Quality Improvement Commons^™

Churning The Tides Of Care: When Nurse Turnover Makes Waves In Patient Access To Primary Care, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Trang N D Pham, Laura A Petersen, Lechauncy Woodard, Richard Sorelle, Cheng Rebecca Jiang, Frederick L Oswald, Daniel R Murphy, Hilary N Touchett, Joshua Hamer, Sylvia J Hysong

Faculty, Staff and Students Publications

BACKGROUND: Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

OBJECTIVE: This study aims to empirically assess how the stability of RN staffing within …

Does Hospital–Physician Integration Improve Hospital Performance? Results From A Usa Longitudinal Study, Soumya Upadhyay, Randyl A. Cochran, William Opoku-Agyeman

Healthcare Administration and Policy Faculty Research

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians’ leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and …

M3t-Lm: A Multi-Modal Multi-Task Learning Model For Jointly Predicting Patient Length Of Stay And Mortality, Junde Chen, Qing Li, Feng Liu, Yuxin Wen

Engineering Faculty Articles and Research

Ensuring accurate predictions of inpatient length of stay (LoS) and mortality rates is essential for enhancing hospital service efficiency, particularly in light of the constraints posed by limited healthcare resources. Integrative analysis of heterogeneous clinic record data from different sources can hold great promise for improving the prognosis and diagnosis level of LoS and mortality. Currently, most existing studies solely focus on single data modality or tend to single-task learning, i.e., training LoS and mortality tasks separately. This limits the utilization of available multi-modal data and prevents the sharing of feature representations that could capture correlations between different tasks, ultimately …

Gynecological Cancers And Quality Of Life, Shaina E. Ettinger

Internet Journal of Allied Health Sciences and Practice

ABSTRACT

Background: Every five minutes a woman in the United States receives a gynecological cancer diagnosis. On average, 88,128 women in the United States are diagnosed with gynecological cancer yearly and 12,158 of those women, or 7% require hospital readmission. Although patient readmission rate is relatively low for this population, a better understanding of how patients frame quality of life (QoL) may decrease readmission stemming from QoL complications. Objective: The aim of this study was to identify the QoL issues that contributed to hospital readmission following surgical intervention in women newly diagnosed with gynecological cancer. Method: The study used a …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

Let’S Make It A Game: Utilizing An Escape Room To Study Variables And Interventions That Impact The Development Of Psychological Safety, Kimberly N. Williams

Doctoral Dissertations and Master's Theses

To thrive in today’s competitive markets, organizations must harness the insights of all members. This requires employees to feel comfortable collaborating and sharing diverse knowledge—a process enabled by psychological safety. Although extensively studied over the past two decades, how and when psychological safety develops remains unclear. This research addresses these gaps by exploring temporal changes in psychological safety and examining the role of team inputs, processes, and interventions in shaping psychological safety perceptions at individual and team levels. This study utilized a quasi-experimental design with repeated and independent measures in a sample of 74 medical and physician assistant students. Within-subject …

Documented Newborn Hearing Screenings In Florida Administrative Hospital Data: State Policy Compliance By Hospital Types, Teresa Anthony, Blake Barrett, Adam Brown, Jessica Ryan

Journal of Early Hearing Detection and Intervention

Purpose: Florida policy mandates newborn hearing screenings (NBHS) in hospitals. U.S. inpatient administrative hospital data reflects low rates of documented screenings. This analysis investigates inconsistencies between Florida policy and administrative records.

Method: Analysis of Florida statutory language was completed. Florida hospital administrative data was retrospectively analyzed using various statistical methods to explore differences in proportions of documented NBHS among distinct hospital types based on profit and teaching statuses.

