Quality Improvement Commons^™

The Weight Of The White Coat, Jonathan Cunningham

Advances in Cancer Education and Quality Improvement

This is a poem reflecting on the mission of the medical provider through the image of the white coat.

Beyond Boundaries: A Model For Boosting Staff Retention And Morale Through Career Mobility, Tiffany Hughes, Abigail Caudle, Robert Ghafar, Brandon Freudensprung, Paloma Vasquez

Advances in Cancer Education and Quality Improvement

Retention and morale in health care are strategic imperatives that directly influence patient care, quality outcomes and operational stability. At The University of Texas MD Anderson Cancer Center, we found a significant gap in the career advancement opportunities for our clinical and administrative staff. Employees lacked visibility into career growth pathways, leaving them disengaged and increasing the overall turnover rate. In response, our division launched a structured, transparent Career Mobility Model to provide employees with the clarity and tools needed for advancement. This model integrates career mapping, shadowing programs, and leader-led career conversations, all of which led to measurable gains …

Advancing The Anesthesia Workforce: The Md Anderson Anesthesia Technology Fast Track Program, Miranda M. Phillips, Mary Sizemore, Sally Raty, Tanveer Khan, Homero Lozano

Advances in Cancer Education and Quality Improvement

The Anesthesia Technology Fast Track Program (ATFTP) at The University of Texas MD Anderson Cancer Center was initiated in 2024 to mitigate a significant national deficit of trained anesthesia technologists. This 40-hour continuing education program, developed in accordance with the American Society of Anesthesia Technologists & Technicians’ (ASATT) Practical Experience Pathway, assists experienced yet non-certified anesthesia technicians in obtaining the Certified Anesthesia Technologist (Cer.A.T.T.) credential. The fully online, asynchronous 10-week CEU program is tailored for working professionals. The course focuses on patient safety, evidence-based practice, and certification preparedness and concludes with two extensive practice examinations and an ASATT CEU requirement–aligned …

Clinical Medical Emergency Team Training Simulation (Cmetts): An Interprofessional Simulation For Medical Students And Nursing Residents, Allan John R. Barcena, Marvin R. Bernardino, Dominic Karl M. Bolinas, Kitz Paul D. Marco, Toni Edwards, Shelita Kimble, James Cavalier, Marites P. Melancon, Jillian R. Gunther

Advances in Cancer Education and Quality Improvement

Effective teamwork and communication are critical during medical emergencies, particularly in oncology, yet health care professionals are often trained separately, creating challenges for interprofessional collaboration. Evidence-based frameworks like Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) offer structured tools to optimize team performance. This study describes a simulation-based program, the Clinical Medical Emergency Team Training Simulation (CMETTS), designed to instill foundational teamwork skills in early-stage learners. First-year medical students and newly graduated nursing residents participated in an interprofessional simulation involving medical emergency scenarios followed by structured debriefing sessions guided by TeamSTEPPS principles. We evaluated the program’s effectiveness …

Lessons Learned For Improving Trainee Engagement And Utilization Of Education And Training Materials For Cancer Research, Katerina M. Santiago, Tania Galindo, Michaela A. Dinan

Advances in Cancer Education and Quality Improvement

Background: A core component of the National Cancer Institute Cancer (NCI) Cancer Center Support Grant requires cancer centers to coordinate research career enhancement and related activities. The Yale Cancer Center, an NCI-designated comprehensive cancer center, established the Cancer Research Training and Education Coordination (CRTEC) component in 2016. In response to the needs of trainees, CRTEC has developed several initiatives that we have identified and described here as best practices to engage and support trainees.

Methods: We had 2 aims to improve engagement: 1) increasing our visibility and trainee awareness of CRTEC and nurturing bidirectional communication and 2) offering …

Centralizing Communication Intake To Improve Workflow Visibility And Engagement: A Quality Improvement Project In A Cancer Center's Education Division, Menatalla El-Sharkawi, Mohamed Ait Aiss

Advances in Cancer Education and Quality Improvement

Background: In large or complex organizations, multiple teams may be charged with managing different components of a project, initiative, or administrative assignment. When these teams have overlapping needs for information, the absence of a structured intake and tracking process can limit transparency, reduce efficiency, and hinder coordination across communication channels.

