Quality Improvement 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 …

Motivational Interviewing Vs. Educational Handouts For Caregiver Smoking Cessation In Pediatric Asthma Patients: A Scoping Review, Michael Stefano, Hannah Marsh, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Secondhand smoke exposure can significantly worsen asthma outcomes in pediatric patients, leading to increased exacerbations and healthcare utilization. Caregivers can play a critical role in reducing secondhand smoke exposure, however sustained smoking cessation can be challenging to achieve. Two powerful healthcare interventions to assist in caregiver smoking cessation include motivational interviewing and educational handouts, however their compared effectiveness has not yet been fully reviewed. This scoping review compared the effectiveness of motivational interviewing and educational handouts in promoting smoking cessation among caregivers of children hospitalized for asthma exacerbations over the course of 90 days.

Applying Lean Six Sigma To Optimize Pediatric Liver Transplant Workflows: An Investigational Quality Improvement Initiative And Process Improvement Framework, Sarah E. Auletta

Online/Hybrid MPH Integrative Learning Experience (capstone projects)

For children with end-stage liver disease, liver transplantation is the only cure. While organ scarcity is a national challenge, internal pre-listing processes remain within an institution's control. This quality improvement initiative applied Lean Six Sigma and mixed-methods process mapping to the pediatric deceased donor liver transplant pathway at Boston Children's Hospital. By integrating five years of electronic health record data with multidisciplinary interviews, the project developed a comprehensive process map and performance dashboard.

The study revealed a median of 65 days elapsed between referral and waitlist activation—a timeline entirely within internal operational control. This delay was concentrated in two specific …

Intraoperative Aspiration Risk Reduction Of Diabetic Patients Through Gastric Ultrasound: A Scoping Review, Dakota Sellers Bsn, Rn, Kristy Speight Bsn, Rn, Ginger Chastain Bsn, Rn, Tyler Stone Bsn, Rn, Claudia Bursi Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap, Margaret Harvey Phd, Acnp-Bc, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Patients with diabetes mellitus are significantly more prone to delayed gastric emptying, which can increase their risk for aspiration events in the operating room despite following standard fasting guidelines set by the American Society of Anesthesiologists (ASA). Using point-of-care gastric ultrasound, trained providers can quickly and accurately evaluate gastric volumes and risk-stratify patients based on these findings. However, these methods have not been clearly assessed in the diabetic population. The purpose of this scoping review is to map the existing evidence on the use of gastric ultrasound findings among adult patients with diabetes undergoing anesthesia.

Methods

A scoping review …

Dexmedetomidine As An Adjuvant In Intrathecal Anesthesia Vs. Opioids - Evaluating Adverse Events: A Scoping Review, Autumn Holloman Bsn, Rn, Paige Blackstock Bsn, Rn, Rasmia Ibrahim Bsn, Rn, Chase Logan Bsn, Rn, Hunter Turner Bsn, Rn, Dwayna Accardo Dnp. Crna, Faana, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background 

Spinal anesthesia is widely used in surgical practice because it provides effective anesthesia and analgesia while reducing the need for intravenous anesthesia. Opioids are commonly used as intrathecal adjuvants; however, their use is associated with adverse effects such as pruritus, postoperative nausea and vomiting (PONV), urinary retention, and respiratory depression. Dexmedetomidine, a selective α2-adrenergic agonist, has gained attention as an alternative to opioids due to its sedative and analgesic properties without the opioid side effect profile. This scoping review evaluates current evidence comparing intrathecal Dexmedetomidine and opioids as adjuvants to spinal anesthesia in adult surgical patients.

Methods

A scoping …

Mortality Risk Comparison Of Doacs And Warfarin In Geriatric Adults With Dementia And Atrial Fibrillation, Laraya Gunter Bsn, Rn, Mariah Cloud Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Atrial fibrillation and dementia frequently coexist in older adults, creating complex challenges for anticoagulation management. Although anticoagulation is recommended to reduce thromboembolic risk in atrial fibrillation, current clinical guidelines lack dementia specific recommendations. Resulting in uncertainty regarding optimal therapy in this population. The purpose of this scoping review was to examine and synthesize current evidence comparing mortality risk and adverse events associated with direct oral anticoagulants (DOACs) versus warfarin in adults age 65 and older with atrial fibrillation and dementia.