Results: Florida mandate requires NBHS completion in the hospital prior to discharge from the birth facility or within 21 days after birth and allows for billing a third-party payer. …

Removal Of Common Antimicrobial Agents By Sustained Low- Efficiency Dialysis, Joanna Q. Hudson Pharmd, Bcps, Fasn, Fccp, Madelyn N. Hilgers Bs, Pharmd Candidate, Elvira O. Gosmanova Md

Faculty Publications

Adequate dosing of antimicrobials is paramount for treating infections in critically ill patients undergoing kidney replacement therapy; however, little is known about antimicrobial removal by sustained low-efficiency dialysis (SLED). The objective was to quantify the removal of cefepime, daptomycin, meropenem, piperacillin–tazobactam, and vancomycin in patients undergoing SLED. Adult patients ≥18 years with acute kidney injury (AKI) or end-stage kidney disease receiving one of the select antimicrobials and requiring SLED were included. Blood and dialysate flow rates were maintained at 250 and 100 mL/min, respectively. Simultaneous arterial and venous blood samples for the analysis of antibiotic concentrations were collected hourly for …

Assessing Preparedness, Attitudes, And Knowledge Of Knapp-Utrgv Family Medicine Residents On Geriatric Nursing Home Care: Phase 1 - Creation Of Interactive Modules, Maria M. Ferreira Caceres, Miguel A. Alvarez Silva, Juan C. Lopez-Alvarenga

Research Colloquium

Background: Training in geriatrics and nursing home care are a critical element of medical education. This gap in knowledge becomes increasingly significant given the changing demographics and the need to provide adequate care for an aging population. Improving geriatrics curriculum and implementing nursing home rotations are essential to ensure optimal care for the elderly, thereby fulfilling both educational and healthcare imperatives.

Objective: We aim to analyze and assess the influence of geriatrics training through a survey to collect attitudes, skills, and knowledge of UTRGV Knapp Family Medicine residents. Additionally, the goal is to create interactive modules to boost their skills …

Customer Service Revisited, Allen Vean Dmd

Metro Denver Dental Society Articulator Magazine

MDDS Co-Editor, Dr. Allen Vean reflects on the importance of excellent customer service in dentistry. The article draws on personal experience and underscores the significance of patient retention, personal touches and creating a welcoming office environment.

Decreasing Utilization Of Indwelling Urinary Catheters, Stacie Lomibao Fujimoto

Articles, Abstracts, and Reports

Increased utilization and prolonged dwell times of indwelling urinary catheters (IUCs) are directly related to the risk of catheter-associated urinary tract infections (CAUTIs)- the fifth most common type of healthcare associated infection (HAI). The National Health and Safety Network (NHSN) uses the Standardized Utilization Ratio (SUR) metric to measure and compare device utilization in acute care hospitals across the nation. The national target SUR benchmark is 1.0, and a SUR under 1.0 indicates less device usage than NHSN predicts on an inpatient unit. In 2022 a Neuro Med-Surg unit experienced an overall SUR of 1.047 with 2 CAUTIs observed. A …

Preventive Effects Of Quercetin On The Leaky Gut By Suppression Of Il-1beta-Induced Transcription Factors Involved In An Inflammatory Pathway In Colonic Epithelial Cells, Wannaporn Chayalak, Sumpun Thammacharoen, Chatsri Deachapunya, Sutthasinee Poonyachoti

The Thai Journal of Veterinary Medicine

Flavonol quercetin (Q), found in vegetables and fruits, demonstrates the most potent anti-inflammatory effect. The preventive effect and cellular mechanisms of Q (Q1, Q10, and Q100 µM) on IL-1β induced leaky gut via the signaling molecules of inflammatory pathway, NF-κB p65-iκB/or p38/ERK1/2/MLCK/phospho(p)-MLC were investigated in Caco-2 cells. The cytotoxic effect of Q was initially determined by MTT assay. Transepithelial electrical resistance (TER) and apical-to-basolateral fluorescein isothiocyanate-labeled dextran (FD-4) flux were used to determine paracellular permeability. The protein expression of signaling molecules was examined by Western blot analysis, and their target MLCK mRNA expression was determined using real-time PCR. All Q …

A Systematic Review Of Racial Disparities In Emergency Department Pain Evaluation And Treatment In The United States, Cyrus Wolff

Theses and Graduate Projects

Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.

Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps …

Personalized Nutrition: Tailoring Dietary Recommendations Through Genetic Insights, Saiful Singar, Ravinder Nagpal, Bahram H. Arjmandi, Neda S. Akhavan

Kinesiology and Nutrition Sciences Faculty Research

Personalized nutrition (PN) represents a transformative approach in dietary science, where individual genetic profiles guide tailored dietary recommendations, thereby optimizing health outcomes and managing chronic diseases more effectively. This review synthesizes key aspects of PN, emphasizing the genetic basis of dietary responses, contemporary research, and practical applications. We explore how individual genetic differences influence dietary metabolisms, thus underscoring the importance of nutrigenomics in developing personalized dietary guidelines. Current research in PN highlights significant gene–diet interactions that affect various conditions, including obesity and diabetes, suggesting that dietary interventions could be more precise and beneficial if they are customized to genetic profiles. …

Digital Scribes: A Possible Solution For Provider Burnout By Reducing Provider Workload, Shannon Storley

Theses and Graduate Projects

Background: Provider burnout is continuing to be a massive problem for our healthcare industry. One major contributor to provider burnout is burdensome administrative tasks associated with documentation of electronic medical records (EMR). This review aims to uncover the applications for artificially intelligent digital scribes as a solution to reduce EMR documentation burden. Purpose: Provider burnout has shown to increase the incidence of major mistakes and decreased patient safety grades. Digital scribes could be a solution in reducing provider burnout by reducing the administrative burden of EMR documentation. Methods: A comprehensive literature review was conducted using articles from PubMed using search …

Barriers Primary Care Physician Assistants Face In Referring Patients To Palliative Care Services Early In The Disease Process, Claire Petersen

Theses and Graduate Projects

Background: Medical specialties such as hospice and palliative care have been proven to improve quality of life for patients facing end-of-life and chronic illness. Though increasing awareness of these specialties has resulted in greater availability, it is essential to investigate the barriers clinicians, such as Physician Assistants, face in making these referrals in order to provide quality healthcare to those who need it. Physician Assistants specifically are an essential clinician group to evaluate, as they continue to become more prevalent in the healthcare system.

Purpose: To determine barriers primary care Physician Assistants face when identifying candidates for and referring to …

Health For All: Evaluating The Impact Of Equity-Centered Approaches On U.S. Healthcare Delivery, A Review Of Literature, Angela Leung

Master's Projects and Capstones

This literature review examines the impact of equity-centered approaches on issues affecting U.S. healthcare delivery—multiple databases to identify relevant literature that discussed equity-centered care, associated health disparities, and implementation strategies. Of the 490 search results, ten articles remained after refining the search results to include papers published between 2014-2024 and fit the specific inclusion and exclusion criteria. The key findings highlight the benefits of equity-centered approaches in improving the quality and accessibility issues affecting the U.S. healthcare system. Presently, the status of equity work is siloed between healthcare systems in the U.S., creating an unprecedented roadblock. Nonetheless, the findings suggest …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

Improving Utilization Of Interqual Among Case Managers/Patient Care Coordinators At Santa Clara Medical Center, Czar Binuya Viesca

Master's Projects and Capstones

Problem: The utilization management department at Santa Clara Medical Center had low compliance with InterQual criteria, at 35%. This resulted in inconsistent care decisions, poor resource allocation, and regulatory penalties, affecting patient care and performance.

Context: The project aimed to enhance InterQual utilization, aligning with Santa Clara Medical Center's goals of evidence-based, patient-centered care. The initiative was guided by Jesuit values and ANA ethical standards, focusing on service, justice, excellence, patient advocacy, and professional responsibility.

Interventions: The project implemented three main interventions: comprehensive training programs, regular audits, and performance recognition. These interventions aimed to address gaps and ensure the …

Sustainable Waste-To-Bioproducts Engineering Center Laboratory Safety Project, Claudine Mock

All Graduate Reports and Creative Projects, Fall 2023 to Present

Laboratory accidents are common in teaching and research labs; these accidents can be injurious or even fatal. The consequences of each type of laboratory accident are different based on the activities performed and the hazardous materials used in each facility. However, the most common issue related to laboratory accidents is the lack of proper safety measures (e.g., poor handling of hazardous materials, not reporting incidents immediately, etc.). This project aimed to establish and strengthen best practices and procedures to ensure laboratory safety at the Utah State University Sustainable Waste-to-Bioproducts Engineering Center. To achieve this goal, different practices and measures were …

Assessing The State Of Obesity Care: Quality, Access, Guidelines, And Standards, Lee M Kaplan, Caroline M Apovian, Jamy D Ard, David B Allison, Louis J Aronne, Rachel L Batterham, Luca Busetto, Dror Dicker, Deborah B Horn, Aaron S Kelly, Jeffrey I Mechanick, Jonathan Q Purnell, Ximena Ramos-Salas, Assessing The State Of Obesity Care Writing Group

Faculty, Staff and Student Publications

BACKGROUND: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.

