Quality Improvement Ideas and Topics for QI Project Paper

In nursing, Quality Improvement (QI), also known as Continuous Quality Improvement (CQI) initiatives, is critical in improving and enhancing patient care. The guide below will help you craft a structured quality improvement paper (QI Research Paper) based on well-researched quality improvement ideas, topics, areas, and issues.

What is Quality Improvement? 

In Nursing, quality improvement provides a systematic framework for evaluating, enhancing, and improving care. 

The four steps of nursing quality improvement projects include; 

1. Identifying the nursing practice problem, such as patient falls or medication errors
2. Collecting data on the problem to determine critical indicators such as incidence rates. The quality of the data collected determines the effectiveness of the research and quality initiative. 
3. Develop and implement an intervention that addresses the problem and can contribute to continuous quality improvement. 
4. Evaluate the results and determine the effectiveness of the quality improvement initiative. 

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Importance of Quality Improvement

• It helps an organization’s internal systems and processes to improve outcomes and provide safer, cost-effective, and efficient patient health care.
• CQI implementation requires ethical oversight due to the various ethical issues associated with the process. 
• The CQI implementation should meet the following requirements: social or scientific value, scientific validity, fair subject selection, favorable risk-benefit ratio, informed consent, respect for participants, and independent review.

How do you choose a quality improvement project area?

• Technical Merit – explore areas that provide the most value for patients, nurses, and other practitioners within the organization
• Conduct a root cause analysis to determine the critical areas for improvement such as safety and quality
• Evaluate the community and population to determine any potential areas to improve health care quality. This includes examining issues to do with patient experiences such as barriers to care, conditions, or groups of high-risk patients within the patient population. 
• You can also rely on personal experience of patient care, or observation.
• An audit of a critical incident, organizational process, evidence review, or patient feedback such as complaints, compliments, and discussions. 

Methods of conducting the quality improvement process 

1. Plan Do Study Act (PDSA) is an interactive, iterative, and four-step quality improvement method. It perceives the process, assesses it further, revises it appropriately, and repeats the cycle for sustained improvement (Knudsen et al., 2019). 

• Under the planning stage, the quality improvement team identifies a problem, analyzes it, clarifies goals and objectives, defines success, identifies critical team players, and selects strategies to put the plan into action.
• In the Do stage, the plan’s components are implemented. The stage involves implementing the action plan, collecting data, designing appropriate tools to conduct changes, and performing appropriate change activities.
• The Study stage entails monitoring outcomes and testing the validity of the activities against goals and objectives. The team analyzes the gathered data, ensures the plan is working, and identifies and removes bottlenecks.
• The final stage, Act, is the end of the cycle and involves integrating and learning from insights generated by the entire process.

2. Six Sigma is a quality improvement method widely used to improve processes and performance in the healthcare industry.

• The method eliminates defects and waste, resulting in improved quality and efficiency. It streamlines and improves all healthcare processes.
• Six Sigma identifies defects in a process and indicates the percentage of defect-free processes.
• It employs the DMAIC methodology that involves defining, measuring, analyzing, improving, and controlling quality problems in healthcare processes. 

How to write up a QI project Paper

QI Project Papers or Research papers are often guided by marking rubrics and set instructions on addressing each section of the project.  SQUIRE guidelines provide a framework useful in quality improvement reporting. 

Title Page 

• Includes the name of the quality improvement initiative and any other identifying information, such as the implementation facility and your name. It should be 50 words in length.

Abstract

• Summarize all the critical information in the various sections of the report. 
• The structure should include background, local problem, methods, interventions, results, and conclusion. 

Introduction

The introduction answers the question of why and where. The components of the introduction include; 

• Problem description, which includes the QI Problem Statement. The problem statement should indicate the nature and significance of the problem within the organization.
• Summary of available information and knowledge on the problem, including the empirical studies conducted on the problem in other organizations. This should also highlight contributing factors and barriers.
• Provide a rationale for the problem. This includes using models, frameworks, concepts, and theories to examine the problem.
• Outline any assumptions used in the development of the interventions and reasons why the project will be successful.
• State the specific aims and purpose of the project and the report

Methods

The methods section provides a guide on what measures, strategies, and analysis were used to develop the intervention and during implementation. 

