Quality Improvement Commons^™

Improving Low Fresh Gas Flow Adherence To Lower Co2e Emissions, Luke Charles Ricci

Honors Theses and Capstones

Volatile anesthetic gases contribute significantly to healthcare-related greenhouse gas emissions. These greenhouse gas emissions can be increased due to higher fresh gas flows. At Dartmouth-Hitchcock Medical Center (DHMC), open and semi-open systems with fresh gas flow (FGF) rates above two liters per minute result in anesthetic gas waste. Literature suggests multifaceted quality improvement interventions are effective in improving low fresh gas flow adherence in anesthesia provider practices. The purpose of this study was to evaluate the potential reduction in anesthetic gas waste and carbon dioxide equivalent (CO₂e) emissions at Dartmouth-Hitchcock Medical Center through improved adherence to low fresh gas flow …

Review Of Outcomes: Quality Improvement Of Upper-Extremity Necrotizing Soft Tissue Infections, Cailey A. England Bs, Ryan A. Reinhart Bs, Tien Do Do, Maame A. Effirim Bs, Dylan Bezzini Md

Summer Research Program Abstracts

No abstract provided.

Improving Confidence In Certified Registered Nurse Anesthetists In Providing Care For Patients Undergoing Transcatheter Aortic Valve Replacements, Justin Alley

DNP Scholarly Projects

Abstract

Title: Improving Confidence in Certified Registered Nurse Anesthetists in Providing Care for Patients Undergoing Transcatheter Aortic Valve Replacements (TAVR)

Background: Anesthesia staffing for complex, high-risk procedures like Transcatheter Aortic Valve Replacements (TAVR) is challenging due to a national shortage of anesthesia providers and the company's heavy reliance on non-permanent (locum tenens and 1099) Certified Registered Nurse Anesthetists (CRNAs). At this TAVR procedure location, 70% of the team is comprised of non-permanent staff. A lack of specialized training and experience in TAVR procedures led to a decrease in provider confidence and staffing shortages for these critical cases.

Purpose: The primary …

Impact Of Clinical Decision Support Tool Implementation On Injectable Calcitonin Usage, Petar Jordanov, Ashley Crouch, William Towers

Advances in Cancer Education and Quality Improvement

Calcitonin injection is a high-cost medication used to treat hypercalcemia in hospitalized patients. Many institutions have implemented strategies to reduce unnecessary use or waste of calcitonin, including dose rounding, formulary restriction criteria, and limiting the number of doses a patient may receive. MD Anderson Cancer Center (MDACC) utilizes approximately 1200 calcitonin doses per year with no current formulary or dosing restriction criteria. The goal of this study was to evaluate patterns of use of calcitonin at MDACC and implement and evaluate the impact of clinical decision support tools to reduce unnecessary calcitonin use and waste. This is a single-center quality …

Streamlining Nuclear Theranostic Clinic Workflow, Charisma Desai, Anne Fisher

Advances in Cancer Education and Quality Improvement

Nuclear medicine clinic needs have drastically changed with the emergence of theranostics, exciting new agents in the fight against cancer. However, administering these agents is a resource-intensive task, increasing demand for physician consultation time with patients, clinic office space, and scanner time. We examined our institution’s nuclear medicine clinic workflow and interviewed the clinic’s front desk staff, technologists, nurses, managers, physicians, and patients to find sources of delays, dissatisfaction, and decreased efficiency. An Ishikawa diagram and decision matrix helped us determine the most impactful intervention with our available resources. For this cycle, we focused on the consent process. Theranostic patients …

Interactive Clinical Dashboard For Psychiatric Oncology Services At A Cancer Institution: A Quality Initiative, Maria Shabih, Adelita D. Martinez, Alan D. Valentine, Deepti A. Chopra

Advances in Cancer Education and Quality Improvement

Accurate documentation of reasons for psychiatry consultations is critical for developing an effective treatment plan for the patient and improving quality of care through targeted interventions. The purpose of this project was to create an interactive dashboard on Power BI. We downloaded the report from Epic on SAP BI. On an Excel sheet, we recoded the reason for consults and categorized using a keyword list and recoded the consults into distinct, categories such as "anxiety," "depression," and "altered mental status (AMS)," with data spanning 2 fiscal years.