Methods

A scoping review was conducted using PRISMA-ScR methodology. Peer-reviewed articles published between 2019 and 2023 were identified through …

Optimizing Glycemic Control In Type Ii Diabetes: Continuous Glucose Monitoring : A Scoping Review, Sarah Poe, Bsn, Rn, Bailey Li, Bsn, Rn, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Individuals with Type II diabetes mellitus (T2DM) experience increased risk of cardiovascular disease and higher mortality rates relative to non-diabetic populations. Continuous glucose monitoring (CGM) enables more precise analysis of glucose patterns and trends compared to conventional self-monitoring of blood glucose (SMBG). CGM provides frequent measurements and generate meaningful metrics, such as time in range (TIR), time above range (TAR), and time below range (TBR), allowing evaluation of glucose stability and variability. Despite these advantages, evidence comparing CGM and SMBG remains inconsistent. This scoping review aims to evaluate how CGM compares with SMBG across reported outcomes, including TIR, TAR, …

Evaluating The Screening And Referral Process For The Use Of Phq-9 Screening Tool In Middle-School Aged Students: A Scoping Review, Kaythi Soe, Msn, Pmhnp-Bc, Fnp-Bc, Margaret Harvey Phd, Acnp-Bc, Fhrs, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

No abstract provided.

Efficiency Rx: Emr Training For Resident Wellness, Calder Dorn, Do, Tom Chau, Md, Mba, Facp, Shelley Sanders, Md, Facp

Books, Presentations, Posters, Etc.

Introduction: Physician burnout affects nearly 60% of physicians during their careers, leading to increased medical errors, reduced care quality, higher turnover, and lower patient satisfaction. ii. The widespread use of Electronic Medical Records (EMRs) has been identified as a key contributor, with poor usability, inbox overload, and documentation burden reducing direct patient interaction among cited factors iii. Institutions like UCHealth, OHSU, CHOP, and Mayo Clinic have implemented strategies that improved EMR confidence and reduced burnout vi. While Providence offers training to all providers, there are no initiatives specifically targeted to internal medicine (IM) residents. Methods: Providence St. Vincent Medical Center …

Improving Recognition Of Chronic Kidney Disease In A Federally Qualified Health Center Through A Quality Improvement Initiative, Rachel Monroe, Evan Saulino, Kathleen Mckenna

Books, Presentations, Posters, Etc.

Context/background: Chronic kidney disease (CKD) affects approximately 15% of adults in the United States, yet nearly 90% of affected individuals are unaware of their diagnosis. Early identification in primary care enables interventions such as blood pressure optimization, renin –angiotensin system blockade, and kidney -protective medications that can significantly delay disease progression and postpone dialysis. Screening and diagnosis gaps disproportionately affect high -risk populations, including Latinx patients and immigrant agricultural workers commonly served in federally qualified health centers (FQHCs). National CKD screening rates among patients with diabetes or hypertension remain low, leaving many high -risk individuals unscreened for kidney disease. Improving …

Home-Based Vs Clinic-Based Stool Testing For Detecting Early Cancer Markers: A Scoping Review, S. Elizabeth Brock, Jacqueline Giles, Sydney James, Cha'landria Mccall, Bobby Bellflower Dnsc, Nnp-Bc-Faanp, Fnap, Faan

