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MCW Class of 2022 Scholarly Project Abstracts

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MCW Class of 2022 Scholarly Project Abstracts SCHOLARLY PROJECTS CLASS OF 2022 Director of Scholarly Ac�vi�es: David Brousseau, MD, MS School of Medicine Scholarly Pathway Directors Cynthiane Morgenweck, MD, MA Bioethics Arthur Derse, MD, JD Clinical & Transla�onal Joseph Carroll, PhD Research Jennifer Knight, MD, MS Clinician Educator Joseph Budovec, MD Kirsten Beyer, PhD, MPH Global Health Megan Schultz, MD Health Systems John Meurer, MD, MBA Management & Policy William Hueston, MD Joseph Carroll, PhD Molecular & Cellular Research Alison Kriegel, PhD Quality Improvement & Catherine Ferguson, MD Pa�ent Safety Rebecca Bernstein, MD, MS Urban & Community Health Linda Meurer, MD, MPH Scholarly Pathway Staff Team Meaghan Hayes, MEd Sarah Leineweber Rachel Sommer, MS Kelly Cornelius, MS Sue Korek, MAED Scholarly Pathways are a required component of the M1 and M2 year of the Discovery Curriculum. Students select an area of concentra�on through which they enrich and individualize their medical training, while exploring an area of interest. Students can apply to par�cipate during M3 year, of which 172 Class of 2022 students were accepted to par�cipate. Each Pathway course features a structured curriculum with monthly learning sessions (core), and an experien�al component (noncore) that follows an Individual Learning Plan (ILP) guided by a faculty advisor. Students must complete a faculty-mentored Scholarly Project which meets Glassick Criteria for Scholarship by the end of M3 year regardless of M3 Pathway par�cipa�on. Current M3s and their Scholarly Projects are featured here. Abdel-Reheem, Abdul-Rahman Clinician Educator Teaching URM Students Skills in Teaching and Leadership in order to Become Innovative Healthcare Leaders Authors: Abdel-Reheem AK, Weisgerber MC, Budovec JJ. Project Mentor: Joseph Budovec, MD HYPOTHESIS The objective of the investigation is to encourage the URM students enrolled in the Step-Up boot camp to become community leaders and foster a passion in educating others as they progress through their educational journey and to become leaders in healthcare and academic medicine. The study aims to prove that through the sessions in education provided to the students that their interest in academic medicine and skills in educating others will increase. STUDY METHODS: The investigation was conducted during the 2019 Step-Up Bootcamp. Three Education in Medicine sessions were developed and administered during the duration of the boot camp. An anonymized survey regarding categories such as students' interest in teaching were administered before and after the sessions using a Likert scale of 1-5. RESULTS: Student results were aggregated and averages in each metric were analyzed. Overall averages improved from 4.1 to 4.5. Individual metrics were further analyzed with improvements in each category measured. The largest increase was observed in Comfort in Teaching with an increase from 4.19 pre-survey average to 4.73 post-survey average. CONCLUSIONS: Results indicated that students' interest and comfort in teaching improved following the three sessions. The study suggests that sessions regarding skills in teaching and leadership can improve the student's interest and confidence in being leaders and educators. A longitudinal study of the students that participated should be done to see if students that participate do matriculate to medical school and pursue academic positions when in practice as physicians. Adu-Gyamfi, Afia Health Systems Management & Policy Impact of removal of automatic seven-day stop orders for inpatient antimicrobials Authors: Adu-Gyamfi AB, Dutcher L, Hamilton KW, Cressman L, Lautenbach E. Project Mentor: John Meurer, MD, MBA BACKGROUND: Automatic discontinuation of antimicrobial orders after a pre-specified period has been a strategy for reducing excess days of therapy(DOT) as part of antimicrobial stewardship efforts. However, inadvertent treatment interruptions may occur, contributing to adverse patient outcomes. To evaluate this, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. METHOD: We performed a quasi-experimental study in 3 acute care hospitals. In the pre-intervention(ASO present) period, we had an electronic dashboard to identify and intervene on unintentionally missed doses. For the post- intervention period, the ASO was absent. We compared the primary outcome, DOT per 1000 patient days(PD) per month. The Wilcoxon rank-sum test compared median monthly DOT/1000 PD. Interrupted time series analysis compared trends in antibiotic DOT/1000 PD and the immediate impact of the ASO removal. Manual chart review on a subset of 300 patients, equally divided, was used to assess unintentionally missed doses. RESULTS: ASO present period—a monthly median of 644.5 DOT/1000 PD were administered, compared to 686.2 DOT/1000 PD in the ASO absent period(p<0.001). There was a non-significant increase by 46.7 DOT/1000 PD(95% CI - 40.8 to 134.3) in the month immediately following removal of ASOs. Though monthly change in DOT/1000 PD increased in the ASO absent period it was not significant(p=0.41). Manual chart abstraction showed that in the ASO present period, 9 of 150 patients had a sum of 17 unintentionally missed DOT, while 0 in the ASO absent period did. CONCLUSION: Following removal of the ASO, there was an overall increase in antibiotic use but the change in monthly trend was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the ASO present period. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from ASOs. Affeldt, Zach Health Systems Management & Policy Identifying contributing factors to the economic burden of motorcycle crashes. Authors: Hargarten S, Affeldt Z, Kohlbeck S. Project Mentor: Stephen Hargarten, MD, MPH Use of a helmet by motorcyclists involved in crashes has proven to decrease mortality, injury severity, and cost of admission. Lack of helmet use results in a strain on hospital resources and millions of dollars of preventable medical expenses each year. Our study aimed to quantify the differences in hospital charges between helmeted and unhelmeted riders based on several hospital admission metrics and to what degree those metrics individually impacted cost. We examined 16 helmeted and 52 unhelmeted riders with isolated head injuries who presented to the Froedtert Memorial Lutheran Hospital emergency department between 2004 and 2019. Admission data was pulled from the Froedtert Hospital Trauma Registry Database regarding Glascow coma scale on presentation, days spent in the intensive care unit, days requiring a ventilator, length of hospital stay, injury severity score, abbreviated injury score, and discharge disposition. Helmeted riders were less likely to: present to the ICU (OR .68, P < .069), require a ventilator (OR .48 P < .088), be sent to rehab or the morgue (OR .25, P < .066). Overall admission cost for helmeted and unhelmeted riders was comparable at USD $46599.09 vs $49,532.54 (P < .433). Factors found meaningfully impact admission costs were discharge disposition (P < .003), ISS/AIS (P<.009 and P < .035), length of hospital stay (P<.001). Helmets decrease the likelihood of sustaining injuries associated with independent factors for increasing hospital costs. This suggests that helmets have a protective value in safety but also for decreasing financial burden placed on injured motorcyclists. Afreen, Esha Urban & Community Health State Law Designed to Decrease Postoperative Opioid Prescriptions: Is it Best for the Patient? Authors: Colvin Z, Afreen E, Palatnik A, Peterson E. Project Mentor: Erika Peterson, MD INTRODUCTION: To discourage providers from overprescribing opioids, Wisconsin enacted Wisconsin Act 266 on 4/1/2017. This legislation mandated a search of the prescription drug monitoring program (PDMP) database if prescribing opioids for >3 days duration. Our objectives were to examine whether opioid prescribing patterns, pain control, and postpartum health care utilization changed after enactment of this law. METHODS: A retrospective cohort study of women delivering by cesarean delivery from 4/2016 to 4/2018 at a large academic hospital in Wisconsin was done. Women were excluded if there was no postpartum follow-up care in the hospital system, were prescribed opioids other than oxycodone, or underwent additional major procedures. Maternal and obstetric characteristics, number and total amount of opioids prescribed at discharge, and additional encounters or opioid prescriptions required for inadequate pain control, were compared in women delivering the year prior to and the year after the law was enacted. RESULTS: A total of 1,312 women met criteria for analysis. There was a significant decrease in number (28.1 vs 22.8, p<0.001), and total amount (142.7 vs 116.7mg, p<0.001) of opioids prescribed at discharge in the year after the law was enacted. There were no differences in additional encounters for postpartum pain control or need for additional opioid prescriptions. Both outcomes remained statistically significant after performing a multivariable linear regression. CONCLUSION: Opioid prescribing after cesarean delivery significantly decreased after Wisconsin Act 266 was enacted without compromising postoperative pain control. Future mandates should be considered at a national level to decrease excess opioid prescribing. Aguayo, Antonio Global Health Identifying barriers to standardizing trauma care with an electronic medical record
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