Digital Commons Network^™

Transformative Integration: Navigating Opportunities And Challenges In A Medical School's Evolution Into Integrated Service Units, Chelsea Chang, Everardo Cobos, Michael Sander, Beatriz Tapia, Michael Hocker

School of Medicine Publications

Medical schools must evolve with the changing healthcare landscape and financial pressures. Academic Health Centers have responded to these changes with a novel organizational model known as an integrated service line. Traditional medical school departments often create silos, lack of alignment, and financial burdens. To our knowledge, we were the first medical school to implement an integrated structure combining the tripartite missions of academics, research, and clinical services.

The University of Texas Rio Grande Valley School of Medicine accepted its charter class of 55 medical students in 2016 with a traditional medical school department model. By 2023, it had 154 …

Making Training Stick: Transferring Learning Back To The Job, Amanda Woods Herron, Phoebe Hessen, Katelyn J. Cavanaugh, Wykesha C. Hayes, Victor Hassid, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

Communication remains a central priority in healthcare, making it a key component of many training efforts. The positive impacts of communication training in healthcare settings have been well-established; however, the linkage of communication training to key organizational outcomes (e.g., engagement, performance, retention) remains underexplored. The present study investigated a training program targeting interpersonal communication within a large academic oncology center. We drew from Cognitive Load Theory and Social Cognitive Theory to evaluate the impact of the training on participant learning (retention and utilization), transfer (communication, decision-making, performance), and results-level outcomes (engagement and turnover). The program centered around a personality framework …

Improving Oral Hygiene Practices In A Long-Term Care Setting For Individuals With Advanced Dementia: A Quality Improvement Initiative, Rachel L. Mcinerney

Capstone Experience: Master of Public Health

This quality improvement project utilized the Plan-Do-Study-Act framework to enhance oral hygiene practices in a long-term care setting for individuals with advanced dementia. Advanced dementia often leads to significant oral health challenges due to the individuals’ inability to communicate needs or independently manage oral care. Poor oral hygiene results in pain, systemic infections, and reduced quality of life. The project aimed to identify and address barriers to effective oral care delivery by focusing on organizational factors such as leadership, training, and caregiver support. This capstone paper provides insights into the quality improvement initiative’s aims, background, and methodology, while emphasizing its …

Evaluating The Nebraska Medical Center's Repatriation Of Inter-Hospital Transfers, Natalie Crump

Capstone Experience: Master of Public Health

Background: Bed capacity challenges at large academic medical centers delay the transfer of rural patients, negatively impacting their safety and quality of care. Repatriating inter-hospital transfer (IHT) patients to referral facilities upon completing specialized care can improve tertiary hospital bed capacity and community hospital financial sustainability.

Objectives: This project aims to identify the barriers and facilitators to successful IHT repatriation and the process and outcome variables influenced by the Nebraska Medical Center’s reverse transfer program.

Study Design: A retrospective observational cohort study was conducted to identify barriers and facilitators of NM’s IHT repatriation program.

Methods: Descriptive and comparative analyses of …

Implementation Of Houdini Guidelines Nurse-Driven Protocol To Lower Catheter-Associated Urinary Tract Infections And Foley Utilization Days, Tammie N. Collins

Electronic Theses and Dissertations

Catheter-associated urinary tract infections are a common issue in healthcare settings. These issues contribute to hospital-acquired infections and can lead to complications and increased healthcare costs. The quality project evaluated the impact of the HOUDINI guidelines nursedriven protocol to reduce infection rates and Foley utilization days. A structured guideline for Foley catheter safe removal was implemented using a quantitative method. Catheter-associated urinary tract infection rates and Foley utilization days pre- and postintervention were tracked. Data were collected using the electronic health records, infection control data sheets, and the HOUDINI checklists. A baseline assessment of catheter-associated urinary tract infections rates was …

A Qualitative Study: Patients' Expectation Of Private Hospitals, Sarah Jada, Jessy Jacob, Ahmad Nasrallah

Patient Experience Journal

Objectives: This study was conducted to explore patients' expectations and perceptions of private healthcare facilities, understand the key factors influencing their choice of such facilities, also identify elements that enhance patient satisfaction and loyalty, enabling the development of actionable recommendations to improve patient-centered care in private healthcare settings. Method: A qualitative study using thematic analysis was conducted with 29 patients from various nationalities and backgrounds who received services in private hospitals in Kuwait, including Dar Al Shifa Hospital. Insights were gathered through semi-structured interviews. Results: The study delved into the significant correlation between patients' experience of their healthcare encounters and …

Burnout In The Emergency Room: Corrective Measures Vs. The Absence Of Solutions, Zane Walters, Zachary Woodall

Theses, Dissertations and Capstones

Introduction: Physician burnout has become an increasingly prevalent and critical issue in healthcare systems worldwide, particularly among emergency room physicians who face high-stress, high-demand working conditions. Burnout manifests as emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, leading to negative outcomes for physicians’ mental health, job satisfaction, and overall career longevity. This phenomenon not only threatens the well-being of physicians but also compromises patient care quality and contributes to costly turnover within healthcare organizations.

