Recent ucsdsom_gmepsqisymposium_2026 items

Before the First Visit: A Triage-Forward Outpatient Cancer Diagnostic Pathway

Thu, 18 Jun 2026 00:00:00 +0000

Issues Addressed/Background

Patients with suspected malignancy are routinely admitted inpatient for diagnostic evaluation for urgent but not emergent workups, utilizing limited inpatient resources. We wondered if some of these workups could be managed outpatient in a timely manner with the right infrastructure. Conventional oncology referral pathways follow a consultation-first sequence; ie patients are seen, then tested, then redirected, which delays diagnosis and consumes limited clinic capacity. The UCSD Suspicion of Cancer (SoC) clinic was designed around an inverted model: physician-led triage occurs right at referral, testing is coordinated before the first visit, and patients who can be safely redirected to disease-specific teams never need an SoC appointment. This report describes operational outcomes over the first four months following clinic launch in December 2025.

Description of the Project

The SoC clinic...

Plotting Progress: Improving Recognition and Education for Patients with Elevated BMI

Thu, 4 Jun 2026 00:00:00 +0000

Title: Plotting Progress: Improving Recognition and Education for Patients with Elevated

BMI admitted to the Pediatric Hospital Medicine Service

Authors: Toney, C, Kupelian, C, Chong, A, Pierce, H.

Background/Objective:

Nationally, children with body mass index (BMI) ≥ 95th% have tripled over the last three decades. Children with elevated BMI may be at risk for chronic health problems, adverse psychosocial effects, and increased healthcare utilization (~$14 billion/year). Prior studies have shown suboptimal recognition of elevated BMI. In a retrospective multicenter study, only 13.2% of hospitalized children who had clinical obesity (19.5%) received an appropriate obesity diagnosis. To increase the percentage of non-tube fed patients on the pediatric hospital medicine service (PHM) with BMI >85% to have the diagnosis added to problem list, receive standardized discharge education, and evidence-based follow-up plan communicated to the primary care...

Assessing the Impact of Standardized Simulation Training on Physician Comfort and Confidence in Performing Ultrasound-Guided Injection for Fetal Asystole

Wed, 27 May 2026 00:00:00 +0000

Background: Induction of fetal demise is an advanced procedural skill in Obstetrics and Gynecology (OBGYN) that expands patient access to later-gestation abortion care while mitigating risk of unintended live periviable births. Additionally, the literature shows that many patients prefer induction of fetal demise prior to termination of pregnancy when presented with the option. Despite this, ultrasound-guided injection for fetal asystole is an under-taught skill in abortion training programs, most OBGYN residencies, and many Complex Family Planning (CFP) fellowships. A simulation for this procedure could be a steppingstone for clinicians to learn this skill in a low-risk setting before incorporating it into clinical practice.

Description: This project aims to increase the average clinician comfort and confidence score when performing ultrasound-guided needle procedures such as induction of fetal asystole following standardized simulation training among the participating...

Time Out: Piloting Peri-Procedural Checklists in Minor Procedures Clinic to Reduce Mislabeled Specimens

Wed, 27 May 2026 00:00:00 +0000

Background: Resident-run minor surgery clinics have been shown to increase operative autonomy experience for trainees, while delivering high-quality patient care. However, at least 3 mislabeled lab specimens were reported from the resident-run San Diego VAMC minor surgery clinic from May 2025-November 2025, with 47 mislabeling events total across our institution. A root cause analysis (RCA) investigating institution-wide specimen mislabeling identified a lack of standardized clinic processes as a source of mislabeling errors. We aimed to standardize the minor surgery clinic process by implementing pre- and post-operative checklists, including a double verification of accurate specimen labeling, with a goal of residents recording 75% compliance over 4 months.

Methods: A Gemba walk was performed of the General Surgery Minor Procedures Clinic at the San Diego VAMC, where small soft tissue...

iCONSENT: An Ethics and Humanities-Based Curriculum to Strengthen Patient-Clinician Communication and Informed Decision-Making in Interventional Radiology

Mon, 25 May 2026 00:00:00 +0000

Issues Addressed / Background

Informed consent is a foundational component of ethical, patient-centered care, particularly in procedural specialties such as interventional radiology (IR). At its core, consent is not merely a legal requirement, but a critical opportunity to build trust, foster meaningful patient-clinician partnerships, and support shared decision-making. High-quality consent conversations enable patients to ask questions, express their values and concerns, and make informed, personalized decisions about their care.

Despite this, most clinicians receive limited, if any, formal training in how to conduct these conversations effectively. In high-throughput procedural environments, consent is often compressed into a time-constrained, transactional process, limiting opportunities for dialogue, understanding, and alignment with patient goals. In IR, where patients may first meet their proceduralist immediately prior to...

Improving NTSV Cesarean Delivery Rates in Medi-Cal Patients at UC San Diego Health

Mon, 25 May 2026 00:00:00 +0000

Improving NTSV Cesarean Delivery Rates in Medi-Cal Patients at UC San Diego Health

The Prevention Station: A Graphic Medicine Approach to Enhancing Inter-Clinic Collaboration in Family Medicine

Mon, 25 May 2026 00:00:00 +0000

The Prevention Station: A Graphic Medicine Approach to Enhancing Inter-Clinic Collaboration in Family Medicine

Implementation of the STOP 5 Debrief in the Emergency Department

Mon, 25 May 2026 00:00:00 +0000

Background

The Emergency Department (ED) is often a place of high-stress or difficult cases, with very little time to process these events before returning to other duties in the department. “Hot debriefs”, or short discussions immediately following a difficult case, such as cardiac arrest, pediatric case, or high-stress situation have been shown to decrease burnout, reduce stress, and lead to key process improvements relevant to future codes. Many different styles of hot debriefs have been described, including the Take STOCK, BONE break, and TIM tool. Previous studies have compared hot vs cold debriefs, or examined standardized debrief implementation in the prehospital or ICU setting. In this project, we sought to implement the STOP 5 debrief tool immediately following cardiac arrests, pediatric codes, and other difficult cases in the ED, address physicians perceived lack of time to debrief, and improve confidence of those leading debriefs.

Methods

Nursing...

Improving Frailty Screening for General Surgery Procedures

Sun, 24 May 2026 00:00:00 +0000

INTRODUCTION: Frail patients are at significantly elevated risk of major postoperative complications and mortality. The Risk Analysis Index (RAI) Frailty Index is a validated tool for preoperative frailty assessment. In the Veterans Affairs (VA) system, the Surgical Pause Practice is requiring preoperative frailty index documentation. However, as of September 1, 2025, no frailty scores were being recorded on general surgery cases at our VA. Because the preoperative clinic represents the most consistent and controllable point of contact for surgical patients, this project focused on clinic-based workflow integration to maximize impact. This project aimed to increase documentation of preoperative RAI frailty scores among general surgery patients from 0% to 25% over a 4 month time period. METHODS: This quality improvement project used the Institute for Healthcare Improvement’s Model for Improvement. An interprofessional team of Chief Residents of Quality Improvement and Safety, licensed...

Assessing Availability of Ulipristal Acetate and Levonorgestrel Emergency Contraception at San Diego Pharmacies

Sun, 24 May 2026 00:00:00 +0000

Background

Access to emergency contraception (EC) is a key component of reproductive healthcare and time-sensitive pregnancy prevention. Two commonly used EC formulations include ulipristal acetate, a prescription medication that remains effective for up to 5 days after unprotected intercourse and across a wider body mass index (BMI) range, and levonorgestrel-based EC, an over-the-counter medication that is effective at pregnancy prevention for up to 3 days after unprotected intercourse. Clinical guidelines recommend ulipristal acetate as first-line EC, particularly for individuals with higher BMI or longer delay after unprotected intercourse. However, pharmacy stocking practices may limit timely access to ulipristal acetate, potentially creating disparities for patients with higher BMI and those facing structural barriers to care. This quality improvement project sought to evaluate the availability and dispensing timelines for stocking EC across...

Long Distance Access to Oncologic Care in Patients with Hepatocellular Carcinoma (HCC)

Sun, 24 May 2026 00:00:00 +0000

Background:

Due to uneven geographic distribution of health care infrastructure, long distance travel is a reality of cancer care for many patients. Patients travel significant distances to access tertiary academic centers or receive multidisciplinary care¹. Outcomes for patients have been mixed. A 2021 study of HCC patients undergoing liver resection showed living >50 miles from high volume tertiary academic centers was associated with worse overall survival².

However, a subsequent NationalCancer Database (NCD) study demonstrated that HCC patients who travel >30 km/18.6 mi were more likely to have higher rates of locoregional/surgical treatment, academic center care, and improved overall survival. Authors reflected this population may be highly motivated and financially able to seek distance care³....

Development and Implementation of Asian-Adapted Mediterranean Diet Counseling: A QI Project Approach