Case Presentation: A 21‐year‐old local college student with no medical history presented with progressive odynophagia, dysphagia, and facial swelling. Her symptoms started 1 week prior to admission with a progressive cough, purulent yellow expectorate, and [...]
Case Presentation: A 30‐year‐old Guatemala‐born man presented with severe, nonradiating epigastric and right upper quadrant abdominal pain, intermittent for the past 2 years, requiring several prior hospitalizations. Pain was accompanied by moderate nausea, vomiting, and [...]
Case Presentation: A previously healthy 54‐year‐old man presented with a history of fever, sore throat, myalgias, worsening lethargy, diarrhea, and epistaxis. The patient had traveled to Mount Calazano, Italy, and England the month before admission [...]
Case Presentation: A 44‐year‐old woman presented 6 days aftera cesarean section with worsening left leg swelling. The patient, whose spouse was a physician at the admitting hospital, had been on bed rest for the last [...]
Case Presentation: A 70‐year‐old white female patient was admitted fora subarachnoid hemorrhage and underwent aneurysm clipping of the anterior communicating artery. Postoperatively she complained of angina‐like pain and subsequently became hypotensive with systolic blood pressures [...]
Case Presentation: A 40‐year‐old blind woman presented with progressively altered mental status 1 week after an emergency department visit for a “viral URI.” PMH was significant for giant optic glioma, anxiety, neurodermatitis, and mild mental [...]
Case Presentation: An 81‐year‐old frail man (weight 99 lb) with a medical history significant for chronic obstructive pulmonary disease, lower‐extremity deep venous thrombosis (on warfarin), hypertension, and recent left hip replacement was undergoing rehabilitation and [...]
Case Presentation: A 28‐year‐old woman with a medical history of asthma, migraine, depression, and smoking presented to the emergency department (ED) with shortness of breath and cough fora month. She had previously been treated by [...]
Case Presentation: A 37‐year‐old man with a family history of “heart disease” presented to the emergency room (ER) with a witnessed syncopal event lasting 1 minute. He had no chest pain, dyspnea, dizziness, or palpitations [...]
Case Presentation: An 83‐year‐old‐active white man with a medical history of hypertension and osteoarthritis and 1‐month history of low back pain presented to the emergency department with a right intertrochantericfemurfracture. He underwent emergent open reduction [...]
Case Presentation: A 39‐year‐old woman with a medical history of polycystic ovarian syndrome presented with pleuritic chest pain, fever, progressive dyspnea on exertion for 1 month, and right upper quadrant abdominal pain. Her physical exam [...]
Case Presentation: An 84‐year‐old female patient from an assisted‐living facility (ALF) was admitted with complaints of abdominal pain and diarrhea (7‐8 episodes/day, watery, non‐foul‐smelling) for 2 months. She denied nausea, vomiting, fever, chills, anal pruritus, [...]
Case Presentation: A 74‐year‐old white man with end‐stage renal disease, diabetes mellitus, coronary artery disease, congestive heart failure, and S/P pacemaker placement was admitted to the hospital with a chief complaint of painful red eyes [...]
Case Presentation: A 5‐day‐old male infant born after 38 weeks' gestation presented to the emergency department with hyperbilirubinemia (total bilirubin level 29.8 mg/dL) and anemia (hemoglobin 10.6 g/dL). His other blood indices were normal (white [...]
Case Presentation: A 59‐year‐old man presented to the emergency department with new‐onset right testicular pain in the setting of back pain and abdominal distention. After evaluation by his primary care physician 2 weeks prior, he [...]
Case Presentation: A 62‐year‐old woman with a medical history of chronic obstructive pulmonary disease (COPD), renal insufficiency, and chronic atrial fibrillation was admitted to the hospital for treatment of community‐acquired pneumonia and exacerbation of her [...]