Purpose of the Study: The aim of this study was to systematically investigate the impact of burnout interventions on emergency room physicians. …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Readiness To The Privatization Of The Health System In Saudi Arabia: Translation And Factor Analysis Of Readiness To Organizational Change (Roc) Scale, Ahmed Ali Alasiri, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

The Kingdom of Saudi Arabia (KSA) began a major transformation as a part of version 2030 for its health system. These reform initiatives aim to privatize health services and improve efficiency. Despite this meaningful change, there is a knowledge gap in how healthcare providers prepare for or perceive this shift. Specifically, there has been a lack of validation of Arabic instruments that gauge the individual readiness to this change. This study bridges the gap by localizing and validating the Readiness to Organizational Change scale (ROC) to provide empirical evidence and to understand adaptability for the KSA context.

Method

The …

Understanding The Challenges And Satisfaction Among The Medical Professional Preceptors, Cornelia Ko

West Chester University Doctoral Projects

This study evaluates the Penn Medicine Family Medicine Clerkship program through a mixed-methods approach, exploring the challenges and factors influencing the satisfaction of medical professional preceptors when precepting students. A quantitative survey with 54 preceptor participants reveals the top challenges preceptors face: workload, conflicts with patient care, and limited clinical space. Despite this, there is strong support for the program, with 89% of preceptors enjoying the role and 85% expressing willingness to continue to precept for the next three years. Finally, data analysis shows no statistical correlation between preceptor motivation with gender, ethnicity, age group, years of serving, or total …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Closing Racial And Ethnic Disparity Gaps In Pediatric Asthma Follow Up Care - A Quality Improvement Initiative, Ayodele Ayeko

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Closing racial and ethnic disparity gaps in pediatric asthma follow up care - A quality improvement initiative

Ayodele Ayeko

Introduction/Background: Inadequate management of asthma significantly contributes to poor asthma control, poor quality of life (QOL), and high hospitalization rates among pediatric patients. The Global Initiative for Asthma (GINA) guidelines offer recommendations designed to enhance asthma control and improve the quality of life for those affected (2015), including recommendations for close follow up care. At WVU Medicine Children’s Hospital (WVUMCH), insufficient asthma control has been associated with lower clinic follow-up rates and an increase in hospitalization. Although educational initiatives …

Evaluating The Effect Of A Mindfulness App On Pediatric Nurses Caring For Adolescent Patients Diagnosed With Disordered Eating, Kaitlyn Green

DNP Projects

Abstract

Background. The health and wellbeing of nurses are affected by the demands of their workplace and the people that they care for. In turn, nurses’ wellbeing affects their work and patient outcomes. There are opportunities to address certain workplace structures, systems, and policies that create stressors and lead to burnout, fatigue, and poor mental and physical health. For nurses to continue to provide quality care in environments that have increasing demands, they must first feel healthy, well, and supported themselves. Healthcare leaders have a role in ensuring the wellbeing of their nursing staff. Compassion fatigue is a large focus …

Priorities To Care Within The Military Health System: A Mixed Methods Study On Military Spouse Access To Care During Covid-19 On Okinawa, Elayne L. Wilson

Theses & Dissertations

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore …

Improving Anesthesia Technician Workflow: Implementation Of A Standardized Checklist And Formal Handoff Communication Tool To Enhance Management Of The Pediatric Portable Anesthesia Lockers Recommendation, Megan Shayna Sosnick Msel, Rn

Master's Projects and Capstones

Objective: The surgical department of a well-known Bay Area medical center faces substantial challenges in supply management. These challenges include inconsistent stocking, disorganized storage, and an inefficient ordering process. These logistical issues impact patient care negatively, increase supply costs, and weaken team morale and communication. U.S. hospitals spend $83 billion annually on medical supplies, with $25.4 billion wasted on preventable material expenses (Balkhi et al., 2022). Aim and Methods: This quality improvement project aims to train 80% of anesthesia technicians in proper stocking procedures for portable pediatric anesthesia lockers within three months. Interventions include the implementation of a standardized …

