Quality Improvement Commons^™

Implementation Evaluation Of Blood Flow Restriction In The Rehabilitative Setting, Corbit Franks, Madison Wellborn, Matthew A. Chatlaong, Daphney M. Carter, William M. Miller, Matthew B. Jessee, Robert E. Davis

Internet Journal of Allied Health Sciences and Practice

Purpose: Blood flow restriction refers to a training/rehabilitation method consisting of an external pressure system applied to a limb to partially inhibit blood flow to the tissues. Though much research has been conducted concerning the use of blood flow restriction, there is limited research concerning why clinicians may or may not utilize it. Objective: The current qualitative study utilized the Consolidated Framework for Implementation Research to investigate why clinicians may or may not implement blood flow restriction in the clinical setting. Methods: A semi-structured interview addressing twelve implementation constructs within four domains (Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics …

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

Integrating Mobility Dynamics Into Facility Location Modeling And Optimization, Daniel Hopkins

College of Engineering Summer Undergraduate Research Program

Facility location optimization is a foundational area in operations research and data analytics that is concerned with determining the optimal placement of facilities to serve a spatially distributed demand. However, traditional facility location decision is often approached from a centralized perspective, where the facility planner dictates the allocation of customers to facilities. In this setting, it is typically assumed that customers patronize the nearest facility, and their preferences are not explicitly modeled. This traditional decision-making framework may not accurately reflect real-world dynamics where customers may choose facilities based on a variety of factors beyond proximity. Thus, this project aims to …

Implementing A Pap Smear Tracking Tool For Increased Compliance, Meghan Marie Madea Msn, Cnm, Whnp-Bc, Katherine Ferrell Fouquier Phd, Cnm, Facnm, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

The Papanicolaou “pap” smear screens for cervical cancer in women ages 21-65 with a cervix. Inconsistent locations for lab results lead to a decrease in provider efficiency, and patients are unaware of results or recommended follow-up. This quality improvement project implemented a tracking tool within the electronic medical record (EMR) in a busy midwifery clinic. The outcomes are the identification of patients overdue for pap smears, scheduling the procedure, recording of results, and patient notification with recommended follow-up.

Methods

A one-month chart review was performed of fifty gynecology patients within a midwifery clinic. Results of pap smears were located …

It’S Not Elementary, My Dear Ai, Mali Schantz-Feld Ma, Cde

AADEJ - The Communicator

In this issue, Associate Editor Mali Schantz-Feld cautions dental communicators about the irresponsible use of Artificial Intelligence (AI), highlighting three major risks. The first is the fabrication or "hallucination" of non-existent scholarly references, exemplified by submitted articles where more than half of the citations were fake. The second risk is the removal of human personality, emotion, and nuance, which causes content to feel robotic; this occurred when a profile of an inspiring dentist was run through AI, stripping away their inner light and philosophy. The third danger is the generation of statistics, charts, or figures without providing necessary data or …

Assistive Technology For Proper Seating And Positioning For Geriatrics, Jacee Lyons, Rebecca King

Fall 2025 OTD Capstone Symposium

The lack of staff education on pressure injury prevention places older adults at a higher risk of developing pressure injuries in a skilled nursing facility.

Improving Patient Portal Messaging Workflow, Tanya M. Fitzpatrick

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: Inefficiencies in patient portal secure messaging between providers and patients in a large primary care practice led to delayed resolution times, averaging 5.6 days per message. Most messages were closed by physicians or advanced practice providers, resulting in imbalanced workload distribution, increased provider burden, and reduced communication efficiency. The lack of standardized guidelines for message use, character limits, or triage processes contributed to workflow disruptions, a diminished patient experience, and unreimbursed provider time.

Aim of the Project: The aim of the project was to reduce average portal message closure times by at least 38% through the implementation of standardized …

The Home Visiting Referral Quality Improvement Initiative (Thrive) Change Package, Elizabeth Yakes Jimenez, Theresa Cruz, Rebecca Craig, Ivan De La Rosa

Population Health Research and Scholarship

Early childhood home visiting programs improve maternal and child health outcomes but remain underutilized. Healthcare providers are well-positioned to connect families to home visiting services; however, structural barriers in clinical settings limit consistent and effective referral practices. The Home Visiting Referral Quality Improvement Initiative (THRIVE) change package was developed to provide a starting point for addressing these challenges. The THRIVE change package outlines actionable improvement strategies to test, such as standardizing referral workflows, training clinical teams, and establishing relationships and feedback loops with home visiting programs. It offers a scalable approach to strengthening clinical–community linkages and improving family engagement with …

Differences In Emergency Department Imaging Modalities For Femur Fractures Based On Insurance And Demographics, Patrick De La Torre Schutz, Bryce M. Bellon, Daniel Salinas, Kelsey Baker, Hamaad Gohar

Research Colloquium

Insurance status and race have been significant predictors of delayed care and reduced imaging utilization in emergency settings, particularly among minority and Medicaid-insured populations (Moser, Shan). The reasoning for the disparities in treatment for these underserved populations is still not well understood. To further analyze these claims, this study examined whether demographic factors such as ethnicity, sex, age, insurance type, and fracture classification were associated with differences in imaging modality among patients with femur fractures. Data from the Texas Department of State Health Services Trauma Registry (2018–2022) was analyzed using logistic regression to determine the odds ratios of receiving CT, …

From Imaging To Impact: A Multi-Disciplinary T32 Program Framework And Initial Insights For Training In Image-Guided Cancer Therapy, Kari J. Brewer Savannah, Stephen Y. Lai, Clifton D. Fuller, Kristy K. Brock

Advances in Cancer Education and Quality Improvement

As multi-disciplinary image-guided assessment and therapies become increasingly important for precision oncology, the need for comprehensive training opportunities that effectively prepare the next generation of clinician-scientists and scientists is evident. We present an innovative, evidence-based research training framework that integrates the following critical features: 1) intentional and personalized mentoring and career development, 2) immersive research in image-guided cancer therapy, 3) strategic mentored clinical exposure, 4) structured didactic learning and professional development opportunities, and 5) mentored grant writing. Designed to foster scientific rigor, translational thinking, and multi-disciplinary collaboration, the Image-Guided Cancer Therapy T32 Training Program (IGCT-T32) aims to prepare postdoctoral fellows …

Glucometer Cleanliness On A Neuro-Medical Intensive Care Unit, Abbey Camire

Operations Transformation

Glucometers on the Neuro-Medical ICU are being docked with visible reddish/brown residue, indicating they are not properly cleaned beforehand. This poses a risk of transmitting pathogens, endangering patient and staff safety, and violates hospital policy and regulatory standards. Proper disinfection of mobile medical equipment is essential for infection control and hospital accreditation.

Investigation Of The Optimal Length Of Discharge Summaries In Care Transitions: A Cross-Sectional Study, Taku Harada, Shintaro Kosaka, Aki Morishima, Seitaro Iguchi

Journal of Community Hospital Internal Medicine Perspectives

Introduction

Discharge summaries are essential documents that support continuity of care during patient transitions between inpatient and outpatient settings. They help ensure that crucial clinical information is conveyed accurately and completely. However, while their clinical significance is well established, there is little consensus on the optimal format, particularly in terms of length and structural clarity. Excessively brief summaries may omit key details, while overly lengthy ones can hinder efficient information transfer. Despite varied suggestions in the literature—ranging from half a page to four pages—empirical data on physician preferences are limited.