Case Presentation: A 56‐year‐old physician with vitiligo and hypothyroidism presented to the emergency department with malaise, intermittent fevers and flulike symptoms of 1 month's duration. She had taken ibuprofen for 10 days and self‐prescribed dexamethasone [...]
Case Presentation: A 21‐year old man had been admitted to the ICU for a 30% burn injury incurred in a house fire and explosion. He underwent excision and skin grafting and was receiving 60‐100 mg [...]
Case Presentation: An 11‐year‐old girl presented to the pediatric emergency department complaining of 3 days of right lower quadrant (RLQ) abdominal pain. Her pain was sharp, intermittent, exacerbated by touch or movement, alleviated by lying [...]
Case Presentation: A 64‐year‐old retired shrimper with hypertension, hyperlipidemia, gout, and nonalcoholic steatohepatitis (NASH) with stage 3 fibrosis, presented to the emergency department with fever and vomiting. He had spent the day on his boat [...]
Case Presentation: A 1‐year‐old girl with multiple medical problems including trisomy 18, tetralogy of Fallot, and gastroesophageal reflux presented with a 3‐week history of fever and irritability. In addition, she had had several weeks of [...]
Case Presentation: A 27‐year‐old man presented to the emergency department with 1 week of right‐hand weakness and ataxia. Three weeks earlier, he had developed flulike symptoms consisting of headache, fatigue, and nausea. He took Theraflu, [...]
Case Presentation: A 72‐year‐old woman with moderately reduced renal function (creatinine, 2.1 mg/dL; GFR, 36 mL/min) was admitted to our institution because of worsening chronic back pain. Her physical examination was unremarkable except for decreased [...]
Case Presentation: A 75‐year‐old man with a distant history of laryngeal squamous cell cancer underwent a laryngoscopy to evaluate a new left piriform mass. Complications during the procedure lead to an emergent tracheostomy, and he [...]
Case Presentation: A 36‐year‐old white woman with a history of hypothyroidism and type 2 bipolar disorder presented with a 4‐day history of fever, rigors, nausea, vomiting, neck stiffness, photophobia, and severe diffuse headaches. She had [...]
Presentation of Case 1: A healthy 20‐year‐old primagravid woman was admitted to the hospital for delivery. Her prenatal course was unremarkable with no evidence of hypertension. On admission her blood pressure was elevated up to [...]
Case Presentation: A 51 ‐year‐old white woman with a history of recent‐onset hypertension and diabetes mellitus presented to a community hospital complaining of chest pain, shortness of breath, and several episodes of emesis over the [...]
Case Presentation: A 37‐year‐old man with no significant PMH was admitted for evaluation of a 3‐week history of high fevers, fatigue, decreased appetite, and flulike symptoms. As an outpatient, he had been seen by his [...]
Case Presentation: A 69‐year‐old man was transferred from a community hospital with the complaint of postprandial abdominal pain for 1 year. The pain was described as dull, gradually increasing in severity over 1‐2 hours, often [...]
Case Presentation: A 66‐year‐old woman presented to the emergency room with complaints of weakness and shortness of breath. She had been taking acetaminophen (ACT) tablets for the 2 weeks prior to admission for increasing low [...]
Case Presentation: A 54‐year‐old man was referred for evaluation of polycythemia vera that was diagnosed after a series of dramatic hospitalizations for near‐syncope. The patient first presented with sudden lightheadedness and presyncope, which led to [...]
Case Presentation: A 49‐year‐old man presented with a 1‐day history of headache, drenching sweats, photophobia, and vomiting that prompted a CSF evaluation for meningitis. A lumbar puncture revealed protein of 105 mg/dL, a total of [...]
Case Presentation: A 21‐year‐old woman with no significant medical history presented to the emergency room with a 2‐day history of acute‐onset, intractable nausea associated with nonbloody, nonbilious vomiting. Four years earlier she had experienced similar [...]
Case Presentation: A62‐year‐old white man with a medical history of hypothyroidism and atrial fibrillation was admitted for evaluation of early satiety, nausea, lethargy, and a 20‐pound weight loss over the preceding 3 weeks. On physical [...]
