Master of Science (MS), Ohio University, 2020, Industrial and Systems Engineering (Engineering and Technology)

This study surveyed 114 registered nurses throughout Ohio to determine if there was a relationship between patient acuity and perceived fatigue. Also examined for a potential relationship to perceived fatigue were nurse-patient ratios (NPRs) and the method by which nurse-patient assignments (NPAs) were created. In addition, participants were asked to rate 15 nursing tasks to identify which imposed the most fatigue. Two validated fatigue scales, the Fatigue Assessment Scale (FAS) and the Occupational Fatigue Exhaustion Recovery (OFER) scale were used to capture participants perception of fatigue at their workplace. Results indicated that the interaction between patient acuity and NPR was significantly related to FAS ratings while NPR had a significant relationship to acute fatigue on the OFER scale. It was concluded that most nurses experience substantial fatigue, with high acuity patients having an overall greater impact, according to FAS ratings. OFER scale ratings suggest nurses only exhibit higher levels of acute fatigue for assignments containing more than five patients. For scheduling practices, it was recommended that NPAs shall contain fewer high acuity patients than lower acuity patients to minimize FAS ratings. Additionally, OFER-AF suggests that assignments should contain no more than five patients to mitigate the absence of lower acute fatigue levels.

Committee: Diana Schwerha (Advisor) Subjects: Industrial Engineering; Nursing; Occupational Health; Occupational Safety

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

Purpose: Preventable medical errors resulted in about 400,000 annual deaths in U.S. hospitals (Thornton et al., 2017) and cost the U.S. economy about $20 billion annually (Rodziewicz & Hipskind, 2020). Meanwhile, nurses continued embracing patient care and safety. However, limited research existed associating nurses' perceptions of safety culture with error reporting and patient safety outcomes (Han, Kim, & Seo, 2020). This study aimed to fill that literature gap, advance nurses' roles, and improve care quality. Framework: Self-determination theory (SDT) and Donabedian's Model guided this research. Method: This was a quantitative, cross-sectional correlation design study using bivariate, multivariate, and logistic regression analysis for multi-level modeling with 90,016 nurse participants. Ethical approval came from Franklin University Institutional Review Board. Data: Secondary, de-identified SOPS® data for the analysis was provided by the SOPS Database, funded by U.S. Agency for Healthcare Research and Quality (AHRQ) and administered by Westat under Contract Number HHSP233201500026I / HHSP23337004T. This study analyzed collected data (i.e., 2015 to 2017) from 565 U.S. hospitals that voluntarily submitted their HSOPSC data to the 2018 comparative dataset. Findings: Data findings for unit-level aggregation identified PSC composite Feedback and communication about errors with the most statistically significant positive association with Overall frequency of events reported. PSC composite Teamwork within unit had the greater odds for an increase in Number of events reported. PSC composite Staffing produced a higher, statistically significant positive association with Overall perceptions of patient safety. Furthermore, Organizational learning – continuous improvement produced the higher odds of increasing Patient safety grade. Hospital-level aggregation revealed that Management support for patient safety had the most positive, significant effect acro (open full item for complete abstract)

Committee: Dale Gooden DHSc, MBA (Committee Chair); Jesse Florang EdD, LIMHP (Committee Member); Shawishi Haynes EdD, FACHE, MHA (Committee Member) Subjects: Continuing Education; Cultural Resources Management; Health; Health Care; Health Care Management; Organizational Behavior; Public Health

