Internal Medicine Commons^™

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 …

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.

Minimizing Unnecessary Ttes For Pfo Evaluation In Stroke Patients, Jeffrey Lesser, Salman Islam, Aneesha Shaju, Aarohi Parikh, Jonathan Nguyen, Marelle Montanez

Gulf Coast Division GME Research Day 2026

No abstract provided.

Early Detection And Interventions For Delirium, Angel Ryals, Aneesha Shaju, Veronica Phung, Ijeoma Arubaleze

Gulf Coast Division GME Research Day 2026

No abstract provided.

Multifactorial Fall Reduction Initiative, Anush Agarwal, Emaan Ul Haque, Daniel Visaya

Gulf Coast Division GME Research Day 2026

No abstract provided.

Increasing Patient Safety By Improving Healthcare Team Communication Through Imobile At Hca Healthcare Trident Hospital, Jordan Read, Laura Brant, Matthew Madden

South Atlantic Division GME Research Days 2026

No abstract provided.

Closing The Post-Discharge Gap: Implementing A Structured Transitional Care Management Workflow To Improve Follow-Up Rates, Anikita Ojha, Sakina Haider, Uzma Ali, Daniel Odutola

Gulf Coast Division GME Research Day 2026

No abstract provided.

Qi Project: Improving Utilization Of Cardiac Monitoring On Inpatients Based On Aha Guidelines, Muhammad Humais, Jorim Parmar, Shakir Al-Ezzi, Florence Murray, David Maldonado, Mohan Sengodan

North Texas GME Research Forum 2026

No abstract provided.

Devising A Protocol For Mri Clearance In Patients With Cardiac Implantable Electronic Devices (Cied), Sienna Luk, Alvin Mathew, Darshan Bhatty, Kamran Rizvi

North Texas GME Research Forum 2026

Background: Magnetic Resonance Imaging (MRI) in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a logistical challenge in many clinical settings. At Medical City Denton, the absence of a standardized institutional policy has led to significant inefficiencies, including prolonged hospital stays and increased healthcare costs. The primary objective of this project was to address these barriers by developing a streamlined, evidence-based protocol to improve care coordination and resource utilization for patients with CIEDs requiring diagnostic imaging.

Methods: Launched in 2026, this pilot initiative utilized a multi-stakeholder approach involving hospitalists, EPs, radiology staff, and device representatives. A core component of the …

Cardiac Step-Down Unit (Csu), Two Failures Drive Suboptimal Vte Prevention: Quality Improvement, Jorim Parmar, Shakir Al-Ezzi, Anvi Manduva, Muhammad Suleman, Fahed Alsayed, Debra Medsker

North Texas GME Research Forum 2026

BACKGROUND: In the Cardiac Step-down Unit (CSU), two failures drive suboptimal VTE prevention: (1). over-ordering of SCDs in patients unlikely to benefit and (2). < 10% documented application when SCDs are truly indicated. Baseline data indicates that curbing over-ordering alone would reduce recorded non-compliance by >50%, revealing a clear opportunity for system redesign.

METHODS: To integrate the updated “3 Bucket” Risk Model assessment into the computerized physician order entry (CPOE) in order to delineate the prophylaxis for a given patient population. Once the manual risk assessment proves to be viable in increasing compliance, we can propose having the tool adopted into the CPOE system. Root Cause Analysis revealed that lack of standardized VTE risk stratification leads to inconsistent ordering practices – …

Improving The Utilization Of Palliative Care Services At Medical City Fort Worth, Gennipher Smith, Shervin Sarji, Maanasa Palani, Samuel Chen, Mary Halm, Kristina Bowman, Morvarid Rezaie

North Texas GME Research Forum 2026

Palliative Care (PC) is a specialized medical care that aims to optimize the quality of life and alleviate the suffering of patients with serious medical illness. Benefits of palliative care include improved symptom management, enhanced quality of life, reduced healthcare utilization, better care alignment, improved communication and support, and financial savings. Hospital Corporation of America (HCA) Medical City Fort Worth (MCFW) has a PC consult service. However, it is underutilized. According to data collected from January 2025 to December 2025, the percentage of PC consults for high risk units, such as oncology and ICU, by day 3 of admission varies …

The Effects Of A Stepped-Care Mental Health Program On Trauma Recidivism At A Level I Trauma Center, Gabriella Rivas, Juliette Gammel, Kola George, Kenneth Ruggiero, Tatiana Davidson, Hannah Espeleta, Langdon Hartsock, Kristoff Reid

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.

