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Improving Stroke Care Through Nurse Education in a Rural Hospital
No full textStroke is a leading cause of death in the United States, and those who survive a stroke are at risk for physical and cognitive disability. Rural areas have a 30% greater stroke mortality than urban areas. In-hospital strokes have worse outcomes than out-of-hospital strokes. Bedside nurses play an indispensable role in stroke recognition, management, and treatment, and as such, nurse confidence is central to clinical decision-making. The purpose of this project was to determine whether a structured stroke education program improved nurses' confidence levels and increased compliance with National Institutes of Health Stroke Scale (NIHSS) documentation in a small rural hospital. This quality improvement project used descriptive statistics through retrospective chart reviews and post-intervention data comparisons. A stroke education program for ICU nurses was implemented within the small rural hospital. To obtain pre- and post-education data, a retrospective chart review was conducted, to examine documentation of patients' NIHSS scores. Nurse confidence was measured pre- and post-test via self-reported surveys. Both nurse confidence and NIHSS documentation compliance improved after nurse education. The median nurse confidence score in the pre-test group was 6.67 (out of 10), compared with 8.42 in the post-test group (a 17% improvement post-educational intervention). Documentation of NIHSS scores went from 38% fallouts to 4%. Healthcare organizations must support nurse education on E3stroke to improve stroke outcomes in rural areas
Capturing and Assessing Minor Anesthesia Complications to Improve Practice
No full textMinor anesthesia complications, though generally mild, are common following surgical procedures. Providers are typically unaware of patient complications related to throat or mouth discomfort/pain, myalgias, or paresthesia after discharge. Among these, throat and mouth discomfort are the most frequently reported. This quality improvement project sought to determine the prevalence of these minor complications and identify contributing factors to potentially inform practice changes and strengthen provider confidence. The Department of Anesthesia at a tertiary hospital integrated post-anesthesia questions into a pre-existing follow-up phone call to collect data on these complications. Chart reviews were conducted over a total of 8 months between the pre- and post-implementation periods. Findings indicated increased reporting of all minor complications in the post-implementation period. Notably, throat or mouth discomfort/pain was the most frequently reported complication. Throat or mouth discomfort/pain symptoms were usually mild and primarily seen in early adulthood patients. Overall, this project highlighted the value of systematic follow-up in identifying trends in minor post-anesthesia complications. The results supported continued provider education, reinforced effective existing practices, and identified opportunities for ongoing quality improvement within anesthesia care delivery
Postoperative Nausea and Vomiting Preventing with Intraoperative Propofol
No full textFemales undergoing gynecologic surgery are predisposed to higher rates of postoperative nausea and vomiting (PONV) when compared to other populations. One method to mitigate this during general anesthesia is with the utilization of intravenous (IV) medications such as propofol. In a Midwest tertiary hospital, the common practice is to use either a total IV anesthetic with propofol (control group) or a combined anesthetic with sevoflurane and a background propofol infusion (intervention group). The goal of this study was to determine whether these techniques provided comparable rates of PONV prevention. A secondary outcome measured was the comparison of the number of rescue antiemetics (RA) received postoperatively among patients in each group. The sample population included females ages 18-50 undergoing gynecologic procedures between January 1, 2025, and June 1, 2025. Retrospective chart reviews were completed, and data, including but not limited to demographics, the occurrence of PONV, the procedure type, the type, dose, and number of rescue antiemetics received, timing of antiemetic administration, anesthetic type, duration, and concentration, and the time spent in the post-anesthesia care unit (PACU) were recorded. Data showed that the intervention group had almost 10% higher PONV rates than the control group; however, this difference was not statistically significant (95% CI [-0.25, 0.44], p = 0.63). This matched the frequency of postoperatively administered rescue antiemetic administration. About 26% of patients in the intervention group received antiemetics compared with about 16% in the control group. Again, this was not statistically significant (95% CI [-0.25, 0.44], p = 0.63)
Perioperative Dexamethasone for Cesarean Section
No full textSpinal anesthesia is the standard of care for routine cesarean sections (c-sections) due to an overall positive safety profile and other significant benefits over general anesthesia. However, potential postoperative side effects of spinal anesthesia include pain and nausea. A variety of interventions can be used to reduce these symptoms. One adjunct that reduces side effects and has a favorable safety profile is IV dexamethasone, given after cord clamp. In a Midwest tertiary care hospital, anesthesia provider education was noted as a barrier to the routine use of dexamethasone for c-sections. An education-based project to improve provider knowledge and the subsequent frequency of use was implemented based on substantial evidence of the intervention's benefits. Pre- and post-education surveys, as well as data on dexamethasone usage, were collected. The data were analyzed and revealed an increase in dexamethasone administration from 84.2% to 100%, which was statistically significant (p = .009). These results highlighted the effectiveness of a quality-improvement project focused on education