Case Presentation: A 36‐year‐old woman with no medical history presented to the emergency department complaining of 1 day of chills, vomiting, and progressively worsening epigastric pain. The previous day the patient had had dilatation and [...]
Case Presentation: A 67‐year‐old man with hypertension and hyperlipidemia presented with a 3‐day history of intermittent confusion. His wife had also noticed changes in personality, irritability, ataxia of 3 weeks' duration, and impairment of short‐term [...]
Case Presentation: A 24‐year‐old woman with no significant medical history was admitted for stridor. One month before, the patient had an uncomplicated laparoscopic cholecystectomy. She had an EGD 3 days before admission. The EGD was [...]
Case Presentation: An 89‐year‐old white man presented to the emergency department with diffuse abdominal pain of several days' duration. He was afebrile, an abdominal exam was benign, and a stool sample was negative for occult [...]
Case Presentation: A 29‐year‐old white woman with a history of fever spikes for 1 month presented with complaints of fever, poor appetite, arthralgia, and an erythematous rash on her lower extremities. She had been seen [...]
Case Presentation: A 59‐year‐old woman with a medical history of Crohn's disease and hypertension presented to the emergency room with pain in the left side of her neck that had been progressively worsening for 4 [...]
Case Presentation: A 68‐year‐old woman was admitted to a tertiary referral center after presenting to her local emergency department (ED) with a complaint of shortness of breath. She initially presented to the ED with a [...]
Case Presentation: A 5‐month‐old girl presented to the emergency room with lethargy and respiratory depression. She had multiple injuries consistent with inflicted trauma, including massive intracranial injury, lacerated liver, ruptured bladder, fractured femur, and facial [...]
Case Presentation: A 51 ‐year‐old man was brought to the hospital after being found unconscious in the hallway of his transitional housing establishment. At the time of presentation, he was alert and interactive but made [...]
Case Presentation: A 43‐year‐old man on chronic intravenous antibiotic therapy presented with new‐onset chest pain that had developed while flushing his peripherally inserted central catheter (PICC) line. The pain was pleuritic in quality and was [...]
Case Presentation: A 29‐year‐old man with long‐standing, poorly controlled diabetes mellitus presented with change of mental status. Past medical history included: chronic kidney disease, diabetic retinopathy and neuropathy, left UE occluded AV fistula, congestive heart [...]
Case Presentation: A 41‐year‐old man with a history of Hodgkin's lymphoma treated successfully 20 years prior presented to the emergency room with bilateral ankle fractures after a fall. He underwent operative repair of his injuries [...]
Case Presentation: A 79‐year‐old man with no antecedent coronary artery disease underwent resection of recurrent high‐grade lipo‐sarcoma of the right upper extremity with placement of hollow catheters for perioperative brachytherapy. On postoperative day 2, he [...]
Case Presentation: A 64‐year‐old man with a medical history of hypertension and smoking presented to the emergency department (ED) with an acutely swollen and painful left eye, along with a 2‐week history of fevers, chills, [...]
Case Presentation: A 49‐year‐old woman was admitted to the hospital with fevers, chills, and hematuria and found to have urosepsis with Enterococcus faecalis. Her medical history included ischeal tuberosity ulcer from pressure necrosis and resulting [...]
Case Presentation: A previously healthy 18‐year old man initially presented to his outpatient physician with fevers and a cough. After 1 week of telithromycin, he developed a sore throat, nausea, and recurrent high fevers. His [...]
Case Presentation: A 41‐year‐old Indian man vacationing in the United States presented with a 2‐day history of vomiting and lightheadedness. He had been vomiting at least 6 times a day and felt extremely thirsty. Review [...]
Background: The Office of Inspector General (OIG) of the Department of Health and Human Services established compliance program guidelines for individual and small‐group physician practices and for hospitals. Although having a formal compliance plan was [...]
