adhere to suggested treatment regimens. Lack of compliance is currently generating massive problems within the healthcare system and manifesting a decline in the implementation of appropriate and timely preventative measures. Without proper adherence, the required screenings, immunizations and wellness visits are not occurring as routinely, if at all. Consequently, this is circumventing proper prevention practices and increasing the risk of the onset of various chronic diseases. A lack of patient compliance has been correlated with negative health outcomes. Not only is this detrimental to the health of the patient population but it also further generates increased economic encumbrance within the healthcare system. While it is imperative patients demonstrate compliance, it is just as important for physicians to adhere to recommendations and guidelines for healthcare measures that allow for implementation of time-appropriate screenings and immunizations. With the demanding schedule and workload of physicians the upkeep of patients becomes difficult. Thus, compulsory adherence and implementation of HEDIS measures, a wellness metric and health improvement tool should be utilized as the standard for preventative care. Enforcement of HEDIS measures should consequently increase both patient and physician compliance, increase quality healthcare, and prevent the onset of chronic diseases. The present study’s in-depth analysis of HEDIS measures effect on Hb1Ac regulation will provide further evidence of this notion.
Megan O’Leary Observing compliance and implementing best practices to lower the incidence of hospitalonset Clostridioides difficile infection Thesis Advisor: Rebecca Rodriguez, Risk Management Manager, St. Joseph Hospital of Orange Presentation Abstract: Clostridioides difficile infection is a leading hospital-acquired infection and the most common cause of nosocomial infectious diarrhea in the United States. With Clostridioides difficile infection causing significant morbidity and mortality, it is a priority for hospitals to employ adequate prevention methods to control their occurrence rates. St. Joseph Hospital of Orange has implemented many such methods yet continues to experience a large amount of Clostridioides difficile infection compared to a-like hospitals in the community. With no monitoring in place for compliance to set protocols, this sixteen-week study was designed to observe St. Joseph’s staff and visitor compliance with Clostridioides difficile related protocols. Patient rooms of those tested positive for Clostridioides difficile infection were monitored for availability of isolation supplies and coverage of in-room sanitizer dispensers, a strategy used to remind staff and visitors to use soap and water over alcohol sanitizer for hand hygiene. Hospital staff were observed for cell phone and bleach wipe use while under isolation protocols and staff and visitors were observed for proper hand hygiene and gown and gloves usage. Interventions included staff and visitor education and providing personal belongings bags for visitors. 226 observations revealed precaution signs, gowns, and gloves were available more than 98% of the time. However, 182 staff and 141 visitor observations displayed a need for improvement in hand hygiene and contact precaution compliance. Future actions to increase compliance should include additional awareness, active reminders, and continued surveillance of staff and visitors in the patient care area.
Arthur Chang Impact of a Time-of-Triage Emergency Department Screening Tool on Ambulatory Patients with Suspected Sepsis Thesis Advisor: Dr. David Ha, Assistant Professor of Clinical Sciences, Keck Graduate Institute Presentation Abstract: Sepsis is a life-threatening syndrome requiring timely and appropriate medical intervention. However, patients with sepsis may not exhibit easily-recognizable signs, often resulting in delayed detection and poor outcomes, especially among ambulatory “walk-in� patients in the emergency department (ED). To address this issue, Pomona Valley Hospital Medical Center implemented a novel screening tool at the ED triage window to identify patients with possible sepsis more readily. We conducted a retrospective, quasi-experimental study of the impact of this screening tool on the time-to-antibiotic therapy and other interventions for ambulatory ED patients 50 years and older with suspected sepsis. The study was performed as a 3-arm time series analysis with a contiguous pre-intervention, intervention, and post-intervention cohort design. A total of 902 patients were included. Demographics and infection source distribution were similar across all arms. Compared with the pre-intervention cohort, the intervention and post-intervention groups demonstrated more rapid administration of antibiotics and fluid resuscitation, as well as lower average hospital and ICU lengths of stay. Overall, this novel ED triage screening tool was associated with shorter time to antibiotic therapy in ED ambulatory patients with suspected sepsis.