Key findings from the dashboard revealed that anxiety and depression accounted for most …

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 …

Improving Patient Portal Messaging Workflow, Tanya M. Fitzpatrick

All Doctor of Nursing Practice (DNP) Scholarly Projects

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 …

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 …

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 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. …

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 …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Reporting And Tracking Of Occupational Bloodborne Pathogen Exposures, Olivia Smith

Doctor of Nursing Practice Final Project Abstract

Purpose/Background: Underreporting of occupational bloodborne pathogen (BBP) exposures remains a significant patient and employee safety issue. At UT Health, outdated paper-based systems hindered accurate tracking, timely follow-up, and reporting compliance. The aim of this quality improvement (QI) project was to achieve a 30% increase in quarterly BBP exposure reports, from 30 to 39, by implementing an electronic reporting system between January 1 and March 31, 2025.

Methodology: Guided by the Health Belief Model and using the Implementation and Improvement Science (IIS) Framework, the project replaced the existing paper form with an external, user-friendly digital system. Staff received structured training, and …

Care Alert Program In Chronic Emergency Department Using Patients: Expanded Study, Jonathan Leggett, Kaitlyn Phelps, David Nuñez, Brent Wright, Erica Gibbons, Jonathan Bryan, Brian Griggs

HCA Healthcare Journal of Medicine

Introduction

The Care Alert Program (CAP) is designed to help navigate encounters with patients who are high utilizers of Emergency Department (ED) resources. The CAP intends to address the needs of this challenging patient population by designing individualized care plans that are approved by a multidisciplinary committee. The patient populations that frequently use ED resources often have chronic medical conditions, a poor understanding of their conditions, unrealistic expectations regarding treatment, a lack of outpatient resources, and present with multiple complaints when using ED resources.

Methods

The CAP was adopted by our facility in the spring of 2020. The present study …

Are Hospital-Acquired Sepsis Cases Over-Reported Due To How Sepsis Is Coded In Electronic Health Records?, Michael Sakarya, Cooper Roslund, Spencer Foreman, David Gaieski, Md, Shruti Chandra, Md, Wayne Bond Lau

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Hospital-acquired sepsis (HAS) is a preventable cause of morbidity and mortality for hospitalized patients and is associated with greater cost and resource utilization compared to non-HAS.
• International Statistical Classification of Disease (ICD) coding system is used to identify HAS.
• Patients assigned HAS by ICD coding are presumed to have a nosocomial infection.
• Errors by ICD coding may cause misclassification of HAS cases.
• Unclear whether misclassified HAS have different outcomes than actual HAS

Quantiferon Tb Gold Test Utilization During Inpatient And Emergency Department Encounters At A Multi-Site, Single Academic Institution, Laxman Singanamala, Bs, Laura Walters, Do, Devin M. Weber, Md, Courtney E. Comar, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

• The QuantiFERON-TB Gold Plus test (QG) is an in vitro Interferon Gamma Release Assay that can be used to assess for prior exposure to Mycobacterium tuberculosis (MTB). The optimal use is in screening for latent disease.
• The United States is a low endemic country for MTB infection with 2.5 cases/100,000-persons in 2022 (CDC). Yet, we noted high utilization of the QG in our institution.
• Our goal was to understand our patient population and the clinical rationale for testing to create an electronic medical record (EMR) order set to optimize appropriate test use, decreasing unnecessary testing for patients and healthcare …

Reducing The Percentage Of Intubation Time On Continuous Infusion Midazolam, Arsemen Brown, Emily Highsmith, Michelle Horng

Advances in Cancer Education and Quality Improvement

This quality improvement study was conducted at a comprehensive cancer care center with the aim to decrease the percentage of on continuous infusion (CI) midazolam by 30% by May 5, 2023. The pre-intervention and post-intervention data collection phases occurred from January 1, 2022, to October 31, 2022, and March 7, 2023, to May 5, 2023, respectively. Sedation was assessed utilizing the Richmond Agitation and Sedation Scale (RASS), and delirium was assessed utilizing the Intensive Care Delirium Screening Checklist (ICDSC). A sedation pathway and associated educational materials were developed by a multidisciplinary team and frontline staff. Interventions in the sedation pathway …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Evaluating The Impact Of A Renal Dosing Refreshable Sidebar Report On Appropriateness Of Antimicrobial Dosing At A Large Acute Care Cancer Hospital, Emily Fox, Jovan Borjan, Nancy Vuong, Hannah Aune, Claire Marten, Joshua Hendrickson

Advances in Cancer Education and Quality Improvement

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and …

Improving The Patient Care Experience In Residential Eating Disorder Treatment: A Quality Improvement Project, Paige H. Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project was to implement structured biweekly patient check-ins at a residential treatment facility for eating disorders. This project was intended to increase the patient care satisfaction scores on patient discharge surveys from under 80% to over 90%.