Ultrasound-Guided Intravenous Catheter Training for Labor and Delivery Nurses
No full textDifficult intravenous access is a common problem in labor and delivery (L&D) and can lead to delays in critical treatment, increase potential for complications, and decreased patient satisfaction. This quality improvement project evaluated the effect of an ultrasound-guided intravenous catheter (USGIV) training program on L&D nurses' confidence and utilization of USGIV. Thirteen nurses participated in online education and hands-on simulation training. Pre-, post-, and 2-month follow-up assessments measured confidence, while audit logs and anesthesia paging data tracked USGIV utilization in practice. Confidence in USGIV knowledge and skills increased in all categories immediately following training but slightly declined after 2 months though remained above baseline. Actual utilization of USGIV was limited, with only three attempts recorded by L&D nurses, and no decline in requests for anesthesia staff to start USGIVs. The USGIV education enhanced confidence among all participants, but consistent practice and institutional support are needed to sustain skills and knowledge to translate into clinical use
Outpatient Orthopedic Surgical Oasis Initiative: Program Evaluation
No full textThe 2025 outpatient iteration of the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategy (OASIS) initiative was evaluated to determine its impact on same-day discharge (SDD) efficiency, staff satisfaction, and interdisciplinary workflow in a high-volume tertiary hospital. Guided by the Logic Model, this mixed-methods program evaluation included retrospective chart reviews (N = 457), pre- and post-implementation staff surveys, and direct observations. Quantitative data were analyzed using Fisher's Exact Test, while qualitative themes were derived from field notes. Post-implementation findings revealed a statistically significant reduction in moderate discharge delays (p = .028), with 79.3% of patients discharged within 22 minutes of completing care. Delay documentation improved, with the "None of the Above" category reaching significance (p = .021), suggesting increased awareness of workflow inefficiencies. Survey data showed a significant decrease in perceived staffing shortages (from 60% to 20%, p = .0346), despite no formal staffing changes. However, 70% of respondents did not feel more empowered in their roles, and while structured communication tools and workflow clarity enhanced operational efficiency, deeper stakeholder engagement remains necessary to improve staff experience. The OASIS framework offers a replicable model for outpatient surgical optimization and highlights the importance of aligning operational goals with frontline realities
Incidence of Perioperative Complications in Recovered Covid-19 Patients
No full textThe sequalae of COVID-19 on surgical patients is a challenging, but important, area of research given the lack of current evidence as well as the prevalence of COVID-19. The intent of this study was to identify if recently recovered COVID-19 patients have a greater risk of experiencing perioperative pulmonary and cardiovascular complications compared to patients with no recent COVID-19 infection. A single center retrospective chart review was performed on 25 recently recovered COVID-19 patients who had surgery within 6 months of a COVID-19 infection and 110 negative COVID-19 patients who had surgery prior to the COVID-19 pandemic. Patients received general anesthesia with mechanical ventilation for laparoscopic, robotic, urologic, or otolaryngologic (ENT) surgery. Investigation of the frequencies of pulmonary and cardiac perioperative complications using Chi-square tests and Fisher's exact tests found that patients who had a COVID-19 infection within 6 months of surgery did not exhibit an increased frequency of perioperative pulmonary complications (p = .19, p = .26, respectively) or perioperative cardiac complications (p = .25, p = .35, respectively) compared to patients with no prior exposure to COVID-19. These findings align with the most recent recommendations in the literature regarding the timing of surgery and rates of perioperative complications after a COVID-19 infection
An Evidence-based Education Module to Improve CRNA Preceptors' Confidence
No full textThis pre-post quality improvement Doctor of Nursing Practice (DNP) project was completed in 2025 by two practicing Certified Registered Nurse Anesthetists (CRNAs) at a Midwest academic medical center. The majority of CRNAs (33 of 37) who participated reported never receiving formal training in precepting CRNAs. When two additional CRNA programs were opened locally, clinical precepting increased, and a need was identified to support the CRNA preceptors. The additional trainee load underscored the need for formal training for CRNA preceptors. The goal was to enhance CRNA preceptors' confidence by providing them with an evidence-based training module. An online interactive educational module was created and distributed to the CRNAs, along with a pre-survey and demographic survey. The module consisted of seven sections, each containing strategies and tips for effectively teaching adult learners and handling feedback and conflict. Two months later, a post-survey was completed, which showed improvement in CRNAs' self-assessment of their confidence in clinical precepting. After the module, the average post-test scores increased on all five repeated questions. Data from three questions revealed statistically significant increases in coaching critical thinking, working with students with different learning styles, and providing constructive feedback