Methods

We conducted a cross-sectional, web-based survey among physicians who …

Intensive Telemedicine Transitions Of Care Clinic: A Prospective Feasibility Study Of A Novel Ambulatory Model Serving Appalachian Patients, Jessica Thayer, Brett Miller, Marcelino Mederos Liriano, Kathryn Hoffman, Gina Baugh, Jenna Sizemore

Journal of Appalachian Health

Introduction: Hospital discharge is a complex process plagued with medical errors and poor coordination. Disjointed discharges are detrimental to Appalachian patients with access barriers and multiple chronic diseases. Telehealth is a tool used to improve access within rural Appalachia. To address this high-risk transition period, an interprofessional team deployed telemedicine to improve post-hospital care for Appalachian patients.

Purpose: Patients with uncontrolled chronic medical conditions were enrolled into the Intensive Telemedicine Transition of Care Clinic (I-TTC) with a primary outcome of 30-day Emergency Department (ED) presentations and hospital readmissions. Secondary outcomes included improved control of chronic conditions and patient cost savings. …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

"Improved Obstetric Hemorrhage Care Through Toolkit Revision: A Quality Improvement Project", Amber M. Woodring, Samantha Kalkstein

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric hemorrhage (OBH) remains a leading cause of preventable maternal morbidity and mortality in the United States. Accurate risk identification is critical for initiating timely interventions; however, current risk assessment practices vary significantly. This quality improvement (QI) project aimed to implement the California Maternal Quality Care Collaborative (CMQCC) OBH Risk Assessment Tool on the labor and delivery (L&D) unit of a community-based hospital to standardize risk stratification and improve interdisciplinary communication. Guided by the Johns Hopkins Nursing Evidence-Based Practice model, the project involved a gap analysis, staff education, and the introduction of a paper-based CMQCC tool formatted for visibility and …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

Empowering Independence: Strategies For Safe Aging In The Home And Community For The Older Adult Population, Madelyn Rashford, Becky King, Keegan Mckay

Summer 2025 OTD Capstone Symposium

This capstone project created an occupational therapy–based guidebook to promote safe aging in place for community-dwelling older adults. The guidebook includes fall prevention exercises, home safety strategies, and community resources to support independence in daily activities. Implementation showed increased safety awareness and confidence, reinforcing occupational therapy’s role in fostering independence and quality of life.

Optimizing Inventory Management To Reduce Medication Waste At A Low-Resource Clinic, Maqadus A. Khan

Doctor of Nursing Practice Final Project Abstract

Introduction

This project implemented standard operating procedures for inventory management in a low-resource clinic, incorporating First Expired, First Out (FEFO), Just-in-Time (JIT) ordering, and barcode scanning to reduce medication waste and optimize inventory processes. The aim was to reduce medication waste and optimize inventory processes.

Methodology

The Lean Six Sigma framework guided this project. Root causes of waste included inaccurate demand forecasting, lack of expiration tracking, insufficient staff training, poor stock rotation, and absence of standardized procedures. Baseline waste and practices were recorded. Medications were organized with nearing expirations upfront (FEFO), PAR levels were set, and JIT ordering implemented. Waste …

Patterns And Implications Of Electronic Messaging Use In Clinical Communication: Insights From A Single-Center Survey., Basil George Verghese, Rupinder Buttar, Prakash Upreti, Kaiwen Zhu, Tamer Salhab Altamimi

Advances in Clinical Medical Research and Healthcare Delivery

Background: Efficient communication in healthcare is critical, significantly impacting patient outcomes. Electronic messaging tools, like Epic Secure Chat, are increasingly integrated into healthcare settings to enhance interactions among professionals. However, the practical implications of these tools on workflow and care quality are underexplored.

Methods: We conducted a comprehensive cross-sectional survey involving 309 healthcare professionals, including hospitalist physicians, advanced practice providers (APPs), and internal medicine residents, to evaluate Epic Secure Chat's usage patterns, satisfaction levels, and communication preferences.