Background: At FirstHealth Moore Regional Hospital (FMRH), emergency department (ED) visits since 2003 have continued to increase at an average rate of more than 2.5%. In FY 2006 alone, visits totaled 57,678, a 3% increase [...]
Background: Sleep support surfaces play an important role in preventing pressure injury in hospitalized patients. There are hundreds of specialty beds and mattresses available through scores of companies. Because of differences in terminology, facility contracts, [...]
Background: The early signs and symptoms of patients at risk for clinical deterioration are frequently difficult to assess. The complex nature of patient care coupled with the need for accurate critical evaluation skills contributes highly [...]
Background: Multiple barriers exist to improving patient safety during regular rounds on an internal medicine inpatient unit: lack of standardization, limited time because of high patient turnover, and reduced communication with all members of the [...]
Background: Most patient arrivals at hospitals are unsynchronized with their discharges. If beds are assigned on a first come, first served basis, the result is patients being dispersed among several nursing units. This geographical disconnect [...]
Background: There is increasing evidence that providing early and aggressive nutrition to premature infants improves clinical outcomes related to length of stay, weight gain and growth, and improved neurodevelopment. In addition, the early introduction of [...]
Background: Administration of the pneumococcal vaccine to inpatients more than 65 years old with community‐acquired pneumonia (CAP) is a measure of hospital quality according to the Joint Commission on Accreditation of Healthcare Organizations and CMS. [...]
Background: Communication failures pose a significant and ongoing threat to patient safety. The current modes of training in educational silos foster poor teamwork and lack a shared model for high‐quality patient care. A growing emphasis [...]
Background: Between 5% and 15% of strokes occur in hospitalized patients and are associated with 54% mortality, increased cost of care, and a longer length of stay. Stroke or transient ischemic attack (TIA) patients arriving [...]
Background: Maximal efficiency is increasingly prioritized in the ever‐changing health care environment, and hospitalists are being called on to function beyond their traditional role of patient care provider. Multidisciplinary rounds are increasingly used to improve [...]
Background: To improve patient safety through communication among health care professionals, in 2006 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began to require a standardized approach to physician‐to‐physician handoff communications. Criteria included an [...]
Background: To comply with the 80‐hour workweek restrictions in 2004, the OB‐GYN department at a teaching hospital turned over the routine circumcision program to the pediatric hospitalist group. Taking over the program required a dedicated [...]
Background: Perioperative medicine has gained increasing importance in both academic and community hospitals and has been identified as an area in which physicians feel inadequately prepared during training. Exposure to perioperative medicine continues to be [...]
Background: Rapid‐response teams (RRTs) are a patient safety intervention designed to identify, diagnose, and treat hospitalized patients who are clinically deteriorating outside an intensive care unit (ICU). The ability to implement and sustain a successful [...]
Background: The discharge summary is critical to safe transitions from the inpatient to the outpatient setting. However, there are few educational models on how best to teach those on the house staff, who write most [...]
Background: Health care organizations have had significant difficulty getting providers to prescribe deep venous thrombosis (DVT) prophylaxis for their patients. Organizations including the Joint Commission on Accreditation of Healthcare Organizations and the Agency for Health [...]
Background: In 2006 both the American Academy of Physician Assistants and the Society of Hospital Medicine published core competencies (CCs) in the practice of medicine. There is no published literature on the application of CCs [...]
Background: In the age of declining reimbursement and insurance‐driven health care, it has become increasingly important for hospital systems to proactively address their compliance and revenue patterns. In 2003 our institution began to designate all [...]
Background: In a tertiary‐care setting, the culture of curative medicine can prevent physicians and parents from initiating a palliative medicine consult. Children who most need the service are those with chronic complex disease who have [...]
Background: Venous thromboembolic (VTE) disease is a significant burden for hospitalized inpatients. At our institution, we designed an intervention that would force physician users both to rate degree of VTE risk and to intervene with [...]