AIMS: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.

METHODS: The panel was held in Leesburg, Virginia in September 2019.

RESULTS: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice …

Online Diabetes Program Improving Nurses' Competency In School-Age Diabetes Care, Kristina Donovan

Doctor of Nursing Practice Scholarly Projects

Background: Diabetes affects over 280,000 children under 20 in the US, requiring specialized knowledge and skills for management. In a large urban school district with 54,000 students, 159 have diabetes, cared for by 158 school nurses. These nurses often struggle with the complexities of diabetes care and lack standardized training, leading to potential suboptimal care. An online diabetes education program was implemented to improve their competency, knowledge and skills, and confidence in managing diabetes in school-age children.

Methods: An asynchronous online competency-based diabetes education program to improve nurses’ competency to care for school-age children with diabetes was implemented in an …

Reducing Rates Of Blood Culture Contamination In The Emergency Room, Erika Goldberg

Student Scholarly Projects

Practice Problem: In one emergency room (ER) blood cultures (BC) drawn by nurses had a high contamination rate due to lack of collection standards, which lead to poor patient outcomes.

PICOT: The PICOT question that guided this project was; In adult emergency room patients where blood cultures are drawn (P), how does implementation of an evidence-based practice method (I), compared to the standard method of obtaining blood cultures (C), affect blood culture contamination rates (O), within ten weeks. (T)?

Evidence: Based on multiple sources within the literature; best evidence for lowering blood culture contamination rates (BCC) is done using EBP …

Development And Implementation Of A Digital Quality Measure Of Emergency Cancer Diagnosis, Paarth Kapadia, Andrew J Zimolzak, Divvy K Upadhyay, Saritha Korukonda, Riyaa Murugaesh Rekha, Umair Mushtaq, Usman Mir, Daniel R Murphy, Alexis Offner, Gary A Abel, Georgios Lyratzopoulos, Luke T A Mounce, Hardeep Singh

Faculty, Staff and Students Publications

PURPOSE: Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality.

METHODS: On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Implementation Of A Standardized Acute Care Plan For Complex Care Medicine Service Patients: A Quality Improvement Initiative, Tracy Markwell

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.

LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are …

Transitions Of Care And The Prevention Of Readmissions, Beatriz Granado

Student Scholarly Projects

Unplanned hospital readmissions often result from poor discharge planning and challenges during the transition from hospital to home, including medication errors and weak communication with primary care providers. A well-organized and personalized discharge plan can significantly reduce hospital stays, lower readmission rates, minimize medication errors, and improve patient outcomes, all while decreasing healthcare costs. In post-discharge Medicare-eligible patients (P), how does transitional care coordination through organized, personalized, and patient-focused discharge planning (I), compared with standard or no transitional care coordination provided (C), affect readmissions (O) within the 30-day post-discharge phase monitored over a 10–12-week period (T)? A search was conducted …

Implementation Of A Patient Decision Aid For Atrial Fibrillation Ablation Improves Patient Procedural Knowledge But Does Not Impact Perceived Involvement With The Shared Decision-Making Process, Nicholas Sommers, Jason C. Rubenstein, Abdur Rahman Ahmad, James Oujiri, Ridhima Kapoor, Graham Adsit, Marcie Berger

Journal of Patient-Centered Research and Reviews

Purpose: Shared decision-making (SDM) is a method for a patient and physician to cooperatively consider a diagnostic or therapeutic option, ultimately empowering the patient to make an informed decision. Atrial fibrillation (AF) ablation is a procedure that would benefit from SDM given the risk of serious adverse events, the high rate of arrhythmia recurrence, and alternative treatment options. Implementing a patient decision aid (PDA) may help facilitate AF ablation SDM by succinctly conveying important information to patients.

Methods: Patients scheduled for initial AF catheter ablation were randomized to a virtual SDM visit utilizing a PDA, which covered procedural risks and …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …