Departmental Grand Rounds Research Articles

Advancing learning equity through virtual radiology grand rounds

PurposeThe COVID-19 pandemic rapidly accelerated the adoption of virtual learning in medical education, including departmental grand rounds lectures in radiology. This retrospective study sought to assess the impact of an open access virtual grand rounds program. We tested the hypothesis that virtual grand rounds would advance learning equity by increasing access to learners outside of our institution. MethodsTwenty-two open access virtual grand rounds lectures were presented and recorded using an online videoconferencing platform. After the lecture, registrants received online access to the lecture recording for later on-demand viewing. The email address, geographical location, institutional affiliation, and medical specialty for all virtual registrants and attendees were retrospectively collected from a required online registration form. The primary outcome measure included an assessment of geographical diversity using descriptive statistics. ResultsAttendees of the virtual lectures were from 75 academic institutions and 27 non-academic institutions and located in 32 states, 88 cities, and 9 countries. Twenty-seven medical specialties were represented. ConclusionThe virtual grand rounds program in radiology contributes to free and open access educational content online for learners around the world. To address learning equity and promote international inclusion, we recommend that grand rounds organizers consider including a virtual option that allows free sharing of knowledge.

Representation of Women Among Grand Rounds Speakers at an Academic Health System Early in the COVID-19 Pandemic.

Introduction An invitation to speak at grand rounds (GR) is considered an honor and an activity important for academic promotion. The aim of this study was to determine the representation of women among invited speakers at departmental GR and assess the impact of the COVID-19 pandemic on it. Methods We conducted a retrospective descriptive study on gender differences in all GR speakers between January 2019 and June 2021 at an academic health system in Western Massachusetts. We calculated the overall percentage of women presenters and compared it with the percentage of women faculty at our institution and nationally.To evaluate the impact of COVID-19 on this association, we calculated the absolute percentage difference between women and men speakers using the date of March 13, 2020, as the cut-off and conducted a sensitivity analysis using June 15, 2020, as the cut-off. Results During the study period, 46% (276/607) of GR speakers at our institution were women. This percentage reflected the percentage of the women faculty overall at our institution and was similar to women's representation among faculty nationally. Departments with high percentages of women faculty (Obstetrics and Gynecology, 76%; Pediatrics, 65%) had high percentages of women GR speakers (Obstetrics and Gynecology, 70%;Pediatrics, 51%; Psychiatry, 62%).COVID-19 did not appear to significantly influence gender representation among speakers. Conclusion At our institution, less than half of the GR speakers were women.However, this percentage appears to reflect the overall percentage of women faculty. Potential barriers and opportunities resulting from the COVID-19 pandemic did not appear to impact this finding.

Training gynecologists in the management of HIV pre-exposure prophylaxis: a 2-year experience

We aimed to evaluate the efficacy of different modalities of PrEP training sessions for OB/GYN providers given the disproportionate under-utilization of PrEP among women. Three separate training sessions were held for providers in the OB/GYN department at an academic medical center in New York City: 1) in-person resident didactics, 2) virtual resident didactics, 3) virtual departmental grand rounds. The participants were surveyed after the training on PrEP awareness, knowledge, and management. Two-sample t-test was used to compare difference in proportions of binomial variables and difference in means of likert-scored answers.

Implementation of a longitudinal quality improvement curriculum for hematology/oncology fellows.

