At IM16: Poster Project as Catalyst for Change

By Robert Israel
Vital Signs Editor

The sound of many voices speaking in the hallway of the Fenway conference room at MMS headquarters on December 2 emanated from clusters of medical students excitedly preparing their displays. Additional voices could be heard from MMS members and judges standing in line to view the projects.

Welcome to the Research Poster Symposium, a highly anticipated annual event at the MMS Interim Meeting (IM16).

11th Annual Research Poster Symposium contestants.
11th Annual Research Poster Symposium contestants at MMS headquarters at IM16.

In total, 126 abstracts were submitted by MMS residents, fellows, and students from throughout Massachusetts, with 67 contestants chosen to showcase their work at IM16. A panel of eight judges — from Harvard Medical School, Boston University School of Medicine, Brigham and Women’s Hospital, Massachusetts General Hospital, and others — selected 20 award winners in four categories: Basic Research, Clinical Research, Health Policy/Medical Education, and Clinical Vignettes. All entries represent original work by teams of aspiring medical scholars. Many projects result in fostering change.

Vital Signs interviewed two first-place winners to report how their project did just that: serving as a catalyst for improvements at Steward Carney Hospital in Dorchester.

Tackling Telemetry Overuse

Hassan Ghoz, M.D., a native of Cairo, Egypt, and Anil Jha, M.D., from Kolkata, India, are second-year residents at Steward Carney, a Tufts University School of Medicine teaching hospital. Their team was awarded First Place in the Health Policy/Medical Education category for tackling a vexing problem: telemetry overuse.

“We began by researching how telemetry is used or overused by other small hospitals like ours,” Dr. Ghoz explained. “We read, in an article in JAMA, that nurses at many hospitals experience stress and fatigue when multiple telemetry alarms go off at the same time from machines located at patients’ bedsides. Additionally, we learned patient safety is an issue. Several hospitals reported incidents where patients have tripped or fallen on the wires attached to telemetry devices.”

When the residents completed their research, they identified that Steward Carney Hospital faced similar telemetry challenges.

“We designed a survey questionnaire and distributed it to nurses on the floor to determine how we could resolve these issues,” Dr. Jha said.

When the results of the survey were tabulated, the residents noticed that orders for issuing or stopping use of telemetry instruments were often omitted from patients’ charts. In one particular case, the telemetry device had been forgotten and had been running a patient’s reports for over a week. This led the residents to recommend strengthening communication between doctors and nurses at Steward Carney so these and other problems would not recur.

Improving Communications

“We designed a simple information sheet,” Dr. Ghoz explained, “that asks doctors to list reasons why the telemetry device is being ordered and to enter start and end times for the device. Once completed, the sheet is reviewed by the hospitalist who signs it and distributes copies to the staff, attaching a copy to the patients’ records.”

The telemetry information sheet, which takes only minutes to complete, has proven to be a game-changer. Since its implementation, the mean weekly number of telemetry orders fell from 36.8 hours to 26.5 hours. A further reduction of mean weekly indirect costs for non-ICU cardiac telemetry followed, from $3,612 to $1,398.

“Our project not only improved staff efficiencies at Steward Carney,” noted Dr. Ghoz, “we also showed that we could save the hospital money, too.”

Catalyst for Change

Marvin Diaz-Lacayo, M.D., program director for education and training at Steward Carney Hospital, supervises the residents. He said the telemetry project is illustrative of the hospital’s overall commitment to quality improvement.

“We knew we had a problem,” Dr. Diaz-Lacayo said, “and we knew we had to fix it. We determined we would all address it. Since the residents are hard at work in the trenches, they were assigned to gather the facts because they have a close view at how things succeed or how things fail. They went beyond just fact finding, however. By developing a simple tool, they have brought awareness to the scope of the problem. And they came up with a recommendation about the changes we needed to make going forward.”

The residents are proud of their successes, Dr. Diaz-Lacayo said. Gaining recognition as a first-place award-winning project in the MMS Research Poster Symposium, he added, has spurred Steward Carney Hospital to look into how they might influence other hospitals to undertake similar improvements.

Copies of the MMS 11th Annual Research Poster Symposium book with abstracts for all projects are available from Colleen Hennessey at chennessey@mms.org.

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