Publications by authors named "Terrell S Caffery"

7 Publications

  • Page 1 of 1

Development and validation of a cellular host response test as an early diagnostic for sepsis.

PLoS One 2021 15;16(4):e0246980. Epub 2021 Apr 15.

Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America.

Sepsis must be diagnosed quickly to avoid morbidity and mortality. However, the clinical manifestations of sepsis are highly variable and emergency department (ED) clinicians often must make rapid, impactful decisions before laboratory results are known. We previously developed a technique that allows the measurement of the biophysical properties of white blood cells as they are stretched through a microfluidic channel. In this study we describe and validate the resultant output as a model and score-the IntelliSep Index (ISI)-that aids in the diagnosis of sepsis in patients with suspected or confirmed infection from a single blood draw performed at the time of ED presentation. By applying this technique to a high acuity cohort with a 23.5% sepsis incidence (n = 307), we defined specific metrics-the aspect ratio and visco-elastic inertial response-that are more sensitive than cell size or cell count in predicting disease severity. The final model was trained and cross-validated on the high acuity cohort, and the performance and generalizability of the model was evaluated on a separate low acuity cohort with a 6.4% sepsis incidence (n = 94) and healthy donors (n = 72). For easier clinical interpretation, the ISI is divided into three interpretation bands of Green, Yellow, and Red that correspond to increasing disease severity. The ISI agreed with the diagnosis established by retrospective physician adjudication, and accurately identified subjects with severe illness as measured by SOFA, APACHE-II, hospital-free days, and intensive care unit admission. Measured using routinely collected blood samples, with a short run-time and no requirement for patient or laboratory information, the ISI is well suited to aid ED clinicians in rapidly diagnosing sepsis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246980PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049231PMC
April 2021

Improving Patient Safety Communication in Residency Programs by Incorporating Patient Safety Discussions Into Rounds.

Ochsner J 2017 ;17(3):273-276

Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.

Background: Engaging residents in patient safety and quality improvement initiatives is sometimes difficult. The primary goal of the current study was to develop a standardized learning experience designed to facilitate patient safety discussions during rounds.

Methods: Residents who were on inpatient rotations during a 2-month period in 2014 were exposed to patient safety discussions on rounds. Residents who were not on inpatient rotations served as a control group. Faculty received weekly text reminders with 3 questions designed to engage residents in patient safety discussions. Before and after the intervention, residents were asked to complete a modified Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. Faculty members were asked to complete a brief survey designed by the study investigators.

Results: Of the 160 residents who participated in the study, 49 responded to both the preintervention and postintervention surveys (31%). Residents who participated in patient safety discussions during rounds reported higher frequencies of safety events reported compared to the control group (<0.05). Both groups of residents reported better communication (<0.01) and an increased number of safety events reported (<0.01) at the end of the intervention. Twenty-two faculty were surveyed, and 19 responded (86%). Most faculty felt incorporating patient safety discussions on rounds was constructive and that the residents were responsive. Few faculty members felt the patient safety discussions were burdensome.

Conclusion: Using weekly text reminders with 3 prompts to incorporate patient safety discussions into rounds was well received by faculty and residents and had an impact on communication and error reporting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625988PMC
January 2017

Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement.

J Patient Saf 2017 Oct 4. Epub 2017 Oct 4.

From the *Internal Medicine Residency Program-Baton Rouge Campus, Louisiana State University Health Sciences Center School of Medicine in New Orleans; †Department of Quality and Safety, Our Lady of the Lake Regional Medical Center, Baton Rouge; ‡Internal Medicine, Tulane School of Medicine, New Orleans; §Emergency Medicine Residency Program-Baton Rouge Campus, ∥Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana State University Health Sciences Center School of Medicine in New Orleans; ¶Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington; and **Family Medicine, Louisiana State University Health Sciences Center, School of Medicine in New Orleans, New Orleans, Louisiana, Baton Rouge, Louisiana.

Objective: We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access.

Methods: Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course.

Results: Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02).

Conclusions: Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.
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http://dx.doi.org/10.1097/PTS.0000000000000425DOI Listing
October 2017

Graduate Medical Education as a Lever for Collaborative Change: One Institution's Experience with a Campuswide Patient Safety Initiative.

Ochsner J 2016 ;16(1):81-4

Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.

Background: The 2013 closure of a public hospital in Baton Rouge, LA transformed graduate medical education (GME) at Our Lady of the Lake Regional Medical Center (OLOL). Administrators were tasked with incorporating residents into patient safety and quality improvement initiatives to fulfill regulatory obligations. This report outlines our experiences as we built these patient safety and quality improvement initiatives in a rapidly expanding independent academic medical center.

