Quality Improvement Commons^™

Air-Jet Bioprinting Of Stem Cell-Encapsulated Alginate Micro-Droplets For Organoid Biomanufacturing, Mirabella B. Stump

Electronic Theses and Dissertations

Biomanufactured 3D-organoids show promise for modeling and treating various conditions, particularly insulin-dependent diabetes mellitus (type-1 diabetes). Pancreatic islet organoids serve as sustainable sources of insulin-producing β-cells, potentially restoring insulin regulation in patients and providing a long-term solution for diabetes. Hydrogel droplet printing is an emerging technique in regenerative medicine due to its advantageous tunability and biocompatibility; however, challenges of consistency, quality control, and scalability persist. To address these issues, we developed a novel air-jetting based droplet bioprinting system for the generation of monodispersed alginate micro-droplets. The objective of this project was to incorporate human induced pluripotent stem cells (hiPSCs) into …

Describing And Predicting Trajectories Of Healthcare Utilization Among Older Adults Presenting To An Emergency Department Using The Interrai Emergency Department Screener, Matthew B. Downer, Kristina Kokorelias, Andrew P. Costa, Don Melady, Samir K. Sinha

Journal of Geriatric Emergency Medicine

Introduction: Although older adults visit emergency departments (EDs) more than any other age group, the trajectories of healthcare utilization older adults experience post-ED are not well described. Further, whether rapid ED assessment tools can predict trajectories and discharge destinations remains unclear.

Methods: Older adults (≥65 years) who presented to an ED at a large Canadian urban academic hospital were recruited (January 2018-April 2019). The interRAI ED Screener (EDS) was completed on presentation. Patients were categorized by EDS risk score (1/2=low, 3/4=moderate, 5/6=high) and had their discharge destinations tracked. Patients admitted to hospital were tracked until their final discharge destination. …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Teela Sade Miller-Buford

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths and hospital length of stays.

Context: A group of students studying to become Clinical Nurse Leaders (CNLs) evaluated Hospital A's Emergency Department (a clinical microsystem) located in the greater Bay Area. This microsystem provides diverse emergency care for patients with various medical conditions and diagnoses. The CNL students concentrated on patients diagnosed with sepsis for their quality improvement project.

Interventions: Although time constraints prevented the implementation of interventions, the CNL students proposed recommendations …

Evaluation Of A Community Based Teaching Hospital’S Geriatric Emergency Medicine Initiative, Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose

Journal of Geriatric Emergency Medicine

INTRODUCTION: To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) emergency department (ED) began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults.

METHODS: This retrospective program evaluation describes SH’s novel ED processes for at-risk older adults and compares GEMI and non-GEMI assessed patient outcomes using aggregate frequencies on throughput metrics such as length of stay (LOS), 72 hour and 30-day re-admission rates, and other outcomes of interest. Chi-square tests and group t-tests were used for all analyses with a p-value of …

Developing A Blueprint For Health Equity Programs And Investigating Interventions And Metrics, Belita Strudwick

MUSC Theses and Dissertations

Racial and ethnic minority groups and rural and low-income populations are examples of populations who continue to experience health disparities despite policy mandates to eliminate them. This doctoral project will provide a foundational blueprint to aid health plans in addressing and improving health equity internally and with external stakeholders. The blueprint will be based on research comparing the robust health equity initiatives of four states to the NCQA national guidelines. The barriers to achieving and recommendations for advancing the field of health equity by implementing and analyzing policies and data that target health disparities through improved access to quality care …

Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter

Doctoral Projects

The social determinants of health encompass the various circumstances and environments in which individuals reside, develop, labor, and experience aging (Social Determinants of Health, 2022). These variables significantly contribute to the existence of health inequities and disparities within populations. In order to effectively mitigate health disparities, it is imperative to consider the various determinants that influence health outcomes, as this consideration is crucial for advancing the goal of achieving health equity. This public health concern encompasses multiple sectors within our society, necessitating the collaboration of various organizations and communities to effectively address and mitigate its impact.

The fundamental …

Swimming Together Upstream: How To Align Mlp Services With U.S. Healthcare Delivery, William M. Sage, Keegan D. Warren

Faculty Scholarship

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience: Master of Public Health

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

A Quality Improvement Project To Increase Awareness And Utilization Of Employee Assistance Program Services Among Healthcare Providers, Scarlet Gould

Doctoral Projects

Mental health distress among healthcare providers (HCP) is a common problem, yet Employee Assistance Programs (EAP) are consistently underutilized. Unmanaged workplace stress can lead to problems such as provider burnout and increased rates of turnover, which can result in decreased access to patient care. The purpose of this project was to increase awareness and utilization of EAP services by using the Plan-Do-Study-Act cycle (PDSA) for quality improvement. Nurse Practitioners at a community-based hospital were provided with a PowerPoint^® presentation via email that contained information regarding the facility’s employee assistance program, mental health wellness education, as well as ways to …

Providing Optimal Resident Sleep Hygiene In Assisted Living Communities; Opportunities For Design And Operation Teams To Collaborate And Share Their Unique Knowledge, Beverly B. J. Miller

Architecture Masters of Science Program: Theses

Research is emerging relating sleep hygiene to disease pathogenesis including Parkinson's, dementia, Alzheimer’s disease and increased cardiovascular risk. The application of circadian science as it relates to human wellness has intensified as a result. The quality of sleep significantly impacts the wellness of residents living in long term care, however sleep hygiene research is lacking in assisted living (AL) communities.