Background: Rapid‐response teams (RRTs) are associated with decreases in unexpected inpatient death, code blue, and unexpected ICU transfer rates. There are many RRT designs, but little has been written about RRTs coordinated by internal medicine [...]
Background: Medical students traditionally learn the clinical skills of taking a patient history and performing a physical examination in Introduction to Clinical Medicine (ICM) courses. Increasingly, these courses use real or simulated patients to give [...]
Background: Low sound levels are important for the normal neurological development of preterm infants. The American Academy of Pediatrics recommends an average noise level of 45 dB for premature infants. However, as a consequence of [...]
Background: In July 2003 the ACGME 80/30 work hour regulations went into effect. To maintain compliance with these regulations, new systems of care that might include cross cover and patient handoffs were created. Cross cover [...]
Background: The exchange of clinical information and patient care responsibility between physicians is crucial in the care of hospitalized patients. Many studies have looked at sign‐out/handoffs involving residents and interns and elicited mixed opinions. Very [...]
Background: Medical patients frequently experience medication changes during hospitalization. This increases the risk of medication‐related errors at discharge that may cause adverse events, resulting in increased mortality, readmission, and costs. As a result, the Joint [...]
Background: Clinical research has developed slowly in most hospitalist programs. Although partly related to the field's youth, it likely also reflects a lack of specific expertise about the clinical issues most worthy of study. Because [...]
Background: Physician‐patient communication is of paramount importance in providing efficient, cost‐effective, and compassionate patient care. Many lawsuits stem from poor communication between health care providers and patients. Face‐to‐face contact is essential for providing good patient [...]
Background: Following a regional natural disaster, our hospital experienced an influx of patients who presented unique challenges. Patients formerly managed by the local charity system instead were processed through our emergency department, nearly tripling our [...]
Background: When elderly patients are discharged home following an acute hospitalization, they are at high risk of having an unsuccessful transition with untoward health care outcomes. Our team has developed an interdisciplinary, comprehensive intervention to [...]
Background: A hospitalist program serves numerous stakeholders: patients, hospital administration, primary care physicians, and nursing staff, to name a few. It is imperative to gauge hospitalist performance as evaluated by these stakeholders. Although surveying patients [...]
Background: Since the advent of hospitalist programs, multiple studies reported in the literature have compared readmission rates on hospitalist and nonhospitalist services. However, specific reasons for readmission are often not available. Purpose: To describe the [...]
Background: A number of studies reported in the literature suggest there is overuse of proton pump inhibitor (PPI) medications in hospitalized patients. Purpose: The goals of the study were to implement a computerized physician order [...]
Background: The resident duty‐hour limitations mandated by theACGME increases the number of handoffs of patient responsibility, raising concerns about discontinuity of care and patient safety (Charap, Ann Intern Med. 2004). Meanwhile, the handoff process is [...]
Background: Incorporating continuing medical education for hospital medicine programs is an important component of practice development. This can be particularly challenging for practices that do not have access to grand rounds and the usual calendar [...]
Background: As hospitalist groups grow larger, it is important for every member of the team to be on the same page with new developments and in‐house rules and regulations. Exchanging e‐mails has the limitation of [...]
Background: Internal medicine (IM) resident training in the United States is undergoing a “relook” through “residency reform” by various medical organizations. One idea is to give residents more flexibility in planning their training to meet [...]
Background: ACGME duty‐hour limitations were intended, in part, to reduce resident fatigue and decrease its many negative consequences. Prior data suggest fatigue‐related reductions in patient safety and resident well‐being. We aimed to assess the factors [...]
Background: Admission to the general internal medicine (GIM) service at our 1100‐bed tertiary‐care hospital occurs randomly, with bed assignments determined on a first come, first served basis. Consequently, patients are dispersed to geographically disparate nursing [...]
Background: The TIMI risk score has been validated in the emergency department (ED) setting as a tool for risk stratification of patients presenting with chest pain. The TIMI risk score is a 7‐point scale that [...]