Methods: We joined the Alliance of Independent Academic Medical Centers (AIAMC) to meet and learn from national peers. To fulfill the scholarly activity requirement of the AIAMC's National Initiative IV, we formed a multidisciplinary team to develop a patient safety education project. Prioritized monthly team meetings allowed for project successes to be celebrated and circulated within the organization.

Results: The public-private partnership that more than quadrupled the historic size of GME at OLOL has, in the past 2 years, led to the development of an interdisciplinary team. This team has expanded to accommodate residency program leadership from across the campus. Our National Initiative IV project won a national award and inspired several follow-up initiatives. In addition, this work led to the formation of a Patient Safety and Clinical Quality Improvement fellowship that matched its first fellow in 2015.

Conclusion: Through the commitment and support of hospital and medical education leaders, as well as a focus on promoting cultural change through scholarly activity, we were able to greatly expand patient safety and quality improvement efforts in our institution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795510PMC
April 2016

Questions regarding the utility of the 30-degree test in measuring optic nerve sheath diameters in ED patients.

Am J Emerg Med 2015 Apr 31;33(4):595-6. Epub 2015 Jan 31.

Emergency Medicine Residency Program, LSU Health-Baton Rouge, Baton Rouge, LA 70808. Electronic address:

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http://dx.doi.org/10.1016/j.ajem.2015.01.039DOI Listing
April 2015

Smartphones in medicine: emerging practices in an academic medical center.

J Med Syst 2015 Jan 2;39(1):164. Epub 2014 Dec 2.

Louisiana State University School of Medicine New Orleans, Baton Rouge, LA, USA.

Advances in mobile phone technology now provide a myriad of resources to physicians' fingertips. However, the medical profession continues to struggle with potential for misuse of these devices. There is a need for better understanding of physicians' uses of smartphones in order to establish guidelines for appropriate and professional behavior. The purpose of the current study was to survey physicians' and medical students' practices concerning smartphone use in the healthcare setting. Physicians and medical students were asked to complete anonymous surveys regarding uses of smartphones within the past month in various healthcare settings. Overall, the participants reported distinctly different patterns in the uses they made of their phones in different settings (P<.001), with most individuals engaging in most behaviors while on break but few using their smartphones while with patients or during procedures. It appears that physicians and medical students make decisions about using their smartphones according to some combination of three considerations: degree of relevance to patient care, the appropriateness of the behavior in front of patients, and the issue of how disruptive that behavior may be.
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http://dx.doi.org/10.1007/s10916-014-0164-4DOI Listing
January 2015

Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure.

Am J Emerg Med 2014 Dec 18;32(12):1513-5. Epub 2014 Sep 18.

Emergency Medicine Residency Program, LSU Health-Baton Rouge, 5246 Brittany Drive, Baton Rouge, LA 70808. Electronic address:

Objective: The purpose of this study was to determine if patients with nontraumatic causes of elevated intracranial pressure (ICP) could be identified by ultrasound measurement of optic nerve sheath diameter (ONSD). It was hypothesized that an ONSD greater than or equal to 5 mm would identify patients with elevated ICP.

Method: This was a prospective observational trial comparing ONSD with ICP measured by opening pressure manometry on lumbar puncture (LP). The cohort consisted of a convenience sample of adult patients presenting to the emergency department, requiring LP. The ONSD measurement was performed before computed tomography and LP. The physician performing the LP was blinded to the result of the ONSD measurement. An opening pressure on manometry of greater than or equal to 20 cm H2O and an ONSD greater than or equal to 5 mm were considered elevated.

Results: Fifty-one patients were included in our study, 24 (47%) with ICP greater than or equal to 20 cm H2O and 27 (53%) with ICP less than 20 cm H2O. The sensitivity of ONSD greater than or equal to 5 for identifying elevated ICP was 75% (95% confidence interval, 53%-90%) with specificity of 44% (25%-65%). The area under the receiver operator characteristic curve was 0.69 (0.54-0.84), suggesting a relationship between ONSD and ICP.

Conclusion: An ONSD greater than or equal to 5 mm was associated with elevated ICP in nontraumatic causes of elevated ICP. Although a relationship exists, a sensitivity of 75% does not make ONSD measurement an adequate screening examination for elevated ICP in this patient population.
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http://dx.doi.org/10.1016/j.ajem.2014.09.014DOI Listing
December 2014