Evaluating The Perceived Benefits Of Education In Revenue Cycle Management And The Impact On Medical Claims Reimbursement, Jessica L. Miller

Student Dissertations

Efficient Revenue Cycle Management (RCM) is essential for healthcare organizations to ensure timely and accurate reimbursement for medical claims. The research problem was the significant inadequacies in RCM process in medical billing that has resulted in financial burdens imposed on providers, patients, and the organizations that provide medical services. There are clearly identified educational gaps in RCM that contribute to claim denials, delays, and revenue loss, underscoring the need for robust training programs. The purpose of this study was to explore the perceived impact of education in RCM on medical claim reimbursement outcomes within the U.S. healthcare system. The study …

Enhancing Emergency Department Efficiency: Utilization Of Streamlined Triage System To Reduce Waiting Times, Sunah Kim

Student Scholarly Projects

Emergency departments (EDs) often experience prolonged waiting times, leading to patient dissatisfaction and potential negative health outcomes. This project addresses the need for improved triage processes to enhance patient flow and reduce delays in care.

PICOT

In adult patients presenting to the emergency department (P), how does the implementation of a streamlined triage process (I) compared to standard emergency department protocols (C) lead to a reduction in waiting times (O) within a twelve-week period (T)?

Evidence

A review of current literature indicated that streamlined triage systems can significantly decrease patient wait times and improve overall ED efficiency by incorporating colors …

Transitions Of Care And The Prevention Of Readmissions, Beatriz Granado

Student Scholarly Projects

Unplanned hospital readmissions often result from poor discharge planning and challenges during the transition from hospital to home, including medication errors and weak communication with primary care providers. A well-organized and personalized discharge plan can significantly reduce hospital stays, lower readmission rates, minimize medication errors, and improve patient outcomes, all while decreasing healthcare costs. In post-discharge Medicare-eligible patients (P), how does transitional care coordination through organized, personalized, and patient-focused discharge planning (I), compared with standard or no transitional care coordination provided (C), affect readmissions (O) within the 30-day post-discharge phase monitored over a 10–12-week period (T)? A search was conducted …

The Future Of Nursing Leadership: Incorporating E-Learned Artificial Intelligence (Ai) Pathways With A Precautionary Focus On Patient-Centered-Care, Jamie Anne Marcus Dr., Bonnette Villalba Webb

FDLA Journal

Artificial Intelligence (AI) is a data-driven mathematical process that incorporates machine-based-logic, usually in the form of algorithms. Education, training, and competencies are now conducted through virtual reality, robotics, simulation, and technology learning-based-platforms by healthcare organizations. This represents a significant change in the future of nursing practice. The adaptability of technology-based-learning platforms can impact the quality and efficiency of learning for some of the workforce population. Nurses' perception of technology and AI-driven nursing practice may vary based on generational orientation and can be a potential barrier to learning, practicing, and adaptability of this framework. The forging of well-trained resilient nurse leaders …

Leadership In Extreme Contexts: An Emerging Typology, Ashley Williams

Electronic Theses and Dissertations

This study investigates the relationship between leadership and extreme contexts through the lens of rural hospitals facing environmental jolts. Rural hospitals offer a unique setting for this research, given their inherent geographic isolation, lack of resources, and the critical role these facilities play in their communities. Through a qualitative analysis of interviews with Chief Executive Officers of rural hospitals, this research takes a grounded approach to build theory surrounding how leadership not only shapes but is shaped by extreme contexts and environmental jolts. The research results in four primary contributions. Namely, this study extends existing typologies on leadership in extreme …

The Impact Of Electronic Health Record Unintended Consequences On Quality Of Care Within A High Complexity Healthcare Organization, Joetta Powell

ATU Theses and Dissertations 2021 - Present

“Unintended consequences are unexpected, and unwanted outcomes that can limit the value of EHR implementation and adversely affect quality of care and patient safety” (Lee & Kang, 2021, p. 898). Few organizations have redesigned the EHR to improve usability to mitigate potential patient safety concerns. This study aims to identify unintended consequences in patient care workflows and determine educational needs related to EHR usability. A mixed method approach was used to investigate unintended consequences in deidentified patient safety reports submitted Jan 1, 2020, through December 31, 2023. The data was analyzed to identify error types and educational deficits. The Acute …

An Examination Of Cardio-Vascular Patients’ Experiences In A Rural Food Prescription Program, Julia Hansen

Honors Theses

The burden of diet-related chronic diseases in rural communities has prompted the implementation of food prescription programs in rural areas to investigate the impact of more affordable and accessible fresh produce on these vulnerable populations. Because there is little research on the impact of food prescription programs on cardiovascular patients in rural areas, this study will focus on how food prescription programs can benefit this at-risk population. Another goal of this study is to receive feedback from participants to improve food prescription programs to better suit cardiovascular participant needs. To accomplish these goals, a series of questions were asked to …

Healthcare Team Members’ Views On Social Determinants Of Health Screening And Referral Practices In A Pediatric Emergency Department, Jadelynn Nagy, Natalie J. Tedford, Sahlil Ahmed, Sofia Thoms, Akiko Kamimura, Maija Holsti

Patient Experience Journal

We aimed to explore the healthcare team members’ (HTMs) views on social determinants of health (SDH) screening and referral processes in a pediatric emergency department (PED). We conducted a cross-sectional, mixed-methods study to explore PED HTMs’ views on social care practices at a quaternary-level children’s hospital. The survey was created using a goal identification framework. The survey gathered quantitative and qualitative data by assessing SDH screening practices, comfort and personal habits in screening, prioritization of SDH domains, workflows to perform screening, and perceived barriers to screening. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis …

Adaptive Leadership: Nurse Executives Building Organizational Adaptive Capacity During Times Of Crisis, Challenge, And Change, Kristian Poitier

Dissertations

Purpose: The purpose of this exploratory phenomenological study was to identify and describe the strategies used by nurse executives in acute care hospitals to build an adaptive capacity based on the five key characteristics of adaptive leadership identified by Heifetz et al. (2009).

Methodology: This qualitative phenomenological study identified and described the perceived impact of adaptive leadership on building an organization’s adaptive capacity as perceived by nurse executives in acute care hospitals, for-profit and not-for-profit, with the title of chief nursing officer (CNO) or chief nurse executive (CNE) in Southeast, West, and North Florida. The researcher was part of a …

The Impact Of Covid-19 On The Utilization Of Early Magnetic Resonance Imaging (Emri) In The Assessment Of Acute Uncomplicated Low Back Pain (Lbp) And The Subsequent Effect On Health Care Service Utilization And Patient Outcomes, Kimberly F. Radcliffe

MUSC Theses and Dissertations

OBJECTIVES: To examine changes in MRI rates between Pre-COVID-19 period (Feb-April 2019) and COVID-19 period (Feb-April 2020) among commercially insured patients aged 18-60 with a diagnosis of acute LBP, and to analyze differences in patient characteristics and outcomes between the time periods. Additionally, to examine the impact of eMRI on patient outcomes and health care costs for patients in the COVID-19 period.

DESIGN/METHODS: Using IBM® MarketScan® Commercial Database (MarketScan) we performed a quantitative pre-post comparative retrospective observational study of 117,150 total patients to examine adjusted differences in patient characteristics and rates of MRIs between time periods. We analyzed 49,020 patients …

Quality Improvement In Healthcare: A Practical Guide For Providers (Part 3), Jeremy Ellis

Transformative Medicine

No abstract provided.

Efficiency In Hr: Lean Management With E-Sep And Auto Closing System In Pasar Minggu Hospital, Melanie Husna, Prima Syahputra

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The study focuses on enhancing efficiency in outpatient transactions at Pasar Minggu Hospital, which, in 2019, experienced a high volume of visits primarily covered by national health insurance. With 299,041 outpatient visits using national health insurance that year, the hospital's transition to a COVID-19 referral facility in 2020 underscored the urgency of streamlining operations. Presently, outpatient transactions are manually closed by three staff members, led by the financial administrator, who handles Participant Eligibility Letter files, resolves transaction issues, and finalizes services. Given the imperative for digitization accelerated by the pandemic, the study adopts lean thinking, employing a value stream map …

On The Brink: Unveiling The Crisis Of Burnout Among Va Clinic Physicians, Aaron Clarke

Theses, Dissertations and Capstones

Introduction: This study investigates the significant challenge of burnout among physicians at Veterans Affairs (VA) clinics. Characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, physician burnout is a growing concern that compromises the well-being of the doctors and the quality of healthcare they provide. Recent studies have shown an alarming increase in burnout symptoms among healthcare providers, reflecting systemic issues that adversely affect patient care and the operational efficacy of healthcare institutions.

Purpose of the Study: The research aimed to dissect the intricate effects of physician burnout on medical outcomes within the VA healthcare system’s outpatient settings. …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …