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Background: As public and private stakeholders demand higher quality of care in the hospital setting, hospitalists play a critical role in leading performance improvement. As hospitalists seek ways to improve quality and lower costs, malnutrition [...]
Background: With nearly 12.3 million inpatient discharges per year attributed to geriatric patients, hospitalists need to be proficient in the practice of geriatric medicine. Our objective was to conduct a systematic literature review to identify [...]
Background: Although code status discussion does not routinely happen at hospitals in Japan, many people reportedly start to think of their end of life issue and would like to express it, according to questionnaire survey [...]
Background: Delirium is a prevalent and dangerous state of confusion that affects millions >65 years of age (1-3). Delirium is underdiagnosed and undertreated due to lack of effective screening methods (4, 5). Undetected delirium in [...]
Background: Patient care at the end of life is largely based on experience of provider and the care that is delivered may not be aligned with what was detailed by patient preference via prior [...]
Background: Triple negative breast cancer (TNBC) comprises of approximately 15% of the total breast cancers. There is limited data on treatment outcome of these patients in elderly population. We report our experience with elderly patients [...]
Background: The Charlson comorbidity index (CCI) has been one of the most commonly used and validated prognostication tools. In addition to being a valuable resource for health services researchers, the CCI is being used in [...]
Background: Earlier discharge time is an important satisfaction metric for patients, maximizes the utilization of hospital beds, and reduces waste and capacity issues in EDs /PACUs. Overall, early discharge represents high-value care and responsible stewardship [...]
Background: Interprofessional teamwork in healthcare organizations is crucial to the delivery of quality patient care. Efforts to improve teamwork on hospital medicine units commonly fail due to clinicians and other care team members (case managers [...]
Background: The American College of Graduate Medical Education requires resident involvement in patient safety and quality improvement (PS/QI) but it remains difficult to engage house officers (HOs) in meaningful and sustainable projects. In 2011, the [...]
Inpatient Intermittent Confusion and Hypoxia – Thinking out of the Box but From the Bottle Case Presentation: A 62-year old Caucasian female, a Psychiatrist, was brought by her friend for multiple falls and heavy alcohol [...]
Case Presentation: A 29 year old African American male presented with non-radiating, mid-sternal chest pain, which was relieved by sitting up. His vital signs and physical examination were unremarkable. His initial EKG showed J point elevation in [...]
Case Presentation: A 42 year old African American male with a recent diagnosis of Ulcerative Colitis (UC) presented with recurrent bloody diarrhea, abdominal pain, fevers, chills, weight loss and was admitted for management of a [...]
Case Presentation: A 42-year-old male with a history of T2DM, subacute bilateral LE weakness and paresthesia presented with UTI, urinary retention and anejaculation. One month prior to admission the patient was taken to the ED [...]
Case Presentation: A 64 year old male presented with a three day history of fever, hand soreness and rash. On the day of presentation, he had just returned from the Caribbean, however denied any history [...]
Background: Hospital admissions are the majority contributor to the cost in caring for diabetes, accounting for about 40% of the costs. As most hospital reimbursements are based upon diagnosis-related groups, hospitals have strong financial incentives [...]
Background: Hospitalized older adults are increasingly referred to skilled nursing facilities (SNFs) for post-acute care following hospitalization. However, whether hospitalized older adults are enabled to make high-quality decisions about different post-acute care options is unclear. [...]
Background: Cirrhosis is the permanent fibrosis of the liver and carries a prevalence of 600,000 cases per year. Hospitalizations due to cirrhosis have doubled from 2001 to 2011 with an average hospitalization cost of $15,000. [...]
Background: As part of the ABIM Foundation’s Choosing Wisely campaign the Society of Hospital Medicine recommended providers avoid performing repetitive CBC and chemistry testing in the face of clinical and lab stability. In 2014 as [...]
Background: In response to skyrocketing healthcare costs, providing high value care is an increasing priority for health care systems. Physicians are responsible for translating high value care (HVC) to the bedside, however there is a [...]
Background: Guiding health care delivery towards patient-centered value can be accelerated by reforming physician reimbursement. Recent legislation including the Medicare Access and CHIP Reauthorization Act (MACRA) and the Affordable Care Act have created frameworks for value-based [...]
Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine [...]
Background: Venous thromboembolism (VTE) is a common preventable condition in hospitalized medical patients. Chemoprophylaxis with heparin or fondaparinux has been recommended for all hospitalized patients who are not at low risk, and appropriate thromboprophylaxis is [...]
Background: In an era where the cost of healthcare in the United States is rising at an unsustainable rate, promoting high value care has never been more important. As highlighted by the Society of Hospital [...]
Background: Inappropriate laboratory utilization in hospitalized patients is a significant contributing factor to health care expenditures, iatrogenic anemia, downstream testing, and poor patient satisfaction. For these reasons, the Society of Hospital Medicine has recommended through [...]
Background: Avoiding repeated complete blood count (CBC) testing in the face of clinical and laboratory stability is a Choosing Wisely initiative recommendation endorsed by the Society of Hospital Medicine. We investigated the prevalence and clinical [...]
Background: Cardiac telemetry is frequently overused in the hospital. Our institution requires telemetry while patients are on the Clinical Institute Withdrawal Assessment (CIWA) protocol, regardless of the presence or severity of alcohol withdrawal (AW). Telemetry use [...]
Background: Inappropriate telemetry use has been associated with increased health care cost and unnecessary diagnostic procedures. For these reasons, the Society of Hospital Medicine’s Choosing Wisely campaign promoted use of both American Heart Association (AHA) [...]
Background: Misuse of laboratory tests can be difficult to determine unless tests are clearly overused or repeated routinely. However, excessive testing of chronically critically ill patients treated in long-term acute care hospitals (LTACHs) can be [...]
Background: Decades-old clinical data and practice guidelines support the use of lipase over amylase in the workup and management of acute pancreatitis. Yet, laboratory testing for amylase continues to cost the Center for Medicare and [...]
Background: Transthoracic echocardiography (TTE) is one of the most popular tests in healthcare. Studies of Medicare beneficiaries for example have shown that each year approximately 20% undergo at least one TTE. Repeat TTE defined as [...]
Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but deadly thrombotic microangiopathy (TMA) that is caused by ADAMTS13 deficiency. The PLASMIC clinical scoring system was developed and validated to determine the pretest probability of severe [...]
Background: Hospital Medicine is a rapidly growing specialty and a higher percentage of patients are under the care of hospitalists across the country. Like other internal medicine subspecialties, an increasing number of residents have expressed [...]
Background: End of life discussion is very important for preventing undesired cardiopulmonary resuscitation (CPR). It is reportedly associated with less aggressive medical care near death and better quality of life. Its importance has been gradually [...]
Background: The Choosing Wisely Campaign encourages physicians to avoid over-utilizing routine labs in hospitalized patients with clinical and laboratory stability. A number of studies have shown adverse effects on hospitalized patients from lab overutilization. In [...]
Background: Diabetic ketoacidosis (DKA) is a serious, acute complication of diabetes mellitus caused by a state of insulin deficiency requiring exogenous insulin administration. Significant variation in intensive care unit (ICU) admission rates for DKA exists [...]
Background: Chest pain accounts for 2-5% of all Emergency Room (ER) visits. Tools like TIMI score and HEART score exist to risk stratify patients, but a low threshold for admission has been traditional because the [...]
Background: The healthcare system in the United States is often times costly and inefficient. Some estimates suggest that 20-34% of healthcare dollars are spent ineffectively. Despite efforts such as the Choosing Wisely Campaign to limit [...]
Background: Unnecessary diagnostic testing contributes to the escalating cost of health care in the US and can cause harm to patients. Daily blood work has become a routine part of care for hospitalized adults though [...]
Background: Previous studies have determined that a small subset (~10%) of the results of tests pending at discharge (TPADs) require action. Challenges for hospitalists in dealing with actionable TPADs include identifying TPADs that are truly [...]
Background: We identified a number of quality, patient satisfaction, and staff satisfaction issues that all seemed to be linked to throughput challenges. We had trouble getting patients out of the hospital on discharge day, which [...]
Background: Inappropriate antibiotic use is associated with bacterial resistance, adverse events, and an increased risk of Clostridium difficileinfection. However, providers often prescribe antibiotics for viral respiratory infections and treat infections such as bacterial pneumonia for [...]
Background: Amanda Guay, outreach coordinator at North Country HealthCare in Flagstaff, Arizona, believes that affordable nutrition based meals are an important issue in the Flagstaff community, especially for underserved populations. Diabetes, obesity, hypertension, and hyperlipidemia [...]
Background: Reducing LOS promotes value, and when aligned with patient preferences, can improve care. Patients referred for palliative care (PC) generally have longer length of stay (LOS) due to their serious illness, multiple complex management [...]
Background: Septic patients that require ICU level of care are treated empirically with vancomycin. Although this treatment is effective for MRSA infections, prolonged vancomycin exposure can cause nephrotoxicity and antibiotic resistance. A test to identify [...]
Background: Peripherally inserted peripheral catheter (PICC) use is associated with many complications including line related thromboembolism. Several studies and meta- analyses confirmed the increased risk to develop venous thromboembolism in non-O blood group patients. We [...]
Background: By 2026 the number of prostate cancer survivors is expected to reach 4.5 million. Although the mortality from prostate cancer has been steadily decreasing, cancer survivors usually have poor outcomes compared to their peers [...]
Background: Approximately 1-2% of the U.S. population gets community-acquired pneumonia (CAP) annually in the U.S. and CAP is associated with substantial mortality, morbidity and costs. While the incidence of CAP is well-defined, the incidence of [...]
Background: Peripherally inserted center catheter (PICC) use is associated with many complications including thromboembolism. The role of pharmacological prophylaxis in prevention of PICC line related thromboembolism is controversial. In our study,we assessed the role of pharmacological [...]
Background: Diabetes Mellitus is one of the most common chronic diseases in the United States and worldwide.1-2 Hemoglobin A1C is a surrogate marker for the average blood glucose level over the previous 3 months.3 In [...]
Background: Patient understanding of prescription medication regimens is an important aspect of health literacy and inpatient medication reconciliation. There is a lack of data regarding patient knowledge of their own outpatient prescription medications. This study [...]
Background: Multiple studies have established that delays in discharge summary transmission were associated with higher rates of all-cause hospital readmissions. It has been recently shown that delaying the completion of discharge summaries beyond 72 hours [...]
Background: Transition of care between physicians remains a vulnerability in providing optimal patient care. The Clinical Learning Environment Review (CLER) program identifies Care Transitions as a core pathway for evaluation. Specifically, they assess a program’s [...]
Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. Many interventions have been tried, with varying degrees of success, and often the problem has been with implementation rather than theoretical [...]
Background: Hospitalized medical patients transitioning to new house staff at the end of an inpatient resident rotation are associated with an increased risk of mortality as compared with patients not exposed to such handoffs, yet [...]
Background: U.S. healthcare costs are rising due to the increase in polypharmacy, which is a potential risk factor for hospital readmission.1 In a cohort study of 5,507 patients with ≥10 discharge medications, more than 25% of [...]
Background: Discharge summaries (DS) play a large role in transition of care from the inpatient to outpatient setting. At academic centers DS are largely completed by house staff, though few residency programs and medical schools [...]
Background: Patients are often transferred between hospitals to provide access to required specialty services. However, prior research suggests that transfer destinations are often chosen based on institutional relationships rather than solely on patient need. In [...]
Background: Inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) exposes patients to risks of discontinuity of care and remains a largely unstudied process of care. In this study, we aimed to investigate [...]
Background: According to Medicare Payment Advisory Commission, about 75% of hospital readmissions are potentially preventable, representing an estimated $12 billion in Medicare spending. Prompt follow-up of hospital patients before primary care and subspecialist appointment may decrease [...]
Background: Hospital readmissions remain highly prevalent despite being the target of policies and financial penalties. Evidence comparing effectiveness and costs of interventions to reduce readmissions is lacking, leaving healthcare systems with little guidance on how [...]
Background: Poor communication between healthcare providers has been identified as an important contributor to poor patient outcomes and adverse events. The transition period from inpatient to outpatient care is a particularly high risk time for [...]
Background: Homeless patients have a higher incidence of medical and psychiatric diagnoses, which often necessitate hospitalization. Studies show that homeless persons have increased lengths of stay with an average excess of 4.1 days, accounting for [...]
Background: Readmissions after hospitalisation are a healthcare quality indicator and carry considerable financial penalties in some healthcare systems. Internationally, readmission rates at 28 – 30 days for medical inpatients range between 10 - 22%. However [...]
Background: Financial readmission penalties hold hospitals responsible for 30-day readmissions regardless of whether the patient was readmitted to another hospital. Emerging evidence suggests patients readmitted to non-index hospitals may experience higher mortality rates. Hospitals with [...]
Background: National readmission rates for all-cause hospitalizations are as high as 14 readmits per 100 index admissions and have been relatively unchanged for at least the last 5 years (Fingar K, et al. Agency for [...]
Background: Patients admitted to inpatient hospital services are increasingly cared for by hospitalists rather than their primary care providers. When transitioning from hospital-based to ambulatory care, suboptimal information transfer can lead to serious adverse events [...]
Background: Patients discharged against medical advice (AMA) have disproportionately high healthcare costs and increased morbidity, mortality, and hospital readmissions. While patient risk factors for discharge AMA are known, there is little data regarding providers’ practice [...]
Background: With advances in medical care, there is a growing population with childhood-onset chronic health conditions reaching adulthood. A 2011 consensus statement by the AAP, AAFP and ACP identified an algorithm for transition from pediatric [...]
Background: The original goal of progress notes is to provide a concise, up-to-date reflection of the patient’s condition and the provider’s thought processes. Electronic health records (EHRs) allow physicians to supplement traditional manual data entry [...]
Background: Accurate problem lists linked to the electronic medical record (EMR) can be a source of structured clinical data useful for communication among clinicians for patient care, clinical decision support design, and EMR phenotyping. Nevertheless, [...]
Background: Sepsis is a leading cause of mortality among hospitalized patients. Early detection and intervention reduces sepsis-related mortality. We implemented a novel early warning system (EWS 2.0) based on a machine-learning algorithm to prospectively identify [...]
Background: Sepsis is a leading cause of death among hospitalized patients. Early detection of sepsis has the potential to reduce mortality by facilitating timely evidence-based interventions. Past studies have used electronic health records (EHR) to [...]
Background: Increased Emergency Department (ED) boarding times have been linked to increased patient length of stay, increased mortality and lower patient satisfaction scores. Discharging hospitalized patients earlier in the day has been proposed as one [...]
Background: Incidental pulmonary nodules are prevalent in hospital medicine, and many require follow-up imaging to exclude lung cancer. The Fleischner Society Guidelines were developed to guide practitioners in their management of these nodules. The purpose [...]
Background: A widely used test for glucose control is the hemoglobin A1c, which correlates with the patient’s mean blood glucose levels over the previous 2-3 months. To evaluate long-term glycemic control during an inpatient hospitalization, [...]
Background: A “safe” hospitalist workload - that is, the point at which caring for too many patients leads to poorer outcomes for each individual patient – has not been defined. We sought to understand whether [...]
Background: It has long been recognized that a comprehensive bundled and coordinated care affects sepsis mortality. The Center for Medicare and Medicaid Service’s (CMS) has mandated reporting of severe sepsis/septic shock management with emphasis on [...]
Background: Hospital medicine has significantly grown over the last two decades with increasing focus on providing improved quality of care while also reducing cost. A recent focus has been on transitions of care and handoffs, [...]
Background: Approximately 75% of patients with hepatitis C virus (HCV) are born in the years 1945 to 1965. The CDC recommends a one-time screen for patients within that age range, regardless of risk factors. The [...]
Background: Post-hospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on aspects of hospitalization that contribute to this decline, but until an [...]
Background: Prognostication of survival in advanced cancer patients has been challenging and contributes to poor illness understanding. Prognostic disagreement occurs even amongst providers and is a less studied phenomenon. We introduced the Surprise Question (SQ), [...]
Background: The Society of Hospital Medicine and the ABIM Foundation‘s Choosing Wisely Campaign have made tackling overutilization of routine labs part of their mission. Based on the literature, 30-50% of routine labs ordered for hospitalized [...]
Background: Hospital discharge handover is a primary metric for measuring healthcare quality and patient safety. Effective post-discharge follow-up (FUPD) reduces costly readmissions, adverse medical events, and preventable deaths. Despite the importance of hospital discharge follow [...]
Background: Frequent readmissions pose a challenge to hospitals across the country. They are associated with increasing healthcare costs and display a failure to effectively care for certain groups of patients. The Centers for Medicare and [...]
Background: Regulatory agencies have set a 60-minute window to communicate positive CT PE (computed tomography pulmonary embolism) results to ordering providers. Improving the effectiveness of communication among caregivers for critical results of tests is a [...]
Background: The majority of patients on medicine wards are phlebotomized daily. This is particularly problematic in academic centers where trainees are primarily responsible for patient care. Unnecessary phlebotomy is not only costly, but can lead [...]
Background: Unnecessary laboratory (lab) testing contributes to excess health care expenditures and patient harm. Multiple professional societies have recommended avoiding repetitive lab testing in the absence of clinical indications and some institutions have reduced lab [...]
Background: Evidence-based medicine is inconsistently used in the evaluation of syncope, leading to misutilization of resources. We studied the effect of a multifaceted intervention on the adherence to evidence based recommendations. Methods: A multidisciplinary group [...]
Background: Delays in care may lead to increased length of stay and cost. Identifying and quantifying the reasons for these delays could help target interventions and reduce unnecessary hospital days. Methods: We conducted a cross-sectional [...]
Background: Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. Electronic health record (EHR) data can provide contemporaneous data for quality improvement but has not yet been studied extensively. [...]
Background: Evidence is equivocal that unit-based interventions improve quality on inpatient medical services, but most studies have reported their effect in isolation. These interventions may be better conceptualized as complementary components of a redesigned clinical [...]
Background: The 2011 the updated IDSA guideline on Community Acquired Pneumonia (CAP) in children recommends a blood culture in children with moderate to severe bacterial CAP requiring hospitalization. This recommendation was included in the Seattle [...]
Background: It has been detailed in the literature that a patient’s socioeconomic status (SES) may play a role in their risk of readmission for specific diseases. For instance, factors such as low income, low educational [...]
Background: In 2016, the Centers for Medicare & Medicaid Services (CMS) released a guide to preventing readmissions among diverse patient populations. According to CMS, once the health system effectively picks up the root causes and [...]
Background: With gender inequalities decreasing in the Western Hemisphere, the number of women physicians has increased. However, women are not equally represented in leadership roles in academic medicine. One heoryabstract?te referenc es isubmissionseukocytosiser'petition were selected. [...]
Background: Inpatient hospital care cost $971.8 billion in 2014 and costs are projected to rise by 5.8% per year. Inpatient operational efficiency and waste reduction have become the focus of cost-reduction measures. A recent study [...]
Background: Adverse drug events (ADE's) are a major problem in healthcare and can lead to increased hospital admissions, length of stay, and healthcare costs. With appropriate intervention, ADE's are largely preventable. The purpose of this [...]
Background: Atrial Fibrillation is the most common cardiac arrhythmia in medical practice. In 2010, the RACE II trial demonstrated that lenient rate control (resting bpm < 110) in patients with permanent A-fib was just as [...]
Background: Administering opiates safely in hospitalized patients with acute on chronic pain is challenging. There is limited data to guide pain management in this population due to high prevalence of opiate tolerance and variance in daily opiate exposure. There [...]
Background: The development of systems that optimize quality of care, reduce costs, and enhance safety is vital to patient care. The VA healthcare system utilizes 27 quality metrics which allow for institutions to assess their [...]
Background: Laboratory testing is an integral part of modern medicine with an estimated 4-5 billion tests performed in the United States each year, and accounts for 3-5% of healthcare spending. At our resident-run clinic in [...]
Background: Several studies attest the effectiveness of physician order set, also known as Power Plan (PP) in standardizing patient care and improving outcomes. In general, PP use is suboptimal. We hypothesized that PP use in [...]
Background: Compared with patients in the community, patients acutely hospitalized are at higher risk of developing venous thromboembolism (VTE), contributing to patient morbidity and mortality and healthcare costs. The need for thromboprophylaxis for post-surgical patients [...]
