Quality Improvement Commons^™

Patients’ And Family Caregivers’ Experiences With A Newly Implemented Hospital At Home Program In British Columbia, Canada: Preliminary Results, Sean P. Spina Bsc(Pharm), Acpr, Pharmd, Fcshp, Rounak Haddadi Bsc, Bhsc, Pg Dip Sc, Katy Mukai Ba, Mpa, Michelle Riddle, Beth Bourke Bscn, Rn, Lisa Thompson Bsc, Elizabeth Borycki Rn, Phd, Facmi, Fcahs, Fiahsi, David Forbes Bsc(Pharm), Mpa, Acpr, Bcps, Cte, Taylor Hainstock Bhsc, Ma, Curtis K. Harder Bsc(Pharm), Acpr, Pharmd, Fcshp, Nancy Humber Bsc, Md, Ccfp, Cfpc, Mha, Ffrms, Andre Kushniruk Phd, Facmi, Fcahs, Fiahsi, Tara Mcmillan Bsc, Shauna Tierney Md, Ccfp, Melinda Zeron Mullins Md, Phd, Ccfp

Patient Experience Journal

The Hospital at Home (HaH) model of care, which enables the provision of acute-level care in the patient’s own home as an alternative to brick and mortar hospital admission, was introduced in British Columbia, Canada in November 2020, starting with 9 inpatient “beds” in the community. The AT-HOME research group applied a patient-oriented approach to evaluate the patients’ and family caregivers’ (FCGs) experiences with the program as it was implemented and expanded throughout Victoria, BC. In this paper, we discuss the development of the survey instruments, including process and timelines (three phases); and present preliminary findings of the observational research …

Enhanced Recovery After Surgery (Eras) For Cardiothoracic Surgery, Emile Shaw, Samantha Schultz, Taylor Woods, Emma Zollmann, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Background/Purpose

Enhanced Recovery After Surgery (ERAS) protocols are multi-disciplinary approaches that optimize recovery and reduce surgical outcome variability. This scoping review compares surgical outcomes associated with traditional perioperative care to outcomes associated with an ERAS protocol for patients undergoing cardiothoracic surgery.

Methods

A literature review evaluating traditional perioperative care versus ERAS protocols in cardiothoracic surgical patients was performed to set inclusion and exclusion criteria based on current peer-reviewed journal articles for qualitative data. Group members selected 14 articles based on inclusion criteria and relevance to the PICOT question for review and placed findings in a synthesis table. Findings included compliance …

Limitations Of Telemedicine Vs. Face-To-Face Eye Examination In A Patient With New Headaches, Joseph Hallak, Od, Danielle Kalberer, Od

Optometric Clinical Practice

Background: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints.

Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache …

The Influence Of Surgical Stress And Inflammatory Biomarkers On The Occurrence Of Postoperative Delirium, Kirsten Davis, Yulisa Flores

Symposium of Student Scholars

Research focusing on hypothermia has established a relationship between surgical stress and inflammatory biomarkers on delirium incidents in critically ill non-cardiac surgical patients. Unfortunately, postoperative delirium is a common complication after surgery and results in acute brain failure. Though the cause of delirium is still relatively unknown, systemic inflammation with neurological involvement is one of the leading etiologic theories. Another common complication in surgical patients is the occurrence of unplanned hypothermia during non-cardiac surgeries. For our study, we will be looking at two inflammatory biomarkers: C-reactive protein (CRP), and Interleukin 6 (IL-6). CRP is produced in the liver and is …

The Effectiveness Of Increasing Frequency Of Central-Line Dressing Changes And Monitoring On Clabsi Rates: A Scoping Review, Jacob Schmidt, Bsn, Rn, Ccrn, Georgia Brown, Bsn, Rn, Laura Dickey, Agpcnp-C, Lauren Faulkner, Bsn, Rn, Margaret Harvey, Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Abstract

Purpose/Background

Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines.