315 Background: Quality improvement (QI) is an integral part of healthcare systems and an essential skill for trainees to develop. Education and engagement in QI activities is an ACGME core competency for GME trainees regardless of program or post-graduate year (PGY). There are many ways in which these competencies may be fulfilled and often vary widely between programs and institutions. Here we present the implementation of a longitudinal QI curriculum for hematology/oncology fellows at our institution. Methods: In July 2020 we implemented a 3-year longitudinal QI curriculum to meet criteria set forth by ACGME regarding QI training to improve fellow engagement in QI activities. The curriculum consists of 3 components: 1) introductory lectures on QI concepts and methodology including PDSA cycle and Lean Six Sigma, 2) monthly morbidity & mortality conferences utilizing root cause analysis to identify opportunities for improvement, and 3) fellow-initiated QI projects with regular feedback sessions. Fellows are encouraged to participate in ASCO’s Quality Training Program (QTP) for further project development. A senior QI fellow is appointed to organize didactics and oversee project development. Milestones are set per training year. PGY1 fellows participate in didactics and feedback sessions to gain understanding of QI methodology and application to ongoing and future projects. PGY2 fellows develop and implement a project utilizing core QI principles. PGY3 fellows complete their longitudinal QI project, culminating in presentation and conference submission. At the conclusion of the curriculum, fellows are expected to achieve competency in 1) identifying clinical and institutional opportunities for QI, 2) understanding and applying QI concepts and methodology to project development, and 3) designing and implementing a QI project utilizing core concepts and methodology. Pre- and post-curriculum self-assessments will be used to evaluate knowledge of QI principles. Results: Since implementation fellows have actively participated in all components of the QI curriculum resulting in improved fellow satisfaction in QI education and engagement. Four fellow-initiated QI projects have been developed, resulting in 1 participation in ASCO QTP, 3 presentations at departmental grand rounds, and 3 abstract presentations at national meetings including ASH Annual Meeting, ASCO Annual Meeting, and ASCO Quality Symposium. Two projects have been completed, leading to interventions that have been implemented into routine practice at our institution. Conclusions: Implementation of a longitudinal QI curriculum at our institution has resulted in improved fellow experience in QI and successful implementation and presentation of QI projects at both the local and national levels. This curriculum has been well received by both fellows and faculty and has led to improved engagement in QI education and practices.

A multidisciplinary approach to operationalizing financial toxicity interventions: The MSK Affordability Working Group.

2 Background: The financial toxicity (FT) of cancer is a concern for the healthcare system. Rising costs and increased cost-sharing result in high levels of financial burden, with negative implications for treatment adherence, quality of life, and financial well-being. As FT interventions must consider the interdependent systems of barriers patients face, this project highlights efforts toward developing and testing hospital-based FT interventions through the creation of the Memorial Sloan Kettering (MSK) Affordability Working Group. Methods: An interdisciplinary task force aimed to 1) characterize FT among patients receiving treatment at MSK; 2) identify areas for systemic change. Members included physicians, nurses, and social workers, and representatives from patient billing/financial services, health services research, and hospital administration and strategy. The team first conducted a review of medical records (2016 – 2018) to determine FT incidence and current practices for financial assistance uptake. Absent a formal FT screening, proxy measures defined FT as having bill payment issues, applying for financial assistance, or expressing financial concerns to Social Work, and we analyzed the percent of each category referred for assistance. Post-analysis program processes are also described. Results: Of 89,283 records reviewed, 22,187 (25%) patients experienced FT. Of 14,178 patients with payment issues, only 22% had been referred for financial assistance. As such, streamlining the assistance referral process became a priority, leading to the creation of an FT order set for providers to make direct referrals. From 3/2021-2/2022, 843 orders were placed, with $836,000 in co-pay assistance and $13,500 in essential needs assistance linked to the order set. The task force then met with hospital leadership to formally expand into an institutional working group, with organizational buy-in demonstrated through increased staffing and monetary support of patient-level pilot interventions. Stakeholders were engaged through presentations at departmental grand rounds and to individual disease teams. Operational and research efforts are now focused on systematic FT screening of patients, including validating a screening tool, developing nurse-led staff and patient education, assessing stakeholder feedback, and determining an appropriate screening cadence and workflow by disease type. Conclusions: With at least 25% of patients at MSK experiencing financial difficulties related to cancer treatment, it was, and remains, vital to develop systems-based interventions to proactively assess FT risk and refer to tangible resources. Planned future work includes implementation of universal FT screening with reflex referral to financial assistance, testing patient-level educational interventions, and developing policy/advocacy recommendations.