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

The Institute of Medicine (IOM) report “To Err is Human” sparked a movement in the healthcare industry to improve patient safety. Patients and families have been identified as untapped resources for healthcare safety. They are consistent observers who can partner with healthcare providers to decrease preventable harm, decrease healthcare costs, and improve the well-being of populations (Kalisch, McLaughlin, & Dabney, 2012). Children's hospitals report low scores on the C-HCAHPS question, “During this hospital stay did your provider or another healthcare professional tell you how to report mistakes or concerns in your child's care?”(S. L. Toomey et al., 2017). The purpose of this pilot project was to assess the impact of a multimodal patient and family education initiative on the percentage of families who respond to this question with top scores. The “Be the Voice” multimodal intervention included an instructional video, an escalation pathway, cards or white board displays with parent identified priorities and concerns, and leadership rounding to support family engagement. Quality improvement (QI) methods were used to implement interventions on two pilot units and assess impact. The pilot yielded insufficient data points to know if there was improvement in the C-HCAHPS concerns in care metric, but the two data points post-launch were above the median on the pilot that also demonstrated positive shifts in process measures. The second pilot unit had two out of three data points above the median post-launch but did not demonstrate improvement in process implementation. Ongoing QI study is needed to determine the impact of the multimodal intervention. Future research is recommended to explore the relationship between understanding how to report concerns and the rate of reporting and the impact on safety outcomes.

Committee: Debra VanKuiken PhD, RN, AHN-BC (Committee Chair); Susan Schmidt Ph.D., C.N.L., C.O.H.N.-S, C.N.S. (Committee Member) Subjects: Health Care; Nursing

Doctor of Philosophy, The Ohio State University, 2015, Nursing

More than 400,000 premature deaths per year occur due to preventable harm in U.S. hospitals, costing over $20 billion per year in healthcare expenses, lost worker productivity, and disability. Conceptual frameworks, such as the Generic Reference Model, contribute to a greater understanding of patient safety because they explain the context of patient harm. The healthcare context, including organizational factors such as strong safety culture and human factors like teamwork, may improve patient outcomes. Patient outcomes, such as adverse events, are more readily detected using instruments such as the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT), which may detect up to ten times more adverse events than existing methods. The GTT uses keywords or triggers to guide chart reviews. Currently, relationships between safety culture and teamwork and adverse event detection using trigger-tools remain underexplored. The purpose of this study was to explore relationships between organizational and human factors with adverse events that result in patient harm detected using a modified trigger-tool methodology. The descriptive, cross-sectional design used the Safety Attitudes Questionnaire (SAQ) to measure interprofessional staff perceptions of safety culture using safety climate and teamwork climate subscales, and a retrospective, modified IHI GTT chart review methodology to measure patient outcomes at the unit level. The convenience sample was comprised of 32 nursing units/departments from one 750+-bed Midwestern U.S. regional acute care hospital that employed over 1000 nurses. Safety and teamwork climate percentage agreement averages were 75.61% and 70.07%, respectively. Medical surgical units reported the strongest safety climate whereas critical care units reported the strongest teamwork. An average of 69 adverse events occurred per 1,000 patient days, 21.83 adverse events per 100 admissions, and approximately 20% of admissions experienced a (open full item for complete abstract)

Committee: Pamela Salsberry Ph.D., RN (Advisor); Laura Szalacha Ph.D. (Committee Member); Emily Patterson Ph.D. (Committee Member); Esther Chipps Ph.D., RN (Committee Member) Subjects: Health Care; Nursing

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2025, Health Programs

This study examined the impact of electronic prescription generation and transmission, patient access, and secure electronic messaging on health information exchange (HIE) utilization during healthcare transitions. Leveraging longitudinal data from the 2018 CMS EHR Incentive Program, this research tested hypotheses concerning the influence of these variables on HIE utilization using a quantitative method. Findings from logistic regression analyses indicated that electronic prescription practices (B = 2.265, OR = 9.628, p < .001) and patient electronic access capabilities (B = 1.108, OR = 3.027, p < .001) significantly increased HIE usage, aligning with previous studies that underscored the importance of digital prescription systems and patient empowerment in HIE enhancement. Additionally, secure electronic messaging showed a significant association with HIE utilization (χ²(1) = 126.982, p < .001), further reinforcing the role of secure communication in effective healthcare information exchange. A combined predictive model revealed that electronic prescriptions and patient electronic access drastically improved the likelihood of HIE adoption (B = 4.546, OR = 94.284, p < .001), highlighting a synergistic effect. These findings underscored the need for integrated technological frameworks within healthcare systems to optimize communication and care coordination, ultimately improving patient outcomes. The study advocated continued investment in digital health tools to strengthen HIE systems and enhance healthcare delivery.