Background: Subcutaneous (SC) administration of human recombinant hyaluronidase (rHuPH20) temporarily increases the permeability of connective tissues by degrading hyaluronan and facilitating dispersion of coinjected molecules. SC administration of morphine + rHuPH20 in healthy volunteers and [...]
Background: Subcutaneous (SC) administration of human recombinant hyaluronidase (rHuPH20) temporarily increases connective tissue permeability by degrading hyaluronan. Because this technique enhances dispersion of coadministered molecules, we evaluated whether rHuPH20 coadministered with SC morphine enhances morphine [...]
Background: Methylnaltrexone, a quaternary derivative of naltrexone, is being developed for the treatment of opioid‐induced constipation in patients with advanced illness and postoperative ileus. GI transit, slowed by morphine, is reversed by intravenous, subcutaneous, or [...]
Background: Health care‐acquired infections (HAIs) represent a far too common risk and cost of hospitalization. Urinary catheter‐associated urinary tract infection is the most common cause of HAIs, with prolonged catheter use conferring a relative risk [...]
Background: Physician documentation is the principal determinant of reimbursement for services provided. In 2001 the Office of Inspector General cited $20 billion of Medicare overpayment, 29% of which resulted from improper coding.1 Conversely, the Health [...]
Background: Aspiration pneumonia (AP) is the most common cause of death in children with neurological impairment who have gastroesophageal reflux disease (GERD). Fundoplications and gastrojejunal feeding tubes (GJT) are frequently employed to prevent AP in [...]
Background: Duty‐hour limitations led to many changes in the residency experience at academic medical centers. Studies have suggested the quality of life of residents has improved but have questioned the impact on resident education and [...]
Background: Prematurity is a risk factor for primary immunization series delay. Catch‐up vaccination can take up to 3 years. Specific, neonatal‐based risk factors associated with immunization delay in the neonatal intensive care unit (NICU) have [...]
Background: Although counseling of inpatient smokers is a hospital quality measure, few hospitals assess preparedness of smokers to quit, an important predictor of future quit behaviors. This study aimed to assess the preparedness of hospitalized [...]
Background: Inpatient hyperglycemia is common and associated with adverse patient outcomes. Current guidelines recommend treatment to achieve glucose levels below 180 mg/dL in the inpatient non‐ICU setting. The best ways to achieve this glucose target [...]
Background: Catheter‐associated bloodstream infection (CA‐BSI) causes significant morbidity and mortality. Yet there are no national data describing the extent to which American hospitals are using proven strategies to prevent CA‐BSI, nor are there data assessing [...]
Background: Postoperative bariatric surgery (BS) infection rates (IRs) of 1%‐16.5% have been reported, with a mortality rate of up to 21.7%. This study investigated the 30‐day postoperative IR and mortality rate at our institution. It [...]
Background: Detection of geriatric syndromes is a critical step in caring for older patients and determining eligibility for post‐acute care services. Geriatric syndromes, notably delirium and malnutrition, are often undiagnosed and untreated in hospitalized elderly [...]
Background: Patients with hip fracture are generally elderly, have coronary artery disease (CAD) or risk factors for CAD, and require urgent surgery. Perioperative use of beta‐ers is associated with decrease cardiac mortality and morbidity. However, [...]
Background: Hyponatremia is a common electrolyte disorder in hospitalized patients often resulting from elevated arginine vasopressin (AVP) levels. Conivaptan (CNV) is a novel AVP‐receptor antagonist that produces aquaresis, the solute‐free, electrolyte‐sparing excretion of water, by [...]
Background: Postoperative ileus (POI) occurs in patients undergoing bowel resection and can lead to prolonged hospitalization. Methylnaltrexone, a quaternary derivative of naltrexone, avoids the peripheral effects of opioids while sparing their central analgesic effects. It [...]