Changing Dynamics in Medical Education during COVID-19 Pandemic: Are Integrated Plastic Surgery Programs Adapting for Residency Applicants?

The coronavirus disease of 2019 (COVID-19) pandemic drastically changed the 2020 to 2021 residency application process.1 The American Association of Medical Colleges released recommendations against visiting rotations and in-person interviews. Traditionally competitive fields, including plastic surgery, strongly encouraged students to participate in visiting rotations, which offer students an opportunity to network broadly, experience the specialty outside their own school’s department, and learn about different residency training programs.1,2 Loss of in-person evaluations may impact programs’ assessments of applicants and applicants’ impressions of programs. In this article, we describe how integrated plastic surgery programs adapted for the 2021 application cycle by developing a social media presence and implementing virtual opportunities. An official list of accredited integrated plastic surgery residency programs was obtained from the Electronic Residency Application Service, identifying 82 programs. All programs were included and reviewed for the presence of departmental and residency Twitter, Instagram, and Facebook accounts. Platforms, program websites, and the American Council of Academic Plastic Surgeons website were reviewed for posts regarding virtual subinternship and open house opportunities. The Visiting Student Application Service website was reviewed for virtual subinternship opportunities. All data were collected on September 9, 2020. Social media presence and virtual opportunities are profiled in Tables 1 and 2. In total, 138 social media accounts were identified, 65 programs (80 percent) had an online presence on either Twitter, Instagram, or Facebook, and 12 (15 percent) had a presence on all three platforms. Table 1. - Social Media Characteristics of Integrated Plastic Surgery Programs: Ownership and Creation Date of Program Social Media Accounts Program Characteristics No. of Accounts (%) No. Established before 2020 (%) No. Established after 2020 (%) Twitter Departmental Twitter 27 (33%) 23 (85%) 4 (15%) Residency Twitter 4 (4%) 4 (100%) 0 (0%) Instagram Departmental Instagram 22 (27%) 21 (96%) 1 (4%) Residency Instagram 49 (60%) 38 (78%) 11 (22%) Facebook Departmental Facebook 30 (37%) 28 (93%) 2 (7%) Residency Facebook 6 (7%) 5 (83%) 1 (17%) Table 2. - Social Media Characteristics of Integrated Plastic Surgery Programs: Number of Programs with Open House and Subinternship Opportunities Program Characteristics Twitter Instagram Facebook Programs with open house opportunities on social media, no. 10 (12%) 36 (44%) 6 (7%) Programs with virtual subinternship opportunities on social media, no. 2 (2%) 8 (10%) 1 (1%) Open houses were listed by 50 programs (61 percent) on American Council of Academic Plastic Surgeons and four program websites (5 percent). Instagram offered 88 total open house opportunities, and 17 programs (21 percent) posted more than one offering. Three virtual subinternships (4 percent) were identified through the Visiting Student Application Service website and none through American Council of Academic Plastic Surgeons or program websites. Two virtual subinternships listed on the Visiting Student Application Service website were not advertised on social media, and six virtual subinternships available on social media were not listed on the Visiting Student Application Service website. Hosting of virtual open houses appears to be the preferred method of outreach to applicants this year, adhering to COVID-19 social distancing recommendations and travel limitations. Open houses hosted by residency training programs may have increased impact over virtual subinternships, creating program diversity for applicants. The apparent lack of virtual subinternship standardization through an official American Association of Medical Colleges platform is novel, and we recommend exploration of program social media to elucidate opportunities. We anticipate that letters of recommendation from students’ home institutions and program director communication will play an enhanced role in the 2021–2022 residency application year. Almost all integrated plastic surgery residency social media accounts were made before 2020 (Fig. 1). Instagram is the preferred social media platform of integrated programs, supported by 2020 studies.3,4Fig. 1.: Date of social media account foundation.This article has limitations, including its retrospective nature. Data may be skewed due to the constantly changing social media platforms. In addition, the opening of departmental grand rounds, didactic conferences, and the like were not captured. Integrated plastic surgery residency programs adapted to the novel COVID-19 pandemic by creation of virtual open houses for applicants. Programs demonstrated minimal virtual subinternship opportunities. Instagram is the preferred social media outlet for integrated plastic surgery residencies. DISCLOSURE None of the authors has a financial interest in any of the products mentioned in this article. No funding was received for this article.