Methods: Drawing on principles of strategic communications and project management, we created a structured and centralized information sharing process for teams within the education division of a comprehensive cancer center. The intervention included workflow redesign, development of a standardized intake system, and use of real-time dashboard analytics to support operation …

Icu Decision Tool Impact On Rebound Hyperglycemia, Daniel J. Donovan, Emily Highsmith, Sonya Khan, Michelle Horng

Advances in Cancer Education and Quality Improvement

Hyperglycemia, defined as a blood glucose level ≥180 mg/dL in the hospitalized patient, is linked to negative outcomes including longer hospital stays, increased infection risk, and higher morbidity and mortality rates. In addition to critically ill patients with diabetes, hyperglycemia can develop in individuals without diabetes due to factors such as steroid use, continuous tube feedings, and an elevated stress response. Patients who have uncontrolled hyperglycemia are often placed on continuous insulin infusions (CII), but rebound hyperglycemia frequently occurs after CII discontinuation if the maintenance insulin regimen (MIR) is insufficient. Implementation of a MIR decision support tool integrated within an …

Mapping The Evidence On The Maternal–Fetal Triage Index (Mfti): A Scoping Review, Taylor Harris, Kelsey Downie, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Maternal morbidity and mortality remain persistent challenges in the United States, with obstetric triage serving as a critical point of entry for timely recognition and management of high-acuity maternal-fetal conditions. Despite recommendations for acuity-based triage models, many obstetric units continue to rely on non-specific emergency triage tools, such as the Emergency Severity Index (ESI), which inadequately account for pregnancy-specific physiological changes and fetal status. To address these limitations, the Association of Women’s Health, Obstetric and Neonatal Nurses developed the Maternal-Fetal Triage Index (MFTI), a five-level obstetric-specific triage tool. Although the MFTI has been increasingly adopted in clinical practice, the …

Examining Racial And Ethnic Differences In Quality Of Care Between Home And In-Center Hemodialysis, Sukhman Bains

2026 Symposium

Home hemodialysis (HHD) offers improved flexibility and clinical outcomes compared to in-center hemodialysis. However, its use remains limited, particularly among racial and ethnic minority populations disproportionately affected by end-stage renal disease (ESRD). This systematic review analyzed seven retrospective cohort studies (2004–2025) to assess disparities in HHD utilization and outcomes. Minority patients were significantly less likely to initiate HHD, with adjusted odds ratios ranging from 0.45 to 0.70, while no disparities were observed within Canada’s universal healthcare system. Although HHD was associated with lower mortality, this finding is likely influenced by selection bias, as HHD patients tended to be younger and …

Transforming Patient Safety And Care Practices Through Interprofessional Education, Kaleena Ramirez, Claudia C. Tamara, Jennifer Sells, Karen Clatt, Banan Abuharb, Mary Coolbaugh-Murphy, Iris Culwell, Anca Fumurescu, Mary Gust, Lori Simmons, Delores Whiteing, Annie Koenig, Sara Martinez, Wilton Muriithi, Shaun T. Caldwell, Susan Lee, Mary Sizemore, Kimberly Ann H. Krumwiede

Advances in Cancer Education and Quality Improvement

As healthcare increasingly relies on interdisciplinary teams to deliver safe and effective care, the development of interprofessional collaboration competencies among students in health care professions has become an educational priority. In response, The University of Texas MD Anderson Cancer Center School of Health Professions integrated a longitudinal interprofessional education curriculum to foster collaborative practice readiness and prepare students for team-based interdisciplinary environments that ensure safe and patient-centered care. The curriculum was guided by the Interprofessional Education Collaborative 2016 and 2023 core competencies for interprofessional collaborative practice, reinforced with the Real Colors® Personality Instrument and Team Strategies and Tools to Enhance …

Viral Hepatitis Screening In Early Breast Cancer Patients Receiving Cancer Therapy: A Quality Improvement Initiative, Katherine Klein, Jessica Hwang, Vicente Valero, David Ramirez, Jaime Kaushik

Advances in Cancer Education and Quality Improvement

American Society of Clinical Oncology guidelines recommend screening all patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) before initiation of cancer therapy. Cancer patients receiving cancer therapy represent a vulnerable population, and reactivation of undetected hepatitis virus can lead to devastating consequences. At MD Anderson Cancer Center, rates of hepatitis screening for all cancer patients have been historically low. The overall aim of this quality improvement (QI) study was to increase rates of HBV and HCV screening to at least 50% in early-stage breast cancer patients before cancer therapy in the Breast Medical Oncology clinic at MD …

Interprofessional Education Development In An Oncology-Focused Healthcare Institution, Mary Sizemore, Michael Morris, Mohamed Ait Aiss, Gregory Botz, Jolyn Taylor, Joshua Kuban, Diane C. Bodurka

Advances in Cancer Education and Quality Improvement

Background: Despite growing recognition of the value of interprofessional education (IPE), most IPE work has focused on undergraduate learners, leaving a critical gap in postgraduate and clinical environments. This report describes a phase 1, formative, pre-implementation quality improvement (QI) initiative to establish an institution-wide IPE program at an oncology center without a traditional medical school.