Methods

An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed …

The Utilization Of Depression Screening Tools In Patients With Diabetes Type 2, Hanna Book, Kennedy Eldridge, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Artangela Henry Dnp, Agacnp-Bc, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Diabetes and depression are highly prevalent and concerning conditions impacting millions worldwide. Evidence-based guidelines recommend regular depression screening of individuals with type II diabetes (DM2) to appropriately diagnose and treat depression and proactively enhance clinical outcomes. The gold standard for determining depression in patients with chronic disease is the diagnostic clinical interview; however, many clinicians have turned to brief, self-reported screening tools such as the PHQ-2 and the PHQ-9 whose use are recommended by evidence-based guidelines. This study aims to assess the utilization of the PHQ-2 and PHQ-9 versus no screening on DM2 patients in a primary care setting. …

Virtual Visits In Routine Prenatal Care, Katrina K. Wu

MUSC Theses and Dissertations

Problem

One million pregnant persons in the United States do not receive early prenatal care or the recommended number of prenatal visits each year, and this gap in care access disproportionately affects people of color, those with lower incomes, and those living in rural communities. Telemedicine was widely utilized in prenatal care during the COVID-19 pandemic, and optimizing prenatal telemedicine has the potential to improve prenatal care access beyond the pandemic.

Purpose

This dissertation focused on examining the integration of virtual visits in routine prenatal care during the COVID-19 pandemic. The purpose of this dissertation was to:

Aim 1. Explore …

A Hapi Reduction Qi Project: Don't Leave Your Patient In S.H.A.M.B.L.E.S, Anissa Guzman, Ashlee Garcia, Valerie Lindsay

Articles, Abstracts, and Reports

No abstract provided.

Patient And Provider Experience With Artificial Intelligence Screening Technology For Diabetic Retinopathy In A Rural Primary Care Setting, Brian M. Nolan, Emma R. Daybranch, Kerri Barton, Neil Korsen

Journal of Maine Medical Center

Introduction: The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine.

Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention.

Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified …

An Inflection Point To Improve Emergency Care For Older Adults, Jonny Macias Tejada, Michael Malone, Kevin Biese

Journal of Geriatric Emergency Medicine

Not applicable.

The Effects Of Hospital-Mandated Nurse To Patient Ratios On Patient Care, Vince Latorre

Nursing | Student Research Posters

Background Nurse to patient ratios or nurse staffing is a controversial topic that is often discussed and argued in the medical field for its pros and cons. Nonetheless, the nurse to patient ratio plays a vital role on how nurses’ deliver quality care and provide safety to patients in a hospital setting. In 1999, California’s legislation passed a mandated nurse to patient ratio (AB 394) that requires all hospitals in California to have a set amount of patients a nurse can have depending on the unit the nurse works for. In 2023, California is still the only state that has …

The History Of Geriatric Emergency Medicine, Teresita M. Hogan Md, Lowell Gerson Phd, Aurthur B. Sanders Md

Journal of Geriatric Emergency Medicine

Abstract: Excellent emergency care does not happen by chance. The standard emergency approach that excels in the young, fails in older patients. Older adults experience unnecessary morbidity and excess mortality in our emergency departments. This article describes the pursuit of excellent emergency care in the historically challenging older adult population. A pivotal point occurred once emergency physicians recognized older patients as a distinct population in need of unique evaluation and treatment.

In the early 1990s a group of geriatricians, philanthropists, and emergency physicians joined forces to improve older patient care. Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these …

Pectoralis Nerve Block Compared To Thoracic Paravertebral Nerve Block In The Mastectomy Patient: Evidence-Based Practice Recommendations, Eric Boyer

Doctor of Nursing Practice Scholarly Projects

Patients undergoing a mastectomy are at increased risk of becoming opioid dependent. Most patients undergoing a mastectomy are diagnosed with breast cancer, and the use of opioids is known to aid in cancer metastasizing due to the suppression of the body's natural killer cells. In addition, regional anesthesia, also known as a nerve block, has long provided a reduction in sensation by blocking the nerve pathway, thus numbing the feeling of pain in the operative area. The Pectoralis nerve block (PECS) and the Thoracic Paravertebral block (TPVB) are used in patients undergoing a mastectomy to help reduce the severity of …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

A Quality Improvement Initiative To Improve Follow-Up Time And Reduce Readmissions And Emergency Department Utilization For Oncology Patients, Delaney Serfling

MUSC Theses and Dissertations

Hospitals across the nation are facing extreme challenges with overcrowding. Unplanned readmissions and emergency department use are two significant contributors to this urgent issue. Historically, oncology patients are high utilizers of emergency department services, and have elevated numbers of unplanned readmissions. This is especially true of gastrointestinal medical oncology patients. In an effort to move the needle in the right direction, an operational quality improvement initiative to decrease emergency department utilization and unplanned readmissions was conducted. This pilot project took place over a three-month period, and consisted of protecting time for advanced practice providers (APPs) and updating inefficient workflows. The …

Improving Diabetes Management For School Health Workers Using A Live, Virtual Training Course, Bonnie Mccann-Crosby, Lisa Setchfield, Yvonne Barham, Dawn Espinosa, Jennifer Bailey, Beth Pali, Amanda Garey, Sarah Lyons, Rona Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Type 1 diabetes is one of the most common chronic diseases in childhood. Optimal school nurse and staff education is critical to creating a safe learning environment and influencing long term outcomes of students with type 1 diabetes. The purpose of this project was to develop a virtual continuing education diabetes management course for school health workers to improve their knowledge of diabetes management and evaluate the effectiveness of the learning platform.

Methods: A total of 199 participants completed the live, virtual continuing education course. Participants completed a pre and post-test to assess improvements in the key learning objectives …

Geriatric Depression Screening And Chief Complaint: What Is The Risk For 30- And 90-Day Readmission?, Eric James, Joan Michelle Moccia, Victoria Lucia

Journal of Geriatric Emergency Medicine

Abstract

Background:

Readmission to the hospital within 30-days has a high cost and represents a gap in care for older adults. Older adults are at significant risk for depression, particularly given their medical comorbidities and social factors such as isolation due to SARS-CoV-2. Many patients who screen positive for depression may have no known history of depression. This investigation examines the relationship between a positive geriatric depression screen and chief complaint as a function of 30- and 90-day readmission risk.

Methods:

We examined the electronic medical record of 329 older adults aged 65 and older from February 1, 2020, to …

Improving Metabolic Monitoring During Transfers Of Care For Psychiatric Patients Discharged From The Inpatient Psychiatric Residency Service On An Antipsychotic Medication – Part 2, Allison Cohen, Anisha Boetel

View All Graduate Medical Education Content

No abstract provided.

Developing, Implementing, And Evaluating A Clinical Dashboard To Improve The Efficiency And Ease Of Tracking Institute For Healthcare Improvement Ihi Age-Friendly 4ms Framework Data., Margaret Parniawski Nsn, Ne-Bc, Kenneth Forte, Denis Mohess Md, Ray Wauthier Bsn, Erica Zerl Ssa, Edward Ostrowski Msn

Posters

The purpose of this study was to describe a user-centered development, implementation and preliminary evaluation of clinical dashboards to track Age-Friendly 4M Framework Data.

Reducing Blood Culture Contamination In The Emergency Department: A Multi-Method Quality Improvement Project, Daryn Brauner Msn, Marlene Schmidt Msn, Nikki Campbell Bsn, Anthony Renzoni Pharmd, Keri Bill Msn, April Alfano

Posters

The goal of this quality improvement project is to reduce the monthly percentage of BCC in an academic emergency department (ED) through implementation of a multimethod intervention targeting registered nurses (RN) and patient care technicians (PCT) who perform phlebotomy for blood cultures