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Increasing Awareness and Referral Rates of Palliative Care for Bone Marrow Transplant (BMT) Inpatients
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Implementing an Oral-immune Therapy (OIT) Guideline in the Newborn ICU: An Evidence-Based Quality Improvement Project
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Bridging the Gap: An Evidence-Based Quality Improvement Initiative to Increase Palliative Care Referrals in Primary Care
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Improving the Utilization of Malnutrition Screening Tool (MST) At a Regional Gastrointestinal Outpatient Oncology Clinic: An Evidence-based Quality Improvement Project
No full textMalnutrition is prevalent among cancer patients and impacts patient outcomes and quality of life. The Malnutrition Screening Tool (MST) is a valid and efficient method for screening patients for increased risk of malnutrition. Currently, the MST is embedded in a regional cancer hospital\u27s electronic health record (EHR) system. Local Despite its availability, the utilization of the MST has been suboptimal, resulting in potentially missed nutritional interventional opportunities for patients at risk of malnutrition. This quality improvement project aimed to identify the barriers to utilizing the MST and facilitate its utilization in a regional GI outpatient oncology clinic by implementing a toolkit. The project consists of assessing the staff\u27s current usage of MST, developing and implementing a toolkit, and evaluating the usage of the MST toolkit pre- and postimplementation. The assessment included in-person observations and pre- and post-intervention surveys. The toolkit is an online training module that provides background about malnutrition\u27s impact on patients with cancer, a step-by-step guide to using the MST, and knowledge quizzes. Data on MST usage, flagged patients, completed screenings, and subsequent referrals were collected and analyzed over a pre- and post-implementation period, 90 days vs. 45 days, respectively. During the pre-intervention phase, 15% of flagged patients were screened via the MST, leading to a referral rate of 0.89 per 100 visits. Post-intervention, screening rates increased to 20%, and the referral rate rose to 1.21 per 100 visits. The pre- and post-intervention survey responses identified primary barriers, including forgetfulness, workflow time constraints, and lack of training for MST utilization. Survey responders suggested including MST training during employment and orientation in the unit. Implementing a toolkit improved MST utilization and referral rates in a 45-day, post-implementation period. A significant finding is that about 10% of screened patients were consistently referred to the dietitian consultation in both pre- and post-intervention phases, suggesting the critical importance of the MST screening to identify patients at risk of malnutrition. Identified barriers should be addressed, including improving staff engagement, workflow efficiency, and appropriate training. The clinic\u27s leadership and support from the interdisciplinary team in overcoming the barriers are essential in facilitating the MST use and expanding it hospital-wide, ultimately impacting patient outcomes
Autism Screening and Referral in Rural Primary Care: A Quality Improvement Project
No full textAutism Spectrum Disorder (ASD) is a neurodevelopmental condition that requires early identification and intervention to optimize developmental outcomes. Despite recommendations from the American Academy of Pediatrics (AAP) for standardized autism screening at 18 and 36 months during well-child visits, implementation remains inconsistent in rural primary care settings. Many factors in rural areas, including limited provider training, time constraints, and lack of standardized processes, limit ASD screening. In the Uintah Basin, a rural region in Utah with limited pediatric specialists, most children receive care from family practice providers who may not consistently implement ASD screening. Screening rates among family practice providers in the region are undocumented but presumed to be low. Common ASD screening tools are often time-consuming and challenging to integrate into busy clinic workflows. This project addressed these barriers by implementing a more time-efficient, standardized ASD screening protocol in rural primary care clinics. A quality improvement initiative using the Plan-Do-Study-Act (PDSA) framework was conducted to integrate the Parent\u27s Observations of Social Interactions (POSI) screener into routine well-child visits at three rural clinics. Providers and staff received training on the POSI administration process, and pre-and post-implementation surveys assessed provider confidence, feasibility, and workflow impact. Data were collected on provider-rated satisfaction, the project\u27s feasibility, and user-rated usability. The POSI screener was implemented at well-child visits for children aged 18-36 months. Medical assistants administered the screener during vital sign collection, and the results were communicated to providers. Children screened at risk were referred to the local health department for further evaluation and early intervention services. Training sessions and real-time feedback loops addressed implementation challenges, and workflow adjustments were made throughout the intervention. Post-implementation findings revealed an increase in standardized ASD screening rates. POSI utilization rose from 0.15% pre-implementation to 69% post-implementation. Provider satisfaction with the screening process reached 85%, and confidence in autism screening improved from 15% to 62%. Referral pathways were improved, and 64% of providers reported improved confidence when making referrals. Challenges included EHR integration limitations and the necessity to rely on support staff to remember to implement the screeners without EHR prompting or recording, which were addressed through workflow modifications. This project demonstrated that integrating standardized ASD screening in 18-36 month well-child visits was satisfactory for rural family practice providers. The intervention increased provider confidence and adherence to standardized screening practices and strengthened the usability of these processes. Future projects should focus on sustaining the intervention through continued provider training, advocating for EHR integration, and addressing administrative barriers to referral follow-through
Bridging the Gap - Provider-Led Transition from Pediatric to Adult Healthcare for Patients Insured by Medicaid: An Evidence-Based Quality Improvement Project
No full textTransitioning from pediatric to adult healthcare is a crucial adjustment for adolescents and young adults (AYA). Healthcare transition (HCT) involves moving from pediatric care to the adult healthcare system. AYAs are frequently lost to care and do not undergo routine well-person visits that include healthcare transition preparation, especially when they do not perceive the benefit of such visits. Essential screenings, anticipatory guidance, and preventative care should occur during these early adult years, which can significantly impact a person\u27s health trajectory and relationship with healthcare. With approximately 29% of the total population under 18, Utah has one of the youngest populations in the United States. Nearly half of all children in Utah are insured by Medicaid, providing healthcare access to a large population. Medicaid insures teens and young adults with complex healthcare needs and social determinants of health (SDoH) deficits. Without addressing the transition from pediatric to adult care in people insured by Medicaid, a large population will lack the necessary health literacy to understand and access adult healthcare services. Delay and neglect of adolescent healthcare can lead to increasingly severe health problems when AYAs obtain delayed care. The initiative aims to improve pediatric providers\u27 documented HCT interventions using evidence-based guidelines to improve healthcare outcomes. The project utilized the Johns Hopkins Evidence-Based Practice Model (JHEBP) to guide improvements in HCT from pediatric to adult care. The initiative was based on a need identified by providers in a local pediatric practice. The practice gap led to developing a practice question, which guided the search for evidence supporting best practice. We synthesized evidence from peer-reviewed articles and national organizations and tailored information into a clinical practice guideline (CPG) specific to the local pediatric clinic\u27s Medicaid-insured population. Participants included twelve providers and approximately forty support staff, including medical assistants, receptionists, and administrators. The project tracked HCT CPG implementation over eight weeks. We refined the evidence-based practice improvement guideline through rapid cycle iterations involving inquiry, reflection, and evaluation; ongoing informal surveys informed rapid cycle changes of the medical team and observation of EHR data. Interventions: We evaluated the change in HCT intervention documentation and provider attitudes. We analyzed qualitative and quantitative survey data to identify feasibility, usability, satisfaction, future needs, and areas for improvement. The team tracked the uptake of use and near-misses, which informed improvements before disseminating the CPG to the broader clinical group. Results: Pre- and post-surveys demonstrated significant improvements in staff knowledge (U=10, p<0.05), while feasibility, usability, and satisfaction were variable. During the two months of implementation, 17% of all age 14+ well-child checks had documented HCT interventions; the chi-square test of independence (χ²= 29.5 with p < 0.00001) showed a significant increase in documented interventions. This initiative adapted and implemented a CPG that improved documented healthcare transition interventions in the pilot clinic. Additional initiatives are needed to address structured transitions, consistent measures, and longitudinal outcomes
Improving Resilience and Self-Efficacy in Burn Trauma ICU Nurses: An Evidence-Based Resilience Skills Group
No full textDue to the stressful and emotional nature of the job, nurses experience high levels of burnout and adverse mental health outcomes. Burn-unit nurses are at particularly high risk for these adverse outcomes because of their frequent exposure to patients\u27 trauma, pain, and suffering. In addition to adverse outcomes for individuals, burnout and poor resilience negatively affect healthcare systems. Burnout is associated with increased rates of nursing turnover, which carries a profound financial cost-an average of $4.82 million per hospital in 2023. Hospitals with higher rates of burnout experience longer patient lengths of stay, increased incidence of failure to rescue, and higher patient mortality rates. These associations indicate that poor mental health among nurses carries a cost for individuals, hospitals, and patients. The project site is a 15-bed burn unit, employing around 60 nurses, that provides critical and acute care to patients from initial injury to discharge. Turnover in the first 1-2 years of practice is