Recent ucsdsom_gmepsqisymposium_2024 items

Syphilis Infection and Increased Odds of Neurologic & Psychiatric Morbidity

Mon, 14 Apr 2025 00:00:00 +0000

Background: America is in the midst of a syphilis epidemic. The CDC documented 207,255 new cases of syphilis in 2022, representing the highest incidence of disease observed since 1950 and a 17.3% increase from 2021. Treponemal central nervous system (CNS) invasion is estimated to occur in approximately 25-60% of infections, however, the current standard of care for non-neurologic syphilis does not provide antimicrobial dosing sufficient to achieve CNS clearance. This raises concern for a preventable burden of neurologic morbidity secondary to treponemal CNS persistence and subsequent neurosyphilis. Our central hypothesis is that individuals with a history of syphilis infection will experience greater odds of neurologic morbidity relative to their uninfected counterparts.

Methods: A preliminary 10-year retrospective analysis (01/2013-12/31/2022) of deidentified electronic medical records (EMR) from an academic health system was undertaken utilizing Epic SlicerDicer. The...

An education intervention to increase the use of evidence-based labor induction techniques

Wed, 12 Jun 2024 00:00:00 +0000

Background:

The incidence of induced labor has tripled from 9.5% to 31.4% between 1990 and 2020, due to an increase in the incidence of maternal and fetal indications for induction, as well as an increased recognition of the safety of induction of labor by maternal request at 39 weeks of pregnancy1,2,3. Induced labor has been shown to lead to decreased antepartum office visits and postpartum hospitalizations, with an overall neutral impact on healthcare utilization4,5. However, the increased time and number of interventions on labor and delivery for patients undergoing induction can be challenging for patients and the health care system.

Induction of labor practices vary among physicians, midwives, and nursing staff, driven by both patient and provider preferences. Furthermore, UCSD cesarean birth rates for induced labor are higher than that for spontaneous labor. Given that induction itself is not thought to increase the risk of cesarean, this may be...

Using a Best Practice Advisory and an Epic Order Set to Improve Mineralocorticoid Receptor Antagonist Prescription after Admission for HFrEF

Tue, 11 Jun 2024 00:00:00 +0000

Using a Best Practice Advisory and an Epic Order Set to Improve Mineralocorticoid Receptor Antagonist Prescription after Admission for HFrEF

Association between mental health aftercare telephone calls and post-discharge mental health visits for patients on a CL service

Mon, 3 Jun 2024 00:00:00 +0000

Background:

Mental health (MH) engagement after discharge from hospitalization is considered an important outcome measure for MH patients. The VA San Diego Healthcare System (VASDHS) has implemented mental health aftercare calls (MHACs) for psychiatric patients discharged from the emergency department, the psychiatric unit, and the medical floors. While every patient discharged from the medical floors receives a primary care aftercare call, only a subset of patients admitted to the medical floors receive MHACs. These patients are identified by a mental health admission diagnosis. In this quality improvement study and innovation, we assess the association between MHACs and the probability of post-discharge MH visits in patients discharged from the medical floors who were seen by the inpatient consult-liaison (CL) psychiatry service.

Description of the Project:

This project is a retrospective review based on encounter codes of an electronic health record for...

Improving Communication in the Operating Room: Interprofessional Simulation Training for General Surgery and Anesthesiology Residents

Mon, 3 Jun 2024 00:00:00 +0000

Background:

Bridging the communication gap between General Surgery and Anesthesiology residents is critical for enhancing team performance in emergent situations within the perioperative setting. Historically, these residents have practiced simulation training independently, despite the necessity for interprofessional collaboration in their daily practice. This disconnect can lead to compromised patient safety, poor work relations, and physician burnout.

Description of the Project:

To address this, we introduced an interprofessional simulation training program. The program utilizes high-fidelity mannequins for anesthesiology training and box trainers or live pigs for surgical training. Designed to be appropriate for various training years (Table 1), the simulations were written by anesthesia attendings and residents to focus on joint decision-making, enhancing communication, camaraderie, confidence, and respect among...

