William Barnett

Autopsy learning module: a tool for assessing self-reflection and practice improvement competency

Practice-based learning and improvement is one of the six core competencies listed by the Accreditation Council for Graduate Medical Education (ACGME) for residency programs (post-graduate medical training). ACGME defines practice-based learning and improvement as “an ability to investigate and evaluate the care of patients, appraise and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning”.1 Assessing resident (also known as housestaff or a house officer) competency in practice-based learning and improvement is the most challenging of the six competencies as there are very few published tools to assess a residents performance in this competency. We aim to develop a standardized resource, which could be utilized by residents for learning and self-reflection, and would also provide evaluators with an objective tool for assessing practice-based learning and improvement competency of residents through an approach known as the “Autopsy Learning Module”. Autopsy has long been recognized as an important tool for learning and quality improvement in clinical practice. Physicians often utilize autopsy findings for evaluating the accuracy of their clinical diagnosis, identifying any unsuspected conditions, and establishing a cause of death. To reiterate the importance of autopsy in medical education, we performed a study through a retrospective chart review of 141 autopsies conducted at our institution between January 2011 and May 2015. We measured the level of agreement between the clinical cause of death established by the treating clinician and the cause of death listed by the pathologist after autopsy using Kappa coefficients. We found there was poor agreement between the clinical and autopsy diagnosis, especially among cases of pulmonary embolism and liver cirrhosis, while there was moderate agreement among cases of myocardial infarction. Our findings were consistent with the available literature.2 The rate of disagreement between the clinical diagnosis and autopsy findings highlights an opportunity to use an autopsy in a meaningful way as both a learning experience and as a tool for self-reflection.

Endotracheal Tube Sizes and the Development of Ventilation-Associated Events: Does Gender Play a Role?

Hermann Simo* Aahd Kubbara William Barnett Kevin Qin Wail Alamoudi Madiha Fida Nawaf Almashal Asif Iqbal Amala Ambati Ajit Ramadugu Christopher Marino Faisal Khateeb Fadi Safi and Ragheb Assaly University of Toledo Medical Center, Toledo, OH IO N , R E S E A R C H , A N D Q U A L IT Y IM P R O V E M E N T PURPOSE: Ventilator-associated events (VAEs) are surveillance paradigms established by the CDC. They denote three categories of increasing progression in mechanically ventilated patients from a ventilator-associated condition (VAC), to an infection-related ventilator-associated complication (IVAC), and finally to a ventilator-associated pneumonia (VAP). In a recent study, Gacouin et al., incidentally found that risk of late-onset VAP was higher in patients with a tube size greater than or equal to 7.5 mm. While there has been association found between ventilator associated pneumonia and endotracheal tube (ETT) size, there has not been a study done looking at CDC defined Ventilator Associated Events occurence and ETT size. We wanted to determine if there is an association between endotracheal tube size and the development of VAEs and whether that association is gender base.

Assessment of ventilator-associated events using the geometric distribution

&NA; Hospital‐acquired rare events, such as nosocomial infections and other low‐occurring incidents, in the clinical environment are difficult to monitor using traditional quality indicators. Using the Centers for Disease Control and Prevention definition of ventilator‐associated events, we demonstrate an alternative method for assessment of rare events.

Effects of Steroidal Therapy on the Incidence of Ventilator-Associated Events in a Northwestern Ohio Hospital

C R IT IC A L C A R E PURPOSE: Corticosteroids are commonly administered in critically ill patients for a variety of reasons. They were estimated to be used in about 26% of critically ill patients. Controversies have always surrounded their outcomes in the ICU. While they have been shown to increase death in Intensive Care Unit acquired pneumonia, they have been proposed to prevent hospital acquired pneumonia in intubated patients with multiple trauma. In the Society of Critical Care Medicine guidelines, it was recommended to consider hydrocortisone treatment for patients with septic shock with no mortality benefit. Herein, we present a sample of an ongoing analysis of the use of hydrocortisone and the risk of Ventilator Associated Events compared to other steroids in our university hospital. Ventilator Asscoiated Events (VAE) defined by the CDC National Healthcare Safety Network developed in 2013.