Background: Thrombophilia testing is frequently ordered in the inpatient setting. However, testing is costly and can be misleading in the setting of acute thromboembolism or concurrent anticoagulation use. Furthermore, hereditary thrombophilias do not predict a [...]
Background: Preoperative assessment is a common medical practice, with latest guidelines emphasizing use of additional diagnostic testing only in patients to whom it would bring substantial change in management. The objective of our study is [...]
Background: Interprofessional rounds have the potential to improve patient safety, quality, and experience. Although increasingly implemented, significant variation in rounding practice patterns exist and few data are available to evaluate impact on patients’ experiences. We [...]
Background: Do-not-resuscitate (DNR) orders are intended to allow patients to forgo cardiopulmonary resuscitate (CPR) in the event of cardiac arrest. They are applied to cases of cardiac arrest, and they cannot be applied to any [...]
Background: Although controversy exists regarding the effectiveness of rapid response teams (RRTs), they are an essential tool in most hospitals to address rapid patient deterioration and ideally optimize patient safety (1-5). The utility of RRTs is [...]
Background: Many red blood cell transfusions (RBCT) are unnecessary or harmful according to clinical trials and guidelines. These RBCT put patients at risk and waste scarce healthcare resources. Clinical decision support (CDS) using the Epic™ [...]
Background: Proton pump inhibitors (PPIs) are commonly started inpatient for stress ulcer prophylaxis and wrongly continued on discharge. But in addition to polypharmacy and patient cost, there are significant adverse events associated with chronic use [...]
Background: Blood transfusion is the most common procedure performed in US hospitals.1 The Joint Commission recently determined that transfusion is among the top five overused procedures,2 and now five societies have Choosing Wisely aims to [...]
Background: One year all-cause mortality rates after a fragility fracture are as high as 24%. Treatment of osteoporosis following fracture reduces mortality, recurrent fractures rates, and healthcare costs. Without endocrinology involvement, clinicians often fail to [...]
Background: CMS and other entities have focused on reduction of readmissions as a national quality improvement goal. The 30-day risk standardized readmission rate is derived from administrative data and requires the accurate coding of a [...]
Background: Patients admitted to the Medicine Service from the Emergency Department (ED) at times when no beds are available pose a particular challenge to workflow, staffing and patient care. Due to the expansion of our [...]
Background: Extended stay (> 30 day stay) cases strain hospital resources, psychologically burden staff, increase average length of stay (ALOS) and ultimately are not patient-centric. In 2008, extended stay patients represented 15% of the average daily [...]
Background: The number of hospitals with dedicated observation units has grown in recent years to one-third of all United States hospitals and 80% of academic medical centers, though much is still unknown about how to [...]
Background: With the advent of the electronic health records an increasing amount of data is available for feedback to physicians. However, the impact of regular team-based feedback is unknown particularly physician perceptions of the relevance [...]
Background: Sleep is generally poor in hospitalized patients and sleep deprivation has many harmful effects, including delirium, insulin resistance, hypertension, and impaired function of the immune system. In this quality improvement (QI) project, our goal [...]
Background: Communication failure between patients and providers in hospital settings lead to patient dissatisfaction. Simple, low-cost interventions, (e.g., bedside whiteboards and face cards), have been used to enhance communication between patients, families and medical teams. [...]
Background: Kaiser Permanente Roseville Medical Center is a 340 bed facility in Northern California. Reducing readmissions has been a focus, and the current observed over expected rate is 0.77. Starting from this relatively low readmission [...]
Background: The overall incidence of Clostridium difficile infection (CDI) is higher among patients with inflammatory bowel disease (IBD). The nature of this disease association is unknown but likely involves an altered gut microbiome and impaired [...]
Background: Up to 67% of patients have at least one medication error on admission to the hospital with over a quarter of hospital prescribing errors attributed to incomplete medication histories at admission. Key aspects of [...]
Background: Cardiac readmissions are an ever expanding burden spanning from patients, to hospitals, all the way up to the national healthcare system. Currently, there is a lack of consensus regarding appropriate inpatient screening tests for [...]
Background: Although 1 in 10 people suffer from chronic insomnia, the prevalence among hospitalized patients is likely higher, due to common comorbidities such as depression and chronic pain in this population. We aimed to assess [...]
Background: Imaging exams performed on hospitalized patients commonly reveal findings representing possible cancer and requiring follow-up. Our objective was to quantify how often indeterminate or suspicious masses are detected on inpatient abdominal and pelvic imaging [...]
Background: Throughput is an issue that is discussed often in hospitals around the country. Multiple factors influence the time the discharge orders are placed to the time the patient leaves the hospital. In academic centers, [...]
Background: Chemoprophylaxis with subcutaneous heparin or low-molecular weight heparin is recommended for venous thromboembolism (VTE) prevention in appropriate medical patients. However, all doses are not always administered and the consequences are unclear. We sought to [...]
Background: Health care expenditures in the United States have been increasing exponentially while hospital care accounts for one-third of the costs. Approximately 18% of hospitalized Medicare beneficiaries are being readmitted within 30 days following their [...]
Background: Ultrasound-guided thoracentesis and paracentesis are frequently performed for both diagnostic and therapeutic indications. While the risk of aspiration is low, our institution has historically required patients to be fasting for 4 hours prior to [...]
Background: The Society of Hospital Medicine’s Choosing Wisely guidelines recommend regular assessment of inpatients’ need for urinary catheters and telemetry monitoring. Since studies suggest clinicians are not aware which patients have an indwelling catheter or [...]
Background: AKI occurs in 10% of hospitalized patients and the incidence is rising. Renal Ultrasound (US) is frequently performed but its clinical utility has been questioned. The goal of this study was to evalaute US diagnostic yield in [...]
Background: Hospital-acquired delirium is a common cause of increased morbidity and mortality. In an earlier pilot study, we identified through surveys that adult medicine inpatients slept an average of 4 hours. Also, multiple factors including [...]
Background: Patient experience scores are now widely accepted as a measure of healthcare quality and contribute to Medicare’s value-based purchasing quality reimbursement program. In order to enhance the patient’s experience, we must first seek to [...]
Background: The opioid epidemic continues to exert a significant impact on our health care system. Patients with intravenous drug use (IVDU) often develop life threating infections leading to prolonged hospitalizations with poor outcomes. Traditionally, the [...]
Background: Although the national quality improvement campaigns are implemented to reduce Door-to-Balloon (DTB) time in the U.S.A., the community hospitals in Japan lack human resources and appear to be particularly challenging to implement these strategies [...]
Background: Observation care has evolved significantly since its original inception by the Centers for Medicare and Medicaid Services (CMS). Originally intended to span less than 48 hours in the majority of cases, the Office of [...]
Background: National guidelines recommend sampling unilateral pleural effusions to characterize the fluid as either transudative or exudative. Currently, the only method to characterize pleural fluid is by collecting a sample through an invasive drainage procedure [...]
Background: Severe aortic stenosis (SAS) had been identified as being at elevated risk for non-cardiac surgery. However, two reports demonstrated that SAS did not increase mortality of intermediate to high risk non-cardiac surgery. The European [...]
Background: Surgical site infections (SSI) can complicate any operative procedure although this risk is mitigated through the use of preoperative antibiotic prophylaxis. While antibiotic prophylaxis can provide great benefit, inappropriate use can lead to the [...]
Background: Many pediatric hospitalist programs in community hospitals around the country function with a 24-hour shift model for 24/7 coverage. This creates significant discontinuity and daily inefficiencies in patient care. Furthermore, there is a robust [...]
Background: Maternal chorioamnionitis usually means an otherwise healthy appearing newborn gets cultured and treated for presumptive bacterial infection pending culture results. This is often done in a NICU setting. These babies are overwhelmingly well and [...]
Background: Nationally, there has been a loss of pediatric inpatient beds (-4.3%), and large swings in ward (-7.2%) and pediatric (non-neonatal) intensive care (PICU; +15.8%) beds. These shifts have important implications for access, safety and [...]
Background: Bronchiolitis is a clinical diagnosis, with growing research supporting limited use of diagnostic tests and interventions. Hospitals have reduced use of bronchodilators and imaging, but the national average of respiratory viral testing (RVT) in [...]
Background: Increased asthma and obesity prevalence are independently associated with health disparities. This study sought to examine the relationship between these two conditions, particularly within the pediatric population at a major inner city teaching hospital. [...]
Background: The systematization of the teaching and training of internal medicine residents should be done with the standardization of techniques, simulations, use of manikins and theoretical lessons. A procedure team was created in a tertiary [...]
Background: Given the widespread adoption of electronic health record systems, the majority of patient orders are now enacted through electronic orders. We aimed to describe the average number of electronic orders entered for medicine patients [...]
Background: While studies in the ambulatory care setting have found that patients with high level of psychological well-being have high satisfaction with their physicians, no study has evaluated the relationship between psychological well-being and satisfaction [...]
Background: Drug-induced prolonged QT syndrome significantly increases the risk of fatal arrhythmias such as torsades de pointes. Patients with baseline QTc prolongation are particularly vulnerable. Limiting administration of QT-prolonging medications to high-risk individuals is important [...]
Background: Delirium is associated with increased duration of mechanical ventilation, longer intensive care unit (ICU) length of stay, increased mortality and cognitive impairment after discharge. Quetiapine has been associated with faster resolution but long-term use [...]
Background: While use of technologies such as ultrasound and electrocardiographic (EKG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the setting, experience or practice of providers that use [...]
Background: Prophylactic anticoagulation is effective at reducing the risk of venous thromboembolism (VTE), but can also increase the risk of bleeding. Whether anticoagulant prophylaxis should be modified for underweight patients to minimize bleeding complications is [...]
Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days. However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and [...]
Background: Intravenous low-molecular weight iron dextran is indicated for patients with iron deficiency who are unable to take oral iron or experience insufficient efficacy with oral replacement. Adverse effects have been reported, including anaphylaxis and [...]
Background: As of December 2015, 49 states initiated the CMS mandated legislation on “Prescription Drug Monitoring Programs.” Yet opiates continue to be commonly prescribed in older adults, despite their well-known risks. This study aims to [...]
Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication. In the United States, there are more than 20,000 CLABSI per year, resulting in a cost of about $30,000 per infection. A number of interventions [...]