• Provide contextual elements to introduce the intervention and the local problem.
• Describe and elaborate on the intervention to ensure others can replicate or reproduce it. Also, provide precise specifics on the team involved in the design and implementation of the intervention. 
• Perform a study of the intervention
  • – state the approach used to determine the effect of the intervention
  • – state the measures used to establish if the measured outcomes were as a result of the intervention
• Measures
  • – discuss the measures selected for studying the intervention’s processes and outcomes by stating the rationale for selecting the measures, operational definitions, validity, and reliability. 
  • – describe the evaluation measures and elements that led to the effectiveness of the measure
  •  – state and provide a rationale for the method used to determine the completeness and accuracy of data. 
• Analysis
  • – You can use either qualitative or quantitative methods of analysis
  • -define the methods useful in determining variations in the data and the effects of time as a variable
• Describe the ethical aspects of the project and intervention and how they were addressed.

Results 

When writing the results section of the QI, 

• Start the results section by outlining the initial steps of the intervention and it’s change over time. Visual/statistical representations such as flow charts or tables effectively present results. 
• Provide extensive details of the process measures and outcomes
• Define the contextual parts that interacted with the intervention during the implementation stage
• Report on the observed connections between the outcome and intervention, as well as other relevant issues that occur during the project
• Report on the unintended results of the implementation process, such as unexpected benefits, problems, failures, or costs 
• Include a section on any missing data

Discussion 

The discussion section provides a summary and interpretation of the key findings and highlights the project’s limitations. The last part of the discussion section concludes the project by describing the usefulness, sustainability, and implications of the project in practice. 

When working on the discussion section, 

• Provide a summary of the key findings and how they are related to the rationale and specific aims, and also summarize the strengths of the project
• Provide interpretations on the connection between the intervention and the outcomes 
  • – makes a comparison between the results and findings from empirical studies 
  • – Describe the project’s impact on people (patients and staff), the organization, and the systems. 
  • – Describe any reasons for any differences between expected results and actual findings 
  • – define any opportunity costs 
• Highlight the limits to the generalizability of the work and any measures taken to minimize the effect of limitations.
• Provide a clear conclusion to the QI project highlighting usefulness, sustainability, use in other fields, implications of the project on practice, and any suggested next steps. 

Nursing Quality Improvement Ideas, Topics, Issues and Areas

10 Examples of nursing quality improvement issues

The common quality improvement issues include;

1. Workflow Redesign to Reduce the Time Interval Between Patient Check-In and First Needle Stick for Ultrasound-Guided Thyroid Fine Needle Aspirations
2. Utilizing Clinical Resources to Reduce Clinical Messages
3. Improving the Transfer Process In The MICU
4. The Patient Satisfaction Experience: Enhancing Bedside Shift Report
5. Structured Family Meetings in the Medical ICU at Emory University Hospital
6. Revenue Cycle Improvement – Decrease Days in Accounts Receivables
7. Reduction of Urosepsis as a Cause for 30-Day Hospital Readmissions in Radical Cystectomy Patients
8. Reduction of Catheter-Associated Urinary Tract Infections, a Team Approach
9. Reduction in Ventilator-Associated Pneumonia
10. Reducing the Rate of “Nonclassifiable” PCI Procedures for Appropriate Use Criteria Reporting in Two Teaching Hospitals

30 Practical Topics for Your QI Paper

1. Reducing Post-Operative Urinary Tract Infections: Implementation of a Nurse-driven CAUTI Protocol on 10E
2. Reducing Mechanical Restraint in an Acute Behavioral Health Setting
3. Reducing Inappropriate Blood Transfusions
4. Reducing Imaging Exam Order-to-Start Turnaround Time for ED Patients at EUH
5. Reducing Idle Room Time at Winship Clinic
6. Reducing Door to Antibiotic Administration Time in Suspected Sepsis
7. Reducing Central Line Infections in 11 ICU
8. Reducing Breast MRI No-Shows
9. Reduce Errors in Height and Weight Assessment and Documentation for Winship Cancer Institute
10. Radiology Report Attestations
11. Radiology Report Attestations
12. Quality Project to Reduce Absenteeism at the Transitions Senior Program
13. Psychiatric Patients in the ED – Wording of the Safety Hold Order
14. Provider Billing & Schedule Link Improvement Project
15. Prevention of Contaminated Blood Cultures: Protecting Patients from Additional Interventions
16. Preoperative Beta Blocker Administration Quality Improvement Initiative
17. Please Release Me: A Restraint Reduction Initiative
18. Patients who Leave the PACU with a Urinary Catheter and No Order
19. Patient Cycle Time Laboratory Building A
20. Patient – Practice Communications, Department of Neurology
21. Partial Hospitalization Program Geriatric Depression Scale Compliance
22. Orthopaedics Charge Capture Improvement
23. Oral Care with Chlorhexidine Gluconate: Does it Reduce VAP rates?
24. Ontime Starts Chemotherapy
25. Omnicell Reconciliation
26. Notification of Waits and Delays to Patients
27. No Patient Left Behind, Real Time SCIP Data Collection
28. Medication Coverage at Discharge
29. Medicare Rights Notification Compliance
30. IR On Time Start

20 Quality improvement ideas for nursing students

1. Internal Medicine (TEC A4) Check-out Waits & Delays
2. Intentional Bathroom Breaks as a Fall Reduction Strategy
3. Increasing the Rate of Tdap Vaccination Offering to Patients in a Resident Run Urban Community Primary Care Clinic
4. Increase Mobilization of Surgical Patients
5. Improving the Recognition and Assessment of Obesity In the Resident Primary Care Clinic
6. Improving the Rates of Patients Bringing their Medications to the Clinic: the Show-Your-Medications (SYM) Project
7. Improving the Rate of Response to Safety Events in Radiology
8. Improving the Rate of HIV Testing in Eligible Clinic Patients: Implementation of a Dot Phrase and Template Change in EMR
9. Improving the Clinic Visit Summary Process in General Internal Medicine at MOT
10. Improving Social Services Consult Compliance Rate for Stroke Patients
11. Improving Safety through Updating Medication Lists in Sports Medicine
12. Improving Radiology Final Report Turn Around Time for After Hours Emergency Department Imaging Exams at EUH and EUHM
13. Improving Quality Scores Of Hypertensive Patients At Dunwoody
14. Improving Provider Communication: Transplant’s Lung Program
15. Improving Provider Communication: Inpatient Correspondence Center Utilization
16. Improving Pneumonia Vaccine Screening
17. Improving Pneumonia Quality Measures in the Emergency Department
18. Improving Percentage of Patients with Self-Management Goals in Emory Patient Centered Primary Care
19. Compliance with Intentional Rounding Tool (IR)
20. Chairside Checkout in Medical Oncology Building C
21. CCU CLABSI Prevention: CHG Bath Project.

24 Topics for Quality Improvement Research Paper

1. Improving Admission Medication Reconciliation Rates on a Hospital Medicine Unit of a Large Academic Medical Center: An Official Sounding Study
2. Improve Patient Access: Emory at Smyrna & Emory at Eagles Landing
3. Implementation of POD Teams in the EUHM Emergency Department
4. Implementation of an Electronic MRI Scanner QA Log Using RedCap
5. Implementation of a Falls Reductions Program in an Acute Care Setting
6. HTN-2: Blood Pressure Control
7. Newborn Hepatitis B Vaccination QI Project: Delivery Before 12 hours of life
8. Improving Newborn Hepatitis B Vaccination
9. Hand Hygiene Compliance in a Hemodialysis Unit
10. Guest Services: Patient Transporters
11. Front Desk Arrival Time SMG-Vascular Surgery
12. Fix The Phones
13. EUHM Pre-Admission Testing Reducing Patient Wait Times
14. ER Patient Exam Delay
15. Drug Purchasing Based on Utilization: A Formula for High Margins
16. Document Control of the Prospective Reimbursement Analysis (PRA)
17. Discharge Order + Instruction Improvement Project
18. Diagnostic Ultrasound: QI Project to Standardize Exams Across Emory Healthcare
19. Diabetic Ketoacidosis Protocol
20. Development of the Emory Healthcare Bedside Shift Report Bundle and the Effect on Patient Satisfaction
21. Impact of quality improvement initiatives on patient care
22. Quality improvement program outcomes in various settings
23. Quality improvement efforts in addressing medical errors
24. Implementing Quality Improvement in Healthcare Settings

25 Quality Improvement Areas 

1. Advocacy for vulnerable population
2. Death and dying, hospice care, palliative care
3. Hospital without walls
4. Nursing centers
5. Home care issues
6. Therapeutic Touch and other health patterning modalities (imagery, relaxation, music, therapy, light therapy, aromatherapy)
7. Pain control management in specific populations
8. Fall injury prevention
9. Social support
10. Family caregiver
11. Coping with chronic illness
12. Prevention/treatment of heart disease, cancer, etc., through nutritional approaches (diet, vitamins, minerals, herbs)
13. Leadership issues
14. Restructuring the work environment
15. Power enhancement
16. Violence toward women/populations at risk/nurses
17. Elder/child spouse abuse
18. Post-traumatic stress response/management
19. Wellness
20. Mentoring
21. Burnout
22. Role restructuring
23. Advance directives
24. Alternatives to restraints
25. Palliative Care

13 Examples of Quality Improvement Projects in Overall Patient Care

1. Improving Patient Satisfaction in the Patient Centered Medical Home
2. Improving Patient Outcomes Through Inpatient Psychiatric Core Measures
3. Improving Nutrition Delivery for Mechanically Ventilated Patients Receiving Enteral Nutrition
4. Improving Medication Reconciliation in a Resident Primary Care Clinic
5. Improving Inpatient Charge Capture (Professional Fees)
6. Improving Hypertension Control in the Patient Centered Medical Home
7. Improving Hypertension Control at Emory Patient-Centered Primary Care (PCPC)
8. Improving Hepatitis C Screening in a Primary Care Internal Medicine Resident Clinic
9. Improving EUHM Radiology Interdepartmental Patient Hand Offs
10. Improving Counseling for Tobacco Cessation in a Resident Primary Care Clinic
11. Improving Continuity of Care: Establishing Primary Care Physician-Patient Relationships in a Resident Clinic
12. Improving Cardiology OP SCIP Compliance Rate at EUH & EUHM.
13. Improving Blood Glucose Control in the Cardiothoracic Surgery Patient Population

8 Examples Of Quality Improvement Initiatives In Healthcare & Hospitals

1. CAUTI Prevention Team
2. Care Initiation’s Patient Transfer Times
3. Care Initiation Rounds and Interdisciplinary Communication
4. Budd Terrace Skilled Nursing Facility Readmissions Pilot
5. Atlanta Community-based Care Transitions Program (CCTP)
6. Antibiotic Stewardship: Reducing Quinolone Use in the Hospital
7. Antibiotic Protocol in EJCH ED Sepsis Patients
8. Advanced Health Care Directive Education in the Primary Care Setting
9. Achieving 100% Documentation of the Pre-operative Checklist Beta Blocker Section
10. Addressing Medical Errors through Quality Improvement
11. Enhancing Quality of Care in Healthcare Settings

5 Examples of Quality Improvement Projects

1. Reducing Medication Errors Quality Improvement Project
2. Quality Improvement Initiative for Pedophilic Disorder
3. Implementation of TQM in Nursing Care
4. Quality Improvement and Patient Safety Practicum
5. Intimate Partner Violence Practicum Evaluation