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Enhancing care transitions: Improving the planned chemotherapy admission process [Meeting Abstract]

Jasinski, S; Roman, E
Background: The direct admissions process is an intricate patient care model that is affected by gaps in communication as well as unforeseen deviations that have the potential to negatively impact patient safety as well as decrease patient/family and provider satisfaction. This is especially true when dealing with a high-risk pediatric oncology population. In order to optimize this aspect of transition of care, we sought to establish and sustain a system to restructure our workflow for planned inpatient chemotherapy admissions.
Objective(s): Our smart aim was to streamline the admission process to decrease the rate of unplanned chemotherapy admissions from the pre-intervention baseline of 32.5% to 15% within 3 months. This was based on our global aim of improving logistics as well as stakeholder satisfaction with the planned admissions process for scheduled chemotherapy. Design/Method: Key stakeholders in the process were administered brief 5 question surveys to identify the key drivers in the current planned admissions process. Using Plan-Do-Study-Act (PDSA) quality improvement methodology, we identified areas of potential intervention. Our first PDSA cycle included education on the planned admission process, discussion of planned admissions at our weekly, multidisciplinary, divisional sign-out meeting and implementation of a calendar to document admissions in advance along with the chemotherapy to be administered. This new workflow replaced our previous emailbased admission notification system. A short survey was again administered at the end of the PDSA cycle to assess stakeholder satisfaction and identify other areas for improvement.
Result(s): Within the last 3 months, our rate of unplanned admissions has decreased below our anticipated goal to a level of 8%. Analyzing the post-intervention surveys, providers were satisfied with the new workflow, but still noted deficiencies in the multidisciplinary communication when pertaining to admitting patients. While this rate will likely never decline down to zero due to the constant presence of unforeseen clinical circumstances and changes in patients' status, we hypothesize that a lower rate of unexpected events will improve patient safety and satisfaction.
Conclusion(s): We hope to be able to continue this reduction of unplanned admissions through maintaining this standardized process. Future PDSA cycles will focus on improving communication about admissions and the establishment of a standardized admission checklist
ISSN: 1545-5017
CID: 4805652

Implementation of a Safety Bundle to Prevent Venous Thromboembolism as a Hospital Acquired Condition [Meeting Abstract]

Sherani, Farha; Nunn, Catherine; Roman, Elizabeth
ISSN: 1545-5017
CID: 2545052

Splice site mutation in factor X gene manifesting as severe intracranial haemorrhage in neonatal period with a challenging treatment course [Letter]

Madhusoodhan, P P; Lu, B Y; Chen, J; Jones, C L; Meyer, J A; Roman, E A; Nardi, M; Carroll, W L; Bhatla, T
PMID: 27995737
ISSN: 1365-2516
CID: 2374292

Transfusion Therapy for Coagulation Factor Deficiencies

Chapter by: Roman, E; Larson, PJ; Manno, CS
in: Hematology : Basic Principles and Practice by
[S.l.] : Elseiver, 2017
pp. 1769-1780.e3
ISBN: 9781455740413
CID: 3527762

Bilateral parotid gland enlargement and palpable nephromegaly in infant acute lymphoblastic leukemia: case report and review of the literature

Saha, Aniket; Dandekar, Smita; Milla, Sarah; Roman, Elizabeth; Bhatla, Teena
Acute lymphoblastic leukemia (ALL) in infants below 1 year of age accounts for 2.5% to 5% of childhood ALL. Most children with ALL present with fever, bruising, mucosal bleeding, bone pain, pallor, hepatosplenomegaly, and lymphadenopathy. Common sites of extramedullary involvement at diagnosis include liver, spleen, lymph nodes, brain, and testes. Nephromegaly has also been reported. We present a novel case of bilateral parotid enlargement along with bilateral palpable nephromegaly in a patient with newly diagnosed infant ALL. This unique presentation highlights the importance of considering ALL in the differential diagnosis of parotid enlargement especially when associated with abnormal blood counts.
PMID: 24309613
ISSN: 1077-4114
CID: 969862

An unusual case of donor-derived myelodysplastic syndrome following double-unit umbilical cord blood transplantation in acute lymphoblastic leukemia [Letter]

Cotter, Ryan; Najfeld, Vesna; Isola, Luis; Del Toro, Gustavo; Roman, Elizabeth; Petersen, Bruce; Mascarenhas, John
PMID: 22730059
ISSN: 0361-8609
CID: 178317

Autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura in pediatric solid organ transplant recipients, report of five cases and review of the literature