Committee: Crissie Jameson (Committee Chair); Sunddip Aguilar (Committee Member); Alexander Akulli (Committee Member) Subjects: Health Care Management

Doctor of Nursing Practice , Case Western Reserve University, 2024, School of Nursing

Among hospitals, the number of chief executive officers (CEO) who are nurses is small. For example, only two of the 400 major academic medical centers-health care systems are led by nurses (Bean et al., 2022). Even fewer hospital and health system CEOs are advanced practice registered nurses (APRNs). The CEO is the highest ranking executive leader in an organization, in this case, a hospital. APRNs have grown from less than 68,000 before 1990 to over 355,000 in 2023 (American Association of Nurse Practitioners, 2023). The APRN brings essential and possibly unique knowledge, skills, and attitudes to the CEO role, as they are well versed in providing bedside nursing care, similar to a CNO's expectations. They are also licensed independent providers and can relate to other advanced practice providers (APPs) and physicians, much like the expectations of a chief medical officer (CMO). This project is a theory-driven narrative exploring the evolution of two nurse-manager-led quality improvement (QI) projects in which one chief executive officer-APRN (CEO-APRN) provided the initial vision and oversight and how reflection on this narrative led to an organizing, hard-wired framework to reduce patient harm through multiple QI projects hospital-wide. This report is a program evaluation specific to one institution and is not ready for generalizability outside one hospital system.

Committee: Chris Winkelman (Advisor); Peter Pronovost (Committee Member); Terry Winemiller (Committee Member); Shelly Loop (Committee Member) Subjects: Nursing

Doctor of Nursing Practice, Mount St. Joseph University , 2024, Department of Nursing

Apparent cause analyses (ACAs) are conducted within healthcare organizations to evaluate patient safety events and create action plans. ACA action plans can vary in levels of reliability. An evidence-based, quality improvement doctorate of nursing practice (DNP) project was conducted within the emergency department of a large pediatric academic medical center to increase the levels of reliability in ACA action plans. The Model for Improvement and the Iowa Model of Evidence-Based Practice served as the framework for the DNP project. An implemented intervention bundle improved the proportion of ACA action items that scored a level 2 reliability or higher from 11% to 46% throughout the project. Further evaluation outside the DNP project timeline is needed to evaluate if the intervention bundle prevents the reoccurrence of patient safety events.

Committee: Kristin Clephane DNP, RN, CPN (Advisor) Subjects: Nursing

Master of Science (MS), Ohio University, 2023, Industrial and Systems Engineering (Engineering and Technology)

Using computer simulation in healthcare is a longstanding endeavor, where alternative scenarios and system configurations can be tested before they are implemented in the real world. One facet of healthcare that has an apparent lack of simulation work is that of emergency transportation, especially that which has a goal to reduce the amount of time a crew works over their designated shift. In collaboration with a Midwest USA Hospital, the researcher sought to model the current system, then experiment by altering crew schedule start times, the number of crews, and policy to reduce the frequency and duration a crew works past their scheduled end time. Therefrom, a framework was developed to help other institutions with similar aims. After the simulation model was verified and validated, experiments varying the start times of the crews, scheduling the crew constituent resources separately, and the number of crews were investigated. With the goal to reduce the time a crew spends working past their scheduled shift without negatively affecting productivity, scenarios that performed similarly in the number of transport requests serviced where there was a decrease in over-shift metrics were identified. The results of the simulation experimentation can be summarized this way: reducing over-shift comes at a cost, likely, either a reduction in productivity or an additional crew. A seven-themed framework for future studies was derived: a sound mission, system understanding, data availability/understanding, respect for process, simulation experience, results analysis and recommendations, and empathy.

Committee: Tao Yuan (Advisor); Dušan Šormaz (Advisor) Subjects: Health Care; Industrial Engineering; Management

Doctor of Education (EdD), Wright State University, 2023, Leadership Studies

This qualitative study focused on exploring the relationships between personal, emotional, and relational elements and the decision to speak up during critical safety moments. A phenomenological single site case study was employed using semi structured interviews to examine the healthcare professionals' stories. The participants shared their lived experiences when making the choice to speak up or not, and the consequences – positive and negative, for themselves, their patients, and the organization. Results showed the decision to speak up is complex. There are many components that influence the decision to raise voice in the face of known risk. Personal elements, including sense of competence and psychological safety, relational elements including team trust, and emotional elements - especially fear, anger, and anticipatory regret, play a role. Findings include implications for leaders to implement modeling and principles of transformational leadership to proactively create a culture where raising voice is not only accepted but expected.

Committee: David Bright Ph.D. (Committee Co-Chair); Dan Noel Ph.D. (Committee Co-Chair); Jinwahn Jo Ph.D. (Committee Member); John McAlearney Ph.D. (Committee Member) Subjects: Health Care

DNP, Otterbein University, 2023, Nursing

Medical errors account up to 250,000 patient deaths annually. Research suggests medical errors are attributable to poor healthcare team communications. The Institute of Medicine posits that communication and teamwork are essential components to safe and successful health care environments. According to the Joint Commission poor communication is considered the root cause of nearly 80% of all serious medical errors. Consequently, the Department of Defense and Agency for Healthcare Research and Research created a team-based training program, known as TeamSTEPPS®, which has shown to improve team communication, performance, effectiveness, patient safety, satisfaction, and health outcomes in healthcare settings. Despite evidence supporting TeamSTEPPS®, one family practice clinic was not practicing standardized team communications and at an increased risk for potential miscommunications, medical errors, and adverse patient health outcomes. Consideration of perceptions and attitudes of staff before implementing system process changes like TeamSTEPPS® is important to ensure program success. Thus, the project's purpose was to assess and describe the staff attitudes, perceptions, and intent to make change, regarding team communication as it relates to clinic patient care and safety. The descriptive scholarly project focused on staff questionnaire responses about perceived team communications and intent to change communication processes in a clinic setting. A systematic data review indicated 86% of respondents agreed the clinic was at risk for committing medical errors, 71% strongly agreed a standardized communication method would benefit the clinic, and 64% of respondents remained neutral regarding to the staff receiving TeamSTEPPS®. Thus, more research is warranted before effective implementation and sustainment can occur at the clinical project site.

Committee: Chai Sribanditmongkol (Advisor); Regina Prusinski (Committee Member); Joy Shoemaker (Committee Member) Subjects: Nursing

DNP, Otterbein University, 2023, Nursing

Second victim syndrome describes the constellation of symptoms suffered by healthcare clinicians because of the stresses of caregiving, experiencing adverse patient outcomes, and the increasing pressures of the care environment. The occurrence of second victim syndrome (SVS) in nurses is well supported in literature, along with resultant effects on patient safety, organizational culture, and the organization's financial outcomes. The interconnectedness of nurses with patients is undeniable, and relational impacts can be both profound and enduring. Burnout and stress, manifested by mental, psychological, and physical effects, are possible and may affect the ability of the nurse to provide effective nursing care to patients. The state of nursing in the facility ultimately determines whether the obligation to provide quality, safe patient care to the community is met by the organization. High rates of turnover and vacant positions, often necessitating the use of unknown travel nurses, can also compromise patient care, potentially increasing patient complications and worsening outcomes. The many implications of these factors on healthcare organizations cannot be understated, not the least of which are financial. Executives and other leaders must recognize the wellness of the staff and the state of facility culture when considering goals, initiatives, and the organization's overall sustainability. This project addresses the barriers to nursing support through the development of an educational infographic targeted for organizational executives, highlighting second victim syndrome and its potential consequences on nurses, patients, and the facility at large. The infographic directs leaders to examine current facility culture closely, suggesting why and how to ensure a supportive care culture.

Committee: Joy Shoemaker DNP, RN, APRN.CNP, FNP-C, CNE (Advisor); John Chovan PhD, DNP, RN, CNP, PMHNP-BC (Committee Member); Chai Sribanditmongkol PhD, RN, IBCLC, CNS (Committee Member) Subjects: Health Care; Health Care Management; Nursing

MS, University of Cincinnati, 2021, Medicine: Clinical and Translational Research

Background and Objectives Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in our system, we aimed to decrease emergency transfers (ETs) to the intensive care unit (ICU) by 50% over 10 months. Methods An interdisciplinary team of physicians, nurses, respiratory therapists, and families convened to improve the original SA model for clinical deterioration and address communication inadequacies and evolving technology in our inpatient system. Key drivers included establishing a shared mental model, psychologically safe escalation, and efficient and effective SA tools. Novel interventions, including the intentional inclusion of families and the interdisciplinary team in huddles, a mental model checklist, door signage, and an electronic health record SA navigator, were evaluated via a time series analysis. Sequential inpatient-wide testing of the model allowed for iteration and consensus building across care teams and families. The primary outcome measure was ETs, defined as any ICU transfer where the patient receives intubation, inotropes, or three or more fluid boluses within one hour. Results Special cause improvement in the rate of ETs per 10,000 patient days was observed in association with our work, as the rate decreased from 1.34 to 0.41 during the study period. This coincided with special cause improvement in process measures, including risk recognition prior to medical response team activation and utilization of tools to facilitate shared SA. Conclusions An innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs. This finding aligns with prior work which has demonstrated reduced preventable harm with improved situation awareness, while introducing novel tools focused o (open full item for complete abstract)

Committee: Patrick Ryan Ph.D. (Committee Chair); Patrick Brady M.D. (Committee Member) Subjects: Surgery

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

Mental illness is a growing concern among families in the United States, as one in five children between the ages of 13 and 18 suffer from a severe mental illness (National Alliance on Mental Illness, 2013). That means that 20% of children in the country are suffering from an illness whose treatment is difficult to access. Unfortunately, one-fourth of families report problems finding and initiating services for their children, with wait lists that typically start at three months (American Academy of Child and Adolescent Psychiatry, 2013). Even more troubling is the fact that 80% of children with mental illness do not receive any treatment at all (American Academy of Child and Adolescent Psychiatry, 2013). However, to improve access to treatment, organizations need to feel confident that they can open safe, financially sustainable mental health units. The Children's Hospital of Orange County (CHOC) in California recently opened an 18-bed inpatient psychiatric unit that services children ages 3-17 (Perkes, 2016). Many months of thoughtful consideration occurred to develop this elite and cutting-edge model of care. This researcher developed a specific model to approach pediatric mental healthcare through a different lens, called The Core Value Driven Care Model. The model of care is centered around three pillars of focus firmly built on the groundwork of core values. The pillars are representative of People, Place, and Practice, and are anchored in a foundation of empathy, compassion, trust, integrity, dignity, respect, sincerity, unity, honesty, and open-mindedness, as well as trauma-informed thinking. Implementing the Core Value Driven Care Model in a pediatric mental health unit directly impacts the perception of safety and quality of care being provided. The purpose of this study will be to assess the impact the 11 foundational core values have on employee perception of employee safety, patient safety, and quality of care.

Committee: David Meckstroth (Committee Chair); Alyncia Bowen (Committee Member); Jesse Florang (Committee Member) Subjects: Health Care; Health Care Management; Management; Mental Health; Occupational Health; Occupational Safety; Psychology; Systems Design

PhD, University of Cincinnati, 2020, Nursing: Nursing - Doctoral Program

Problem: Home healthcare workers (HHCWs) are an integral part of the rapidly growing home healthcare industry. HHCWs work in an environment that is neither regulated nor predetermined to be safe. Occupational hazards include exposure to blood and body fluids; cleaning chemicals; needle sticks; slip, trip, and fall hazards; indoor air quality concerns including secondhand smoke; pests; pets; violence; and ergonomic stress. Guided by the Conceptual Model for Integrated Approaches to Protection and Promotion of Worker Health and Safety, the purpose of this manuscript option dissertation was to develop an observation tool to be used within the home care environment to identify and describe the occupational hazards HHCWs encounter. Three projects included an integrative review; development, content validity, and interrater reliability of a new observation tool; and piloting the use of the HHCW observational tool in the home care environment. The specific aim of project 1 and 2 was to inform, develop, and validate the observation tool; whereby, ensuring the ability of project 3 to identify and describe the occupational hazards this workforce encounters. Methods: Project 1 followed the steps of Whittemore and Knafl (2005) for an integrative review. Project 2 was the development of an observation tool following three steps: determining content domain, content validity, and inter-rater agreement. Project 3 used a cross-sectional design using the newly developed observation tool during home healthcare visits. To this date, a study has not been identified using persons trained in occupational safety and health to directly assess the occupational environment of HHCWs. Findings: Project 1 identified nine articles providing an overview of the occupational hazards HHCWs encounter, with similarly recognized occupational hazards across studies. Studies were methodologically limited to self-reports and include quantitative and qualitative data. Project 2 entailed the developmen (open full item for complete abstract)

Committee: Gordon Gillespie Ph.D. (Committee Chair); Kermit Davis Ph.D. (Committee Member); Susan Reutman Ph.D. (Committee Member) Subjects: Occupational Safety

MS, University of Cincinnati, 2020, Medicine: Clinical and Translational Research

Background: An estimated 10% of Americans experience a diagnostic error annually, yet little is known about pediatric diagnostic errors. Physician reporting is a promising method for identifying diagnostic errors. However, our pediatric hospital medicine (PHM) division had only 1 diagnostic-related safety report in the preceding 4 years. We aimed to improve attending physician reporting of suspected diagnostic errors from 0 to 2 per 100 PHM patient admissions within 6 months. Methods: Our improvement team utilized the Model for Improvement, targeting the PHM service. To promote a safe reporting culture, we used the term Diagnostic Learning Opportunity (DLO) rather than diagnostic error, defined as a “potential opportunity to make a better or more timely diagnosis.” We developed an electronic reporting form and encouraged its use through reminders, scheduled reflection time, and monthly progress reports. The outcome measure, the number of DLO reports per 100 patient admissions, was tracked on an annotated control chart to assess the effect of our interventions over time. We evaluated DLOs using a formal two-reviewer process. Results: Over the course of 13 weeks there was an increase in the number of reports filed from 0 to 1.6 per 100 patient admissions, which met special cause variation, and was subsequently sustained. Most events (66%) were true diagnostic errors and were found to be multi-factorial upon formal review. Conclusions: We utilized quality improvement methodology, focusing on psychological safety, to increase physician reporting of DLOs. This growing data set has generated nuanced learnings which will guide future improvement work.

Committee: Patrick Ryan Ph.D. (Committee Chair); Patrick Brady M.D. (Committee Member); Philip Hagedorn (Committee Member) Subjects: Surgery

Doctor of Nursing Practice , Case Western Reserve University, 2020, School of Nursing