Assessment of Adherence to Status Epilepticus Treatment Guideline after Initiation of Status Epilepticus Order Set

Thu, 23 May 2024 00:00:00 +0000

OBJECTIVE An order set was created to optimize the time to administration and ensure proper dosing of benzodiazepine and anti-seizure medications in patients with status epilepticus (SE).

BACKGROUND The Neurocritical Care Society and American Academy of Neurology have developed expert consensus guidelines and quality measures on management of acute SE which recommend that upon seizure onset, benzodiazepines and anti-seizure medications should be administered rapidly (within 5 and 10 minutes, respectively per NCS guidelines) with appropriate weight- based dosing.

DESIGN/METHODS A SE order set was designed in an electronic health record which included pre-determined loading dosages of anti-seizure medications and benzodiazepines in accordance with current guidelines. Education regarding status epilepticus and order set was given to emergency medicine, neurology, neurosurgery, and neurocritical care divisions prior to order set availability in July 2023. We tracked...

Syphilis Infection and Increased Odds of Neurologic & Psychiatric Morbidity

Thu, 23 May 2024 00:00:00 +0000

Blood Product and Transfusion Dashboard

Wed, 22 May 2024 00:00:00 +0000

Background:

Blood product transfusions are one of the most common therapeutic procedures performed in hospitalized patients. Currently, transfusion information is primarily available in UC San Diego’s electronic medical record, EPIC, in a “Transfusion” summary tab. Data available on this tab is incomplete and challenging to navigate. Furthermore, it is difficult to find pertinent blood product data and identify the status of blood product orders in an efficient manner, as data is dispersed throughout multiple locations in EPIC. As a result, delays in blood product transfusions are common. For instance, nurses and providers often call the Blood Bank directly to determine if ordered blood products have been prepared. Not only does this increase the volume of tasks for clinical team members, the phone calls also disrupt the work of Blood Bank staff, affecting the turnaround time for all orders. Consequently, blood transfusions may be delayed,...

Views on Psychotropics and Lactation Before and After an Educational Intervention

Wed, 22 May 2024 00:00:00 +0000

Authors: Rachel Dhillon MD, Jessica Kriksciun MD, Ashley Clark MD, Alison Reminick MD, Michelle Singh DO

Background: Breastfeeding rates have increased worldwide following advocacy efforts that emphasize the benefits for mother, baby, and society. In the United States there are approximately 500,000 pregnancies in women who have or develop psychiatric illnesses (1). Many of these illnesses benefit from psychotropic medications, and oftentimes these medications are safe to continue during pregnancy and while breastfeeding. Misinformation about the safety profile of psychotropics during lactation can lead to premature discontinuation of medications and worsening of psychiatric symptoms. This can have detrimental consequences for the mother-child dyad and the broader family, as well as societal implications. The aim of this project was to assess the views among psychiatry residents towards psychotropics and lactation...

Naval Aviation Safety in Medicine: Reducing Errors from Human Factors

Wed, 22 May 2024 00:00:00 +0000

Background: Medical errors are a major cause of morbidity and mortality in the healthcare industry. Human factors make errors much more likely to occur. However, explicit instruction on mitigating human factors is underrepresented in graduate medical education. The Naval Aviation community has systematically evaluated the risk posed by human factors and implemented specific approaches for reducing error, an intervention which has exponentially decreased preventable aviation mishaps over decades. Applying those principles from Naval Aviation to the way in which healthcare is delivered will reduce errors and improve safety.

Description of the Project: Human factors are a broad category within error analysis. Naval Aviation has grouped human factors into four broad categories: active factors, preconditions, supervisory factors, and organizational factors. Naval Aviation applies frameworks such as Threat and Error Management (TEM) and Crew Resource Management...

