Quality Improvement Commons^™

Digital Touchpoints: Investigating Contact Page Accessibility And Visual Authenticity Within Medical Tourism Health Websites, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers, Sakshi Bhati, Himika Akram

Faculty Submissions

This study examines two critical digital touchpoints on medical tourism provider (MTP) websites: (1) the accessibility of contact pages which often function as entry points for inquiries, scheduling, and pre-travel coordination, and (2) the authenticity of visual imagery used to shape expectations about care environments, personnel, and technological capacity. A sample of 105 MTPs across all six World Health Organization regions were analyzed using quantitative web accessibility testing and qualitative visual analysis. Results indicate pervasive accessibility errors on contact-page touchpoints and extensive reliance on inauthentic imagery to depict patients, providers, and medical technologies. Together, these practices may distort user expectations …

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 …

Diva Difficult Intravenous Access Assessment, Aileen M. Romero, Mary Jo Sarver

Articles, Abstracts, and Reports

No abstract provided.

Eating Disorder Prevention And Early Intervention In U.S. Higher Education – A Comparative Benchmarking Study, Jake R. Arcement

Senior Theses

Eating disorders (EDs), including anorexia nervosa, have the highest mortality rate of any psychiatric illness, yet remain underrecognized relative to their severity and treatment burden. Because the period of peak onset aligns with the college years, institutions of higher education are uniquely positioned to play an important role in prevention, early identification, and referral to specialized care. However, limited research has examined how colleges and universities structure ED prevention and treatment resources. This thesis applies a comparative benchmarking framework to assess current institutional practices across U.S. colleges and universities. A national survey of student health and counseling centers examined staffing, …

Free Money And Safer Patients, Kaitlyn R. Livingston, Kennedy G. Crites, Jazmine Razo, Erin Radigan, Kennedy Crites

SPARK Symposium Presentations

This quality improvement project aims to improve consistency of nurse compliance with daily chlorhexidine gluconate (CHG) bathing in a local oncology unit to reduce the risk of central line-associated bloodstream infections (CLABSI’s). CLABSI’s remain a preventable source of patient morbidity, prolonged hospitalization, delayed cancer treatment, and increased healthcare costs, particularly among immunocompromised oncology patients who frequently require central venous access. Evidence supports daily CHG bathing as an effective infection prevention intervention; however, inconsistent completion and documentation across day and night shifts limit reliability in practice. This project addresses both documentation accuracy and actual bathing completion to ensure care consistency. Implementation …

Early Mental Health Screening In The Gi Patient Population: A Quality Improvement Project, Jacqueline Sagala

Loma Linda University Electronic Theses, Dissertations & Projects

Aims

This quality improvement project aimed to increase awareness and better integrate mental health screening in a GI clinic by educating staff and providers. The project evaluated changes in depression literacy, attitudes toward mental illness assessment, perceived training effectiveness, use of the training in clinical practice, and referrals to the Resiliency Clinic.

Background

Patients with chronic GI disorders commonly experience anxiety and depression, yet mental health concerns are often overlooked in specialty care. Although annual depression screening was already a part of the standard care at the Digestive Disease Center at Loma Linda University Faculty Medical Clinics, staff education and …

Improving Bedside Nurse Central Line Policy Compliance And Combating Clabsis, Keyshawna N. Chambers

Doctor of Nursing Practice Final Project Abstract

Central line-associated bloodstream infections (CLABSIs) are a problem, both globally and locally at this 20-bed pediatric cardiovascular ICU in Houston, TX. Bedside nursing staff had gaps in knowledge of central line policies and were often unaware of when dressings needed to be changed. This posed a significant concern, as this nosocomial infection is among the most life-threatening and costly complications in healthcare. Leadership attempted to correct this issue with weekly multidisciplinary rounds, but with high turnover, this was not a long-term fix. This quality improvement project aimed to increase central line policy compliance among bedside nursing staff to 93%, from …