Iron Deficiency Screening In Patients With Heart Failure : A Quality Improvement Project, Sinthugan Selvaranjan, Arthika Sakthevel, Amy Duff, Alexia Foy-Crowder, Mohamed Faris

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.

Optimizing Antibiotic Stewardship In Pneumonia: Evidence-Based Protocols For Enhanced Treatment And Resistance Reduction In A University-Affiliated Community Hospital, Carlos Luis Alejos, Jennifer Rojas Huen, Joan Beatrice Capellan, Ricardo Serna, Tejaswini Swamy, Jose Campo Maldonado

Research Colloquium

Introduction: National guidelines recommend early, targeted diagnostics such as respiratory viral panels, procalcitonin testing, Methicillin resistant staphylococcus aureus (MRSA) nasal swabs, and sputum cultures, for the effective management of pneumonia. However, our retrospective review at a university-affiliated community hospital revealed inconsistent application of these tools. These may contribute to excessive use of broad-spectrum antibiotics, higher costs, and increased antimicrobial resistance. The reason is that we aim to implement a standardized pneumonia order set in the electronic medical record (EMR) to improve diagnostic accuracy and antibiotic stewardship.

Methods: We conducted a retrospective chart review of adult inpatients admitted with community-acquired, hospital-acquired, …

Impact Of A Sepsis Quality Improvement Initiative On Clinical And Operational Outcomes, Christopher B. Thomas, Benjamin Wyler, Claude M. D’Antonio, Mark Laperouse, Shannon Alwood, Kristen Richard, Alyse Grantham, Roya Sheybani, Matt G. Sorrells, Wei Jien Tan, James W. Teague, Hollis O’Neal, Tonya Jagneaux

School of Medicine Faculty Publications

Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: …

Reducing Overnight Interruptions For Nonurgent Electrolyte Repletion, M. Duncan Kilpatrick, Md, Trishya Srinivasan, Md, Bertilia Tavarez, Md, Tatianna Branch, Do, Edwin Perez, Md, Zachary Pang, Md, Ryan Gardner, Md, Daniel Taupin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Overnight patient interventions, including electrolyte repletion, contribute to hospital acquired delirium.¹
• Among patients admitted to TJUH, we identified many cases of IV magnesium (Mg) repletion given overnight, waking up patients when urgent repletion may not be clinically necessary.
• This may be driven by resident belief that IV Mg increases serum Mg more effectively than PO Mg
• TJUH has implemented the Electrolyte Hub in EPIC which standardizes the dosing and ordering of electrolytes in most cases.
• However, the default in most non urgent cases is to administer the first dose of electrolyte now, whether it is PO or IV. …

Updating A Rural Clinic In Tiburón, Haiti, Akankcha Alok, Mohamed Bakhit, Djenie Helne, Philipe Milord, Marcellas Socrate, Camil Clermont, Marie A. Kima

HCA Healthcare Journal of Medicine

Background

Tiburón is a small fishing village in Haiti with a clinic overseen by the Oblate missionaries and the Ministry of Public Health and Population (MSPP). This village was hugely impacted by Hurricane Matthew in 2016, leading to increased health care demands. The clinic was inaccessible from the furthest parts of the village and lacked basic medication supplies and adequate manpower. We aimed to reinforce the infrastructure and update the clinic using a multifaceted approach.

Methods

We developed a quality improvement project to strengthen the clinic's infrastructure and modernize its facilities with a comprehensive approach focused on enhancing health care …

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 …

Resident And Fellow Call Schedule: Implementation And Analysis, Joshua Gelber, Dj Jiang, Syed Basit Haider

Gulf Coast Division GME Research Day 2025

No abstract provided.

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.

Reducing Time To Heparin Administration In A Cardiac Center, Shai Ring, Shafaq Jawed, Taylor Teshon, Siva T. Sarva

Gulf Coast Division GME Research Day 2025

No abstract provided.

Qi Project On Depression Screening Phq2 And Phq9 In Kingwood Im Clinic, Anam Zara, Sara Shahid, Anusha Putta

Gulf Coast Division GME Research Day 2025

No abstract provided.