Background: Inpatient falls are a patient safety concern in all healthcare facilities. There is currently limited data on the utility of head computed tomography (CT) for inpatient falls. The New Orleans Criteria (NOC) is a [...]
Background: Clinicians encounter sudden death among aortic stenosis (AS) patients especially after they become symptomatic. Mortality is 50% at 1 year and 70 to 80% at 2 years without aortic valve replacement. However, there have [...]
Background: Advancements in technology have expanded accessibility to telemetry via remote monitoring and resulted in increased application in hospitalized patients. The American Heart Association (AHA) telemetry guidelines restrict use to patients with sepsis, severe electrolyte [...]
Background: Physician awareness of the finalized results of tests pending at discharge (TPAD) is poor (~40%). We previously designed and implemented a system that automatically notifies the inpatient attending and primary care physician (PCP) of [...]
Background: Respiratory rate (RR) is an independent predictor of in-patient mortality, intensive care unit admission and cardiac arrest across a variety of conditions. It is also an integral component of many risk prediction calculators (such [...]
Background: The current American Society of Hematology (ASH) guideline recommends the use of thrombopoietin receptor agonists, eltrombopag or romiplostim as one of the second-line therapies for chronic immune thrombocytopenia (ITP). The efficacy and safety of [...]
Background: The convergence of rising post-acute health care costs with incomparable outcomes havemade reform a priority resulting in the development of new models of care that often extend the scope of practice andjob duties among [...]
Background: Electronic cigarettes (E-cigarettes) have grown in popularity as an alternative to traditional cigarettes especially among consumers who want to reduce the risk of morbidity and mortality associated with smoking. Nonetheless, a recent study showed that [...]
Background: Limited research exists exploring the impact of nutrition interventions, including oral nutritional supplement (ONS) usage, on clinical outcomes of patients at risk/with malnutrition. We aimed to assess the impact of a hospital-based, comprehensive nutrition-focused [...]
Background: In 2011, sepsis accounted for more than $20 billion (5.2%) of total US hospital costs. The CDC estimates that hospitalizations for sepsis or septicemia increased from 621,000 to 1,141,000 in 2000 and 2008 respectively. [...]
Background: The Modified Early Warning Score (MEWS) is a physiological scoring system developed to identify patients in early stages of clinical deterioration and prevent delays in proper care. It consists of systolic blood pressure, heart [...]
Background: The Center for Disease Control and Prevention estimates that 1.7 million patients per year develop hospital-associated infections (HAI), of whom 99,000 die. HAIs financially impact the United States healthcare system with an estimated cost [...]
Background: Acute kidney injury (AKI) following cardiac surgery occurs in 30% of cases with 1% requiring dialysis resulting in significant morbidity and mortality. HMG-CoA Reductase Inhibitors (“statins”) have been postulated to be of benefit in [...]
Background: A documented penicillin allergy is associated with increased length of hospital stay and an increased incidence of Clostridium difficile, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterocci. These findings are attributed to use of broader-spectrum ‘second-line’ [...]
Background: Hospitals are incentivized to reduce 30-day readmissions under the Affordable Care Act. Medicare payments can be reduced when inpatient readmissions are excessive. The Centers for Medicare & Medicaid Services (CMS) readmission measure is defined [...]
Background: Previous studies suggest that the type of healthcare is associated with distinct clinical characteristics and outcomes, but there are few studies addressing this in patients with a ST-elevation myocardial infarction (STEMI) in our country. Methods: [...]
Background: Sickle cell disease (SCD) affects about 100,000 people in the US. The disease causes significant mortality, morbidity and frequent hospitalizations secondary to primary manifestations of the disease and its complications. We conducted a retrospective, [...]
Background: Reduced payments from Medicare related to high rates of hospital-acquired pressure injuries has prompted hospitals to invest in new technologies and strategies to improve wound care and prevention. While many hospitals have increased the [...]
Background: Reduced payments from Medicare related to high rates of hospital-acquired pressure injuries has prompted hospitals to invest in new technologies and strategies to improve wound care and prevention. While many hospitals have increased the [...]
Background: A Rapid Response (RR) Team is activated when there is an acute change in a patient’s condition. Rapid responses are called when certain criteria are met. A delay in activation of the rapid response [...]
Background: Mechanically ventilated patients are often administered analgesic medications such as dexmedetomidine (DEX) and lorazepam (LZP) to reduce pain and anxiety. Studies have suggested that benzodiazepines may increase the risk of developing acute brain dysfunction, [...]
Title: ANTI-MOTILITY USE IN PATIENTS WITH C. DIFFICILE --POTENTIALLY SAFE? Background: Anti-motility agents have typically been avoided in patients with Clostridium difficile diarrheal infections (CDI) due to fear of gastrointestinal complications such as toxic mega-colon. [...]
Background: Approximately 15% of women in the United States aged 35-79 year are at high risk for developing breast cancer, however less than 0.2% of these women reported taking chemoprevention to reduce their risk. Objective [...]
Background: While pattern of readmissions in young survivors of acute myocardial infarction and heart failure has been described, burden of 30-day readmissions following hospitalization for pneumonia in young adults is poorly understood. Further, gender differences [...]
Background: Overuse of urine testing may result in downstream events that impact antibiotic use and hospital length of stay (LOS). The aims of this study were to examine the impact of inpatient urine culture testing [...]
Background: Malnourished patients compose 25% to 54% of the admitted patient population. Much attention has been given to identifying these malnourished patients. However, few published articles have focused on identifying the gaps in care that [...]
Background: Although diagnostic errors are common in hospitals, little is known about the resulting economic burden. Whether the increasing attention to patient safety has led to a decrease in diagnostic error-related claims and cost over [...]
Background: The randomized controlled ANZ-STATInS trial demonstrated that de novo statin use did not alter interleukin-6 levels or Sequential Organ Failure Assessment (SOFA) score in of what before SEPSIS-3 was known as severe sepsis. Prospective [...]
Background: Results from the recent SPRINT trial demonstrate lower rates of fatal and non-fatal major cardiovascular events and all-cause mortality in non-diabetics at high cardiovascular risk with intensive versus standard treatment, i.e., less than 120 [...]
Background: The Centers for Medicare & Medicaid Services (CMS) started penalizing hospitals with “excess” 30-day readmissions, as determined by observed-to-expected ratio, for patients discharged after treatment for an acute exacerbation of chronic obstructive pulmonary disease [...]
Background: In the United States, studies have reported mixed results on outcomes following out–of–hospital cardiac arrest. We postulated that such variation is not only dependent on the populations included or excluded in these studies but [...]
Background: As of 2016, there are approximately 36.7 million people living with HIV around the world. HIV infection is associated with tremendous psychological burden. Improvements in coping methods would be highly beneficial in this scenario. [...]
Background: The UCLA Department of Medicine (DOM) Rapid Mortality Review (RMR) is an innovative in-person, near real-time review of all deaths to capture the unique insight of the care providers into aspects of end-of-life care [...]
Background: Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in [...]
Background: Ultrasound-guidance has become the standard for bedside procedures in the Emergency and Inpatient setting due to its perceived impact on first success rate and reduced complications. However, literature data on the rate of complications [...]
Background: Evidence suggests that risk of central line-associated bloodstream infection (CLABSI) between patients with traditional central venous catheters (CVC) vs. peripherally inserted central catheters (PICC) is similar. However, how best to predict CLABSI in patients [...]
Background: Congestive heart failure (CHF) and pneumonia are amongst the leading causes of hospitalization in the United States. Although a growing number of hospitals use both teaching and nonteaching hospitalist services for patient care, [...]
Background: The successful management of ABSSSI requires prompt assessment and appropriate antibiotic therapy. Antibiotic selection requires consideration of patient comorbidities to ensure appropriate pathogen coverage and to avoid contraindications related to comorbidities and concomitant medications. [...]
Background: Acute heart failure (AHF) is the major cause of hospital admission and death. Furthermore, patients admitted with AHF have high readmission rates and postdischarge mortality. Although there have been some reports, which demonstrated the [...]
Background: For most people, music serves as a calming influence or as a pleasurable stimulus that lifts their spirits. Hospitalized patients may experience boredom, fear, and unease while in the hospital, away from the comforts [...]
Background: Studies have shown a direct relationship between patient satisfaction and patients following their physician’s recommendations which leads to favorable patient outcomes. While several physician and patient-specific characteristics have been found to be associated with [...]
Background: New onset third degree or complete heart block (CHB) is a medical emergency and usually requires permanent pacemaker. CHB can be caused by cardiac ischemia or non-ischemic conditions such as infiltrative diseases or fibrosis. [...]
Background: Clinical images are photographs that serve as succinct and memorable lessons. Importantly, patient right to privacy dictates appropriate consent be obtained prior to publication. Significant disagreement exists surrounding what makes a photograph identifiable, and [...]
Background: Cirrhosis-related complications and resulting decompensation are associated with poor prognosis. Reducing the risk of cirrhosis-related complications is an important goal when managing patients with cirrhosis. Bacterial-derived endotoxins are hypothesized to be a major contributor [...]
Background: Moral distress, the inability to act in accordance with one’s ethical beliefs due to hierarchical or institutional constraints, has been associated with burnout and poorer well-being. Significant moral distress amongst American physician trainees might [...]
Background: Contrast-induced Nephropathy (CIN) is a major cause of mortality and morbidity among elderly patients. Its occurrence increases with the patient’s age. Elderly patients who suffer from impaired renal function constitute a large percentage of [...]
Background: Prior research in the field of academic hospital medicine has described unique challenges to achieving promotion for academic hospitalists. A consensus conference identified challenges for academic hospitalist success including alignment of hospitalists with clinical [...]
Background: Prior research in the field of academic hospital medicine has used promotion as the measure of success, but little is understood about what motivates individual academic hospitalists or how individuals define career success. Conceptual [...]
OBJECTIVES: To study the influence of physician-patient gender and race concordance on patients’ assessment of the hospitalist physician’s performance. Background: In the United States, there have been numerous studies showing health disparities and inequities in care related [...]
Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more [...]
Background: The number of physician assistants (PA) practicing hospital medicine is increasing.1 The number of PA schools in the US has also increased from 54 in 1992 to 218 in 2015.2While there is an increasing [...]
Background: After Libby Zion died tragically in a teaching hospital, much attention from the medical community, public and government, was directed at resident training and the number of hours worked consecutively. This marked a new [...]
Background: Patients at high risk for cardiac events often receive telemetry, however, overutilization of cardiac monitoring leads to unnecessary interventions and increased healthcare costs. The American Heart Association (AHA) recommends classification of cardiac risk via [...]
Background: Previous studies demonstrate that hand hygiene compliance among healthcare workers is suboptimal. To better understand drivers of poor compliance, we investigated changes in hand hygiene (HH) attitudes and practices among medical students to determine [...]
Background: Duty hour limitations have raised concern that shorter work shifts are compressing resident workload, which may result in a negative learning environment. Increasing patient complexity intensifies workload compression; however, temporal trends in complexity of [...]
Background: In 2016, there were more than 50,000 hospitalists working in the United States. The Society of Hospital Medicine (SHM) published ‘The Core Competencies in Hospital Medicine’ as a blueprint to standardize expectations of practicing [...]
Background: Medical educators worldwide have been aspiring to transition from time based training to a competency based medical education model. The degree of alignment between competencies, residents’ self-identified training goals, and variations in different countries [...]
Background: Point-of-care ultrasound (POCUS) is a diagnostic modality that can improve diagnosis, reduce cost, and increase patient satisfaction. POCUS is being increasingly utilized in internal medicine (IM), and IM residents desire training in POCUS. A [...]
Background: Limited data exist regarding rates of mechanical complications associated with placement of non-tunneled acute central venous catheters (CVC) at a training institution. Additionally, trainee perceptions and experiences managing CVC complications are unknown. Our objective [...]
Background: Accreditation Council for Graduate Medical Education (ACGME) program requirements for family medicine permit wide variability in adult inpatient medicine curricula. Family physicians compose a significant percentage of the hospitalist workforce, and the American Board [...]
Background: Patients with serious mental illness die an average of eight years earlier than the general US population, partly related to their higher burden of chronic medical conditions. With the development of patient-centered medical homes, [...]
Background: Rosiglitazone is one of the thiazolidinedione groups which enhance insulin sensitivity through stimulating peroxisome proliferator-activated receptors in the adipose tissue, liver and muscle. Resulted in decrease glucose production and enhances its utilization. Fluid retention [...]
Background: Consultation in hospital is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consult utilization on hospital outcomes and resource utilization of acute CHF [...]
Background: Advance care planning is nationally recognized as important for honoring patient wishes at the end of life. Despite this widespread recognition, many patients lack advance care planning and spend their last days in ways [...]
Background: Patient evaluation of satisfaction with their physician has been utilized for several years and is now being included as a parameter utilized to calculate reimbursement. Despite the routine use of these evaluations by most [...]
Background: Patient evaluation of satisfaction with their physician has been utilized for several years and is now being included as a parameter utilized to calculate reimbursement. Despite the routine use of these evaluations by most [...]
Background: Effective communication between health-care providers, patients and their families is a key aspect of the discussion surrounding a patient’s goals of care. One crucial part of this process is reaching a shared understanding of [...]
Background: Lack of urgency indicators and receipt confirmation are two of several known alphanumeric paging limitations. To address absence of urgency indicators, a Priority Structured Paging (PSP) system that allowed nurses to communicate priority was [...]
Background: Understanding of the Do-Not-Resuscitate (DNR) order varies among different ethnic backgrounds. In Korea, the concept of DNR is not well-known. We therefore conducted a questionnaire-based study to explore and characterize ethnic differences (Korean vs. [...]
Background: Cardiac arrest on the wards may be preceded by unmet palliative care needs, including advance care planning and specialty palliative consultation that can seek to align patients’ prognoses and goals for care. Identification of [...]
Background: Most academic general medical services cover patients across several different care units in the hospital. Studies have shown that de-regionalized care leads to a lack of team cohesion and poor communication between healthcare providers. [...]
Background: Prior To March 2016 interdisciplinary rounds were held in the back of the nurses’ stations on two inpatient medial units. Patients satisfaction scores around the discharge process and communication were consistently low. Medical director [...]
Background: Rising healthcare costs have driven both the government and the private sector to seek cost-saving innovations in health care delivery. The Center for Medicare and Medicaid Innovation (CMMI) is leading this charge from a [...]
Background: Determination of patient stay status, e.g. inpatient vs. observation, is highly important to payers, physicians, and patients alike. Non-Medicare payers perform near concurrent review of admission notes and orders in order to approve the [...]
Background: Telemetry is a useful tool to detect malignant cardiac arrhythmias but may be associated with increased cost and patient inconvenience. In 2004 the American Heart Association (AHA) established recommendations regarding appropriate telemetry use for [...]
Background: The Choosing Wisely campaign was launched in 2012 with a goal of “advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.[1] ” The Society of Hospital Medicine published 5 [...]
Background: Up to forty-five percent of Americans do not fill prescriptions secondary to cost. Medication non-adherence leads to morbidity and mortality (~$100-300B annually). The majority of physicians cannot price medications within 25% of cost. Our [...]
Background: Hospital medicine is the fastest growing specialty in the United States. An interesting aspect of the rapid expansion of hospital medicine is the current expansion of the field beyond North America. While the health [...]
Background: Observation units were initially intended to function as a short stay unit for lower acuity patients with specific diagnoses, however this traditional model is currently evolving. Rising health care costs and changing health care [...]
Background: Reducing denied days, or days of hospitalization that aren’t reimbursed by payers, is critical for hospital financial stability, and to ensure efficient, patient-centered care. In 2015, payers denied payment on ~20% of all hospital [...]
Background: Formal curricula for teaching medical students high value care are lacking, and there is little evidence identifying strategies that can effectively impact students’ knowledge and skills. Research is needed to develop models for student-led [...]
Background: Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-acquired infection nationally, and in the era of publically reporting and reimbursement based on outcomes, represents a preventable hospital-acquired infection that harms patients and institutions. [...]
Background: Patient safety can be jeopardized if there is inadequate transitional care planning as patients move from the hospital to the outpatient setting. A reliable means for patients and their caregivers to reach a physician [...]
Background: Post-discharge follow-up appointments (PDFA) are an important component of care transitions. Many hospital medicine groups dedicate substantial time arranging these visits. In a one year retrospective analysis of patients discharged from our hospitalist service, [...]
Background: Communication breakdown plays a part in the majority of adverse events in healthcare. Physician to physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematized according [...]
Background: Emergency department (ED) overcrowding is a commonly encountered challenge and is associated with adverse events and poor patient satisfaction. One of the factors that can contribute to ED overcrowding is the boarding of admitted [...]
Background: Transitioning patient care between hospitals and skilled nursing facilities (SNFS) brings many challenges. Patient and family anxiety, unfamiliarity and even misinformation about SNFs increase the opportunity for unsatisfactory outcomes and readmissions to the hospital.. [...]
Background: Care transitions between hospitals, nursing homes, and home are a vulnerable time for patients. Given the increasing elderly population and the shortage of primary care physicians with training in geriatrics or nursing home care, [...]
Background: Patients are discharged home on medications different than those they were taking before admission. New and discontinued medications as well as dosage changes contribute to medication-related adverse events. Purpose: To help address this problem, [...]
Background: Transfers to academic tertiary care centers often involve complicated patients requiring subspecialty consultation and coordination of care. Therefore appropriate handoff and communication from sending to receiving institution is needed to streamline care and minimize [...]
Background: Patients diagnosed in-hospital with acute venous thromboembolism (VTE) are at high risk for post-discharge complications and readmission similar to patients with chronic conditions. Patient navigation reduces post-discharge complications and readmissions in patients with chronic [...]
Background: Patient care may be enhanced as they transition from one health care setting or provider to another. However, studies have shown that as many as 1 in 5 patients suffer an adverse event within [...]
Background: Communication has been cited as the most common root cause in sentinel events, with failed patient care handoffs contributing to an estimated 80% of serious preventable adverse events. Handoffs to sub-acute care such as [...]
Background: It remains unclear how implementing new technology in the inpatient setting affects patients and providers. MyChart Bedside, a tool that allows patients open access to their health record, was implemented across several inpatient units [...]
Background: The quality of communication between physicians and nurses plays an important role in patient safety and provider job satisfaction. Efforts to improve the effectiveness of MD-RN communication have traditionally disseminated new programs such as [...]
Background: Triaging patients from the emergency room, an outside hospital or a service-line within your institution can be a challenging endeavor regardless of the size of your group. The Ohio State University Wexner Medical Center [...]
Background: The Centers for Disease Control and Prevention (CDC) estimates over 1.2 million Americans are living with HIV (human immunodeficiency virus). Of those, approximately 14% are unaware of their HIV-positive status. In 2014, most hospitals [...]
Background: Though the use of point of care ultrasound (POCUS) has increased over the last decade, hospitalists may still find it difficult to gain formal hospital credentialing for POCUS. National organizations have not yet published [...]
Background: Current staffing models cannot deliver the benefits of hospital medicine to the 1300 critical access hospitals (CAHs) located throughout the rural United States. Staffing each CAH with local hospitalists would require at least 5500 [...]
Background: The discharge process is often not initiated until late during hospitalization and typically perceived by patients as disorganized. Poor discharge planning is not only a source of dissatisfaction, but may adversely impact safety during [...]
Background: Risk stratifying patients for potential development of hospital-related venous thromboembolism (VTE) is an important aspect of inpatient safety and is recommended by current guidelines. Many risk stratification tools are cumbersome and require significant time [...]
Background: Patients, physicians and health technology developers are increasingly interested in mobile health applications. However, there are few examples of partnerships between hospitalists and the private companies to test novel health technologies in the inpatient [...]
Background: As hospitals continue to see increasing costs, quality improvement interventions are essential to maintaining a high level of quality care in the inpatient setting. Multiple studies have shown that a systems based approach offers [...]
Background : As part of the Choosing Wisely campaign, the Society of Hospital Medicine recommends against performing "repetitive complete blood count [CBC] and chemistry testing in the face of clinical and lab stability.” This recommendation [...]
Background: In the past 20 years, the "10/30" rule for blood transfusions has been replaced with conservative guidelines which have demonstrated improved patient outcomes and reduced overall healthcare costs. Hospitals across the country have enlisted [...]
Background: Capacity constraints are a common problem at many academic institutions. At Duke University Hospital (DUH) , capacity constraints continue to result in critical bed shortages. Our affiliated hospital, Duke Regional Hospital (DRH) which is [...]