The Impact of Color Fidelity on Evaluation of Patients in the Outpatient Dermatologic Setting.

To demonstrate that high color fidelity light-emitting diode (LED) sources are preferred by dermatologists for the evaluation of patients during standard-of-care, outpatient visits when compared to low color fidelity LED sources similar to fluorescent lighting. Three different LED sources were installed in exam rooms at a single, academic, medical institution (low color fidelity [82 color rendering index (CRI)] similar to fluorescent lighting, and high color fidelity [97 CRI and 96+red CRI]). A cross-sectional survey study was conducted in three parts. Naturalness (i.e. ability to reproduce natural, daylight conditions), effectiveness, color contrast, comfort, and overall performance of each LED source were rated on a 5-point scale from 0 to 4 with 0 being the worse, and 4 being the best. The first part included a survey of board-certified dermatologists (n = 3) assessing their visual experience while clinically evaluating a subset of patients during standard-of-care outpatient visits. The second survey was completed by dermatologic medical providers (n = 55) at three separate monthly departmental Grand Rounds sessions in which standardized patients were evaluated with the LED sources. Lastly, patients (n = 75) finished a survey assessing the comfort level of the LED sources. In the first part of the study, all dermatologists significantly preferred the high color fidelity sources over low color fidelity sources based on all five evaluation criteria, with two preferring the 97 CRI LED source overall, while the third dermatologist favored 96+red CRI. Assessments provided by the 55 participants at Grand Rounds demonstrated that the 97 CRI was most "liked." Patients also preferred the high color fidelity LED source, reporting the 96+red CRI source was the "most comfortable." Dermatologists, dermatologists-in-training and mid-level providers significantly prefer high color fidelity LED sources for outpatient evaluation of dermatologist patients in enclosed spaces, rating them the more natural, effective, comfortable, and providing superior color contrast than low color sources. Patients also favor high color fidelity LED sources as being the most comfortable in the clinic room. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Fostering Certainty in an Uncertain Era of Virtual Residency Interviews.

Fostering Certainty in an Uncertain Era of Virtual Residency Interviews.

University of South Alabama College of Medicine.

University of South Alabama College of Medicine.

Dell Medical School at the University of Texas, Austin.

Dell Medical School at the University of Texas, Austin.

Impact of a Quality Improvement Initiative on Prescribed Opioids for Cesarean Delivery [14P

INTRODUCTION: Cesarean deliveries (CD) are one of the most common procedures performed in the United States, with patients being routinely discharged with prescriptions for opioids. Previous studies show that the amount prescribed is significantly greater than what patients require. Our objective is to decrease the number prescribed at discharge through education and monitoring of prescription practices. METHODS: The quality improvement initiative was introduced in May 2018 through a departmental Grand Rounds presentation. Data on post-operative prescription practices were collected by performing a retrospective chart review of all patients undergoing CD at our hospital in the month of January 2018 and in January 2019, 6 months after introduction of the initiative. IRB approval was obtained for this review. RESULTS: A total of 89 records of patients who underwent CD was reviewed: 42 records from January 2018 and 47 records from January 2019. A significant decrease (P<.001) in the number of pills prescribed at discharge was found, with a median of 30 (IQR 28–30) in January 2018 compared to a median of 20 (IQR 20–30) in January 2019. There was a significant difference (P<.001) in the type of opioid prescribed, shifting from oxycodone with acetaminophen (78% in January 2018 and 10% in January 2019) to oxycodone alone (7% in January 2018 compared to 74% in January 2019). There was no significant difference in refill attempts (P=.7) between January 2018 and January 2019. CONCLUSION: Low-cost interventions such as a department Grand Rounds and ongoing educational initiatives may be an effective strategy to decrease post-operative opioid prescription numbers.