Results: The survey yielded insightful data from 156 complete responses, revealing a notable issue with misdirected messages: 64.1% of hospitalists, 52.6% of residents, …

Can Implementation Strategies Diminish Infection Prevention Barriers And Reduce Cardiac Surgical Site Infections, Jennifer West, Jennifer Gutowski, Jarvis Mcgrath, Kristen Paliani, Emil P. Lesho

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Surgical site infections (SSI) can affect up to 26.8% of patients undergoing coronary artery bypass grafting (CABG). In New York State (NYS), hospitals are evaluated by comparing their risk-adjusted CABG SSI rates to the NYS average rate. In 2021, our facility’s rate was significantly higher than the NYS average at 3.40 and 1.51, respectively. We sought to reduce infection rates using a multidisciplinary Implementation Science (IS) approach across the continuum of care.

Methods:

Standardized definitions from the National Healthcare Safety Network were utilized in a 24-month before and after study at a 528-bed hospital that averages 468 CABG/year. In …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Implementation Of A Triage System For The Residents At A Residential Facility To Improve Triage Assessment Skills Of The Staff As Well As Improve The Level And Timeliness Of Care, Andrew J. Choi Rn, Neha Gopal Rn, Andres N. Padilla Rn, Dana Son

Master's Projects and Capstones

Triage is an integral part of the clinical process which involves assessing patients and determining their level of care in order to get them appropriate, timely treatment. Several countries utilize a standardized triage system with established criteria to aid staff in their decision-making during assessments (Peta et al., 2023). The Nursing and Residential Triage (NaRT) tool, from the Manchester Triage System (MTS), was shown to enhance staff clinical assessment skills and help avoid inappropriate ED transfers during a study among older adults in a residential facility (Markey et al., 2024). For this project, the main issue identified at the residential …

Does The Addition Of Digital Care Along With Standard Chemotherapy Teaching That Is Provided At City Of Hope Increase Patient Satisfaction And Confidence?, Sheridan Wendy Lomeli, Brooklin Mize, Tatyana Franco, Daniela Naemi

Master's Projects and Capstones

Chemotherapy education is critical when it comes to improving patient confidence, reducing anxiety, and enhancing symptom management. However, there is still a variety of patients who begin their infusion therapy with a limited understanding of what to expect. This quality improvement project was conducted at an outpatient infusion center, exploring whether combining traditional nurse-led chemotherapy education calls with a digital care platform would enhance patient satisfaction and confidence compared to standard care alone. A total of forty-one adult oncology patients participated in an educational survey at the end of each follow-up phone call, which was completed three days after their …

Implementation Of A Standardized Onboarding Program, Sarah J. Wall

Doctor of Nursing Practice Final Project Abstract

Purpose: To evaluate the impact of a standardized onboarding program on Advanced Practice Provider (APP) retention and productivity within an academic department.

Background: High APP turnover in specialized settings disrupts care and leads to financial losses. Previously, onboarding lacked structure, leading to early attrition and delayed productivity. A 24-week phased, competency-based orientation program was developed to improve retention, job satisfaction, and clinical performance.

Methods: The program, implemented in April 2024, included clinical precepting, didactic modules, and mentorship. Retention and Relative Value Units (RVUs) were measured before and after implementation. Qualitative data was collected through mentorship surveys and APP focus groups. …

Classification Of Dental Adverse Events Using Iterative Qualitative Analysis, Kiti Siriwatana, Sathirakorn Pongpanich

Journal of Health Research

Background: Effective incident reporting systems (IRS) are essential in dentistry for identifying and preventing adverse events (AEs), with standardized classifications ensuring consistent incident categorization. This study aimed to develop and validate a classification system for dental patient safety incidents based on a 5-year case study at the Dental Hospital at Chulalongkorn University, Thailand.

