Emergency Medicine 2022

Multi-Visit Patient (MVP) Task Force Quality Improvement

Faculty Mentor’s Name: Dr. Brandon Allen
Email: brandonrallen@ufl.edu
Phone Number: (954) 675-4321
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Problem:
The ED MVP population is defined as patients that experience 10 or more ED visits within the past rolling 12 months. High ED utilization is both resource and cost intensive for the organization. 
Objectives:
Identify MVP population (≥ 10 ED Visits within rolling 12 months) in real time utilizing data metrics and dashboards
Assess patient’s unmet clinical, behavioral, and social needs to identify driver of utilization (DOU) for the ED visit(s)
Collaborate with an interdisciplinary team to develop individualized and actionable care coordination plan to reduce MVP ED visits
Track follow-up data to monitor/assess efforts
Reduce MVP readmission rate by 10%
Decrease the cost of care by reducing avoidable ED repeat visits
Measures:
Outcome Measures:

  • ED Visits
  • ED Admissions

30-day Readmissions
Process Measures:

  • (%) MVPs with DOU identified/assessed
  • (%) MVP with Patient Care Coordination notes
  • (%) MVPs with Plan for Return documented in EPIC (ED Care Alert)
  • ED Visits since Discussion for Recurring/Watch and Wait Patients
  • (%) MVPs that had a MOC/Equal Access/Care One visit after ED referral

High Sensitivity Troponin and Acute Coronary Syndrome

Faculty Mentor’s Name: Dr. Brandon Allen
Email: brandonrallen@ufl.edu
Phone Number: (954) 675-4321
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Up to 10% of emergency department visits include patients presenting with symptoms of acute coronary syndrome (ACS), and methods for rapid identification of acute myocardial infarction (AMI) are needed. Traditionally, patients with ACS have required observation until myocardial infarction was ruled out or in using cardiac troponin levels and electrocardiograms. Recent development of high-sensitivity cardiac troponin I (hs-cTnI) assays have allowed detection at relatively low plasma concentrations, providing an opportunity for innovation. Finding ways to safely and quickly discharge patients is of interest to prevent overcrowding in the ED and hospital and cut costs associated with hospital stays. Currently, the UF Health ED uses a protocol requiring three hs-cTnIs to rule out ACS, with measurements taken after ED arrival (T0), one hour after arrival (T1), and three hours after arrival (T3). Safe discharge with serial biomarker testing and/or provocative testing will be assessed for utility and necessity in comparison to the current literature and guidelines.

Biomarker assessment for transplant patients in septic shock

Faculty Mentor’s Name: Dr. Brandon Allen
Email: brandonrallen@ufl.edu
Phone Number: (954) 675-4321
Project Category: Clinical
International Component or Travel: No

Research Project Description:

This project is seeking to assess a single or multi-biomarker strategy to assess the specificity in prediction of septic shock in transplant patients. We will look at high sensitive troponin, lactate, and procalcitonin to determine if this unique population may be affected differently based on the type of transplant, immunosuppression, and/or biomarker elevations. There is no active funding for this project and the student will be performing retrospective chart reviews and computational analysis with the PI.

Pulmonary Embolism Diagnosis in Patients with COVID-19

Faculty Mentor’s Name: Dr. Michael Marchick
Email: marchick@ufl.edu
Phone Number: (704) 968-7618
Project Category: CQI
International Component or Travel: No

Research Project Description:

Patients with COVID-19 are known to be at heightened risk of pulmonary embolism (PE). Unfortunately, the workup for PE often requires a CT, exposing to patient to radiation and nephrotoxic contrast dye. In attempt to reduce CT utilization, modified D-dimer thresholds have been proposed, as well as the use of other patient characteristics and lab values to exclude PE. Unfortunately, data supporting this is lacking. Using data from COVID-positive patients at UF Health, we will work to build the current fund of knowledge regarding the diagnosis of PE in COVID-positive patients. The student will review medical records and participate in the analysis of data with a goal of presenting at an academic conference and subsequent manuscript preparation.