Methods: We used a developmental, multiphase mixed methods design integrating 3 inputs: (1) Virtual Interprofessional Teaching and Learning (VITAL) faculty-development feedback, (2) IPE Steering Committee feedback, and (3) simulation evaluation used as an applied context (not the sole focus). Surveys were administered to VITAL participants, …

Spatial Computing With The Apple Vision Pro In Minimally Invasive Procedure Simulation: A Randomized Crossover Feasibility Study, Sydney Cooper, Aaron Kyle Jones, Rahul Anil Sheth, Koustav Pal, Bruno Odisio, Mark Blaylock, Shelita Kimble, Justin Bird, David Rice, Daniel Shoenthal, Emil Patel, Vipin Kamath, Sanjay Gupta, Jeffrey Siewerdsen, Joshua Kuban

Advances in Cancer Education and Quality Improvement

Purpose: This study aimed to evaluate the feasibility of wearing the Apple Vision Pro (AVP), a mixed-reality headset that integrates augmented and virtual reality, while performing minimally invasive procedures. While studies have demonstrated that spatial computing technology can improve surgical precision and reduce the risks of surgical complications, to our knowledge, no studies have specifically addressed the impact of the AVP on task performance during simulated image-guided procedures.

Materials and Methods: Thirteen diagnostic and interventional radiology residents performed image-guided central venous catheter placement, thoracentesis, and paracentesis on simulation models. Each participant completed a non-timed practice followed by the procedures once …

Utilization Of Hybrid Angiography-Ct Suites In An Interventional Oncology Practice, David Irwin, Kiyoyuki Minamiguchi, Ryosuke Taiji, Aaron Kyle Jones, Gouthami Chintalapani, Roland Bassett, Steven Y. Huang, Sanjay Gupta

Advances in Cancer Education and Quality Improvement

Purpose: To evaluate operational trends in an interventional oncology practice at a tertiary academic center before and after the addition of hybrid angiography–computed tomography (Angio-CT) rooms.

Materials and Methods: The procedure volumes and types performed in the hybrid Angio-CT rooms were retrospectively collected from 2016 to 2020. Procedures were divided into categories, including arteriography, endovascular interventional oncology, ablation, venous intervention, non-vascular catheter placement (biliary, nephrostomy, gastrostomy, etc.), and osseous interventions. Procedural trends in the Angio-CT rooms and the frequencies of combination procedures that used both CT and angiography were assessed.

Results: A major shift of catheter-based tumor-directed cases to Angio-CT …

A Performance And Quality Improvement Intervention Integrating Molecular Testing To Support Personalized Cancer Care In Lung And Thyroid Cancers, Suzanne Murray, Monica Augustyniak, John Vu, Elbert Y. Kuo, Manolo G. Pasia Jr., Sheri L. Rivera, Kelly M. Rodriguez, Vivek Subbiah, Patrice Lazure, Ecaterina E. Dumbrava

Advances in Cancer Education and Quality Improvement

Introduction: Molecular testing has been underutilized in the diagnosis and treatment of cancer patients, despite its potential to significantly impact clinical decision-making and resulting health outcomes.

Objectives: This project aimed to evaluate the process and impact of a performance/quality improvement (PI/QI) intervention to optimize the integration of molecular testing for patients with non-small cell lung cancer (NSCLC) or thyroid cancer (TC).

