1. < Cardiology/Epi

Cardiovascular disease remains the major cause of death worldwide. Faculty in the cardiovascular division within our department, remain at the forefront of innovative patient care, training the next generation of cardiologists and of course leading in research. This week, I spotlight some recent research and clinical achievements by members of our cardiology division.

10th Annual UCLA Health Resident Informaticist Project Virtual Symposium

Our clinicians are busier than ever. Yet, there are many hurdles that frustrate their best intentions as they care for their patients. A select group of our residents recently graduated from the UCLA Health Resident Informaticist Program. Their projects focused on creating tools that remove barriers that our physicians face in providing safe and effective care.

Last year, we introduced you to six DoM residents participating in the UCLA Health Resident Informaticist Program. These residents worked alongside UCLA Health faculty and UCLA Health Information Technology (I.T.) to develop projects that streamline and leverage the electronic health record with the goal of improving workflow efficiency, adopting transformation technologies, and increasing patient quality and safety. Four members of this cohort presented their culminating projects at the 10th Annual UCLA Health Resident Informaticist Project Virtual Symposium. These presentations demonstrate their focus on creating tools that will directly impact our ability to efficiently implement guideline-directed treatments in diverse conditions. Their projects are summarized below.

Resident: Ian Downs, MD
Mentors: Annapoorna Chirra, MD and Lawrence Dardick, MD
Project Title: "Simplifying GLP1 Receptor Agonist Prescription for Diabetes and Obesity"

As an endocrinology fellow, Dr. Downs wanted to focus his project in advancing the treatment of diabetes and obesity by addressing a care gap in the prescription of GLP1 receptor agonists (GLP1RA), which are increasingly being used, given their effectiveness in diabetes and obesity management. GLP1RA prescriptions are being more widely prescribed by primary care providers. However, prescriptions and doses for members of this class of medication are not interchangeable depending on whether they are being prescribed for obesity or diabetes. This has led to difficulty in the adoption of this treatment and errors in prescription. As a solution, Dr. Downs developed two SmartSets, one for diabetes and one for obesity, to help prescribe GLP1RA medications. Each SmartSet provides easily accessible, comprehensive medication information when needed, gives pre-populated intuitive orders for each stage of medication initiation, allows medication instructions to be easily inserted, and provide referrals to ancillary support services. Dr. Downs will continue to optimize visibility, incorporate feedback from providers, and add new medications from the expanding drug class, by collecting data about use and efficiency of the Smart Sets.

Resident: Amarachi Erondu, MD, MS
Mentors: Paul Lukac, MD, MS and Magdalena Ptaszny, MD

Project Title: Enhancing the NICU Feeding Summary in EPIC

Caring for patients in the neonatal intensive care unit (NICU) requires ensuring that they are receiving optimal nutrition. In “Enhancing the NICU Feeding Summary in EPIC,” Dr. Erondu noted that NICU feeding summaries are in different sections in EPIC, which can lead to errors in collecting data, and residents spending over 15 minutes per visit with patients calculating daily fluid and calorie intake data. Sixty-six percent of residents expressed that they are dissatisfied with the process. With her project, Dr. Erondu sought to decrease pre-rounding time, reduce calculation errors, and improve resident satisfaction. Her solution included a NICU feeding summary that includes a consolidated summary of micronutrients. She created a dot phrase with reference formulas for calculating caloric intake, and a NICU storyboard feature allowing residents to update NICU weight. As the project rolls out, Dr. Erondu will be assessing whether there is a decrease in errors in the collection of data and an improvement in resident satisfaction.

Resident: Kevin Truong, MD, MBA
Mentors: Annapoorna Chirra, MD and Lawrence Dardick, MD

Project Title: Improving Pre-exposure Prophylaxis for HIV (PrEP) Management in Primary Care

Dr. Troung presented evidence that although Pre-exposure Prophylaxis for HIV (PrEP) is successful at preventing transmission of HIV, thereby reducing health care costs, there has been a low prescription rate for eligible patients. His project sought to simplify workflows and improve education about PrEP for primary care providers. Currently, a PrEP prescription requires 10+ orders to initiate and 5+ orders for each quarterly clinic visit, which may result care gaps due to suboptimal clinic and cost management of orders or visits. Dr. Truong updated a Smart Set to include standardized orders, decision support, and cues for providers and patients to initiate and monitor PrEP. With implementation of the updated Smart Set in May 2023, his anticipated outcomes include decreasing the administrative burden of placing a PrEP order, increasing patient satisfaction with PrEP counseling, and cost savings associated with conversions of  prescriptions of Descovy and Truvada to generic preparations containing  their active ingredients, emtricitabine and tenofovir.

Resident: Wendi LeBrett, MD

Mentor: Magdalena Ptaszny, MD

Project Title: Inpatient GI Bleed Admission Smart Group

In the Bundled Payments for Care Improvement (BPCI) initiative, the Centers for Medicare and Medicaid Services identified gastrointestinal hemorrhage as an inpatient clinical episode where healthcare expenditure and quality of care is a priority. Dr. LeBrett’s review of the literature found that off-hour hospital admissions for gastrointestinal bleeding resulted in worse clinical outcomes and increased mortality in patients, particularly for patients admitted through medicine. With the goal of reducing inappropriate diet orders, increasing GI bleed medications and orders of coagulation factors, she proposed a solution to include a dynamic smart group for GI bleed admissions within the medicine general admission order set for medicine admissions. The smart group includes standard orders for diets, labs, medications, and provides transfusion guidelines for patients with and without cirrhosis. These efforts could reduce the time to endoscopy, length of stay, and costs associated with GI bleed admission. The order panel has been completed and went live on June 20th and will be undergoing pre and post implementation analysis that will be included in a publication and ultimately expanded throughout the health system.

Congratulations to our resident informaticists whose efforts are seeking to get to the heart of the matter, as it relates to improving quality and safety.

Catherine A. Sarkisian, MD Named a UCLA Health All Star at Dodger Stadium

Last Friday, if you were watching the Los Angeles Dodgers game, you may have noticed a familiar face at the pitching mound at Dodger Stadium. DoM faculty Catherine A. Sarkisian, MD was recognized as a UCLA Health All Star and threw out the first pitch of the game! She set the Dodgers up for success as they won the game against the Houston Astros!

Dale

P.S.

Dr. Michael Jiang is a cardiology fellow who was one of two recipients of the Outstanding Teaching by a Fellow Award at this year’s internal medicine residency graduation. I show this picture to make the case that Mike shares my good taste in neckties.

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