Melanie Valentin Vancomycin Optimization at Queen of the Valley Hospital Thesis Advisor: Dr. Daisy Leong, Clinical Coordinator - Queen of the Valley Hospital, Citrus Valley Health Partners Presentation Abstract: Optimization and standardization of vancomycin use is critical in a clinical landscape where it is clinicians’ first line agent for treatment of critical infections caused by methicillin resistant staphylococcal aureus (MRSA). Vancomycin is a commonly used antibiotic because of its clinical strength against severe staphylococcal infections and its utility as an alternative for patients with penicillin allergies. However, inefficient vancomycin dosing and monitoring can cause nephrotoxicity and acquired resistance that can lead to prolonged hospital stay and patient harm. The Antibiotic Stewardship Program at Queen of the Valley Hospital (QVH) aims to improve patient outcomes and dosing efficiency by reviewing pharmacy consults and enforcing evidence-based changes to their protocol. Data collected and analyzed in a pre-intervention study of 134 patients found that only 38.8% of the patients reviewed reached indication-based therapeutic levels. Protocol adherence to giving critically ill patients a vancomycin loading dose of 20-25mg/kg was found to be poorly followed; 77% of critically ill patients who met criteria for a loading dose did not receive one. QVH patient data along with related peer-reviewed literature was presented to the pharmacy department as an educational intervention. Postintervention data will be presented during this thesis defense along with analysis to see if recommendations were followed by pharmacists and if adherence resulted in improved therapeutic outcomes.
Ria Sara Yalamanchili Analyzing current benefits of increasing breastfeeding rates, skin-to-skin care after delivery, and couplet care prior to discharge on overall health of mothers and infants in both post-caesarean section and NICU conditions Thesis Advisor: Heidi M. Funk, Perinatal Clinical Nurse Specialist, Citrus Valley Medical Center Presentation Abstract: Breastfeeding rates are particularly low in the NICU (Neonatal Intensive Care Unit). Mothers of sick and preterm infants who depend on pumping for a supply of milk face greater obstacles to having consistent and sufficient milk volume until the infant can properly breast feed. However, there are many benefits of breastfeeding for premature and sick infants and mothers. There are also other valuable practices including skin-to-skin care and couplet care for more vulnerable populations (post-caesarean section and NICU conditions). The focus of this study is to analyze the current benefits of these practices and provide possible recommendations for patients at Queen of The Valley Hospital.
Robert Grepo Diauxic-like Batch Multiplexing for Multiplexed Pathogen Identification of Urinary Tract Infections at the Point of Care Thesis Advisor: Dr. Travis Schlappi, Assistant Professor in Medical Diagnostics, Keck Graduate Institute Presentation Abstract: Urinary tract infections (UTIs) affect about 50% of women in the United States at least once in their lifetime. The diagnosis of UTIs involves the use of dipsticks to detect the presence of an infection, as well as culture and sensitivity (C&S) tests to identify the disease-causing pathogen. However, C&S results are provided to patients 2 to 3 days after they are already prescribed an antibiotic by their healthcare provider. Due to these current practices, as well as the lack of rapid and accurate point-of-care diagnostics, more than 30% of patients treated for a UTI are initially given an incorrect antibiotic. With the use of primer blocking oligonucleotides, Diauxic-like Batch Multiplexing (DBM) is a potential solution for multiplexed pathogen identification of UTIs at the point of care which could improve antibiotic selection by healthcare providers.
Keck Graduate Institute (KGI) was founded in 1997 as the first higher education institution in the United States dedicated exclusively to education and research related to the applied life sciences. KGI offers innovative postgraduate degrees and certificates that integrate life and health sciences, business, pharmacy, engineering, and genetics, with a focus on industry projects, hands-on industry experiences, and team collaborations. A member of The Claremont Colleges, KGI employs an entrepreneurial approach and industry connections that provide pathways for students to become leaders within healthcare and the applied life sciences. KGI consists of three schools: Henry E. Riggs School of Applied Life Sciences, School of Pharmacy and Health Sciences, and the Minerva Schools at KGI. Š2019 keck graduate institute