Background: Children and Young Adults with Special Healthcare Needs (CSCHN), especially those with multiple organ systems involvement, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires [...]
Background: Patient complaints reflect their unmet expectations and are a valuable resource to understand key drivers of patient experience. It is unclear, however, how patient complaints can be used to improve service quality and guide [...]
Background: The measurement of fluid balance (FB) for hospitalized patients has been a standard of nursing practice for many years, but its utility and accuracy is questioned in the literature. There is no gold standard [...]
Background: Control over work hours and schedule flexibility are important predictors of clinicians’ career satisfaction, work-life balance, and burnout, which are in turn linked to quality of patient care, recruitment, and retention. In our rapidly [...]
Background: Collaboration between multidisciplinary teams during the discharge process can optimize the safety of discharge planning. At our tertiary academic medical center, case managers (CM) and pharmacists have historically been assigned to patients by unit [...]
Background: The standard of care for the treatment of alcohol withdrawal is symptom triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. However, this 10-item scale is cumbersome to use. Purpose: [...]
Background: The advent of the Electronic Health Record (EHR) has changed the face of medical documentation. Illegibility and absence of data have all but disappeared, and EHRs can foster thoughtful assessments by providing a platform [...]
Background: Medical patients with comorbid psychiatric illness comprise 20-40% of general medicine inpatient admissions. These patients often have multiple providers involved in their care which can lead to poor communication, longer lengths of stay, and [...]
Background: Patients often must wait several hours before being seen by an admitting attending physician. Protracted admit wait times are undeniably associated with delays in care, patient and family dissatisfaction, and very likely increased lengths of [...]
Background: Hospitalization of the patient with advanced cancer can be a pivotal moment and opportunity to explore patient goals of care in order to deliver high value, patient-centered care that emphasizes quality of life. Part [...]
Background: Practical and financial pressures have placed a renewed focus on improving the human experience of healthcare from both the patient and provider perspective. Despite this, aligning patients and interdisciplinary providers around meaningful experience improvement [...]
Background: Hospitalized patients get fewer than five hours of sleep a night. Poor sleep leads to increased rates of delirium, falls, and hypertension, and decreased patient satisfaction. Purpose: To improve sleep among hospitalized patients through [...]
Background: Hospitalized patients have significantly reduced ambulation, which leads to decreased muscle strength, coordination, and balance, all which increase the risk of falls. According to the Joint Commission, hundreds of thousands of patients fall in [...]
Background: Inpatient medication reconciliation errors are common and can lead to serious adverse drug events. Most medication discrepancies are due to errors in taking an accurate medication history. Tools imbedded in the electronic medical record [...]
Background: In the inpatient setting, opioids are the most commonly prescribed medication and the 2nd most frequent cause of adverse drug events (ADE). Identifying patients at high risk for ADEs related to narcotics is essential. [...]
Background: Unit-based medical teams improve cohesiveness and communication among team members and increase time spent with patients. At the University of Iowa Hospitals and Clinics, physician teams had patients in 5-6 different units on an [...]
Background: Sickle cell disease (SCD) causes frequent painful episodes from vaso-occlusion. As hospitalists, we identified that SCD patients occupied a large number of hospital days. Undertreatment and lack of standardization of pain management was a [...]
Background: Congestive heart failure is a leading cause of hospitalization in adults greater than 65 years old. It is estimated that over 1 million people are hospitalized annually with a primary diagnosis of heart [...]
Background: Late-day hospital discharges are associated with emergency room overcrowding, longer length of stay (LOS), worsened quality of care and lower patient satisfaction scores. Early discharge, or discharge before noon (DBN) is an achievable and [...]
Background: Hospital medicine programs have a responsibility to maintain high standards of clinical excellence, patient safety, and efficiency for all hospitalists within their program. Organizational change, program growth, and faculty turnover make this endeavor challenging. [...]
Background: The American Board of Internal Medicine Choosing Wisely initiative advocates avoiding automatic daily labs as a way to lower hospital costs. The Legacy Health Inpatient Medicine Service (LIMS) aimed to reduce unnecessary and inappropriate [...]
Background: Multi-lumen (ML) peripherally inserted central catheters (PICCs) are associated with increased risk of central line associated blood stream infection (CLABSI), venous thromboembolism (VTE) and increased cost compared to single lumen (SL) PICCs. Current guidelines [...]
Background: Despite detailed Infectious Disease Society of America (IDSA) skin and soft tissue infection guidelines, patients with cellulitis at our institution consistently receive antibiotics with high local resistance or that are inappropriate based on IDSA [...]
Background: Hospital-associated infections are a significant cause of morbidity and mortality, and are frequently preventable with careful attention to appropriate hand hygiene (HH). Unfortunately, HH rates among healthcare providers are often unacceptably low. Driving complex [...]
Background: Adverse drug events (ADEs) are common during transitions from the hospital to the ambulatory setting, with approximately 20% of patients experiencing an ADE within 30 days of discharge. ADEs are often due to patient [...]
Background: Determining the quality of medication reconciliation (MR) is a laborious and time-intensive process, often involving chart review and detailed patient interviews. Purpose: To identify meaningful, measurable process measures for high-quality MR obtainable from electronic [...]
Background: Hospital associated injury is the third leading cause of death in the United States. Lack of communication about patient safety issues among care team members and with patients is a key source of hospital [...]
Background: Unexpected overnight adverse events are known to correlate with worse outcomes in inpatients. Unfortunately, the exact occurrence and etiologies of such events have been less known. Purpose: The aim of our study was [...]
Background: At its 2014 peak, the opioid overdose crisis claimed nearly 30,000 lives, but many hospitals and health systems have small opioid-related initiatives working in disjointed fashion rather than a cohesive response. Purpose: We created [...]
Background: A midsize health system recognized a pattern in Serious Safety Events (SSE) occurring in its hospitals. Half of all SSE-1 (deaths) and SSE-2 (severe permanent harm) were attributed to delays in physician evaluation of [...]
Background: Sepsis is a common, costly, and mortal clinical syndrome. Many delays in sepsis recognition and intervention are due to “data latency,” the period of time between data suggestive of sepsis being entered in the [...]
Background: The ACGME Clinical Learning Environment Review (CLER) has focused on six areas of trainee working and learning environments, two of which are safety and quality improvement (QI). Exposure to practical safety and QI training [...]
Background: One key factor cited in physician burnout discussion is the rigid block scheduling that has become ubiquitous for Hospital Medicine. For years, nursing has allowed self-scheduling to improve work life balance and abate burnout [...]
Background: In the 2016 United States general election, only 58.6% of eligible voters cast ballots. Particularly among poor and elderly voters, poor health impedes electoral participation: nearly 42% of eligible voters over 65 years and [...]
Background: Hospitalists experience high rates of burnout. Little is understood about the best way to address hospitalist well-being and resilience in the workplace. User-centered interviews at our institution identified inadequate access to nutritious food as [...]
Background: In Canada, as in the US, hospital medicine has become an increasingly important staffing model innovation. Canadian hospitalists are typically Family Physicians and General Internists. In an attempt to advance its hospitalist staffing model [...]
Background: Many hospitals do not have the means to supervise daily physical therapy (PT) for elderly inpatients. PT delivered in a group setting has the potential to allow hospitals to consolidate resources and extend PT [...]
Background: Following hospitalization, a reported 20% of all Medicare patients are discharged to skilled nursing facilities (SNFs). Sepsis was the cause of 25-68% of readmissions from SNFs based on a review of Medicare readmissions from [...]
Background: There is a critical shortage of Geriatricians in the United States and we are reaching a crisis nationwide without enough trained physicians to care for our rising Geriatric population. We are experiencing a “Silver [...]
Background: Today, Medicare patients account for approximately 50% of hospital days. Hospitalists are a key strategy for providing care to hospitalized older adults, however, most of these hospitalists have not received geriatric training. Faculty development [...]
Background: Among learners, preferred styles of learning vary based on the individual. These learning styles are influenced by a number of factors that play a role in how well the learner is able to interpret [...]
Background: Despite the increase in female medical students and clinicians, gender disparities continue to exist for female clinicians today, from limits on upward mobility and leadership positions to unequal pay and more. Within medical education, [...]
Background: Evidence-based practice (EBP) is associated with the delivery of high value care. The number of Advanced Practice Providers (APPs) at our institution is growing along with breadth of clinical responsibilities. Two existing organizational structures [...]
Background: Communicating with patients with limited English proficiency (LEP) can be a challenge. Despite laws and studies reinforcing the need to use appropriate interpretation services, many fail to do so. Impressing upon learners the importance [...]
Background: Systems-based practice (SBP) is critical to physicians’ work and is gaining emphasis in medical school curricula. Purpose: In this hospitalist-led pilot curriculum for first-year medical students, we developed a novel didactic and experiential approach to teaching SBP skills, [...]
Background: Communication is recognized by the LCME and ACGME as an essential competency with significant patient safety implications; the Joint Commission cites communication errors as a major cause of sentinel events. Consultation is a near-universal method [...]
Background: Faculty development can help new hospitalists set professional goals, identify effective mentorship, and learn foundational skills. Most faculty development occurs within a single hospitalist group; however this may limit the scope and impact, when [...]
Background: Despite widespread mandated use of Electronic Health Records (EHR), many residency programs struggle to find the best strategy to conduct EHR training. Traditional EHR training sessions are typically led by non-clinical IT staff and [...]
Background: Starting March 1, 2016 our academic hospital was part of a new “no diversion” policy in accordance with new county regulations of all hospitals. The goal of the policy was to provide ready access [...]
Background: The substantial increase in medical knowledge along with the pursuit of enhanced outcomes and quality of care has led to significant subdivision of medical and surgical specialties. Physicians, regardless of level of training or [...]
Background: The Society of Hospital Medicine considers stroke care to be a core competency in hospital medicine. Hospitalists must be prepared to lead inpatient stroke alerts, as neurologists may not be readily available outside of [...]
Background: Hospitalists nationwide are faced with complex patient and family behaviors that interfere with medical care. In the acute inpatient setting, few resources are available for physicians to address maladaptive behaviors and many physicians report [...]
Background: Previous studies have shown reduced costs and length of hospital with surgical comanagement performed by hospitalists. In Latin America, however, this practice of comanagement is still not standard among surgeons. The Hospital Nossa Senhora [...]