Patient medication administration is one of the major responsibilities of the professional nurse. Pre-licensure nursing students and new nursing graduates often lack competency to safely administer medications. Nursing educators teach and evaluate safe medication administration by undergraduate bachelor of science nursing (BSN) students during sophomore year. These students are expected to demonstrate safe medication competence through senior year and post-licensure. The purpose of this study was to determine the medication safety competence of undergraduate junior and senior BSN students. A descriptive comparison design of undergraduate BSN students from two cohorts was used to collect data at an urban, public university in Northeast Ohio. The convenience sample included 188 BSN students who agreed to participate in the simulation study, comprised of 98 juniors and 90 seniors. Data was collected over two weeks via observation and focused on the six rights of medication administration using the Medication Administration Safety Assessment Tool (MASAT). Analyses included descriptive statistics and independent samples t-tests to compare the medication competency of juniors and seniors. Results revealed 29.6% of juniors and 14.4% of seniors demonstrated competence on all eight medication checklist items on the MASAT. The difference between the medication safety competence of juniors and seniors on total MASAT scores did not show statistical significance (p > .05). On individual MASAT scores, there was no statistical significance (p > .05) between juniors and seniors on checklist items one through seven corresponding to right patient, right drug, right dose, right route, and right time. Results showed statistical significance (p < .01) on checklist item eight, indicating juniors performed right documentation more frequently than seniors. Two additional analyses revealed (1) no statistical significance (p > .05) between juniors and seniors asking about medication (open full item for complete abstract)

Committee: Celeste Alfes DNP (Committee Chair); Elizabeth Zimmermann DNP (Committee Member); Amy Weaver PhD (Committee Member) Subjects: Nursing

Master of Science, The Ohio State University, 2019, Dentistry

Objective: In the event of a medical emergency in the dental office, the supervising dentist must be able to effectively lead the office team in a concerted effort to stabilize the patient and transfer them to higher-level medical care. This study investigates the impact of a simulation-based medical emergency training curriculum on the ability of general practice residents to effectively manage medical emergencies in a dental environment. Methods: An interventional and pre-post educational trial of 16 general practice residency participants was carried out at The Ohio State University College of Dentistry. Eight participants completed a standard training curriculum as the control group and eight completed a modified training curriculum as the intervention group. The intervention consisted of a simulation-based education curriculum designed for dentists called Medical Emergency Management in the Dental Office (MEMDO). Near the completion of residency, each participant experienced a summative performance-based assessment using an Objective Structured Clinical Examination (OSCE), which was later reviewed and scored by a customized 128-point scoring grid. Additionally, the intervention group completed a baseline performance assessment at the beginning of their residency. Four calibrated faculty reviewers scored each OSCE independently. These data were subsequently analyzed using nonparametric statistical tests with alpha set to 0.05. Reviewer consistency was assessed by calculating an intraclasscorrelation coefficient. All participants completed a survey of demographic information and 11 Likert-type questions. Results: The intervention group performed significantly better than the control group (p=0.0009). This group improved their post-intervention score by an average of 36.9 points out of 128. The intraclass correlation coefficient was found to be 0.9795. Surveys found all participants in agreement with the importance of medical emergency preparedness of all de (open full item for complete abstract)

Committee: Bryant Cornelius DDS, MBA, MPH (Advisor); Kelly Kennedy DDS, MS, FACS (Committee Member); Lipps Jonathan MD (Committee Member); Draper John PhD (Committee Member) Subjects: Dentistry; Educational Psychology; Educational Technology; Educational Tests and Measurements; Medicine

Master of Science in Industrial and Human Factors Engineering (MSIHE) , Wright State University, 2019, Industrial and Human Factors Engineering

Trauma is any physical injury that has the potential to cause prolonged disability and death if the appropriate level of care is not administered in a timely fashion. Existing approaches in the literature and by the American College of Surgeons (ACS) to optimize the network of trauma centers are limiting. To address this challenge, we introduce the Trauma Network Design Problem, a bi-objective mathematical model that aims at determining the optimal trauma network by minimizing the weighted sum of mistriages. We use the trauma network data from 2012 for the state of Ohio to illustrate the use of our approach and conduct sensitivity analysis. While substantial improvements in mistriages can be realized through our approach, the solutions are sensitivity of the weights in the objective terms, trauma volume, and threshold values. We also illustrate how our approach can be used to compare suggestions from the ACS's NBATS tool.

Committee: Pratik Parikh Ph.D. (Advisor); Xinhui Zhang Ph.D. (Committee Member); Nan Kong Ph.D. (Committee Member) Subjects: Industrial Engineering

MS, University of Cincinnati, 2019, Medicine: Clinical and Translational Research

Background: Children requiring chronic mechanical ventilation in the home setting are at extremely high risk of morbidity and mortality. Internal ventilator alarms are one mechanism to improve safety for these patients but there are no guidelines or standard practice for how to use these alarms. Objective: The aim of this quality improvement project was to increase the mean rate of critical ventilator alarms set in our home ventilator population when seen in clinic from 63% to >90%. Methods: Using the Model for Improvement we developed, tested and implemented a series of interventions using Plan-Do-Study-Act cycles. Our measure was tracked using statistical process control methods. Our primary interventions were: (1) standardization of the clinic workflow, (2) development of an algorithm for ventilator alarms, (3) updating that algorithm based on tracking of recurrent failures and inpatient testing, (4) engagement of staff to change the culture surrounding ventilator alarms. Results: Baseline data was collected from May 1 – July 13, 2017 on 130 consecutive patients and showed a baseline of 63% of critical alarms set in patient seen in clinic. Observation of the process, standardization of workflow and adaptation of an alarm algorithm led to an increased to 85.7%. Revision of our algorithm to include an apnea alarm in conjunction to increased provider engagement led to rate of 95.1%, exceeding or goal. Continued improvement to a rate of 98.6% was seen and sustained as a result of culture change related to ventilator alarms. Conclusions: This stepwise approach to ventilator alarms led to a sustained improvement in the rate of critical ventilator alarms used in our chronic ventilator patients. Many of our interventions could be generalizable to other pediatric institutions.

Committee: Patrick Ryan Ph.D. (Committee Chair); Raouf Amin Ph.D. (Committee Member); Dan Benscoter (Committee Member); Barbara Chini (Committee Member); Carolyn Kercsmar M.D. (Committee Member) Subjects: Surgery

MS, University of Cincinnati, 2019, Medicine: Clinical and Translational Research

Background: Effective nurse communication at discharge is critical for safe transition to home for hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reutilization. Little is known about nurse-family communication at hospital discharge. Objectives: To describe and compare the safety and family-centeredness of nurse communication and the level of family-engagement in the discharge process for English Proficient (EP) versus LEP families. Methods: This single-center cross-sectional study used direct observation of discharges for hospitalized EP and LEP patients 0-18 years of age and their parents or caregivers. Trained observers collected quantitative and qualitative details of nurse-family discharge communication focusing on 3 domains: 1) safe discharge; 2) family-centeredness; and 3) family-engagement. Descriptive statistics assessed patient characteristics and percentages of encounters where all components were discussed within each domain. Communication domains were compared between EP and LEP encounters using chi-square test and Fisher's exact test. Field notes were reviewed to clarify and supplement quantitative findings. Results: We observed 104 discharge encounters, of which 40 (38%) were with LEP families. In the safe discharge domain, nurses discussed all 7 components in 37% of encounters; no LEP encounters had all components discussed (p<0.001). Discussion of diagnoses, reasons to call primary care providers, and emergency department return precautions, as well as availability of discharge instructions in primary language were less frequent for LEP compared to EP encounters. All components were used in 10% of encounters for the family-centered domain and 87% of encounters for the family-engagement domain; there were no differences between LEP and EP families for these domains (p=0.74 and p=41, respectively). Conclusions: We identified several opportunities to improve nurse-family discharge co (open full item for complete abstract)

Committee: Aimin Chen Ph.D. (Committee Chair); Amanda Schondelmeyer M.D. (Committee Member); Heidi Sucharew Ph.D. (Committee Member) Subjects: Surgery