Methods: Physicians, advanced practice providers, and nurses were engaged in the PI/QI at 2 cancer centers (Site A and Site B) for up to 18 months following a pre-intervention needs assessment. Gaps identified at baseline informed …

Tom: Treatment Outcome Monitor - A Web-Based Tool Designed Specifically For Clinics With Limited Resources, Saurabh Shashikumar Nair, Alba Kihn Alarcon, Maritza Elodia Cupil Barrios, Milton Estuardo Ixquiac Cabrera, Mynor Villeda, Joseph Steyn, Anneray Richards, Ricardo Ruggeri, Loida Orozco, Angel Velarde, Indranil Mallick, Graeme Lazarus, Christoph Trauernicht, Vicky De Falla, Tim Edwards, Johnny Inthaphone, Adenike Olanrewaju, Laurence E. Court, Joshua Niedzielski

Advances in Cancer Education and Quality Improvement

Background: Although three-fourths of cancer deaths are expected to occur in low- and middle-income countries (LMICs) by 2030, most cancer research still comes from high-income countries. One barrier to cancer research in LMICs is lack of infrastructure for systematic data collection, including electronic medical record systems. We developed Treatment Outcome Monitor (TOM), a cloud-based tool for tracking cancer patient outcomes, designed specifically for resource-limited settings.

Methods: TOM was developed through iterative design cycles with continuous feedback from health care providers from across the world. We focused on creating a simple, web-based solution that addresses real-world challenges in resource-limited …

Process Evaluation Of The Cheers Automated A1c Follow-Up Reminder System In Primary Care, Heather E. Lewis

Doctoral Dissertations & Projects

Background: Missed diabetes follow-up contributes to suboptimal glycemic control in primary care. Health record embedded reminder systems may improve continuity of care, but process evaluation is needed to understand real-world implementation (Bugge, 2024; Rathod et al., 2024).

Objective: To evaluate fidelity, workflow processes, and reach of the Cheers automated A1c reminder program among adults with type 2 diabetes in primary care.

Methods: This retrospective process evaluation used EHR data guided by the CDC Program Evaluation Framework (CDC, 2024). Measures included reminder delivery, follow-up completion, fidelity, and contextual factors.

Results: Of 72 eligible patients, 26 met success criteria (36.1%); 92.0% completed …

Mme (Mini Medical Education): A Preliminary Study Of A Targeted Curriculum To Improve Resident Knowledge And Clinical Confidence, Andrea Francis, Andres Vivar, Paul Mathew

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Haynes County Ems Outreach Quality Improvement, Anna Parker, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

A Quality Approach To Pneumococcal Vaccination, Nimmy Joy, Michaela Mckissack

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Improving Patient Health Portal Enrollment In The Primary Care Setting, Erika L. Bell

Doctoral Dissertations & Projects

In today’s increasingly digital healthcare environment, patient health portals have become critical tools for enhancing communication, improving care coordination, and empowering patients to actively participate in their health management. These secure, web-based platforms allow patients to access medical records, request prescription refills, view lab results, and message providers. Although patient health portals are offered by a vast majority of U.S. health systems, they remain underutilized, with only 15-30% of patients engaging with these platforms despite their potential to improve patient engagement, health status awareness, and care quality. Enhancing patient health portal use not only empowers patients but also supports broader …

Reducing Surgical Site Infection After Colorectal Surgery: A Multidisciplinary Review Of Process Improvement, Robin Daemmrich, Quentin Dipasquale, Deborah Klepac, Nick Mathers, Travis Holloway

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Are You My Doctor? Impact Of Role Identification Badges In Improving Resident Experience, Rasmeet Kaur, Laura Preece

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Ai’S Role In Searching For Evidence: Friend And Foe, Barbara (Basia) Delawska-Elliott, Brandon Wilkinson

Publications 2026-present

No abstract provided.

Nursing Migration And The Global Workforce: How The U.S. Nurse Shortage Impacts Developing Countries, Mololuwa Faithful Lasekan

Honors Thesis

As United States (U.S.) healthcare organizations face persistent staffing gaps driven by an aging population, burnout, and limited educational capacity, many institutions increasingly rely on internationally educated nurses (IENs) to stabilize their workforce. This reliance intersects with longstanding structural challenges in low- and middle-income countries (LMICs), where inadequate compensation and limited professional opportunities contribute to high migration intentions among nurses. Using a systematic literature review guided by PRISMA principles, this study synthesized evidence and five major themes emerged: (1) push factors driving nurse emigration from LMICs, (2) pull factors attracting nurses to the U.S., (3) digital globalization and post-COVID recruitment …

The Impact Of A Mindfulness Meditation Program On Phq-9 Scores In Eskd Clients At The Dialysis Center, Christi Collins Weaver

Student Scholarly Projects

Practice Problem: Patients undergoing hemodialysis for end-stage kidney disease (ESKD) experience high rates of untreated depressive symptoms, which negatively impact quality of life, treatment adherence, and therefore increased hospitalization and higher mortality rates.

