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Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

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Advanced Practice Provider-Physician Collaboration And Medical Staff Governance: A Framework For Patient Safety, Nicolas Testa, Kaysha Hervey, Cynthia Borum

HCA Healthcare Journal of Medicine

The growth of advanced practice providers (APPs) is occurring in parallel with persistent and projected physician shortages. One important solution and increasingly visible response to these workforce challenges is the expanding role of APPs. Strong physician-APP partnerships can help distribute workload, improve access, and support sustainable practice with the delivery of safe, quality patient care. The future of clinical care will depend on effective APP-physician collaboration grounded in sound credentialing, clearly defined supervision and practice expectations, and robust medical staff monitoring programs. We describe the governance and oversight processes in a large health care system to assess and support APP …

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

Thermal Skin Burns Following Infrared Vein Finder Application In Pediatric Patients: A Report Of 2 Cases And Protocol Revision, Sujata S. Rawlani, Nandini Banad, Jenil Sheth, Raja Narsingrao

HCA Healthcare Journal of Medicine

Background

Peripheral venous cannulation remains a cornerstone of pediatric anesthesia practice. Infrared vein finder devices have gained popularity as aids to improve venous visualization in children with difficult access. However, the thermal hazards associated with certain device types, particularly pocket flashlight-based models, remain underappreciated among clinical staff.

Case Presentation

We report 2 pediatric patients who sustained grade 2 thermal burns at peripheral venous access sites following the use of a pocket flashlight-based infrared vein finder during ophthalmic surgical procedures. The first patient, an 8-month-old girl born at term with appropriate developmental milestones undergoing congenital cataract surgery, developed a ruptured blister …

Time To Antibiotic Administration In The Treatment Of Sepsis: A Retrospective Cohort Study, Dennis Anthony Cardriche, Grayson Carter, Thomas Matese

HCA Healthcare Journal of Medicine

Background

The 2026 Surviving Sepsis Campaign (SSC) guidelines recommend antimicrobial therapy within 1 hour for probable septic shock, while the Centers for Medicare and Medicaid Services (CMS) mandates a 3-hour window. Current literature presents conflicting evidence on whether these universal time thresholds yield a definitive survival benefit. This study aims to evaluate the real-world impact of delayed antibiotic administration on patient mortality and length of stay (LOS).

Methods

A retrospective cohort study was conducted analyzing 62 153 adult encounters with severe sepsis or septic shock at emergency departments (EDs) between December 31, 2023, and December 31, 2025. Time to first …

A Heuristic Tool To Enable Root Cause Analysis Of Safety Events, William D. Porter, Kianca Joseph, Demitria Stafford, Kurt Larson, John Mier, Michelle Butler-Jackson, Musaddiq Waheed

HCA Healthcare Journal of Medicine

Background

Hospitals routinely collect wide-ranging data related to quality, efficiency, and clinical practice. As part of these efforts, patient safety event data are collected, compiled, and analyzed to drive process improvement.

Methods

We present a novel adaptation and application of the Department of Defense Human Factors Analysis and Classification System (HFACS) as a heuristic tool to improve the conduct of root cause analysis (RCA) sessions that follow serious patient safety events. To assess individual knowledge improvement after reviewing the heuristic tool, a 1-page summary (including a graphical image of the tool) was developed and provided to a convenience sample of …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

A Digital Safety Detection And Control System For Proactive Risk Management, Karla Miller, Jennifer Lee Mcalister, Keri Melson, Gita Nadimpalli, Becca Moore, Brett Powell, Kenneth E. Sands, Mary Catherine Harris, Cali Cerami, Shanna Arnold Egloff, Yauheni Solad, Randy Fagin

HCA Healthcare Journal of Medicine

Patient safety remains a defining dimension of health care quality, yet systems rely on retrospective assessment after harm has occurred, limiting visibility into upstream risks, including process failures and near misses. This challenge underscores the need for an approach that unifies fragmented safety activities to support proactive safety risk management. We describe a phased pilot implementation and evaluation framework of a Digital Safety Detection and Control System (DSDC) within a large integrated health care system to operationalize enterprise-wide patient safety. The DSDC integrates governance, human oversight, and digital capabilities across 4 operational phases: detection, triage, investigation, and learning. These capabilities …