Miloh, Tamir; Arnon, Ronen; Roman, Elizabeth; Hurlet, Anne; Kerkar, Nanda; Wistinghausen, Birte
Miloh T, Arnon R, Roman E, Hurlet A, Kerkar N, Wistinghausen B. Autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura in pediatric solid organ transplant recipients, report of five cases and review of the literature. Pediatr Transplantation 2011: 15: 870-878. (c) 2011 John Wiley & Sons A/S. Abstract: Cytopenias are common among pediatric SOT; however, autoimmune cytopenias are infrequently reported. We report five cases of autoimmune cytopenias in pediatric LT patients: two with isolated IgG-mediated AIHA, two with ITP, and one with Evans syndrome (ITP and AIHA). All patients were maintained on tacrolimus as immunosuppression. Viral illness commonly preceded the autoimmune cytopenias. All patients responded well to medical therapy (steroids, intravenous immunoglobulin, and rituximab) and lowering tacrolimus serum level. Prognosis appears to be worse when more than one cell line (e.g., Evans syndrome) is affected, and/or there is no preceding viral illness. A critical literature review of autoimmune cytopenias in children following SOT is conducted. Autoimmune cytopenias are a rarely reported complication of pediatric SOT, but clinicians taking care of pediatric transplant recipients need to be aware of this complication
PMID: 22112003
ISSN: 1399-3046
CID: 143868

The administration of general anesthesia to a patient with croup [Case Report]

Man, Gabriel; Roman, Elizabeth; Neustein, Steven M
Croup in a young child may lead to severe airway narrowing, and would present a severe risk for administration of anesthesia. To the best of our knowledge, there have been no previous case reports of patients undergoing general anesthesia with croup. In our report, we describe a case of a 31 month old child with croup who required anesthesia.
PMID: 22435283
ISSN: 0544-0440
CID: 2555592

Rhizomucor variabilis var. regularior and Hormographiella aspergillata infections in a leukemic bone marrow transplant recipient with refractory neutropenia

Abuali, Mayssa M; Posada, Roberto; Del Toro, Gustavo; Roman, Elizabeth; Ramani, Rama; Chaturvedi, Sudha; Chaturvedi, Vishnu; LaBombardi, Vincent J
Rhizomucor variabilis and Hormographiella aspergillata rarely cause human infections. This report details a fatal case of a 14-year-old female with leukemia posthematopoietic cell transplant and relapse with refractory pancytopenia. The patient first developed an R. variabilis var. regularior palate infection and later developed a cutaneous H. aspergillata infection while on posaconazole and caspofungin therapy
PMID: 19846651
ISSN: 1098-660x
CID: 120837

Sequential administration of sargramostim and filgrastim in pediatric allogeneic stem cell transplantation recipients undergoing myeloablative conditioning

Waxman, Ian M; Militano, Olga; Baldinger, Leah; Roman, Elizabeth; Qualter, Erin; Morris, Erin; Garvin, James; Bradley, Mary Brigid; Bhatia, Monica; Satwani, Prakash; George, Diane; Del Toro, Gustavo; Hawks, Ria; Wolownik, Karen; Foley, Sandra; Cheung, Ying-Kuen; Schwartz, Joseph; van de Ven, Carmella; Baxter-Lowe, Lee Ann; Cairo, Mitchell S
G-CSF and GM-CSF both hasten myeloid engraftment post-MA-alloSCT; however, GM-CSF is earlier acting and less expensive. The objective was to evaluate efficacy/safety of sequential administration of GM-CSF followed by G-CSF in children post-MA-alloSCT. From January 2001 to June 2005, 31 children received 32 MA-alloSCT: mean age 6.65 yr; MRD BM or PBSC vs. related or unrelated UCB 11:21; malignant vs. non-malignant disorders 22:10. GM-CSF (250 microg/m(2) IV QD) began on day of stem cell infusion. GM-CSF was switched to G-CSF (10 microg/kg IV QD) when WBC >or= 300/mm(3) x 2 days. G-CSF continued until ANC >or= 2500/mm(3) x 2 days, then tapered to maintain ANC >or= 1000/mm(3). Median time to myeloid engraftment (ANC >or= 500/mm(3) x 3 days) was 17 days [13 days vs. 24 days, MRD BM/PBSC vs. UCB (p < 0.0001)], occurring at a median time of two days after switch to G-CSF. Clinically relevant adverse events were bone pain (n = 8) and large pleural effusion (n = 1). It was estimated that sequential GM-CSF/G-CSF was cost-effective compared with G-CSF alone [cost-savings of $1311/patient ($41,952/study), 2007 Red Book Average Wholesale Price]. In summary, it was demonstrated that sequential administration of GM-CSF/G-CSF post-MA-alloSCT was safe, cost-effective and resulted in prompt myeloid engraftment
PMID: 18785912
ISSN: 1399-3046
CID: 120838