Browsing by Author "Thomas, Samantha"

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    Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.
    (Journal of Graduate Medical Education, 2017-04) Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G
    Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities.This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics.We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours.A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P < .001; and 82% versus 70%, P = .002, respectively). Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results.Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.
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    Myeloablative conditioning with total body irradiation for AML: Balancing survival and pulmonary toxicity.
    (Adv Radiat Oncol, 2016-10) Stephens, Sarah J; Thomas, Samantha; Rizzieri, David A; Horwitz, Mitchell E; Chao, Nelson J; Engemann, Ashley M; Lassiter, Martha; Kelsey, Chris R
    PURPOSE: The purpose of this study was to compare leukemia-free survival (LFS) and other clinical outcomes in patients with acute myelogenous leukemia who underwent a myeloablative allogeneic stem cell transplant with and without total body irradiation (TBI). METHODS AND MATERIALS: Adult patients with acute myelogenous leukemia undergoing myeloablative allogeneic stem cell transplant at Duke University Medical Center between 1995 and 2012 were included. The primary endpoint was LFS. Secondary outcomes included overall survival (OS), nonrelapse mortality, and the risk of pulmonary toxicity. Kaplan-Meier survival estimates and Cox proportional hazards multivariate analyses were performed. RESULTS: A total of 206 patients were evaluated: 90 received TBI-based conditioning regimens and 116 received chemotherapy alone. Median follow-up was 36 months. For all patients, 2-year LFS and OS were 36% (95% confidence interval [CI], 29-43) and 39% (95% CI, 32-46), respectively. After adjusting for known prognostic factors using a multivariate analysis, TBI was associated with improved LFS (hazard ratio: 0.63; 95% CI: 0.44-0.91) and OS (hazard ratio: 0.63; 95% CI, 0.43-0.91). There was no difference in nonrelapse mortality between cohorts, but pulmonary toxicity was significantly more common with TBI (2-year incidence 42% vs 12%,P< .001). High-grade pulmonary toxicity predominated with both conditioning strategies (70% and 93% of cases were grade 3-5 with TBI and chemotherapy alone, respectively). CONCLUSIONS: TBI-based regimens were associated with superior LFS and OS but at the cost of increased pulmonary toxicity.
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    Patient Acuity Scores to Prevent Rapid Responses
    (The Ochsner journal) O'Donnell, Christopher; Thomas, Samantha; Johnson, Crystal; Verma, Lalit; Bae, Jonathan; Gallagher, David
    Background: In the last 10 years, patient safety committees nationwide have focused on creating taskforces such as rapid response teams (RRTs) that can intervene when patients start to decompensate prior to a code. At Duke Regional Hospital, approximately 50% of RRT activations were found to occur during the first 24 hours of a patient’s stay. Unlike critical care medicine, internal medicine does not have a widely accepted scale to grade the severity of illness. A scale was developed by Edelson et al in 2011 to quantify the likelihood of decompensation. The Duke hospitalists adapted this scale and used it prospectively to determine whether there was a correlation in the presenting acuity of illness and the number of RRT interventions in the first 24 hours and to see if there would be a decrease from year to year. Methods: A patient acuity score was adapted with permission, and patients were graded prospectively from admission. Patient data from June to December 2013 was summarized using N (%) for categorical variables and mean (standard deviation) for continuous variables. Patients transferred to resident service were excluded from the analysis, making the effective sample size 4,322 patients. The differences in mean severity score by occurrence of an RRT intervention in multiple categories were examined using analysis of variance. The total number of RRT interventions (at any time, within 12 hours, and within 24 hours) and unplanned transfers for June to December in 2012 and 2013 were compared using Wilcoxon rank sum tests for independent nonparametric samples. Additionally RRT interventions were grouped by score of 5 and above vs 4 and below and analyzed via chi square test. Results: From June to December 2013, there were a total of 4,577 encounters by the hospitalists. A total of 4,322 patients met inclusion criteria. Ninety-two percent of the patients had a recorded acuity score. An RRT intervention occurred in 113 patients. Mean acuity scores were compared between subgroups. There were significant differences in mean acuity scores between patients who experienced an RRT intervention at any time and those who did not, patients who experienced an RRT intervention within 12 hours of admission and those who did not, patients who experienced an RRT intervention within 24 hours of admission and those who did not, and patients who underwent an unplanned transfer and those who did not (all P<0.007). It is notable that 100% of the level 7 scores that had a rapid response were transferred to the critical care unit, as well as 79% of the level 6 scores. There were no significant differences in the number of rapid responses between 2012 and 2013. Patients were then analyzed via chi square test in grouped distribution of scores of ‡5 and <5. Significant differences were seen in the total number of RRT interventions, the number of unplanned transfers and the number of RRTs within 24 hours. However, when looking at the grouping among patients with only RRT intervention, there was no significant difference between groups with a score ‡5 and those 4. Conclusion: A patient acuity scale to quantify how likely a patient is to have an adverse event has been shown to correlate with rapid responses and transfers to a higher level of care within the first 24 hours. Patients who had an RRT intervention had a higher score overall with a trend toward increasing transfer rates with elevated scores. Using this scoring system did not lead to a lower amount of rapid responses in comparing years; however, it could be used for selective monitoring to prevent sentinel events.
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    Residents Finding Their Roots: Resident Workshops to Improve Patient Safety on the Wards while Teaching Residents Root Cause Analysis
    (2014-04-01) Boole, Lindsay; Seidelman, Jessica; Zaas, Aimee; Cheely, George; Chudgar, Saumil; Clarke, Jeffrey; Gallagher, David; Jolly Graham, Aubrey; O'Brien, Cara; Setji, Noppon; Shah, Bimal; Thomas, Samantha; Bae, Jonathan
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    The Burden of Burnout: An Assessment of Burnout Among Internal Medicine Residents After the 2011 Duty Hour Changes.
    (Am J Med Qual, 2016-02-25) Elmariah, Hany; Thomas, Samantha; Boggan, Joel C; Zaas, Aimee; Bae, Jonathan
    This study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach Burnout Inventory. Surveys were collected biweekly for 48 weeks during the 2013-2014 academic year. Burnout severity was compared across subgroups and time. A score of 3 or higher signified burnout. Overall, 944 of 3936 (24%) surveys were completed. The mean burnout score across all surveys was 2.8. Categorical residents had higher burnout severity than noncategorical residents (2.9 vs 2.7, P = .005). Postgraduate year 2 residents had the highest burnout severity by year (3.1, P < .001). Residents on inpatient rotations had higher burnout severity than residents on outpatient or consultation rotations (3.1 vs 2.2 vs 2.2, P < .001). Night float rotations had the highest severity (3.8). Burnout remains a significant problem even with recent duty hour modifications.