Recent ucsdsom_gmepsqisymposium_2025 items

Improving Goal-Concordant Care: Increasing LST Note Completion in High-Risk Veterans at VA San Diego

Wed, 29 Apr 2026 00:00:00 +0000

See PDF.

The Beginning of Change: Characterizing Families who Refuse Neonatal Preventative Services.

Wed, 29 Apr 2026 00:00:00 +0000

The Beginning of Change: Characterizing Families who Refuse Neonatal Preventative Services.

Assessing Availability and Expanding Access to Mifepristone at Pharmacies in San Diego County

Wed, 29 Apr 2026 00:00:00 +0000

Background:

Mifepristone is used for both medication abortion and medical management of early pregnancy loss (EPL). In 2023 the FDA REMS for mifepristone was modified, allowing pharmacies to become certified to dispense mifepristone. This modification facilitated medication abortions via additional providers, and telehealth, which studies have shown is equally safe and effective compared to in-person medication abortion care. Despite the evidence supporting medication abortion without an in-person clinic visit and the ability of pharmacies to dispense these medications, this is not yet a routine part of abortion care. It is unknown how many pharmacies are certified to order, stock, and dispense mifepristone.

Description:

This project aims to understand the number of San Diego pharmacies that are able to dispense mifepristone. In addition, among pharmacies not dispensing, we assessed interest in being able to dispense...

Expanding Access to HIV Pre-Exposure Prophylaxis (PrEP) at VA San Diego

Tue, 24 Jun 2025 00:00:00 +0000

Background: HIV remains a significant public health issue in the US, with over 30,000 new diagnoses annually. The Veterans Health Administration (VHA) is the leading provider of HIV care. HIV pre-exposure prophylaxis (PrEP) medication is over 99% effective in preventing HIV. Despite CDC recommendations, PrEP is underutilized, with 36% of high-risk patients prescribed PrEP nationally and only 20% in VA San Diego (VASD). Barriers to accessing PrEP at VASD were identified through Gemba walks and stakeholder interviews, including knowledge gaps of primary care providers (PCPs), lack of an efficient system to assess PrEP indications, low patient awareness, and required referral or e-consult to the Special Infectious Diseases (SPID) clinic for PrEP prescriptions. Inspired by a similar initiative at the Greater LA VA (GLAVA), interventions were developed to address barriers, including a PCP educational session, a note template to assess PrEP indications and handouts clarifying the...

Caring for the Caregivers: A Process Group Approach to Enhance Resident Resilience

Tue, 24 Jun 2025 00:00:00 +0000

Needs and Objectives

Medical residents face significant emotional challenges during demanding rotations, such as the two-week ward rotation at UCSD Jacobs Medical Center. During this rotation, residents care for patients with complex medical conditions and frequently lead goals of care discussions. In our pre-survey, 56% of residents agreed or strongly agreed that they “feel personally affected when providing care to terminally ill patients.” 56% also disagreed or strongly disagreed with the statement, “I have time to process emotionally challenging patient encounters during clinical rotations.” Therefore, we developed and implemented the Resiliency Roundtable Process Group to provide a safe and structured environment to debrief and process emotionally distressing events and to equip residents with practical tools for engaging in self-care.

Setting and Participants

The process group is held every...

Improving adherence to endocrine long-term follow-up guidelines in Hematopoietic stem cell transplantation survivors: A Quality Improvement project at Rady Children’s Hospital

Sat, 7 Jun 2025 00:00:00 +0000

Background: Hematopoietic stem cell transplantation (HSCT) survivors are at risk for developing late complications secondary to peri-transplantation exposures. National guidelines recommend screening for late effects of HSCT, including endocrine disorders. At our institution, we observed that adherence to guidelines was suboptimal. Among pediatric allogeneic HSCT recipients with hematologic malignancy or severe aplastic anemia (SAA) diagnosis, only 1/16 patients (6%) received all the recommended screening evaluations/tests at 12 and 24 month follow-up visits between January and September, 2023.

Methods: Global Aim: Improve long-term endocrine health in HSCT survivors.

SMART Aim: From July 1, 2024 to May 31, 2025, the percentage of allogeneic HSCT recipients with hematologic malignancy or SAA diagnosis at Rady Children’s Hospital-San Diego, who receive all the recommended endocrine screening evaluations/tests at 12 and 24 months after transplant,...

Improvement on Literature-Based Management and Counseling of Oral Mucositis acrossDermatologic Entities

Sat, 7 Jun 2025 00:00:00 +0000

Background: Dermatologists often have limited exposure to the management of oral mucositis, despite its frequent occurrence in patients with autoimmune blistering conditions, severe cutaneous drug reactions, congenital blistering disorders, and other dermatologic diseases. This gap in familiarity presents a challenge in providing optimal care for affected patients. Furthermore, oral mucositis can significantly impact quality of life, nutrition, and overall health, necessitating a standardized and evidence-based approach to treatment. Given the overlap between dermatologic conditions and oral mucosal involvement, equipping dermatologists with structured management tools is essential. To address this, we conducted a comprehensive literature review and developed clinical decision-support tools in the form of smartphrases (dotphrases) to standardize treatment approaches.

Methods: A literature review was performed on updated oral mucositis management guidelines,...

Quality Boost: Improving Post-Tonsillectomy Hemorrhage Care in the Pediatric ED with Nebulized TXA

Sat, 7 Jun 2025 00:00:00 +0000

Pediatric post-tonsillectomy hemorrhage (PTH) affects up to 6.7% of patients. Nebulized tranexamic acid (nTXA) is low in cost, safe, achieves hemostasis, and decreases the return to the OR (ROR). Only 14% of patients who presented to the ED at a large pediatric emergency department received nTXA.

No More Missed Signs: Electronic Health Record Integration of Intimate Partner Violence Screening and Response in Primary Care

Sat, 7 Jun 2025 00:00:00 +0000

Background: Intimate partner violence (IPV) is a serious public health issue; 1 in 2 transgender individuals, 1 in 3 women, and 1 in 4 men experience IPV in their lifetime. IPV has lasting physical and mental health effects, including headaches, abdominal pain, anxiety, and depression. UC San Diego Health (UCSDH), one of the major leaders in research and innovation in San Diego and globally, lacked IPV screening and response protocol. To close this gap, we conducted a literature review and environmental scan of electronic health record (EHR) tools to develop an outpatient IPV screening protocol and implemented it within outpatient clinics’ EHR.

Methods: Using previous validated IPV screening tools, conducting a literature review on environmental scan of clinical workflows and EHR tools, and collaborating with a multidisciplinary team of researchers and health providers, we integrated the Abuse Assessment Screen (AAS) IPV screening tool into UCSDH...

Neuro-check Yo'self: The Implementation of a Customized Inpatient General Neurology Admissions Order Set

Mon, 26 May 2025 00:00:00 +0000

Background: Patients with acute neurological illness requiring hospitalization have a specific set of inpatient needs that are distinct from those who are admitted for primary medical or surgical indications. Many of these needs can be addressed on initial admission with specific orders. Currently, the inpatient general neurology team uses the “acute care non-ICU admission” order set for all admissions onto the service that is an order set that is available to all UCSD services. However, this admission order set is not tailored to meet the specific needs of a patient population that is ill with an acute neurological disorder requiring hospitalization.

Description: Earlier in this academic year, an M&M conference was held by the clinical service chair, inpatient neurology faculty, and neurology residents regarding an inpatient case. A root cause analysis was conducted during this M&M that determined the “acute care non-ICU admission” order set was not optimized...

Improving cord management in preterm neonates at birth.

Mon, 26 May 2025 00:00:00 +0000

Background

Umbilical cord management is a critical aspect of neonatal care, impacting both immediate and long-term health outcomes for newborns. The timing of cord clamping and the methods used can significantly influence the infant's adaptation to extra-uterine life, affecting parameters such as blood volume, iron status, and respiratory transition. Current guidelines and practices vary widely, necessitating optimizing these procedures based on the latest evidence.

Description of the Project

Our setting is the University of California San Diego NICU, a 52 bed Level 3 NICU with a birthing center that delivers approximately 40 infants with gestational age < 30 weeks per year. Recently, our unit adopted an innovative approach involving trolley deliveries (Figure 2) for delayed cord clamping (DCC) of 90 seconds as part of a multicenter randomized clinical trial. This method facilitates the initiation of ventilation...

Assessing Availability and Expanding Access to Mifepristone at Pharmacies in San Diego

Mon, 26 May 2025 00:00:00 +0000

Background:

Description:

The Beginning of Change: Characterizing Families who Refuse Neonatal Preventative Services.

Fri, 23 May 2025 00:00:00 +0000

Introduction:

Current universal standards of care in the healthy newborn include intramuscular vitamin K (prevent vitamin K deficiency bleeding), topical erythromycin (prevent gonococcal ophthalmia neonatorum), hepatitis B vaccination (prevent hepatitis B), newborn screen (identify significant congenital diseases), hearing screen, and pulse oximeter screening for critical congenital heart disease.1-6 However, refusals for these services have been increasing.7 Other studies have identified factors that may contribute to declinations, but these studies have variable refusal patterns especially with refusal of all interventions.8-9 Most studies previously focused on vitamin K, erythromycin, and hepatitis B vaccine refusals, but none have been comprehensive to include other recommended preventative efforts.

Objectives:

Assess rates and patterns of refusal. Identify common demographic and clinical factors...

Prescription Precision: An Exploration into Antimicrobial Management of Central-Line Associated Bloodstream Infections at UC San Diego Health

Thu, 22 May 2025 00:00:00 +0000

Background

Central-line associated bloodstream infections (CLABSIs) are a major source of preventable morbidity and mortality in hospitalized patients. Antimicrobial stewardship (AMS) practices are key in preventing antimicrobial resistance in healthcare-associated infections such as CLABSIs. According to the CDC and IDSA guidelines, this includes initiation of empiric antimicrobial therapy, followed by de-escalation of antimicrobials once microbiological data is available. Suboptimal AMS practices result in disrupted microbiome and selection of resistant organisms and are associated with increased morbidity and mortality, cost of care, and duration of hospitalization. This study aims to characterize patterns associated with CLABSIs in patients hospitalized at UC San Diego Health and to analyze AMS practices in the management of CLABSIs, including empiric choices, de-escalation, and the consultation with the infectious diseases team.

Methods

Electronic...

Demographic Analysis of Patients Diagnosed with Cerebral Infarction in a Rural Critical Access Hospital