Background: Surgical co-management is an up-and-coming field within Hospital Medicine, with great successes documented in the improvement in quality metrics and patient satisfaction owing to the involvement of hospitalists in peri-operative inpatient care. Currently, orthopedic [...]
Background: Residents are frequently the first physicians notified when acute changes occur in patient conditions. Delays in appropriate diagnostic testing or treatment can adversely affect patients if residents are unfamiliar with certain clinical situations and [...]
Background: Due to low cost, dependability, and familiarity, one-way alphanumeric paging continues to be a commonly used method of in-hospital communication. However, lack of urgency indicators has been cited as a key limitation. To address [...]
Background: The rapidly changing and increasingly complex hospitalist work environment has placed new focus on provider burnout and resilience. As hospitalist leaders seek tools to address these issues, the design thinking process offers a novel user-centered approach. [...]
Background: Substantial portions of hospitalized patients in the United States do not understand their plan of care. Hospitalized patients’ knowledge of their plan of care affects their ability to provide truly informed consent and assent [...]
Background: Improving hospital throughput is a barrier facing medical facilities. Poor throughput leads to prolonged patient wait times for beds, a cause of patient complaints. Often these wait times are the result of late discharge [...]
Background: There is variability in care expectations and perceptions of terminally ill patients who are expected not to benefit from intensive care unit (ICU) level care. This created significant angst amongst members of the health [...]
Background: SHM Key Characteristic 9.1 on patient centered care encourages using guidelines/checklists to reinforce effective communication. Focused practice performance evaluations (FPPE) are a required regulatory hospital process for new medical staff members. In cognitive specialties, [...]
Background: Effective and timely communication among caregivers is one of the 2016 Hospital National Patient Safety Goals set forth by the Joint Commission. The pager messaging system remains predominant in the U.S health care system, [...]
Case Presentation: Central nervous system (CNS) systemic lupus erythematosus (SLE) is often called lupus cerebritis presenting primarily with non-specific symptoms of headaches, altered mental status, and/ or seizures. Up to 80% of SLE patients develop [...]
Case Presentation: A 71-year-old male presented with 4 months of fatigue, low-grade fevers, night sweats, dry cough, and a 10-pound weight loss. He also recalled developing a central ulcerating pustular lesion on his right anterior [...]
Case Presentation: Here we report a case of atypical manifestation of SLE in a 53 year old man who presented with neutropenic fever. Physical findings of interest included oral ulcers, a malar rash across the [...]
Case Presentation: We report a case of atypical manifestation of SLE in a 53 year old man who presented with neutropenic fever. Physical findings of interest included oral ulcers, a malar rash across the bridge [...]
Case Presentation: A healthy 54-year-old Asian female presented with 7 days of fever accompanied by a rash that spread from her neck and face to the entire trunk and extremities for the past 5 days. [...]
Case Presentation: A 59 year-old man with a history of hepatitis C virus infection and hepatocellular carcinoma who received an orthotopic liver transplant 8 years ago, presented with acute onset epigastric pain and melena 6 [...]
Case Presentation: A 78 year old obese male with narrow angle glaucoma, BPH, hiatal hernia, abdominal hernia and right inguinal hernia presents with longstanding urinary symptoms of weak stream and incomplete emptying with increased urinary [...]
Case Presentation: A 59 year old Asian-Canadian female with a history of hypertension and hyperthyroidism, with recent travel history to China 4 months prior, presented with a 2 month history of right sided abdominal pain [...]
Case Presentation: The patient is a 33 year old woman with no significant past medical history who presented with recurrent encephalitis. She initially collapsed while walking with her toddler. She was unresponsive and had seizure [...]
Case Presentation: A 36 year-old male came in to the ED with 2 day history of painful itchy rash on the left side of the neck and face. The patient denied any fever or chills. [...]
Case Presentation: A 64-year-old male with history of hypertension and pauci-immune glomerulonephritis presented with fatigue, cough associated with weight loss for past 2 months. Prior to the presentation, he was treated with prednisone and cyclophosphamide [...]
Case Presentation: A 75 year-old male presented to the hospital with abdominal pain, nausea, vomiting, and dizziness for two weeks. He also endorsed a gradual onset of generalized weakness, and decreased oral intake over the [...]
Case Presentation: A 38-year-old Japanese man with past medical history of central retinal vein occlusion at the age of 36 years presented with one-week duration of dyspnea, precipitated by common cold-like symptoms. He denied having [...]
Case Presentation: A 84-year-old woman with a history of Alzheimer’s disease presented to our hospital for evaluation of persistent fever. Because of swallowing dysfunction due to the advanced dementia, she had difficulty in eating and [...]
Case Presentation: CG is a previously healthy 25M who presented with one week of high-grade fevers, abdominal pain, and worsening fatigue despite outpatient evaluation and treatment with Tamiflu. Travel history was significant for visiting family [...]
Case Presentation: A 37-year-old Asian female with no significant medical or surgical history presented with acute diffuse abdominal pain, nausea and vomiting. Her physical exam and laboratory testing were unremarkable. She was diagnosed with viral gastroenteritis [...]
Case Presentation: A 65 year-old Caucasian male presented with complaints of small amounts of hematochezia and constipation. Colonoscopy showed a large, ulcerated partially obstructing sigmoid mass concerning for cancer 25cm proximal to the anus. The [...]
Case Presentation: A 21-year-old male with a reported history of essential hypertension since the age of 16 presented with a four-day history of abdominal pain, nausea and vomiting. He was noted to have systolic blood [...]
Case Presentation: A 50 year-old woman with past medical history of diabetes mellitus presented complaining of a “spider bite” and abdominal pain. She later admitted to heroin abuse via “skin popping”. Significant vital signs on [...]
Case Presentation: A 69 year-old man with no known prior medical history presented with one month of dyspnea on exertion associated with abdominal, scrotal, and bilateral leg swelling. He reported orthopnea, a dry cough, and [...]
Case Presentation: A 37-year-old female with a history of uncontrolled migraine headaches and hypertension presented to the Emergency Department with upper and lower extremity muscle weakness resulting in a fall. Her symptoms were progressive over [...]
Case Presentation: A 53-year-old female presented to our hospital with diffuse, severe, and crampy abdominal pain for 1 week associated with generalized weakness and fatigue. She has a past medical history of hypertension, hyperlipidemia, type [...]
Case Presentation: A 75-year-old man presented with nine months of progressive rash, palmoplantar keratoderma, chronic oral lesions, and weight loss (Figure). The cutaneous lesions began as erythematous patches on his hands and then spread to his [...]
Case Presentation: A 23-year-old woman presented with complaints of jaundice, nausea, and epigastric pain for ten days. She had a history of epithelioid hemangiodendothelioma (EHE) of the lungs, diagnosed six months prior to presentation. She [...]
Case Presentation: A 28-year-old man presents with suspected recurrent right forearm cellulitis. The patient has had four episodes of pruritic, edematous, erythematous plaques on the arms and neck over the past three months. Each episode [...]
Case Presentation: 80 year-old female with history of dyslipidemia on statin therapy, and diabetes presented to the clinic with a three month history of progressive weakness. She initially presented with lower extremity weakness and was [...]
Case Presentation: A 40-year-old female with hemoglobin SC disease presented with a 2-day history of severe headache and progressive vision loss. On initial evaluation, she was febrile to 100.8 F and tachycardic. Her exam was [...]
Case Presentation: An 88-year-old woman with hypertension, osteoarthritis, type II diabetes, and no past psychiatric history presented to our hospital with three months of progressive paranoia and two weeks of confusion and hallucinations. The week [...]
Case Presentation: A 70-year-old female with history of type II diabetes, hypertension and depression presented with confusion and rigidity. She was fully functional till two months ago. Family initially noticed behavior changes such as forget [...]
Case Presentation: This is a 59 year-old woman with ulcerative colitis (UC) who initially presented with frequent episodes of bloody diarrhea and persistent abdominal pain for two months. The patient had been controlled for years [...]
Case Presentation: A 55-year-old woman with history of hypertension presented with 1-day duration of inability to urinate despite adequate fluid intake. Patient has no known history of renal dysfunction. Review of system positive only for [...]
Case Presentation: A 55 year-old woman with a history of antibody-mediated autoimmune encephalitis (AME) treated 1 year ago presented to the hospital with confusion and hyperactivity following intentional overdose of amitriptyline and clonazepam. 1 week [...]
Case Presentation: A 67-year-old woman presented with acute substernal chest pain that came on suddenly 10 minutes after she had taken frovatriptan for a migraine. The pain radiated down both arms. Her medications were Frovatriptan [...]
Case Presentation: A 40-year-old immigrant from Bangladesh with a history of uveitis presented to the emergency department for evaluation of abdominal pain. He first developed fevers 10 days prior to admission, when he was visiting [...]
Case Presentation: A 47-year-old woman with type one diabetes and end stage renal disease received a simultaneous kidney and pancreas transplant with thymoglobulin induction and enteric drainage. Five months after transplant, she came [...]
Case Presentation: A 55 yo African American Male with DMII, HTN, CKD, Hyperlipidemia who initially presented with worsening right leg swelling and diagnosed with an unprovoked right femoral vein non-occlusive Deep Venous Thrombosis (DVT) and [...]
Case Presentation: A 46 year-old gentleman presents with an acute worsening of his chronic low back pain with radiation and paresthesias down his left leg. On admission, he was febrile, tachycardiac and uncomfortable appearing. He [...]
Case Presentation: A 50-year-old white female presented with the acute onset of right lower quadrant abdominal pain. The patient’s temperature was 37.7° Celsius. Physical examination was remarkable for voluntary guarding and rebound tenderness, which [...]
Case Presentation: A 52-year-old woman presented with the subacute onset of exertional dyspnea and non-productive cough. The patient admitted to smoking 10 cigarettes daily, and described the regular use of inhaled (smoked) methamphetamine. Physical exam [...]
Case Presentation: A 43-year old man presented with the acute onset of paralysis. The patient had helped a sibling move heavy furniture throughout the day prior to admission. He awoke from sleep that evening unable [...]
Case Presentation: A 75 year-old man presented with a four week history of worsening involuntary movements, primarily involving his arms. The movements had initially been minimal, but by the time of presentation had become disabling. [...]