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 …

Use Of A Structured Rounding Model To Improve Interprofessional Communication And Collaboration Among Mds And Rns In A Medicine Unit – An Evidence-Based Practice Project, Jackie Raygoza,

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose/Aims

This DNP project aims to improve communication and collaboration between physicians (MDs) and registered nurses (RNs) on medical units by implementing a structured three-step communication-rounding model integrated into the daily workflow and leveraging existing communication tools. As patients’ conditions become more complex and healthcare demands increase, it is crucial to foster an environment where communication among providers and staff is clear, transparent, respectful, and collaborative. By leveraging information technology and evidence-based strategies, the project seeks to strengthen interprofessional collaboration and improve patient satisfaction and the quality of care. The project includes educational sessions for both MDs and RNs to …

Optimizing Communication In The Periprocedural Area: Implementing Sbar: A Quality Improvement Project, Autumn Chang

Loma Linda University Electronic Theses, Dissertations & Projects

The primary aim of this project is to improve standardized nurse-to-nurse communication at the electrophysiology lab of a large Los Angeles hospital. By providing nursing education on a unit-specific, structured handoff communication framework (SBAR) and incorporating a procedure-specific handoff form for electrophysiology (EP) across pre-, intra-, and post-procedure units, this project aims to improve nurses’ perceptions of the handoff process and the effectiveness of handoff education across the periprocedural units. The project further aims to assess nursing incorporation of the training four weeks post-education and changes in patient satisfaction related to nursing teamwork and communication.

Educating Nurses On Caring For Patients With Intellectual And Developmental Disabilities – An Evidence-Based Practice Project, Amyela Adarlo

Loma Linda University Electronic Theses, Dissertations & Projects

Intellectual and developmental disabilities (IDD) refer to a range of conditions that begin before age 18 and impact physical, cognitive, and socioemotional development. Patients with IDD often experience poorer health outcomes due to healthcare providers’ limited training in effective communication strategies. This evidence-based project aims to evaluate whether educating nurses on effective communication with IDD patients improves nurse self-efficacy and confidence in communication and enhances caregiver perceptions of nursing care.

Implementing A Noise Reduction Protocol To Reduce Perceived Noise In The Icu – An Evidence-Based Practice Project, Soh Jeon

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims:

This project aims to reduce perceived noise in the ICU and promote a healing environment through a multi-interventional noise-reduction protocol and nursing staff education.

Rationale/Background:

The World Health Organization (WHO) recommends that hospital noise levels remain below 35 decibels during the day and 30 decibels at night. However, ICU noise often exceeds 50-70 decibels. Increased noise levels are primarily caused by conversations, monitoring alarms, and routine care activities, such as cleaning and procedures. These high noise levels directly affect patients’ sleep, which is essential to recovery. Insufficient rest can lead to immunosuppression, prolonged mechanical ventilation, and elevated stress …

Scrub Up For Success: Transforming Infection Control In Transplant Patients Through Microlearning Video And Poster – A Quality Improvement Project, Wendy Dio

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Background

Healthcare-associated infections (HAIs) threaten patient safety, affecting about 1 in 25 hospitalized patients. Clostridium difficile infection (CDI) is a significant contributor, impacting both high-risk groups and the general population. Proper hand hygiene is crucial for preventing CDI transmission. In the U.S., hospital-acquired CDI costs over $1.5 billion annually and causes nearly 500,000 cases and I15,000 deaths each year. California reported 3,526 CDI cases in acute care hospitals, with Loma Linda University hospitals accounting for 16 cases, or 23% of their health system's infection rate.

Methodology

Nurses in the 6A West-Transplant Unit received a PowerPoint presentation on when …

Evaluation Of Pinhole Castration Techniques Compare With Traditional Method For Castration In Rabbits, Wakash Oad, Faiz Muhammad Khand, Habibullah Janyaro, Muhammad Mohsen Rahimoon, Muhammad Ramzan, Dilpat Rai Menghwar, Benazir Sahito

Journal of Bioresource Management

Castration is a routine surgical intervention used to sterilize animals. Among the different conventional methods, the pinhole castration provides offer significant advantages. This study was conducted on 12 healthy male domestic rabbits at Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Sakrand, to evaluate the physiological impacts of traditional versus pinhole castration techniques. The rabbits were randomly divided into group A and group B with six rabbits per group. Key parameters included preoperative vital signs, intraoperative monitoring at 5, 10, and 15 minutes, intra- and postoperative complications, serum cortisol levels (preoperative, 24 hours, 5 and 10 days post-surgery) and …

Utilizing Proactive Rounding With Nursing Leadership To Improve Patient Satisfaction Scores In An Adult Medical-Surgical Unit, Lily A. Bogyah

Student Scholarly Projects

Practice Problem: Patient satisfaction is a key quality indicator that reflects patients’ perceptions of care and the healthcare system’s performance. Patient satisfaction scores at the project site were significantly lower than the national benchmark, particularly on the adult medical-surgical unit.

PICOT: The PICOT question that guided this project was: In patients on an adult medical-surgical unit (P), how does the use of proactive patient rounding conducted by nurse leaders (I) versus current practices alone without such rounding (C) affect patient satisfaction scores over an eight-week period (T)?

Evidence: A literature review of multiple studies found that implementing daily nurse leader …

Strategic Planning Time Horizons And Hospital Performance Outcomes, David Meyer

MUSC Theses and Dissertations

Background: Despite widespread adoption of strategic planning in healthcare, empirical evidence linking strategic planning time horizons to hospital financial and quality performance outcomes remains limited. Healthcare executives invest substantial resources in strategic planning processes, yet lack evidence-based guidance on whether longer or shorter planning horizons yield enhanced financial and quality-related results.

Methods: This study employed an exploratory sequential mixed-methods design combining executive survey data with archival performance data. A REDCap survey was administered to 22 hospital CEOs, CFOs, and other C-suite executives between January and February 2026. Survey responses were matched to publicly available financial and quality performance data from …

Hybrid Diabetes Coaching Model: Integrating In-Person And Telemedicine Strategies To Improve Glycemic Outcomes, Sandis A. Mundackal

Student Scholarly Projects

Practice Problem: In patients with type 2 diabetes, poor glycemic control among adults remains a significant challenge in primary care settings, particularly within federally qualified health centers (FQHCs) that serve underserved populations. At the FQHC practice site, patients were managed using standard care with quarterly follow- up visits, without a structured hybrid coaching approach. This inconsistency contributed to a high number of patients with hemoglobin A1c (HgbA1c) levels ≥ 9%, placing them at increased risk for diabetes-related complications.

PICOT Question: In adults with poorly controlled type 2 diabetes (HgbA1c ≥ 9%) (P), does monthly hybrid coaching delivered through in-person and/or …

Redesigning Outpatient Chemotherapy Scheduling: A Management Approach To Site-Integrated Operations, Dominick J. Morrone

MUSC Theses and Dissertations

Outpatient infusion centers face persistent scheduling complexity driven by variable treatment durations, coordination between clinics, pharmacy lead times, and constrained staffing. This doctoral project develops and reviews a comprehensive framework for infusion scheduling transformation that integrates workforce role redesign, site‑level communication pathways, and data‑informed workqueue governance. Using a multi‑phase case at a large cancer center as an anchor, the framework specifies responsibilities across central schedulers, on‑site teams, medical coordinators, and nursing; details communication and escalation design (secure messaging and in‑basket use); and outlines training and proficiency tiers. The project synthesizes evidence from scheduling science and time-driven activity-based costing principles to …

Synchronizing Success: Interprofessional Teamwork In Optimizing Throughput Management, Deborah Nimick, Eran Wilkerson

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Evaluating The Impact Of A Nurse-Driven Oxygen Titration & Weaning Guidelines On Length Of Stay And Costs Of Care: Qi, Stephanie Zarate

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Creating A Culture Change Around Stroke: Integrating Process Improvement To Reduce Door-To-Needle Time, Shayna Brewer, Benedict Pereira, Rose Bisellach, Jason Greenspan

Providence Nursing Research Conference 2023 – Present

No abstract provided.