Doctor of Nursing Practice Projects

Purpose/Background 

Colorectal cancer (CRC) remains a significant public health concern in the United States, with screening rates below national targets due to persistent socioeconomic and structural barriers, particularly among underserved populations. Stool-based screening modalities offer accessible alternatives to colonoscopy, and emerging evidence suggests that home-based delivery models may improve screening uptake; however, implementation strategies vary and comparisons between home-based and clinic-based approaches remain limited. This scoping review examines current evidence on strategies that support CRC screening uptake, with a focus on stool-based modalities, including fecal immunochemical testing (FIT), fecal occult blood testing (FOBT), and multitarget stool DNA testing (mDNA), and …

How Does Cognitive Behavioral Therapy (Cbt) And Antipsychotics Compare To Antipsychotics Alone Impact Inpatient Length Of Stay: A Scoping Review, Morgan E. Johnson, Hailey M. Wade, Y'Esha V. Williams-Click, Rocquell Duncan, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Background

Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on …

Moving Toward Standardization Of Breast Cancer Screening: A Scoping Review Comparing Uspstf And Acs Recommendations For Women Aged 40–74, Gerita F. Perry, Krystal D. Hester-Smith, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose 

To compare U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines for women aged 40–74, and to recommend adopting one consistent, standardized guideline in practice. Standardization can improve care continuity, patient adherence, reduce anxiety, support early detection, and lower mortality.

Background 

Breast cancer is the second leading cause of cancer-related death amongst women. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The ACS recommends an annual mammogram. Differences between the two organizations for screening emphasize the need for a common alignment to reduce breast cancer mortality. As breast …

Recovery Instruction Improvement Project, Jonathan Eyestone, Katy Germundson

Publications 2026-present

No abstract provided.

Optimizing Costs & Efficiency With Heartcode Complete: A Quality Improvement Project, Jessica Bryant

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to implement HeartCode Complete (HCC), a simulation-based BLS training platform, at a 154-bed community hospital. The goal was to replace instructor-led BLS training, improve training efficiency, reduce costs, increase certification compliance, and enhance staff satisfaction.

BACKGROUND

Maintaining competency in CPR is a regulatory requirement for healthcare providers. Traditional instructor-led BLS training requires scheduled classes, instructor availability, and staff time away from clinical duties, contributing to certification delays and operational inefficiencies. Simulation-based training platforms offer self-directed learning with real-time feedback.

METHODOLOGY

This quality improvement project used Lean Six Sigma principles and Plan-Do-Study-Act cycles to guide …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

Psychological Safety In Health Care: A Prerequisite For High Reliability, Sonali Thosani

Advances in Cancer Education and Quality Improvement

This paper presents a viewpoint on how psychological safety contributes to patient safety, teamwork, and high reliability.

Kobayashi Maru, Daniel Mahoney

Advances in Cancer Education and Quality Improvement

This poem invites the reader to consider the uncertainty of facing an unwinnable situation. Kobayashi Maru is a reference to a fictional leadership test from Star Trek, designed to confront participants with a no-win scenario. While the test is famously “beaten” by the show’s hero, this piece aspires to depict the often unwinnable circumstance of caring for a child with incurable illness. The reader is provided space to consider how the balance of emotions and values may shift when read through the eyes of a parent, clinician, or observer.

The Weight Of The White Coat, Jonathan Cunningham

Advances in Cancer Education and Quality Improvement

This is a poem reflecting on the mission of the medical provider through the image of the white coat.

Beyond Boundaries: A Model For Boosting Staff Retention And Morale Through Career Mobility, Tiffany Hughes, Abigail Caudle, Robert Ghafar, Brandon Freudensprung, Paloma Vasquez

Advances in Cancer Education and Quality Improvement

Retention and morale in health care are strategic imperatives that directly influence patient care, quality outcomes and operational stability. At The University of Texas MD Anderson Cancer Center, we found a significant gap in the career advancement opportunities for our clinical and administrative staff. Employees lacked visibility into career growth pathways, leaving them disengaged and increasing the overall turnover rate. In response, our division launched a structured, transparent Career Mobility Model to provide employees with the clarity and tools needed for advancement. This model integrates career mapping, shadowing programs, and leader-led career conversations, all of which led to measurable gains …