Case Presentation: A 76-year-old female with a history of chronic sinusitis presented with fever and cough. Physical exam was remarkable for temperature of 102° F and diminished breath sounds in the left base. WBC was [...]
Case Presentation: A 27-year-old man with a past medical history of ulcerative colitis (UC) presented to the hospital with pleuritic chest pain. It had been ongoing for 6 days with no alleviating or aggravating factors. [...]
Case Presentation: A 19-year-old male with a past medical history of malaria and recent immigration to the U.S. from Somalia presented with a witnessed episode of tonic-clonic seizure. He had no history of seizure disorder, [...]
Case Presentation: A 33-year-old patient with a history of ST-elevation myocardial infarction (STEMI) requiring 2 cardiac stents at the age of 30, presented with intermittent substernal chest pressure. He denied a previous history of nicotine, [...]
Case Presentation: A 22-year-old male with no PMH or FH of autoimmune diseases and no substance use history presented with several days of worsening dyspnea, pleuritic chest pain, cough and hemoptysis. On evaluation, his vital [...]
Case Presentation: A 52-year-old female with no PMH or FH of autoimmune diseases and no substance use history presented with worsening dyspnea, dry cough and brownish nasal discharge over several weeks. On physical examination, vital [...]
Case Presentation: A 59-year-old woman with a history of ductal carcinoma in situ status post mastectomy presented with dizziness exacerbated by change of head position. Patient endorsed a history of intermittent dizziness in the past [...]
Case Presentation: Syphilis is known as the “Great Imitator” for good reason. With its insidious onset and nonspecific presentation, it is often mistaken for other diagnoses or overlooked altogether. Here, we describe a case of [...]
Case Presentation: A 38-year-old man with a history of intravenous drug use presented with right-sided head swelling for three weeks. A 4 cm nodule was noted over the right temple. A new diagnosis of HIV [...]
Case Presentation: A 56-year-old male presented with acute crampy, diffuse abdominal pain, distension, constipation and nausea. Last year, he had similar episode that was clinically diagnosed as diverticulitis and managed conservatively. Other review of systems [...]
Case Presentation: A 41- year old female with history of hypertension was admitted to our hospital with complaints of intermittent diffuse abdominal pain, diarrhea, and generalized rash. Vital signs were normal. Physical examination was notable [...]
Case Presentation: An 18 year-old man presented with two months of progressive weakness and dysphagia. He was previously active in high school wrestling and weightlifting but is now unable to participate in either due to [...]
Case Presentation: A 72 year old female with history of chronic atrial fibrillation not on anticoagulation was brought to the emergency department (ED) after she was found gasping for breath. She was found to have [...]
Case Presentation: A 52-year-old man originally from West Africa presented with two episodes of hematemesis over one day and with intermittent diffuse abdominal pain and fatigue over one week. He is a known HIV/AIDS patient [...]
Case Presentation: Case 1- 83 year old male with past medical history of knee surgeries and lumbar laminectomy presented with acute onset of fever, confusion and left lower extremity weakness for the past three days. Physical [...]
Case Presentation: A 29-year-old African American man presented as a transfer from an outside hospital for uncontrolled diabetic ketoacidosis. Two months prior to admission he was diagnosed with ketosis prone type 2 diabetes mellitus. On [...]
Case Presentation: A 47-year-old woman presented with abdominal pain, diarrhea, hematochezia, and fever. Medical history consisted of a previous episode of diverticulitis and a right partial nephrectomy due to Renal Cell Carcinoma. On physical examination, [...]
Case Presentation: A 62-year-old man presented with progressive lower back pain for six months’ duration. He noticed significant weight loss, occasional sweats, and subjective fevers. No significant neurological symptoms or any other significant complaints. Patient [...]
Case Presentation: A 39 year old G7, P5 female at week 36 of gestation presented with a two day history of back pain and shortness of breath. There was no significant past medical history. The [...]
Case Presentation: A 47-year-old Caucasian male presented with left ankle pain and swelling for 3 weeks. He denied history of trauma. He was treated for gout with minimal improvement. X-ray of ankle did not show [...]
Case Presentation: A 85-year-old Caucasian female presented with nausea, vomiting and generalized weakness for three weeks. She denied any diarrhea, bloody stools or abdominal pain. Review of systems was positive for weight loss of 20 [...]
Case Presentation: A 52-year-old African American male with a history of Diabetes Mellitus Type 2, Hypertension, and Hyperlipidemia presented to the Emergency Department with complaints of dizziness and fluctuating level of consciousness. He was on [...]
Case Presentation: A 55-year-old previously healthy Caucasian male was transferred from a regional hospital after one week stay for worsening ileus in the setting of gall stone related acute pancreatitis. Vital signs were remarkable for [...]
Case Presentation: A 36 year-old female with history of bulimia nervosa, bipolar disorder and borderline personality disorder presented to the emergency department after she woke up with painful spasm of bilateral hands. She had been [...]
Case Presentation: A 25 year-old male with no significant past medical history presented to the emergency department after he woke up with sudden onset weakness in his bilateral thighs and arms. He had history of [...]
Case Presentation: A 48 year-old woman presented to the emergency room with dizziness following five episodes of black stool. She had otherwise been well and denied prior episodes. Her admission labs were notable for hemoglobin [...]
Case Presentation: A 61-year-old male with past medical history of hypertension, hyperlipidemia and coronary artery disease presented with sustained tachycardia. His history was remarkable for ST segment elevation myocardial infarction (MI) and had a stent [...]
Case Presentation: A 80-year-old female with a past medical history of diabetes mellitus, hypertension and coronary artery disease status post stenting 4 years ago presented with coffee ground emesis, epigastric pain, dysphagia and melena. On [...]
Case Presentation: A 52-year-old male, active hiker presented to the emergency department with fever, chills and palpitations for one week. He had noticed a 20 cm rash in his groin for 6 weeks. On examination, [...]
Case Presentation: A 55 year old non obese African American male with the past medical history of HIV on tenofovir/emtricitabine/efavirenz and HCV genotype 1 infection who was being treated with ledipasvir/sofosbuvir came in with complaints [...]
Case Presentation: A 54-year-old Hispanic woman presented with 5 days of subjective fevers, jaundice, nausea, vomiting, and right-sided abdominal pain. On presentation, she was febrile with borderline hypotension and tachycardia, abdominal tenderness, and laboratory values notable for [...]
Case Presentation: A healthy 25-year-old man presented with 8 days of progressively worsening sore throat, fever and neck swelling which were unresponsive to 2 outpatient courses of clarithromycin. On presentation, he was febrile, tachycardic, hypotensive, [...]
Case Presentation: A 36-year-old African American male, with accelerated phase Philadelphia chromosome positive CML on dasatinib, presented to a community hospital with abdominal pain, distention, and melenic stools 10 days after being discharged. During the [...]
Case Presentation: A 39 year old woman with history of GERD presented to the ED for unretractable abdominal pain with nausea and vomiting despite chronic treatment with omeprazole. She also noted dyspnea on exertion, fatigue, [...]
Case Presentation: A 60 year-old woman with chronic mesenteric ischemia was admitted for symptomatic inferior mesenteric artery (IMA) stenosis. She underwent IMA stent placement with a postoperative course notable for abdominal pain and nausea. Two [...]
Case Presentation: We present a 47 year-old male who experienced chest discomfort and a syncopal episode. He was found to be in ventricular tachycardia and was immediately electrocardioverted. Afterwards his symptoms resolved and he was [...]
Case Presentation: A 54-year-old African American woman presented with complaints of headache, blurred vision, and progressive bilateral leg swelling for the past week. This was her 4th visit to the hospital in 4 months with similar [...]
Case Presentation: A 45-year-old woman presented to our hospital for evaluation of chronic kidney disease. Three years earlier, she had been diagnosed at an outside institution with Sjögren's syndrome after developing sicca symptoms with positive [...]
Case Presentation: A 60 year old woman with a history of hypertension and low back pain was brought it by family after she was found unresponsive in bed. According to the patient’s family, at baseline [...]
Case Presentation: An 84 yo female with a past medical history of HTN, HLD, GERD and reactive airway disease presented with acute shortness of breath and wheezing. Patient appeared anxious, with cyanotic lips and labored [...]
Case Presentation: A 46 year-old healthy man presented to urgent care with 4 weeks of abdominal distension, epigastric pain and a 10lbs weight loss. CT of the abdomen and pelvis showed a soft tissue mass [...]
Case Presentation: A 50 year old woman with hypertension and sciatica presented with a 2 month history of intermittent abdominal, leg and back pain, and a 14-lb weight loss. Her initial exam was unremarkable. Laboratory [...]
Case Presentation: 64 year old male with history of stage 4 prostate cancer status post radiosurgery and hormonal therapy in remission for 6 months presented with 1 month of left upper quadrant and epigastric pain [...]
Case Presentation: 62 year-old female with a history of intracranial hemangiopericytoma admitted to the ICU with altered mental status due to profound hypoglycemia. She was previously diagnosed six years prior with intracranial hemangiopericytoma and treated [...]
Case Presentation: A 62-year old female with history of severe persistent asthma on chronic steroid and montelukast, allergic rhinitis, and peripheral neuropathy who presented with a two- month history of worsening left foot weakness. On [...]
Case Presentation: A 75 year-old man presented with one week of worsening altered mental status and recurrent falls. He also reported dyspnea, non-productive cough and chills of similar duration. He had history of DM2 well [...]
Case Presentation: A 59 year-old female with past medical history of Hashimoto's thyrotoxicosis was admitted because of fatigue, myalgia, acute renal injury with hematuria and proteinuria, positive p-ANCA, positive stool guaiac test, and elevated inflammatory [...]
Case Presentation: A 66-year-old man was admitted with abdominal distension, fatigue and dyspnea. Six months prior he underwent elective repair of his aortic valve with a post-operative course complicated by a recurrent right sided exudative [...]
Case Presentation: A 55-year-old male with a history of coronary artery disease status post percutaneous intervention, tobacco abuse, hepatitis C, and liver cirrhosis presented to an outside hospital with severe fatigue and weakness. One month [...]
Case Presentation: A 38 year old lady with past medical history of recurrent kidney stones presented to the emergency department with a 1 day history of lethargy, confusion, and severe right sided abdominal pain. She [...]