Pharmacovigilance As An Act Of Awareness And Mindfulness, Mahima Silas, Hale Z. Toklu

HCA Healthcare Journal of Medicine

The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions due to pharmaceuticals. While it is often framed as a technical and regulatory discipline, it can also be understood through a more reflective lens as a form of mindfulness practice. At its core, pharmacovigilance requires a way of thinking that closely mirrors mindfulness, including sustained attention, openness to uncertainty, and deep awareness of human experience. Viewing pharmacovigilance in this way reframes it not just as a safety mechanism, but as a thoughtful, patient-centered approach to medicine.

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Key Drivers Of Revisit Intention In Dental And Oral Teaching Hospital, Mega Denada Aldila, Wahyu Sulistiadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Digital transformation in dental and oral teaching hospitals demands strategies that not only ensure clinical quality but also sustain patient loyalty. This study examines the effects of digital storytelling and service quality on outpatient revisit intention at the Dental and Oral Hospital of Universitas Jenderal Soedirman (RSGMP Unsoed), with brand image and patient satisfaction as mediating variables. A quantitative cross-sectional design was applied to 115 outpatients aged ≥18 years who had completed one full episode of dental treatment. After exposure to a standardized digital storytelling video about RSGMP Unsoed, respondents completed a structured Likert-scale questionnaire. Data were analyzed using Partial …

Kepuasan Pasien Terhadap Pelayanan Di Rumah Sakit Pemerintah Dan Rumah Sakit Swasta: Tinjauan Literatur, Bahar Syah, Mardiati Nadjib

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Patient satisfaction is an important indicator for assessing the quality and performance of hospital services as it reflects patients’ experiences through the healthcare delivery process; this study explore how patient satisfaction toward hospital services in public and private hospitals by analyzing 23 selected scientific articles published between 2015 and 2024 and gathered from ProQuest, Scopus, PubMed, and ScienceDirect databases from an initial total of 176 articles founded based on inclusion and exclusion criteria, and the findings indicate that service quality has a significant impact toward patient satisfaction in both types of hospitals, with private hospitals generally demonstrating higher satisfaction levels …

Evaluasi Penerapan Rekam Medis Elektronik Terhadap Kinerja Perawat Di Unit Rawat Inap Rs Grha Permata Ibu Kota Depok Tahun 2025, Ratna Dian Andriani, Dicky Yulius Pangkey, Ahdun Trigono

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Electronic Medical Records (EMR) adoption aims to improve documentation efficiency and nurses’ performance; however, system instability and limited continuous training remain obstacles. This study examined the effects of EMR features and functionality, technical support and training, and users’ perceptions and attitudes on nurses’ performance at Grha Permata Ibu Hospital. This study employed an analytic observational design with a cross-sectional approach, using a quantitative survey conducted among 74 inpatient nurses through a Likert-scale questionnaire. Descriptive analysis, Spearman correlations, and multiple linear regression were employed. Results indicate that features and functionality (X1) have a strong positive association with performance (p = 0.652; …

Efektivitas Implementasi Raspro Terhadap Pola Resistensi Dan Biaya Antibiotik Di Rsud Kabupaten Bekasi, Irmawati Hasan, Helen Andriani

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The increasing use of antibiotics over recent decades has significantly affected global public health, primarily through the emergence of antimicrobial resistance (AMR), which contributes to higher morbidity, mortality, and economic burden. As a regional referral hospital, Bekasi Regency General Hospital faces substantial challenges related to high resistance rates, with multidrug-resistant organisms (MDROs) showing MRSA at 22.22% and ESBL at 40% in 2024. This study evaluated the implementation of the Prospective System Antimicrobial Regulation Program (RASPRO) in relation to resistance patterns, antibiotic cost efficiency, and supporting roles of governance, human resources, and monitoring systems. A quantitative prospective cohort design was applied, …

Kualitas Hidup Pasien Penyakit Gagal Ginjal Kronik Dan Kepuasan Pelayanan Di Unit Hemodialisis Rumah Sakit Alia Depok: Studi Mixed-Methods, Bimo Kusumo, Vetty Yulianty Permanasari

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The prevalence of chronic kidney disease (CKD) in Indonesia remains a high-incidence condition and most of it underwent hemodialysis in Hospital. This study aims to analyze the quality of life of patients with chronic kidney disease and satisfaction with services in the hemodialysis unit. This study is a mixed-methods study with a quantitative study using the World Health Organization Quality of Life (WHOQOL-BREF) and Service Quality (SERVQUAL) questionnaires, and a qualitative study with in-depth interviews related to hospital services from both service providers (healthcare professionals) and service recipients (patients). The study found predominantly moderate scores on the WHOQOL-BREF and poor …

Persepsi Dokter Terhadap Kompetensi Perawat Di Rsud Siti Aisyah Lubuklinggau: Analisis Domain Komunikasi, Profesionalisme, Dan Kolaborasi Tim, Novita Purnamasari, Wiku Bakti Bawono Adisasmito

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This study analyzes doctors' perceptions of nurses' competencies at Siti Aisyah Regional Hospital in Lubuklinggau across three domains: communication, professionalism, and team collaboration. Doctors' perceptions are important for supporting interprofessional collaboration, quality of patient care, and patient outcomes. The study results are expected to identify competency gaps and provide an evidence-based foundation for developing measurable and effective nurse training programs. The study used a quantitative descriptive design with a cross-sectional approach, with a sample of 24 doctors who evaluated nurses' overall competencies in their work units. Data were collected through a structured questionnaire containing 11 Likert-scale items and were analyzed …

Practical Implementation Of An Osteoarthritis Treatment Program In A Radiation Oncology Center Within Md Anderson’S Cancer Network, Aaron Shaykevich, Adam Grippin, Warren Floyd, Brady Cripe, Alexander Augustyn, Shalin Shah, Samantha Buszek

Advances in Cancer Education and Quality Improvement

Background: Low-dose radiation therapy (LDRT) for symptomatic osteoarthritis (OA) can add to the workload of radiation oncology services, particularly in small centers with limited capacity and staff. After we launched an OA LDRT program in December 2024, referrals grew rapidly at our rural, single-linac radiation oncology practice at UT MD Anderson’s Cancer Network Partner site (Community Health Network in Indianapolis, IN), leading to long wait times and workflow strain.

Methods: We used load leveling to reserve capacity for cancer care and make OA scheduling predictable. Five 15-minute benign consult slots were set aside each week. Patients then went on a …

From Burnout To Belonging: A Faculty Well-Being Director's Perspective On Leadership, Workplace Culture, Organizational Efficiency, And The Broader Role Of Physician Well-Being, Ajit K. Bisen

Advances in Cancer Education and Quality Improvement

Burnout remains a major challenge in health care, despite increasing investments in physician well-being initiatives. As the faculty well-being director for my department, my perspective on physician well-being has shifted from focusing primarily on individual resilience, mindfulness, and wellness initiatives to recognizing the important roles of leadership, workplace culture, and organizational efficiency. Physician well-being is an essential foundation for high-quality patient care, stronger teams, patient safety, quality improvement, and healthier organizations. Here, I discuss the 3 key shifts in thinking that have influenced my approach as faculty well-being director.

Towards Upstate Well Center: Lessons Learned In Organizational Well-Being Over The Last Decade, Nayla M. Khoury, Asalim Thabet, Kerryanna M. Elhage, Jarrod L. Bagatell, Kaushal Nanavati, Leslie J. Kohman

Advances in Cancer Education and Quality Improvement

Background: Upstate Well has evolved over more than 10 years through the integration of multiple partners, programs, and initiatives. The scope and complexity have increased alongside stronger relationships, shared ownership, and supportive infrastructure.

Methods: This report analyzes implementation lessons learned through program development and impact assessment over 5 years.

Results: Upstate has a growing number of wellness champions across the institution, collaboration among multiple wellness programs, and lessons learned from select programs. Themes include (1) supportive infrastructure, including new full-time equivalent positions to support Upstate Well; (2) active collaboration between stakeholders, and appointed wellness champions in each department; (3) improved …