high, and around 50% of nurses have less than 2 years of experience. High stress among new burn-unit nurses often leads to care-related errors and lower quality care. Despite this, there is no specific education or intervention to improve resilience and confidence in handling work-related stress in onboarding for new burn-unit nurses. A four-session group resilience intervention was administered to two cohorts of new burn-unit nurses. Participants were surveyed before and after the intervention using the Brief Resilience Scale (BRS) and a burn unit-specific self-efficacy scale (BSSES). Participant interviews and surveys were completed post-intervention to assess usability, feasibility, and satisfaction. Intervention: A resilience skills group including four 60-75-minute-long sessions was administered to two cohorts of new nurses over 6-8 weeks. Each session included psychoeducation, self-reflection, group discussion, strategies for handling burn unit-specific stressors, and cognitive skills teaching. Psychoeducation topics included resilience, mindfulness, trauma-informed care, self-compassion, radical acceptance, and self-care strategies. Unit-specific stressors addressed included wound care, critical situations, communicating with patients, communicating with providers, and creating work life-balance. Cognitive skills taught in each session included gratitude exercises, identifying situations, thoughts, and emotions, Socratic questioning, and identifying and strengthening alternative thoughts. Paired pre- and post-intervention scores on the BRS and BSSES surveys were analyzed using the Wilcoxon sign-rank test. The small sample size (N=9) did not yield statistically significant changes in resilience and self-efficacy post-intervention on any of the survey measures. Post-intervention surveys showed the majority of participants felt the intervention was usable and feasible. Ninety-two percent of participants were satisfied or very satisfied with the intervention and recommended continuing the intervention with future cohorts. A unit-specific resilience skills group aimed at improving resilience and self-efficacy for new burn-unit nurses was feasible, usable, and resulted in high levels of satisfaction. While the intervention did not lead to statistically significant improvements in resilience and self-efficacy, the results of the project indicate that participants gained skills and resources to better handle work-related stress and improve their resilience
Providers\u27 Barriers to Family Involvement in Outpatient Mental Health Settings: A Needs Assessment
No full textFamily involvement, including couples, in adult outpatient mental health care has been shown to enhance patient outcomes significantly, yet consistent integration remains a challenge. Patients with mental health conditions often benefit from strong family support networks, which can improve treatment adherence, reduce symptoms, and foster overall recovery. However, outpatient mental health providers frequently face systemic and operational barriers that impede effective family engagement. Addressing these challenges is essential for the full benefits of family-supported care and fostering a more holistic approach to mental health treatment in outpatient settings. A healthcare system in the Salt Lake Valley, serving both urban and rural communities, continues to encounter ongoing difficulties in involving families in patient care. Providers encounter barriers such as limited time, confidentiality concerns, and insufficient guidelines for family involvement, impeding consistent integration of families into patient care treatment. These systemic issues limit opportunities to leverage family support, a crucial component in improving patient outcomes. A needs assessment was conducted within an adult mental health outpatient clinic to evaluate the feasibility and usability of enhancing family involvement by assessing the barriers faced by providers. The needs assessment engaged key stakeholders within an urban adult outpatient mental health clinic to explore barriers to family involvement. An initial survey and interviews with mental health providers, including psychologists, psychiatrists, and psychiatric nurse practitioners, assessed provider challenges and attitudes toward family engagement. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis examined the clinic\u27s current family involvement practices, identifying strengths, weaknesses, opportunities, and threats. Data collection tools, including structured surveys, provided quantitative and qualitative insights to guide potential strategies for improving family engagement in patient care. Survey results (n=17) highlighted significant barriers to family involvement in treatment planning, with scheduling difficulties (82.4%) and patient resistance (76.5%) being the most common. While most respondents (82.4%) believed family involvement improves outcomes, (58.8%) lacked awareness of procedures, and (35.3%) felt unprepared to engage families. Family participation was primarily initiated by patient requests (76.5%), and key organizational barriers included staffing shortages (62.5%) and lack of institutional support (43.8%). Suggested improvements included shareable materials for veterans and hiring more family therapists. Family involvement in the outpatient setting remains complex due to systemic and personal barriers. However, numerous studies support that family involvement in patient mental health care improves patient outcomes, emphasizing its significance. Further assessment of the patient and their family is needed to increase involvement and create a robust strategy