Quality Improvement Commons^™

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Improving Patient Satisfaction Through Post-Urgent Care Visit Follow-Up Calls: A Quality Improvement Project, Lindsay Boyer

Doctor of Nursing Practice Final Project Abstract

Purpose This quality improvement project aimed to determine whether implementing standardized post-visit follow-up calls within 24–48 hours of urgent care visits would improve patient satisfaction by increasing the clinic’s Net Promoter Score (NPS) from a baseline of 62. Background Declining NPS scores during peak clinic seasons suggested a gap in post-visit communication and follow-up, highlighting the need for a standardized nursing intervention to better support patients after discharge.

Methodology Guided by the AIDET communication framework and the Plan-Do-Study-Act cycle, scripted follow-up calls were implemented across five cycles from February to April 2026 to assess recovery, reinforce discharge instructions, answer questions, …

Enhancing Heart Failure Transitional Care To Reduce 30-Day Readmission Rate, Thuy Nhu Uyen Tran

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project is to reduce 30-day readmissions for adult patients with heart failure (HF) by implementing a standardized HF pathway beginning in the intensive care unit (ICU) and continuing through discharge.

Background: The project was implemented within a large healthcare organization in Northwest Houston, Texas.

Methodology: This project utilized a pre- and post-implementation design guided by the Plan-Do-Study-Act (PDSA) model. Eligible adult patients (≥18 years) with a primary or secondary HF diagnosis were identified during March 2026. The My Pathway to Wellness HF education pathway was initiated at the time of ICU downgrade …

The Comfort Cart Initiative: A Quality Improvement Intervention To Improve Patient Satisfaction In The Emergency Department, Heidy Cladimir Ayala

Doctor of Nursing Practice Final Project Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory …

Integrating Music Therapy Into Post-Surgical Care: A Quality Improvement Strategy For Reducing Post-Operative Anxiety, Yosdania Hernandez Benitez

Doctor of Nursing Practice Final Project Abstract

Integrating Music Therapy into Post-Surgical Care: A Quality Improvement Strategy for Reducing Post-Operative Anxiety

Purpose

This quality improvement (QI) project aimed to reduce postoperative anxiety among adult patients after general surgery in the post-anesthesia care unit (PACU) by 30% using nurse-led music therapy in an ambulatory surgical center.

Results

Mean VAS-A scores decreased from 6.9 (SD = 0.5) pre-intervention to 4.0 (SD = 0.5) post-intervention, representing a 2.9-point (41.9%) reduction in anxiety and exceeding the project's target of 30%. Nurse adherence to the intervention protocol was 100%, and the mean patient satisfaction score was 4.6/5.0. All 100 patients completed both …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

Advance Care Planning In Metastatic Lung Cancer Patients: A Quality Improvement Initiative, Khanh H. Thai

Student Theses

Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.

Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.

Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were …

Implementing Preoperative Anxiety Screening To Enhance Patient-Centered Care: A Quality Improvement Initiative, Adam Chaban, Abigail Limary, Amir Ghafarian, Joyce Li, George Mckelvey, Wael Saasouh

Medical Student Research Symposium

Background: Preoperative anxiety affects 40–80% of surgical patients and is associated with poorer perioperative experiences. Despite evidence linking preoperative anxiety to increase postoperative pain, sleep disturbances, morbidity and delayed recovery, structured anxiety assessment is not routinely integrated into outpatient pre-anesthesia workflows. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a validated tool that quantifies patient anxiety and information needs. This quality improvement (QI) project aims to implement APAIS screening in a Pre-Anesthesia Testing (PAT) clinic and evaluate its feasibility, workflow integration, and acceptability.

Methods: This QI initiative will be conducted in adult elective surgery patients at the Detroit Medical …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Implementation Of A Planned Extubation Nurse-Led Safety Bundle In A Pediatric Cardiac Intensive Care Unit, Broderick Sutton

Doctor of Nursing Practice Final Project Abstract

Purpose: To implement and evaluate a nurse-led planned extubation safety bundle designed to improve nurse preparedness, interdisciplinary communication, workflow consistency, and confidence during planned extubation events in a pediatric Cardiac Intensive Care Unit (CICU).

Background: Planned extubation in critically ill pediatric cardiac patients requires effective interdisciplinary coordination. Variability in nurse preparation, communication, and knowledge of sedation pharmacokinetics contributed to workflow inefficiencies and patient safety concerns. Evidence supports standardized nurse-led protocols to improve extubation readiness and reduce practice variability.

Methodology: A prospective pre-post quality improvement project was conducted over eight weeks in a pediatric CICU. The intervention included a nurse-led planned …

Reducing Pharmacy Callbacks And Improving Workflow Efficiency In The Emergency Department: A Quality Improvement Initiative, Philip .. Carhart, Hannah Culleny, Alexis Schuitema, James Espinosa, Robin Lahr, Sergey Medlenov, Gabriel Meister, Alan Lucerna

Rowan-Virtua Research Day

A simple educational intervention combined with structured provider feedback reduced ED pharmacy callbacks by 86%. While individual call duration remained unchanged, the reduction translated into nearly eight hours of provider time saved annually. This study highlights the impact of targeted quality improvement efforts on: • Workflow efficiency • Interprofessional communication • Patient care reliability. Small systems interventions can produce disproportionate operational benefits.

