1. Veteran Satisfaction With Video-
Based Telemedicine for Pre-Transplant
Hassler M, Ellis D, Hicks R, Chester H
Purpose: The primary purpose of this quality improvement
project was to measure and subsequently improve patient satisfaction with video-based telemedicine (VBT).
Background: Since April 1, 2015, the majority of stem cell
transplant patients referred to the Tennessee Valley Healthcare
System from throughout the United States were evaluated
using VBT. Reduction in time to evaluation and overall cost
savings have been well documented. However, we have never
evaluated patient satisfaction with the VBT process.
Methods: We conducted a retrospective record review and determined that (n = 31) patients were evaluated during FY 2016. We found that (n = 16) patients
were deceased, and (n = 4) patients were critically ill and
unable to complete the survey. We developed and mailed
a 12 question anonymous survey, to the remaining
(n = 111). Veterans evaluated using VBT during the selected time frame. Questions were framed with a standard Likert scale from 1-4, with 4 being excellent and
1 being poor. We considered a score greater than 3.5 to translate to a high level of satisfaction. A ranking of less than 2.5
was equated with low satisfaction. Surveys were mailed to the
patient’s address as listed in CPRS on March 6, 2017 and collected through April 10, 2017. We collected demographic and
disease data on all patients surveyed.
Data Analysis: There was a 62.1% response rate (n = 69) in
terms of surveys returned within the specified time frame. We
tabulated average patient satisfaction data based on numeric
responses to each question. We calculated demographic data
including age, sex, disease, mileage from the patient’s VA
to transplant center.
Results: Overall rating of care during the VBT evaluation was
very good at 92.5% (3.7) with no category rated less than 3.4
(85%). Average age of the patient in the sample was 61.45
years, predominately male (n = 106), most prevalent disease
was multiple myeloma (n = 53) average distance from transplant center; 559 miles. Total round-trip mileage saved by
VBT 124,278 miles.
Conclusions: Patients have a high degree of satisfaction with
VBT in the pre transplant evaluation setting.
2. Characterization of Hematology
Consults for Complete Blood Count
Abnormalities: A Single Center
Experience in the Era of Electronic
Barth P, Freeman N, Faricy-Anderson K
Purpose: As patient volumes and complexity of hematology
care increase, subspecialty provider efficiency is of utmost importance. We aim to improve efficiency by characterizing the
nature and outcome of common hematology e-consults.
Background: Veterans Affairs Medical Centers pioneered
electronic subspecialty consultation with the initiation of the
e-consult system in 2011. An increase in number of hematology consultations at one VAMC from 391 in 2010 to 704 after
e-consult implementation in 2013 was described by Cecchini
et al (Blood, 2016).
Methods: A retrospective review of all hematology and oncology consults at one institution between April 1, 2016 and
December 8, 2016 was performed. Cell counts, prior workup,
diagnoses offered, age and comorbidities were determined for
consults about complete blood count (CBC) abnormalities.
Results: 523 hematology/oncology consults were reviewed:
169 questioned CBC abnormalities, 76 consults were for anemia, and 38 consults were for thrombocytopenia. The most
common diagnosis was iron-deficiency anemia (21.1% anemia consults). The most common hemoglobin value for anemia consults was 9.0-9.9 g/dL (27.6% anemia consults). The
most common platelet count for thrombocytopenia consults
was 75k-100k (36.8% thrombocytopenia consults). Referring providers were significantly more likely to have initiated
workup for anemia than for thrombocytopenia consults (71%
vs 29%, P < .0001). Consulting hematologists were significantly more likely to offer a diagnosis if basic workup had already been initiated (68% vs 39%, P = .0025). Age ≥ 70 years
old had higher likelihood of 2-3 cell line abnormalities (RR
1.37, 95% CI, 1.02-1.82).
Conclusions: 169 consults about CBC abnormalities were reviewed. The most common reason for consult was anemia.
Referring providers were significantly more likely to initiate
a workup for anemia than for thrombocytopenia. There was a
significantly greater likelihood of consultants offering a diagnosis if a basic workup had already been initiated. Increased
education regarding mild anemia and basic workup of thrombocytopenia are areas of potential intervention to improve
likelihood of diagnosis on initial consult and improve efficiency of the electronic consultation process.
3. Recurrent Cisplatin Hypersensitivity
Reaction After First Exposure: A Case
Solomon BL, Colonna SV
Purpose: Hypersensitivity reactions to platinum-based
chemotherapies are well documented and are often a limiting factor in treating a variety of cancers. Allergy skin testing has been used to determine if repeat exposure is safe.
We report a case of a false negative skin allergy test in an
atypical presentation of cisplatin hypersensitivity reaction.
Case Report: A 64-year-old male diagnosed with stage IVa