Screening Out Cancer in Primary Care Settings

Wed, 22 May 2024 00:00:00 +0000

Background:

Primary care providers (PCPs) address many issues, including cancer prevention and screening, within the limited time available during appointments. Across the San Diego VA Healthcare System, rates of individuals who are up to date with cancer screenings are below the national VA rates. With PCPs being the first line of defense against screening for cancer, it is essential to address this gap in healthcare. This quality improvement project aimed to increase the percentage of up-to-date cancer screenings across multiple cancers (breast, colorectal, cervical, prostate, and lung) among patients at the VA La Jolla Primary Care clinic.

Methods:

We standardized workflow by incorporating cancer screening into the primary care note template to prompt the primary care provider to screen for breast cancer, colorectal cancer, prostate cancer, cervical cancer, and lung cancer. A customized after visit summary (AVS) that included cancer screening was created...

Trauma Inquiry and Response: Applying the TRIADS Framework to Family Planning Care

Thu, 16 May 2024 00:00:00 +0000

Kelsey B. Loeliger, MD, PhD¹, Zoe Matticks, MPH², Hannah Begna, MSc³, Maud Arnal, PhD⁴, Eleanor Bimla Schwarz, MD, MS³, Megha Shankar, MD⁵

¹ Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego

² University of California, San Diego School of Medicine

³ Department of Medicine, University of California, San Francisco

⁴ Department of Sociology, Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego

⁵ Department of Medicine, University of California, San Diego

Background:

Although...

Evaluating and Improving the Psychotherapy Consult in the Primary Care and Outpatient Psychiatry Settings

Thu, 16 May 2024 00:00:00 +0000

Issues Addressed/Background: Collaborative care between psychiatry, psychology, and primary-care providers is imperative for ensuring patients receive appropriate mental health care. In the hectic academic system, there can be uncertainty in navigating referrals, both between the Departments of Family Medicine and Psychiatry/Psychology, as well as internally within the Department of Psychiatry. In the primary care settings, there can be a level of confusion regarding how to most appropriately refer patients for psychotherapy, given options for both Integrative Behavioral Health and General Psychiatry referrals. In the outpatient psychiatry setting, psychiatry resident physicians rotating at Outpatient Psychiatric Services at Hillcrest (OPS-H), likewise place psychotherapy referrals often to find that barriers occur regarding patients not being successfully contacted, and therefore not receiving psychotherapy in a timely manner. Historically, there has...

Implementation of a validated substance use disorder screening tool and motivational interviewing in perinatal settings to improve engagement in substance use treatment

Thu, 16 May 2024 00:00:00 +0000

Kelsey B. Loeliger, MD, PhD¹, Tanya Jain, BA², Isabel Warner, BS², Jessica Rivas, MD³, Rachel Pacyna, MD³, Jerasimos Ballas, MD, MPH⁴, Carla Marienfeld, MD⁵, Julia Cormano, MD³

¹Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego;

²University of California, San Diego School of Medicine;

³Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego;

⁴Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego;

⁵Department of Psychiatry, University of California, San Diego

Background...

Womb to Improve: Assessing needs for a healthier lifestyle during pregnancy

Thu, 16 May 2024 00:00:00 +0000

Background: Healthy lifestyle behaviors during pregnancy strongly influence maternal and neonatal outcomes. The UCSD/SDSU General Preventive Medicine Residency (PMR) program partnered with San Diego Family Care, a Federally Qualified Health Center (FQHC) to identify patients’ understandings, barriers, and needs to meet the recommendations for healthy lifestyle behaviors during pregnancy.
Methods: The needs assessment followed the PRECEDE-PROCEED model, and the first three phases used a mixed-method design consisting of social, educational, and ecological assessments. PMR residents and students conducted interviews and focus groups with key stakeholders of the FQHC including maternal health patients, clinicians, and clinic staff and leadership. An environmental survey of the clinic’s catchment area was also performed by PMR residents guided by experts in urban design to assess walkability, safety, and available amenities.
Results:...

Reducing emergency department and clinic visits for fever in pediatric patients with benign neutropenia: development of a quality improvement project at Rady Children's Hospital San Diego.

