Quality Improvement Commons^™

A Systematic Review Of Racial Disparities In Emergency Department Pain Evaluation And Treatment In The United States, Cyrus Wolff

Theses and Graduate Projects

Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.

Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps …

Development And Implementation Of A Digital Quality Measure Of Emergency Cancer Diagnosis, Paarth Kapadia, Andrew J Zimolzak, Divvy K Upadhyay, Saritha Korukonda, Riyaa Murugaesh Rekha, Umair Mushtaq, Usman Mir, Daniel R Murphy, Alexis Offner, Gary A Abel, Georgios Lyratzopoulos, Luke T A Mounce, Hardeep Singh

Faculty, Staff and Students Publications

PURPOSE: Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality.

METHODS: On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) …

Ekg Is Key: A Quality Improvement Project To Decrease Door-To-Ekg Time In A Rural Emergency Department, Amanda Southwell

Doctor of Nursing Practice Projects

Background: Electrocardiograms (EKGs) are the priority when evaluating patients with chest pain who present to the Emergency Department (ED). The American Heart Association and other governing bodies suggest a 10-minute door-to-EKG (DTE) time. The target facility displayed a delay in DTE times.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to decrease the average DTE time for patients over 18 years old with chest pain who presented to the ED registration area.

Methods: The DNP project consisted of an EKG suite to perform EKGs near the ED registration/triage area. Registration and ED staff were educated on …

Bilateral Corneal Perforations Due To Elder Neglect, Jaclyn Jordan, Katherine Selman, Richard Byrne

Journal of Geriatric Emergency Medicine

Introduction: Atraumatic corneal melting and perforation is a rare etiology of eye pain and visual loss in the Emergency Department (ED), and xerophthalmia from vitamin A deficiency is primarily described as a cause of blindness in pediatric patients.

Case: A 68-year-old female presented to the ED with worsening eye pain and months of clouding and vision loss. History was limited by cognitive impairment and was provided by spouse. On exam, she was found to have a body mass index of 13.7 kg/m², dry mucous membranes, purulent discharge from both eyes, and opacification and erosion of both corneas. She …

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Management Strategies For Traumatic Injuries In Pregnant Women: A Comprehensive Literature Review, Jaylyn D. Thompson, Jenna Zappetti, Clarence Julian Clark Ii

Rowan-Virtua Research Day

Introduction: Traumatic injuries in pregnant women are the leading cause of non-obstetric death and affect 6% to 8% of all pregnancies. Therefore, it is imperative to maintain updated guidelines to construct a framework for the optimal management strategies for traumatic injuries in pregnant women, considering the perspectives of obstetrics/gynecology, emergency medicine, and orthopedics.

Methods: To conduct this study, research was done via a database search through the Rowan-Virtua School of Osteopathic Medicine’s research library. PubMed was the sole database used to review 8 peer-reviewed sources. Articles that were published within the last 10 years were chosen.

Results: Every woman with …

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 …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

" Does Educational Level Affect The Outcome Of Myocardial Infarction? ", Ahmed Magdy Ahmed Elsayed

Theses and Dissertations

Background: Heath awareness plays a major role in determining the outcomes of serious medical conditions specially when response time is crucial. STEMI patients are prone to serious compilations if they didn’t receive the appropriate treatment on time. Raising the health awareness of the community would result in seeking medical help at earlier stage of the disease. Earlier presentation to the medical center would result in better health outcomes. Certain factors form the health awareness of the community. This includes educational level, previous exposure to similar situations, and exposure to health awareness materials.

Methods: This is a cohort study in …

The Interrai Ed Tool For Screening Older Patients In The Emergency Department: “What Am I Supposed To Do With This?”, Michael L. Malone

Journal of Geriatric Emergency Medicine

not applicable for Collective Wisdom/ Editorial per JGEM author guidelines.

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Boarding Of Older Adults: A Concerning Trend In The Emergency Department, Julie Van Baardwijk, Eric Tharmathurai, Ariba Khan

Journal of Geriatric Emergency Medicine

Emergency department (ED) boarding (EDB) is the practice of holding admitted patients in the ED due to a lack of hospital beds. We identified one ED in our health system with a high rate of EDB. We sought to identify factors associated with EDB in this hospital by comparing it to a similar hospital in our health care system.

Methods: We conducted a retrospective study comparing two community hospitals in our healthcare system. Boarding was defined as a patient waiting ≥8 hours in ED for disposition. One hospital, located in a rural area with 55beds was chosen as it was …

De-Implementation Of Fecal Occult Blood Testing In The Emergency Department And Hospital Units: A Quality Improvement Project, Adewale Ajumobi, Joline De Castro, Ammar Qureshi

Journal of Community Hospital Internal Medicine Perspectives

Background: Fecal occult blood tests (FOBT) are inappropriately used in patients with melena, hematochezia, coffee ground emesis, iron deficiency anemia, and diarrhea. The use of FOBT for reasons other than screening for colorectal cancer is considered low-value and unnecessary. Methods: Quality Improvement Project that utilized education, Best Practice Advisory (BPA) and modification of order sets in the electronic health record (EHR). The interventions were done in a sequential order based on the Plan-Do-Study-Act (PDSA) method. An annotated run chart was used to analyze the collected data. Results: Education and Best Practice Advisory within the EHR led to significant reduction in …

Implementation Of Common Emergency Department Procedure Checklists To Improve Resident Provider Efficiency Background, Abigail Alorda, Alexa Ragusa, Natalie Diers, Taylor Cesarz, Shayne Gue, Latha Ganti

North Florida Division GME Research Day 2024

No abstract provided.

The Pit Crew Card Game: A Novel Gamifications Exercise To Improve Ems Performance In Critical Care Scenarios, Danielle Dicesare, Bridget Scheveck, Jeffrey Adams, Maria Tassone, Vanessa I. Diaz-Cruz, Christine Van Dillen, Latha Ganti, Shayne Gue, Ayanna Walker

North Florida Division GME Research Day 2024

No abstract provided.

Heart Of Medicine: Simulation To Educate Pre-Clinical Med Students In Basic Life Support (Bls) And Advanced Cardiac Life Support (Acls), Taylor Cesarz, Rachel Shi, Adrien Thokalath, Madison Morris, Shayne Gue, Noe Navarro, Rebecca Beiler, Stephanie Cohen

North Florida Division GME Research Day 2024

No abstract provided.

Impact Of Vertical Zone Redesign: One Hospitals Experience, Zachary Shields, Enrique Alvarez-Ventura, Curtis Johnson

North Texas GME Research Forum 2024

Background: Crowding in the emergency department has been a prevalent issue for decades, however, over the last few years, crowding and the number of patient visits in EDs have been higher than normal. Many factors influenced this, including the COVID-19 pandemic. Emergency departments around the country have been at a loss in improving patient flow and time in the ER. Literature has demonstrated some possible methods with varying results, but there has not been significant research on the subject.

Methods: After reviewing the literature, we designed a system where patients were stratified between different groups using the triage system. …

Utilization Of An Activity-Based Journal Club To Deliver Pediatric Education To Prehospital Providers, Lauren Bolton, Ratna Acharya, Jeffrey Katz, Linh Nguyen, Ariel Vera, Ayanna Walker

North Florida Division GME Research Day 2024

No abstract provided.

Escape The Music Festival - Disaster Day With A Twist, Drake Dixon, Alexa Ragusa, Maria Tassone, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Resident Gamification Challenge: Unlocking Pocus Proficiency Board Review Through Play, Kevin Bertrand, Emily Macauley, Michael Falgiani

North Florida Division GME Research Day 2024

No abstract provided.

Gamification To Improve Ems Knowledge Of Medical Capacity Determination, Ross Sinicrope, Nasim Motaghedi, Zachary Yates, Elliott Richardson, Stephanie Schieffert, Jacob Wright, Abigail Alorda, Jeffrey Katz, Linh Nguyen, Shayne Gue, Christine Van Dillen, Ayanna Walker

North Florida Division GME Research Day 2024

No abstract provided.

Mastering The Ite With Em Mastermind: A Board Game For Board Review, Taylor Cesarz, Stephanie Cohen, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Ed Procedural Supply And Operations, Alex Teshon, Konner Cue, Logan Prewitt, Anita Datta

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Targeted Procedure Lab To Improve Self-Identified Deficiencies Among Graduating Emergency Medicine Residents, Stephanie Cohen, Andrew Bobbett, Shayne Gue, Jeffrey Thompson

North Florida Division GME Research Day 2024

No abstract provided.

Single Question Survey Vs The Ongoing Violence Assessment Tool For Intimate Partner Violence Screening In The Ed, Zhengqiu Zhou, Donna Carden, Mariel Michaels, Gretchen Nonawzki, Saria Slowey, Maureen Mohan, Robyn Hoelle

North Florida Division GME Research Day 2024

No abstract provided.

Come One, Come All: Carnival Themed Gamification Of Emergency Medicine Board Review, Shayne Gue, Taylor Cesarz, Maria Tassone

North Florida Division GME Research Day 2024

No abstract provided.

Multiple Casualty Simulation Scenario Secondary To Natural Disaster At A Music Festival, Stephanie Cohen, Robert Pell, Casey Mcgillicuddy, Nidhi Sahi, Ariel Vera, Steven Nazario, Andrew Bobbett, Rebecca Beiler, Noe Navarro, Latha Ganti, Shayne M. Gue

North Florida Division GME Research Day 2024

No abstract provided.

Learning Mass Casualty Incident Triage Via Role Play Simulation, Martin Morales-Cruz, Ayanna Walker, Drake Dixon, Latha Ganti, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Implementation Of Viz.Ai Augmented Intelligence Software To Reduce Door To Puncture Times And Patient Outcomes At A Comprehensive Stroke Center, Cody Bryant, Brandon Womack, Mason Patel, Sanjay Sharma

North Texas GME Research Forum 2024

Introduction: Endovascular therapy (EVT) in the form of mechanical thrombectomy is the mainstay of treatment for acute large vessel occlusion (LVO) ischemic stroke, but its efficacy is highly time sensitive. It is crucial that stroke centers continue to implement process improvements that aim to streamline stroke workflow. Viz.AI is a platform that uses artificial intelligence to automatically detect LVOs with computed tomography (CT) imaging. It provides immediate access to the CT images as well as a platform for centralized communication through the mobile application. We sought to determine if the implementation of Viz.AI at our comprehensive stroke center improved stroke …

Comparative Analysis Of Machine Learning Models For Predicting Healthcare Traffic: Insights For Optimized Emergency Response, Shadman Mahmood Khan Pathan, Sakan Binte Imran, M. M. Shabab Iqbal, Muhammad Enayetur Rahman, Md. Nurul Absar Siddiky, Muhammad Rezaur Rahman, Md Rafid Hasan, Nondon Lal Dey, Md Sobuj Hossain

Electrical & Computer Engineering Faculty Publications

Efficient management of healthcare traffic is crucial for ensuring timely access to medical services, particularly in emergency situations where delays can have severe consequences. This study presents a comparative analysis of three widely used machine learning models—Linear Regression, Decision Trees, and Random Forests—aimed at predicting healthcare-related traffic volumes. A large dataset from a metropolitan traffic system was used to train and evaluate the models based on key performance indicators, including Mean Squared Error (MSE), R² Score, and computational efficiency. The results reveal that the Random Forest model offers the best performance, achieving higher predictive accuracy and faster execution times compared …