Opioid Naive Surgeons and Opioid-Tolerant Patients: Can Education Alter Prescribing Patterns to Total Knee Arthroplasty Patients?

Patterns of opioid overprescribing following arthroplasty likely developed given that poor pain control can diminish patient satisfaction, delay disposition, and lead to complications. Recently, interventions promoting responsible pain management have been described, however, most of the existing literature focuses on opioid naive patients. The aim of this study was to describe the effect of an educational intervention on opioid prescribing for opioid-tolerant patients undergoing primary total knee arthroplasty (TKA). As the start to a quality improvement initiative to reduce opioid overprescribing, a departmental grand rounds was conducted. Prescribing data, for the year before and after this intervention, were retrospectively collected for all opioid-tolerant patients undergoing primary TKA. Opioid prescribing data were standardized to mean morphine milligram equivalents (MME). Segmented time series regression was utilized to estimate the change in opioid prescribing associated with the intervention. A total of 508 opioid-tolerant patients underwent TKA at our institution during the study period. The intervention was associated with a statistically significant decrease of 468 mean MME (23%) from 2,062 to 1,594 (p = 0.005) in TKA patients. This study demonstrates that an educational intervention is associated with decreased opioid prescribing among opioid-tolerant TKA patients. While the effective management of these patients is challenging, surgeon education should be a key focus to optimizing their care.

Representation of Women Among Invited Speakers for Grand Rounds.

Background: Grand rounds and named lectureships are forums in academic medicine for sharing research, scholarly achievements, and clinical expertise. An invitation to speak at grand rounds is regarded as an honor and is part of the pathway to academic promotion. We describe gender representation relative to the national academic medical workforce among invited speakers at departmental grand rounds and annual named lectures at a large academic medical center. Materials and Methods: Lists of external speakers for grand rounds from 2015 through 2017 were obtained from 18 departments and for annual named lectures from 2007 to 2017 from 7 departments. Results: Of the 783 invited speakers to the 25 speaker series, there were 178 women (22.7%). The proportion of women speakers for departmental grand rounds ranged from 0% to 59.3%; representation of women speakers was lower than representation in their specialty in 14 of the 18 departments and significantly lower in 4 of the 18 departments. In four departments, there was a higher proportion of women than available in the specialty-specific academic medicine workforce. The proportion of women who spoke at annual named lectures was significantly lower in two of seven lecture series and ranged from 0% to 21.2%. Three departments had no women speakers. Conclusions: The underrepresentation of women as speakers is a potential target to improve gender representation and role modeling and provide equitable opportunity for academic advancement. Solutions may include formal diversity and inclusion training, intentional overrepresentation of invited female speakers, and inclusion of women on grand rounds planning committees.

The Other Side of Medical Student Mistreatment: Teaching Cultural Competency Across the Generational Divide.

Medical student mistreatment continues to be a significant problem despite increased awareness and longitudinal efforts to address the issue. Through audience discussions of a previously published film depicting learner mistreatment, we identified challenges created by student behaviors that negatively impact the learning environment. In addition, the need to address cultural competency in a multigenerational clinical environment became apparent. We created a film of three vignettes based on perspectives shared in focus groups by faculty, residents, nurses, and staff who work with medical students. We used this film to develop student and faculty curricula elucidating generational differences in behaviors and expectations while also exploring the learner's role in creating a more positive learning environment. Our film was presented to medical education professionals at faculty development workshops and meetings, clerkship students at orientation sessions, residents as part of residents-as-teachers curricula, and faculty at departmental grand rounds. Evaluation data from 176 students and 42 faculty showed that a majority of our participants believed the film accurately reflected challenges they faced in the learning environment and felt better equipped to address them. Film is an effective way to stimulate discussion about complex interactions in the clinical learning environment. Divergent perspectives on behaviors depicted in the film served as a stimulus to create targeted curricula for faculty and student education. Stimulating dialogue through film may enhance understanding and empathy among disparate groups, which is likely to be a necessary step for lasting change.

Targeted Intervention to Increase Awareness of Opioid Overprescribing Significantly Reduces Narcotic Prescribing Within an Academic Orthopaedic Practice

To evaluate the impact of a targeted intervention focused on increasing awareness of opioid overprescribing within an academic orthopaedic practice. Retrospective prescribing data was collected through an electronic chart review. A single time point, a departmental grand rounds titled "Opioid Use, Misuse, & Abuse in Orthopaedics," was conducted on February 8, 2017. Opioid prescribing data was analyzed for the year preceding and year immediately following this targeted intervention. Narcotics were standardized using milligram morphine equivalents (MME) for comparison, and patients were categorized as opioid naive or non-naive based on whether an opioid prescription was written within 90 days prior to surgery. A segmented time series regression model was utilized to determine statistical significance of the educational intervention. Academic Medical Center. All patients undergoing orthopaedic procedures at our institution between January 2016 and March 2018. A total of 5882 patients underwent orthopaedic procedures at our institution during the study period. Of these, 2887 were in the year preceding and 2995 were in the year immediately following the targeted intervention to increase awareness of opioid overprescribing. The interve.ntion was associated with an acute decrease of 167 mean MME from 780 to 613 in opioid naive (p = 0.028) and 154 mean MME from 1,015 to 861 in opioid non-naive patients (p = 0.010). The intervention was also associated with a favorable change in the overall mean MME prescribing trend over time in both naive (p = 0.011) and non-naive (p = 0.064) patients. This study demonstrates decreased opioid prescribing within an academic orthopaedic department after a targeted intervention focused on raising the awareness of opioid overprescribing. Ongoing provider education and awareness are critical parts of any plan to continue curtail opioid overprescribing among surgeons.

Advanced Quality Training in Radiology: Inaugural Report of a 2-Year Program.

OBJECTIVE. The purpose of this study is to describe and analyze the outcomes of a 2-year advanced quality training program for radiology residents. MATERIALS AND METHODS. In 2016, the radiology quality committee of a quaternary health system created a hands-on 2-year advanced quality training curriculum for diagnostic and interventional radiology residents. Internal candidates with the following prerequisites submitted competitive applications: registration for a 2-day lean health care management course, completion of four or more Radiological Society of North America (RSNA) quality essentials certificates, identification of faculty mentor(s), selection of one quality improvement project to champion, and completion of a two-page essay summarizing interest in quality improvement, the proposed project, and its potential impact. Residents were required to attend monthly quality meetings, pursue their project and its derivatives, submit completed work for consideration to a national meeting and for publication, and present at departmental grand rounds. Outcomes were summarized using descriptive statistics. RESULTS. Five residents submitted four projects for consideration, and all five were selected. In addition to the four submitted projects, seven additional projects were pursued. Participants worked on nine local and three multicenter process improvements, gave one to two grand rounds each, presented three oral and five poster presentations, generated eight publications, received three awards, formed 14 mentor-mentee relationships, and influenced local and multisite practice patterns. Participants reported gaining firsthand experience in quality improvement principles and developing real-world leadership skills. CONCLUSION. A targeted 2-year curriculum emphasizing hands-on quality improvement experience with rich mentor-mentee relationships can produce meaningful results.

Enhancing Communication Between Gastroenterology Fellows and Medicine Residents: A Quality Initiative

Introduction: Communication between consultant and primary team is essential for inpatient care. For many years at our institution, gastroenterology fellows and medicine residents seem to have problems regarding communication of these consults. Each side appear to have issues with the methods of the other side, leading to unhappy interactions and fractured professional relationships on both sides. Therefore, we performed a quality improvement project with the aim of improving the communication between gastroenterology fellows and medicine residents on inpatient consults. Methods: A quality improvement project was performed between February 2016 and June 2017. All gastroenterology fellows and medicine residents were included in this study. In February 2016, gastroenterology fellows and medicine residents were surveyed regarding key aspects of the other groups performance on inpatient consults using a Likert scale of 1-5 (with 1 being the worst and 5 being the best). Gastroenterology fellows were judged on comfort level, listening, timeliness, courtesy, informing team of results, happiness for consult, and ability to work with the resident. After review, 6 interventions were performed including departmental Professionalism Grand Rounds, consult etiquette posters throughout the department, ghost consults from gastroenterology attendings, dissemination of results to gastroenterology faculty and fellows, counseling of fellows on proper etiquette, and new fellow orientation training on proper etiquette. In June 2017, a repeat identical survey was performed. Results: Initial surveys (n=46 medicine residents) revealed gastroenterology fellows performed poorly on all aspects (overall mean score 2.7 ± 1.2) with poorest performance on happiness to accept consults (2.3 ± 1.2). After interventions, gastroenterology fellows demonstrated statistically significant improvement all outcomes, including comfort level (2.4 vs 3.5, p < 0.001), listening (2.7 vs 3.7, p < 0.001), timeliness (3.1 vs 4, p < 0.001), courtesy (2.4 vs 3.6, p < 0.001), informing team of results (3.3 vs 4.1, p = 0.001), happiness for consult (2.3 vs 3.6, p < 0.001), and ability to work with the resident (2.9 vs 4.1, p < 0.001). Overall score for gastroenterology fellows improved from 2.7 ± 1.2 to 3.8 ± 0.9 (p < 0.001). Conclusion: Communication between gastroenterology fellows and medicine residents significantly improved with counseling of consult etiquette.

MP36: Can one emergency physician improve department flow? A proof-of-concept trial of a physician float role

Introduction: Emergency departments (EDs) are overcrowded and patient acuity and volumes are ever-increasing. While changes to the flow of ED patient input and output are outside the control of frontline ED teams, the efficiency of ED throughput can be optimized. One widely studied intervention is the implementation of a physician liaison role to assist in managing overall ED flow. The Physician Float (PF) acts as a triage liaison, second physician for resuscitations, ED procedural sedation physician, and fields ED referral calls. This is a first-iteration proof-of-concept trial to plan, implement and evaluate if the PF role could decrease ED length of stay (LOS) by a goal of 30 minutes, over a four-week period, without adverse changes to left without being seen (LWBS) and bounce-back rates. Methods: The PF role was implemented as a scheduled emergency physician shift in the fall of 2017. Ongoing iterations of this role implementation are being reviewed for re-implementation. The primary outcome measure was ED LOS; secondary outcomes included time-to-physician initial assessment (PIA), EMS offload rates, and LWBS and 72-hour bounce-back rates. Qualitative data including patient concerns and physician feedback were also collected. Data were collected after the trial from a centralized, de-identified ED information system database with time-stamp quantifiers and compared to the following four-week time period where the shift is a regular ED physician shift at the same time. The ED physician and nursing team planned and implemented the PF role, then results were evaluated and shared with the wider ED staff in departmental grand rounds and quality council presentation formats, and recommendations were gathered from to adjust and strengthen future iterations of PF role implementation. Results: Descriptive statistics and Mann-Whitney and Median tests were calculated. On average there were 185 daily ED visits in the trial and comparison periods. Median ED LOS decreased by 12 minutes in the PF trial period (p&lt;0.05). Furthermore, there was a 12 minute decreased ED LOS for all discharged patients (p&lt;0.05). PIA time decreased by 13 minutes for patients that were admitted. The average percentage of EMS offloads within 60 min improved from 75% to 80.7% for admitted patients. LWBS and 72-hour bounce-back rates were unchanged. No additional patient concerns arose related to or during the trial. Physician feedback on the PF role was mainly positive. Conclusion: The defined role of a PF in an ED can decrease ED LOS, albeit not achieving the desired 30-minute reduction on the first iteration, this trial supported proof-of-concept for implementation of a PF role in a tertiary care centre ED. Further iterations are needed to evaluate the scalability and sustainability of this role.

LO10: Faculty sim: a simulation-based continuing professional development curriculum for academic emergency physicians

Introduction: Maintaining and enhancing competence in the breadth of Emergency Medicine (EM) is an ongoing challenge for all clinicians. In particular, resuscitative care in EM involves high-stakes clinical encounters that demand strong procedural skills, effective leadership, and up-to-date knowledge. However, Canadian emergency physicians are not required to complete any specific ongoing training for these encounters beyond general CPD requirements of professional colleges. Simulation-based medical education (SBME) is an effective modality for enhancing technical (e.g. procedural) and non-technical (i.e. Crisis Resource Management) skills in crisis situations, and has been embedded in undergraduate and postgraduate medical curricula worldwide. We present a novel comprehensive curriculum of simulation-based CPD designed specifically for academic emergency physicians (AEPs) at our centre. Methods: The curriculum development involved a departmental needs assessment survey, focus groups with AEPs, data from safety metrics and critical incidents, and consultations with senior departmental leadership. Institutional support was provided in the form of a $25,000 grant to fund a physician Program Lead, monthly session instructors, and simulation centre operating costs. Based on the results of the needs assessment, a two-year curriculum was mapped out and tailored to the available resources. Results: CPD simulation commenced in January 2017 and occurs monthly for three hours, immediately following departmental Grand Rounds to provide convenient scheduling. Our needs assessment identified two key types of educational needs: (1) Crisis Resource Management skills and (2) frequent practice of high-stakes critical care procedures (e.g. central lines). The first six months of implementation was dedicated to low-fidelity skills labs to facilitate the transition to SBME. After this, the program transitioned to a hybrid model involving two high-fidelity simulated resuscitations and one skills lab per session. Conclusion: We have introduced a comprehensive curriculum of ongoing simulation-based CPD in our department based on the educational needs of our AEPs. Key to our successful implementation has been support from educational and administrative leadership within our department. Ongoing challenges include securing adequate protected time from clinical duties for program facilitators and participants. Future work will include establishing permanent funding, CPD accreditation, and a formal program evaluation.

Improving Adherence to Intraoperative Lung-Protective Ventilation Strategies at a University Medical Center.

Intraoperative lung-protective ventilation (ILPV) is defined as tidal volumes <8 mL/kg ideal bodyweight and is increasingly a standard of care for major abdominal surgical procedures performed under general anesthesia. In this study, we report the result of a quality improvement initiative targeted at improving adherence to ILPV guidelines in a large academic teaching hospital. We performed a time-series study to determine whether anesthesia provider adherence to ILPV was affected by certain improvement interventions and patient ideal body weight (IBW). Tidal volume data were collected at 3 different time points for 191 abdominal surgical cases from June 2014 through April 2015. Improvement interventions during that period included education at departmental grand rounds, creation of a departmental ILPV policy, feedback of tidal volume and failure rate data at grand rounds sessions, and reducing default ventilator settings for tidal volume. Mean tidal volume per kilogram of ideal body weight (VT/kg IBW) and rates of noncompliance with ILPV were analyzed before and after the interventions. A survey was administered to assess provider attitudes after implementation of improvement interventions. Responses before and after interventions and between physician and nonphysician providers were analyzed. Reductions in mean VT/kg IBW and rates of failure for providers to use ILPV occurred after improvement interventions. Patients with IBW <65 kg received higher VT/kg IBW and had higher rates of failure to use ILPV than patients with IBW >65 kg. Surveyed providers demonstrated stronger agreement to having knowledge and practice consistent with ILPV after interventions. Our interventions improved anesthesia provider adherence to low tidal volume ILPV. IBW was found to be an important factor related to provider adherence to ILPV. Provider attitudes about their knowledge and practice consistent with ILPV also changed with our interventions.