Wed, 15 May 2024 00:00:00 +0000

Issues:Neutropenia can be classified based on pathophysiology as severe versus benign based on bone marrow reserve of neutrophil precursors, which determines the risk of serious bacterial infections (SBI). The current guidelines for management of fever in neutropenic patients are reliant on the knowledge gained in the oncology setting. There are no clear guidelines for management of fever in patients with benign neutropenia regarding evaluation or antibiotic administration, despite their lower risk of SBI. This leads to significant practice variation in management of patients with benign neutropenia who present with fever and may result in unnecessary hospital visits or antibiotic administration, leading to poor quality of life for these patients and avoidable use of healthcare resources. We initiated a quality improvement project to address this issue at Rady Children’s Hospital, San Diego, (RCHSD) with the goal of decreasing the percentage of emergency department...

Implementation of standardized electronic documentation of goals of care discussions to improve cancer care.

Wed, 15 May 2024 00:00:00 +0000
Implementation of standardized electronic documentation of goals of care discussions to improve cancer care.

The effect of a nudge intervention on procalcitonin-guided antibiotic de-escalation in patients with respiratory infections

Wed, 15 May 2024 00:00:00 +0000

Background:
Evidence based procalcitonin algorithms recommend discontinuation of antibiotics at values < 0.25 ng/mL for lower respiratory tract infections. A retrospective study conducted at our academic center in 2021 demonstrated that treatment was continued despite a low PCT value in 80.4% of patients on antibiotics. We examined the impact of a nudge intervention on clinicians' decision to de-escalate antibiotics in patients with a low procalcitonin value.
Methods:
We conducted a pre-post intervention study on adult inpatients with a procalcitonin result < 0.25 ng/mL receiving antibiotics for LRTIs. We excluded patients on antibiotics for non-LRTIs, COPD exacerbation, or VAP/HAP, as well as immunosuppressed and ICU patients. In the intervention stage, we used a dynamic EPIC procalcitonin report to identify eligible patients and contacted 1st call providers via EPIC Secure Chat with a standardized message suggesting antibiotic de-escalation...

The Pediatrics Diversity Collaborative Journal Club: A Resident-led Initiative to Raise Awareness and Educate on Racial/Ethnic and Socioeconomic Health Disparities

Tue, 14 May 2024 00:00:00 +0000

Background:
The Center for Disease Control and Prevention (CDC) called systemic racism a public health crisis in 2021. This crisis underscored the already-documented racial/ethnic and socioeconomic disparities in child health. The Pediatrics Diversity Collaborative is a resident-led initiative established in 2019 at the University of California-San Diego Department of Pediatrics/Rady Children’s Hospital. Our mission is to educate future leaders to address child health inequity and structural racism through academic activities.
Methods:
The Collaborative established a quarterly health equity Journal Club to raise awareness and create discussions on racial/ethnic and socio-economic child health disparities. We conducted a 11-item cross-sectional anonymous survey with Likert-scale and free-text responses to assess impact of our Journal Club, including knowledge and practice, satisfaction, feedback, and...

Bronchodilator Response: A Prognostic Indicator for Inhaled Corticosteroid Efficacy in Pediatric Patients with Asthma

Tue, 14 May 2024 00:00:00 +0000

Background:
Inhaled corticosteroids (ICS) are the recommended controller therapy of choice for pediatric patients suffering from mild persistent asthma. In this study, the goal was to identify which asthmatic children were more or less likely to respond to ICS, as defined by improvement in lung function, in the context of a pediatric pulmonology practice. We hypothesized that baseline bronchodilator response (BDR) is a significant predictor of an individual’s response to ICS.

Methods:
This retrospective study analyzed children between 5 and 18 years of age from the Rady Children’s Hospital San Diego pulmonary clinic from January 2019 to May 2022 who had been diagnosed with asthma. These patients had baseline pulmonary function tests (PFT) which were used to calculate a BDR before initiating ICS therapy. Follow-up PFTs obtained at least 3 weeks after initiating ICS were used to assess changes in lung function,...