Background

The project was implemented at a 12-bed residential treatment facility for adolescents and adults diagnosed with eating disorders located in Cypress, Texas.

Methodology

The Baird 2007 concept of scripting during rounds was utilized as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) patient care experience survey questions when creating the script used during …

Culturally Competent Diabetes Management Guide For African Immigrants, Bryce Hunderman

Doctoral Dissertations & Projects

Abstract

Background: Culturally competent care is a cornerstone in medicine to address health disparities and improve outcomes for vulnerable populations. Suboptimal diabetes management was noted within a federally qualified health center in the Midwest along with a lack of culturally competent diabetes education available for African immigrants. The research question for this project is: Will a culturally appropriate diabetes management guide that addresses barriers to diabetes management improve African immigrant’s understanding and abilities to manage diabetes within a federally qualified health center in the Midwest?

Methods: A culturally competent diabetes management guide for African immigrants was created. We …

Expanded Patient Reach At New Student Run Free Medical Clinic Location, Olivia Krol, Hana Warmflash, Alex Foster

OHSU-PSU School of Public Health Annual Conference

Background: Critical to modern medical education, student run free medical clinics (SRFCs) are present at more than 75% of AAMC member institutions. SRFCs educate students while providing low-barrier, free healthcare to underserved populations. SRFCs provide unique leadership and health systems management opportunities not traditionally emphasized in training, including leading logistical and operational changes.

In this project, we highlight the impact of a student-led operational initiative that transitioned our clinic from the River District Navigation Center (RDNC) to the Resource Center (RC), improving accessibility.

Methods:

Deidentified patient data from medical clinics from January 2024 to February 2025 were analyzed using RStudio …

Provider-Nurse Rounding Checklist: A Qi Project, Danielle Ursone Rn, Bsn, Jennifer O'Neil Bsn, Rn, Ccrn, Susan Penque Ph.D, Anp-Bc, Ne-Bc, Nc-C

Posters

• Communication between healthcare providers and nurses is an essential component for a good working relationship.
• Increased collaboration has been shown to improve staff attitudes and job satisfaction.
• Interprofessional rounds with a rounding checklist provide an organized way to perform rounds to increase satisfaction with teamwork and decrease miscommunication.
• At the DNP project site, a rounding checklist is not being used, resulting in a disconnect between the nurses and healthcare providers.

Dnp Final Report: An Evidence-Based Initiative To Improve Bowel Preparation Quality For Colonoscopy, Jennifer L. Gassett

DNP Final Reports

Good colonic bowel preparation (CBP) is an important component of colonoscopy but is often inadequate. Improving CBP can help increase detection of precancerous polyps, prevent procedures from being canceled or repeated, and decrease medical expenses. A quality improvement project was implemented to increase adequate CBP rates at an ambulatory surgery center specializing in endoscopy. Several factors correlate with suboptimal CBP, but the practice question focused on patient education. The PICOT question guiding evidence synthesis was posed: In adult patients preparing for outpatient colonoscopy, how do revised instructions with visual aids compared to written instructions affect CBP adequacy and patient satisfaction? …

Effective Communication In The Pronunciation Of Brain Death, Sumanth Reddy, Artur Amirkhanyan, Jeremiah Avarana, Praneetha Arge, Alicia Lay

North Texas Research Forum 2025

Background: Clinical brain death determination requires both technical proficiency and sensitive communication with families. However, residents often report inadequate training and confidence in performing and discussing these examinations. This study evaluated an educational intervention combining didactic training and simulation to improve residents’ competence in brain death protocols and family communication. Methods: A mixed-methods cohort study was conducted with resident physicians. Participants completed a pre-intervention questionnaire assessing baseline knowledge, experience, and confidence in brain death determination and communication. An educational session reviewed clinical criteria, examination protocols, and communication strategies. Residents then engaged in an in-person simulation with standardized actors portraying grieving …

Interprofessional Neonatal Resuscitation Simulations: An In-Situ Assessment Of Pediatric Readiness At A Multi-Site Academic Center, Jessyca C. Gibson, Petru C. Nemes

South Atlantic Division GME Research Day 2025

No abstract provided.

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.

Improving Internal Medicine And Emergency Department Communication - The Ed Map Project, Syed Raza, Srinidhi Shyamkumar, Eric Riha, Zuhair Ali

Gulf Coast Division GME Research Day 2025

No abstract provided.

Defend The Season: A Quality Approach To Influenza Vaccination, Robert Reinhart, Michaela Mckissack

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.