The thesis question inquires; How can operation and design teams collaborate to optimize sleep health for residents in assisted living communities? The research methodology utilized a two-phase process. Phase I identified three AL communities as test sites, providing case studies …

Economic Analysis Of Population-Based Next Generation Sequencing For Breast Cancer, Sapphire Curelaru

University Honors Theses

Breast cancer develops due to accumulated DNA replication insults which causes cancer to uncontrollably proliferate. An individual's predisposition to developing cancer, as well as the composition of a tumor, can be sequenced using genetic tests. Myriad's BRACAnalysis CDx^® seems to be the most utilized genetic test. However, Next Generation Sequencing (NGS) seems to be a better genetic test for breast cancer when compared to Myriad's BRACAnalysisCDx^® in terms of return-time, accuracy, efficiency, and healthcare cost. By using Next Generation Sequencing tests, stakeholders can save money on genetic testing which can be invested in more genetic tests. Payers can …

Docai, Riley Badnin, Justin Brunings

Computer Science and Software Engineering

DocAI presents a user-friendly platform for recording, transcribing, summarizing, and classifying doctor-patient consultations. The application utilizes AssemblyAI for conversational transcription, and the user interface allows users to either live-record consultations or upload an existing MP3 file. The classification process, powered by 'ml-classify-text,' organizes the consultation transcription into SOAP (Subjective, Objective, Assessment, and Plan) format – a widely used method of documentation for healthcare providers. The result of this development is a simple yet effective interface that effectively plays the role of a medical scribe. However, the application is still facing challenges of inconsistent summarization from the AssemblyAI backend. Future work …

Emergency Department Patient Navigator Post Chest Pain Diagnosis Discharge, Nancy Simoes

Seton Hall University Dissertations and Theses (ETDs)

Abstract The most common complaint seen in the Emergency Department, along with abdominal pain, is nonspecific chest pain. Often, these complaints cause prolonged lengths of stay in the ED, followed by hospital admissions and subsequent readmissions for various reasons. When thinking about these various reasons, the question for prevention of readmission comes to mind. What could we do as a department to keep patients from continuously using the Emergency Department as a primary point of care instead of outpatient facilities when necessary? Project Aim: The purpose of this quality improvement project was to initiate the need for a patient navigator …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

Quality & Patient Safety Gazette : Volume 2, Issue 4 - 2023, The Aga Khan University Hospital, Karachi

Quality and Patient Safety Archives

• World Quality Day 2023
• Workshop on How to conduct a Root Cause Analysis
• Blast from the Past
• Learn with Fun!
• Stay Tuned with Us…..

Exploration Of The Implementation Of An Integrated Electronic Laboratory Information Management System On Quality Diagnostics Service Indicators At A County Level Public Hospital In Western Kenya., Kelly Allen

Capstone Collection

Underinvestment in pathology and laboratory capacity caused by low visibility in research and in prioritization by public health leaders results in limited effective healthcare coverage and an estimated 1.1 million premature deaths annually in Low-and-Middle-Income Countries. Kenya’s public health laboratories provide a median 41% of the Essential Diagnostic List to their patients and in Kisumu County, as much as 44.2% of the population has little to no access to essential diagnostics. The government of Kisumu implemented the county Health Laboratory Strategic Plan 2018-2022 to address this public health challenge. Little information exists on the effectiveness of these initiatives and the …

Clinical Practice Implementation To Address Ascvd Risk: A Practice Change In Primary Care, Elizabeth Wooten

Student Scholarly Projects

Practice Problem: Heart disease stands as the leading cause of mortality in the United States. While healthcare providers strive to identify and optimize prevention strategies, particularly in high-risk patient populations, notable gaps in care persist, notably in the management of modifiable risk factors such as low-density lipoprotein cholesterol (LDL). By harnessing the power of artificial intelligence (AI) integrated software within clinical settings, we can revolutionize the landscape of this devastating chronic disease.

PICOT: The PICOT question that guided this project was: In Primary Care Advanced Practice Providers (APP) caring for high-risk and/or very high-risk patients with atherosclerotic cardiovascular disease (ASCVD) …

A Clear, Succinct Research Question Portends The Rest Of The Story, Jessica J. F. Kram, Lisa Sullivan Vedder, Brenda Fay, Deborah Simpson

Journal of Patient-Centered Research and Reviews

The goal of any research manuscript is to convey the story of a systematic answer to an important question in the field. A clear, succinct research or study question is what provides the storyline that connects all the sections of a manuscript. One of the most common strategies to developing a meaningful research question is the FINER approach, which encompasses five standards to determine the quality of a question: feasible, interesting, novel, ethical, and relevant. Using the FINER approach can provide the guidepost for all design and reporting decisions. This editorial recommends creating a study protocol aimed at answering your …

A Quality Improvement Initiative For Hiv Prevention In Underserved Communities, Meredith E. Clement, Angie D. Settle, Claudia T. Martorell, Jeffrey D. Carter, Melissa Rodriguez, Chelsie Anderson Chadha, Bonnie Douglas, Laura Simone, Leah Molloy

School of Medicine Faculty Publications

Infectious Diseases Week, IDWeek 2023, October 11 - 15, 2023, Boston, MA