Methods: An iterative qualitative approach was used. A literature review explored existing accreditation standards and AE classification systems. Incident reports from 2018–2022 informed a draft classification system aligned with Thailand’s National Reporting and Learning System and accreditation standards. Reports from 2023 were used for validation. An expert …

Enhancing Nurse Competence And Self-Efficacy In Delivery Of Medication Education At Discharge: A Quality Improvement Project Using The Teach-Back Method., Quinesia James

Doctor of Nursing Practice Papers

Medication nonadherence in pediatric psychiatric care contributes to worsening symptoms, delayed developmental progress, and increased hospitalizations. Adherence rates remain as low as 30–60%, accounting for up to $300 billion in avoidable healthcare costs annually. Low health literacy and inconsistent education strategies further complicate adherence. This quality improvement project took place on the child and adolescent psychiatric units at the project site, a large teaching hospital in a metropolitan area in the south-central United States, which serves patients aged 5–17 with complex mental health needs. The initiative aimed to improve nurses’ competence, self-efficacy, and time efficiency in delivering medication discharge education …

Rethinking Health Systems Responsiveness In Low–And Middle-Income Countries, Meesha Iqbal

Dissertations and Theses (Open Access)

Health systems responsiveness (HSR) refers to a health system’s ability to meet legitimate non-health expectations of the population. Traditionally, HSR has been conceptualized across eight domains: respect for dignity, autonomy, confidentiality, prompt attention to health needs, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. However, as the expectations of populations in high-income countries (HICs) and low- and middle-income countries (L&MICs) differ significantly due to diverse social and cultural contexts, the conceptualization of HSR also varies. We conducted a systematic review of literature to adapt and contextualize the HSR framework for L&MICs based …

Identifying And Breaking Barriers: Addressing Disparities In The Care Of Patients With Gynecologic Cancers, Bhavana Pothuri, Michele Muir, Jean Hurteau, John Farley, Michelle D. Lightfoot, Summer Dewdney, Tara Castellano, John K. Chan, Sharad Ghamande, Al Asante-Facey, Marina Stasenko, B J. Rimel, Electra D. Paskett

School of Medicine Faculty Publications

BACKGROUND: Significant disparities exist in the care of patients with gynecologic malignancies. Higher incidences of gynecologic malignancies among underrepresented subpopulations (eg, racial, ethnic, and/or LGBTQAI+) and lack of representative enrollment within clinical trials have highlighted the need to improve healthcare equity. We aimed to identify barriers to equitable health care and clinical trial participation for specific diverse populations of patients with gynecologic malignancies and to identify potential solutions for overcoming these barriers. METHODS: A series of 4 live and 3 asynchronous advisory boards facilitated by GSK was conducted between January 2023 and July 2024; live advisory boards were population specific. …

Dosimetric Effects Of Pinnacle³ Version 18.0 Advanced Auto-Planning Settings In Oropharyngeal Vmat Optimization, Emily Sanden

Masters Projects

This study evaluated the impact of Pinnacle³ version 18.0 auto-planning advanced settings modulation amount, monitor unit (MU) level, and dose fall-off priority on volumetric modulated arc therapy (VMAT) plan quality for bilateral oropharyngeal cancer. A total of 64 plans were generated using all possible combinations of low, medium, high, and very high settings for each parameter. A standardized base of tongue case was optimized once per plan using a single-time point approach, with planned target volume 1 (PTV1) (6996 cGy) and planned target volume 2 (PTV2) (5412 cGy) coverage evaluated. Each parotid gland, the spinal cord, brainstem, and the oral …

New Patient Onboarding, Jennifer Fournier, Sarah Flagg, Alletta Roberts Dzik, Lyndsay Stevens, Shannon Smith, Karen Waterhouse

Operations Transformation

Currently there are barriers to establish a new patient with a primary care. The workflow for patients who self-refer currently requires 10 steps and is performed by 7 care team members.

• 4 PSR at the front desk complete paper intake forms that are then manually entered into a spreadsheet by 3 other care team members.

The step in the workflow, to obtain the release of information for patient records to be requested and submit the form, is inconsistently followed internally and externally and results in very long process time of 40+ days. This step is frequently overlooked due to the …