Browsing by Author "Yanamadala, Mamata"

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    Development and assessment of a web-based clinical quality improvement curriculum.
    (Journal of graduate medical education, 2014-03) Yanamadala, Mamata; Hawley, Jeffrey; Sloane, Richard; Bae, Jonathan; Heflin, Mitchell T; Buhr, Gwendolen T

    Background

    Understanding quality improvement (QI) is an important skill for physicians, yet educational interventions focused on teaching QI to residents are relatively rare. Web-based training may be an effective teaching tool in time-limited and expertise-limited settings.

    Intervention

    We developed a web-based curriculum in QI and evaluated its effectiveness.

    Methods

    During the 2011-2012 academic year, we enrolled 53 first-year internal medicine residents to complete the online training. Residents were provided an average of 6 hours of protected time during a 1-month geriatrics rotation to sequentially complete 8 online modules on QI. A pre-post design was used to measure changes in knowledge of the QI principles and self-assessed competence in the objectives of the course.

    Results

    Of the residents, 72% percent (37 of 51) completed all of the modules and pretests and posttests. Immediate pre-post knowledge improved from 6 to 8.5 for a total score of 15 (P < .001) and pre-post self-assessed competence in QI principles on paired t test analysis improved from 1.7 to 2.7 on a scale of 5 for residents who completed all of the components of the course.

    Conclusions

    Web-based training of QI in this study was comparable to other existing non-web-based curricula in improving learner confidence and knowledge in QI principles. Web-based training can be an efficient and effective mode of content delivery.
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    Educational interventions to improve recognition of delirium: a systematic review.
    (J Am Geriatr Soc, 2013-11) Yanamadala, Mamata; Wieland, Darryl; Heflin, Mitchell T
    Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.
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    Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.
    (BMJ open quality, 2018-01) Sadun, Rebecca E; Wells, Melissa A; Balevic, Stephen J; Lackey, Victoria; Aldridge, Erica J; Holdgagte, Nicholas; Mohammad, Samya; Criscione-Schreiber, Lisa G; Clowse, Megan EB; Yanamadala, Mamata
    Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women's contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling. We reviewed charts of rheumatology clinic female patients aged 18-45 over the course of 10 months; for those who were on teratogenic medications (methotrexate, leflunomide, mycophenolate and cyclophosphamide), we looked for evidence of documentation of contraception use. We executed multiple plan-do-study-act (PDSA) cycles to develop and evaluate interventions, which centred on interprofessional provider education, modification of electronic medical record (EMR) templates, periodic provider reminders, patient screening questionnaires and frequent feedback to providers on performance. Among eligible patients (n=181), the baseline rate of documentation of contraception type was 46%, the rate of counselling was 30% and interventions after counselling occurred in 33% of cases. Averaged intervention data demonstrated increased provider performance in all three domains: documentation of contraception type increased to 64%, counselling to 45% and provider action to 46%. Of the patients with documented contraceptives, 50% used highly effective, 27% used effective and 23% used ineffective contraception methods. During this project, one unintentional pregnancy occurred in a patient on methotrexate not on contraception. Our interventions improved three measures related to contraception counselling and documentation, but there remains a need for ongoing quality improvement efforts in our clinic. This high-risk population requires increased provider engagement to improve contraception compliance, coupled with system-wide EMR changes to increase sustainability.
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    Increasing Physician Assistant Students' Team Communication Skills and Confidence Throughout Clinical Training.
    (The journal of physician assistant education : the official journal of the Physician Assistant Education Association, 2019-10-25) Hudak, Nicholas M; Pinheiro, Sandro O; Yanamadala, Mamata
    PURPOSE:An intervention was designed to increase physician assistant students' team communication skills using the Situation-Background-Assessment-Recommendation (SBAR) tool. METHODS:A variety of learning activities were implemented longitudinally over 9 months of clinical education. Instructional activities included an interactive lecture, deliberate practice of SBAR at clinical training sites, self-assessment, and small group discussion. Evaluation involved survey of students' perceived learning outcomes and direct observation of students' proficiency using SBAR during a simulated patient encounter. RESULTS:At the beginning of their clinical training, many students (75%) did not have a structured tool for communicating on health care teams. The SBAR tool was readily understood by students following a lecture (89%) and increased their confidence in communicating with preceptors (62%-83%) and nonpreceptors (62%-79%). A majority of students proficiently demonstrated the SBAR components (82%-86%) at the conclusion of the program. CONCLUSION:This approach can be adopted and adapted by other programs aiming to teach and evaluate SBAR and other team skills to better prepare new health professionals to effectively communicate on health care teams.
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    Safe Interorganizational Health Information Exchange During the COVID-19 Pandemic.
    (Journal of the American Medical Directors Association, 2020-12) Wong, Serena P; Jacobson, Heather N; Massengill, Jennifer; White, Heidi K; Yanamadala, Mamata
    Accurate and timely transmission of medical records between skilled nursing facilities and acute care settings has been logistically problematic. Often people are sent to the hospital with a packet of paper records, which is easily misplaced. The COVID-19 pandemic has further magnified this problem by the possibility of viral transmission via fomites. To protect themselves, staff and providers were donning personal protective equipment to review paper records, which was time-consuming and wasteful. We describe an innovative process developed by a team of hospital leadership, members of a local collaborative of skilled nursing facilities, and leadership of this collaborative group, to address this problem. Many possible solutions were suggested and reviewed. We describe the reasons for selecting our final document transfer process and how it was implemented. The critical success factors are also delineated. Other health systems and collaborative groups of skilled nursing facilities may benefit from implementing similar processes.
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    Use of mobile tablet devices and reduction in time to perioperative transesophageal echocardiography reporting: a historical cohort study
    (Canadian Journal of Anesthesia, 2015-01-01) Bottiger, Brandi; McCartney, Sharon; Akushevich, Igor; Nicoara, Alina; Yanamadala, Mamata; Swaminathan, Madhav
    © 2014, Canadian Anesthesiologists' Society.Purpose: Timely communication of intraoperative transesophageal echocardiography (TEE) findings to the postoperative care team is critical to optimizing patient care. We compared the use of a personal computer (PC) system with the use of a mobile tablet device (MTD) system for point-of-care TEE data entry and hypothesized that the MTD-based system would reduce the time to preliminary TEE reporting and decrease the incidence of delinquent reporting by 50%. Methods: In this historical cohort study, we reviewed 508 perioperative TEE reports entered by cardiothoracic anesthesia fellows. Reports were grouped based on whether data were entered on a PC (PC group) or a MTD (MTD group). Time to TEE reporting was defined as the time from the patient leaving the operating room to the time the TEE report was generated. Delinquent reports were defined as those generated >24 hr after the initial exam. Time to TEE reporting and incidence of delinquent reports were compared between the two groups. Results: Mean (SD) time to TEE reporting was significantly improved with MTD data entry vs PC data entry [233 (676) min vs 1,103 (3,830) min, respectively; mean difference 870 min; 95% confidence interval (CI) 293 to 1,448; P = 0.003], and median (IQR) time was also significantly improved [46 (163) min vs 126 (1,000) min, respectively; median difference 80 min; P = 0.0002]. The incidence of report delinquency with MTD data entry vs PC data entry was also significantly reduced [2.1% vs 6.8%, respectively; mean difference 2.2%; 95% CI 0.5 to 9.0; P = 0.02]. Conclusion: Implementation of a MTD system for data entry leads to improved TEE reporting time and reduces TEE reporting delinquency. Further studies are required to determine whether this strategy enhances quality of reporting, optimizes communication between care teams, and improves outcomes without increasing costs.