Optimizing Antibiotic Strategies With A Clinical Pathway Approach: Enhanced Initiation And De-Escalation In Community-Acquired Pneumonia, Ahmad Behzadpour

HCA Healthcare Journal of Medicine

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization, mortality, and health care expenditure worldwide. Inappropriate use of broad-spectrum antibiotics contributes to antimicrobial resistance, adverse drug events, and increased costs. Antibiotic stewardship and standardized clinical pathways are key strategies to improve prescribing practices.

Methods

This quality improvement (QI) initiative was conducted at a 240-bed tertiary care teaching hospital from January 2023 through January 2025. A CAP-specific digital clinical pathway was developed using Curbside Health® and integrated into the electronic health record (EHR), accessible through a structured order set to support real-time clinical decision-making. The intervention included provider education and …

Applying Lean Six Sigma To Optimize Pediatric Liver Transplant Workflows: An Investigational Quality Improvement Initiative And Process Improvement Framework, Sarah E. Auletta

Online/Hybrid MPH Integrative Learning Experience (capstone projects)

For children with end-stage liver disease, liver transplantation is the only cure. While organ scarcity is a national challenge, internal pre-listing processes remain within an institution's control. This quality improvement initiative applied Lean Six Sigma and mixed-methods process mapping to the pediatric deceased donor liver transplant pathway at Boston Children's Hospital. By integrating five years of electronic health record data with multidisciplinary interviews, the project developed a comprehensive process map and performance dashboard.

The study revealed a median of 65 days elapsed between referral and waitlist activation—a timeline entirely within internal operational control. This delay was concentrated in two specific …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

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 …

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, …

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 …

Expanding Waste Segregation Initiatives To Reduce Regulated Medical Waste: A Multi-Departmental Quality Improvement Project, Emily M. Su, Anuja L. Sarode, Mohammed Sami, David R. Nehring, Erica L. Laipply, Mustafa Culcuoglu

HCA Healthcare Journal of Medicine

Background

Regulated medical waste (RMW) drives up health care costs, largely due to misclassification of general waste, especially in operating rooms (ORs), intensive care units (ICUs), and obstetrics and gynecology (OBGYN) departments. This study aimed to reduce RMW volume and costs at Akron City Hospital (ACH) through department-specific interventions aligning with Occupational Safety and Health Administration (OSHA) and Ohio Environmental Protection Agency guidelines.

Methods

Periodic analyses compared hospital-wide aggregate RMW volume, pick-up frequency, and disposal costs before and after interventions. The ORs initiated interventions in October 2022, expanding to ICUs and OBGYN by February 2024. Strategies included staff education, flyers …

After Hours, Faster Reperfusion: A Multidisciplinary Quality Improvement Initiative To Reduce Stemi Door-To-Balloon Time, Suhas Tatapudi, Aarohi Parikh, Jeffrey Lesser, Alexander Rhodes, M Daniel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Improving Sepsis Order Set Utilization Through Targeted Resident Education: A Lean Six Sigma Green Belt Quality Improvement Project, Sarah Sheikh, Puneeth Shridhar, Bushra Bangash, Valerie Chukelu, Tonya Meirhofer, Arunima Jose, Zainab Shakir, Shane Jenks, Augusto Sepulveda, Trung Nguyen, Rajeev Raghavan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Qi: Improving Gdmt Among Discharge Patients With Heart Failure, Daniel Avila Castillo, Amar Kalidas, Parshvi Patel, Khaled Khalaf

Gulf Coast Division GME Research Day 2026

No abstract provided.

Reducing Pressure On Pressure Ulcers; A Study To Educate And Improve Skin Ulcers In The Hospital, Jakob Schnell, Victoria Suh, Peng Tang

Gulf Coast Division GME Research Day 2026

No abstract provided.

Tackling Tele Box Shortage Via Educational Initiative, Guntash Khasria, Bushra Ambreen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Improving False Code Blue Rates In The Hospital, Edrianna Mae Ablola, Muhammad Siddiqi, Veronica Phung, Sivatej Sarva

Gulf Coast Division GME Research Day 2026

No abstract provided.

Implementing Daily Spontaneous Awakening And Breathing Trials In The Trauma Intensive Care Unit: A Quality Improvement Initiative, Bradley Vaughn, Lina V. Mata-Mcmurry, Eric Shaw, James Dunne

South Atlantic Division GME Research Days 2026

No abstract provided.

Enhancing Patient Safety: Yellow Gown Strategy For Fall Prevention, Kimberly Nathan, Obumneke Umerah, Lorenna Garcia-Bochas, Nayda Parisio Poldiak, Jilian Sansbury

South Atlantic Division GME Research Days 2026

No abstract provided.

Impact Of Sputum Collection Within 24 Hours Of Admission For Patients Hospitalized With Pneumonia, Sally Baker, Madelaine Duarte, Lauren Kirk, Mohamed Faris

South Atlantic Division GME Research Days 2026

No abstract provided.

A Quality Improvement Project To Enhance Early And Consistent Prenatal Care In The Spanish Speaking Female Population At The Fqhc West Ashley Fetter Clinic, Ana Martinez Conde, Sophia Zia, Joye Fordham, Dennis Besong

South Atlantic Division GME Research Days 2026

No abstract provided.

A Qi Project: Fostering Methods Of Communication To Promote Hospital Discharge Follow-Up Rate And Access To Primary Care, Radhika Mohan, Sanket Patel, Deepa Nuthalapati, Michael Smith, Valerie Sinkler, Dennis Besong, Pooja Paunikar

South Atlantic Division GME Research Days 2026

No abstract provided.