A Qi: Implementing Pawss And Ciwa Adherence Challenge In The Psychiatric Emergency Department, Bailey Poler

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Pedaling Through Discomfort: A Feasibility Study Of Faculty-Led Spin Classes And Their Impact On Student Engagement, Resilience, And Faculty-Student Relationships, Gabriela Baza, Elizabeth Hathaway

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

This study explored the feasibility and impact of faculty-led Spin classes on college students’ engagement, well-being, and connection with faculty. Offered twice weekly at 7 AM during Fall 2024, the classes aimed to promote physical activity, resilience, and faculty-student relationships. Twenty-six students attended at least one class, with a median attendance of 4.5 sessions. Post-semester surveys (88% response rate) assessed perceived exertion, interest, enjoyment, challenge, improvement, and instructor encouragement. Students reported high levels of engagement and positive challenge (RPE = 15.3; challenge = 6.4/7). Those attending 7 or more sessions reported significantly greater perceived improvement than those attending fewer sessions …

Rural Georgia Hospital Covid-19 Virus Patient Outcomes, Susan P. Smith, Neeraj Dayama, Morgan E. House, Debra Flores, Sharon Hunt, April Dukes, Steven Gautney

Journal of the Georgia Public Health Association

Background: The Coronavirus disease 2019 (COVID-19) has led to over 1.2 million deaths in the United States. Given the staggering scale of the pandemic, rural hospitals faced heightened challenges due to limited resource availability and underlying patient characteristics.

Methods: In this context, we examined patient and hospital-related factors associated with inpatient mortality due to COVID-19. This study is a retrospective chart review of patient outcomes of patients who were hospitalized in a Southwest Georgia rural hospital with COVID-19 during the initial onset of the outbreak and over the following 23 months of the pandemic. Patient demographics, other characteristics, …

Impact Of Acute Flight Training Stress On Cardiovascular Health, Toni Butler, Noah Robbins, Sophia Vaden, Bryan Hinton

Student Research Symposium (SRS)

Student pilots face a unique set of stressors that are a part of their flight training. These acute stressors can have immediate and long-term impacts on their physiological and psychological well-being. Using near-infrared spectroscopy (NIRS) to measure vascular endothelial function (a marker of cardiovascular health), this investigation will help us understand how the stressors involved in acute flight training affects the cardiovascular health of student pilots. We will test the hypothesis that acute flight training stress obtained from a single bout of flight training reduces cardiovascular function as shown by a reduced post-occlusive reactive hyperemic (PORH) response. Cardiovascular health will …

Diagnostic Trends And Service Enhancements In Deaf Mental Health: A Longitudinal Analysis, Kent Schafer, Steve Hamerdinger, Frank Wu, Rie Sakai Bizmark, Charlene Crump

JADARA

A longitudinal study investigated mental health diagnostic trends and patterns among Deaf and Hearing individuals using a comprehensive dataset from Alabama Department of Mental Health spanning 2004-2024 (Deaf=4,547; Hearing=2,056,188). Chi-square analysis revealed significant proportional differences in diagnoses between the groups. Deaf individuals showed significantly higher proportions of psychotic (12.93% vs. 8.33% Hearing), mood (20.76% vs. 18.84% Hearing), and personality (0.58% vs. 0.43% Hearing) disorders. These findings suggest that increased access to specialized and competent mental health services for individuals who are Deaf, particularly following the increase of staffing patterns for the Office of Deaf Services in 2015,contributed to more accurate …