PICOT: In adult patients receiving in-center hemodialysis (P), how does the implementation of a structured mindfulness meditation program (I), compared to usual care (C), affect depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) (O) over an eight-week period (T)?

Evidence: Current literature demonstrates that depression is highly prevalent among individuals with ESKD and is associated with increased morbidity and decreased treatment adherence. Evidence supports mindfulness …

Facilitators And Barriers To Mobile Health Unit Implementation: A Qualitative-Dominant Mixed Methods Study Exploring Staff Perspectives And Service Outreach, Kelsey Hardin

MUSC Theses and Dissertations

Background: Health disparities are linked to rising healthcare costs in the United States, particularly related to healthcare accessibility. Mobile Health Units (MHUs) have proven to be an effective intervention in reducing barriers to healthcare services, for example, providing early access to prenatal care, thus reducing infant mortality rates. This study focused on the facilitators and barriers to implementing an MHU program, based on staff perspectives and service outreach, to improve maternal and infant health outcomes.

Methods: This study employed a qualitative-dominant mixed-methods research design. Data was collected through interviews to assess staff perspectives. Secondary data analysis of quantitative data was …

Development Of The U.S. Academic Ophthalmology Faculty Database (Us-Aofd): A Cross-Sectional Descriptive Analysis, Brenton T. Bicknell, Josephine M. Rudd Zhong Manis, Haley Chishom, Yejin Heo, Lance Dzubinski, Alvina Liang, Taylor L. Aaserud, Shayan Massoumi, Thanushri Srikantha, John Stoffer, Emily Mccourt, Sruthi Arepalli, Beeran Meghpara, Ayan Chatterjee, Basil K. Williams, Janice Law, Steven E. Brooks, Robert Tauscher

Journal of Academic Ophthalmology

Background: Academic ophthalmology plays a critical role in advancing eye care and training the next generation of ophthalmologists. However, comprehensive data on the U.S. academic ophthalmology workforce remains limited. Existing databases focus on individual subspecialties or specific demographics, without capturing a national, integrated perspective.

Purpose: To develop and analyze the U.S. Academic Ophthalmology Faculty Database (US-AOFD), a comprehensive, national resource that characterizes the demographic composition, academic ranks, leadership roles, and research productivity of ophthalmology faculty at Accreditation Council for Graduate Medical Education (ACGME)–accredited programs in the United States.

Methods: This cross-sectional descriptive study compiled data for 4,028 …

Patient Reported Outcome Participation And Completion In Total Joint Arthropathy: A Socioeconomic Analysis, Diana Kernen Ba, Michelle Yi Mse, Kathleen Jahnke Bs, Nevil Khurana Ms, Ezra Goodrich Md, Charles Day Md, Mba

Medical Student Research Symposium

Background
Patient-reported outcome measures (PROMs) assess symptoms, function, and overall health from a patient perspective. Although PROM engagement has been studied across orthopaedics, limited work has examined both participation and completion specifically in joint replacement. This study evaluated associations between sociodemographic factors and PROM participation and completion among total joint arthroplasty patients.

Methods
We performed a retrospective review of all primary arthroplasties completed by a single surgeon in 2023 at a Midwestern tertiary health system. PROMs included PROMIS PF, PROMIS PI, and either HOOS JR or KOOS JR. Demographic data and Area Deprivation Index (ADI) were collected. Participation was defined …

Dexmedetomidine (Precedex) Versus Propofol: In Patients Requiring Sedation While Mechanically Ventilated,, How Does The Use Of Dexmedetomidine (Precedex) Compared To Propofol, Affect Reintubation Within 48 Hours Post Extubation?, Kimberly Barbee, Markela Albright, Malak Amro, Evelyn Caty-Pletcher, Margaret Havey Phd, Aprn, Acnp-Bc, Chfn, Fhrs, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Keywords: dexmedetomidine, propofol, reintubation, sedation2

Abstract Assignment

Background

Sedation management in the ICU plays a key role in extubation readiness and post-extubation outcomes in mechanically ventilated patients. Although both propofol and dexmedetomidine are commonly used in critical care, there is limited evidence comparing their impact on early reintubation. This quality improvement (QI) project examined whether sedative choice was associated with reintubation within 48 hours of extubation.

Methods

A retrospective QI analysis was conducted in a cohort of 38 mechanically ventilated adult patients. Patients received either propofol (n = 31) or dexmedetomidine (n = 7) prior to extubation. Reintubation within …