Background: Hospitalized patients often experience feelings of anxiety and dehumanization. It is not well understood if creating a strong positive relationship between health care providers and patients can positively affect these feelings. We investigated using [...]
Background: Pulmonary complications following abdominal surgery are a major cause of morbidity, mortality, and prolonged hospitalization. Despite this, there is scarce information about national trends in postoperative pulmonary complications. Methods: The National Hospital Discharge Survey [...]
Background: The addition of a clinical nurse specialist (CNS) to an inpatient medical team has been shown to reduce length of stay (LOS) and improve patient satisfaction. Many hospitalists practice in nonteaching settings and without [...]
Background: Although there are some data on the effect of hospitalist‐run teaching services at academic institutions, there is very little data about the effect of nonteaching hospitalist services compared with traditional house staff‐associated teaching services [...]
Background: Some residents report spending less time teaching since the implementation of duty‐hour restrictions. This study aimed to assess factors associated with spending less time teaching and to determine the impact of time spent teaching [...]
Background: Poor glycemic control in hospitalized patients is strongly associated with increased length of stay, mortality, infections, and other undesirable outcomes. Poor glycemic control and suboptimal insulin regimens are the rule in inpatient ward settings, [...]
Background: The initiation or withdrawal of artificial nutrition, via nasogastric and gastrostomy tubes, is a common and difficult issue in medical practice. Resident physicians and hospitalists frequently involve families in making these decisions, as the [...]
Background: Candida species are the fourth most common cause of nosocomial bloodstream infection in the United States. Of the various Candida species, Candida albicans caused the majority of infections during the 1980s. However, during the [...]
Background: Most inpatient physicians learn how to be attending physicians through experience, not formal training. Yet little has been written about how the performance of attending physicians changes over time. Methods: We evaluated attending physicians [...]
Background: Short‐stay units (SSUs) provide traditional inpatient services in locations commonly adjacent to emergency departments (EDs). Hospitalists are well positioned to staff these units because of their expertise in caring for inpatients. However, little is [...]
Background: The hospitalist model has been rapidly adopted across the United States; however, supporting evidence is derived from a small number of studies examining the practice of few physicians. Methods: We conducted a retrospective cohort [...]
Background: Falls remain a source of preventable morbidity and mortality of hospitalized patients with acute medical illnesses. Because of the high cost associated with falls in dollars, length of stay, and patient outcomes, much research [...]
Background: Attending‐only hospitalist services have been developed at academic centers in response in part to resident duty‐hour restrictions. The efficacy of these clinical services as teaching venues for medical students has not been assessed. Purpose: [...]
Background: Patients often have trouble managing their medications after hospital discharge, and adults with limited literacy skills may face added difficulties. These problems and their potential solutions are not well characterized. Methods: Patients admitted to [...]
Background: The forthcoming wave of geriatric patients is expected to result in rising incidence of myocardial infarction (MI), made uniquely challenging by atypical symptoms, multiple comorbidities, and cognitive impairment. Hence, misdiagnosis, undertreatment, and poor outcome [...]
Background: Most patients who undergo hip surgery are elderly with significant comorbidities. Postoperative infection and mortality are potentially preventable complications. As with cardiac risk stratification, infection and mortality risk stratification may be possible. This study [...]
Background: Upper gastrointestinal hemorrhage (UGIH) is a common reason for emergency department (ED) evaluation and hospital admission. Despite validated risk‐assessment methods, it is not known how risk stratification is used to influence early endoscopy (EGD) [...]
Background: The current consensus guidelines of the American College of Cardiology state that troponins (TnT or TnI) are the preferred biomarkers of myocardial necrosis to evaluate patients with chest pain syndrome to make the diagnosis [...]
Background: After coronary artery bypass grafting, hip surgery is the most commonly performed procedure in patients older than 65. In the current American College of Cardiology/American Heart Association (ACC/AHA) preoperative evaluation guideline, orthopedic surgical procedures [...]
Background: Several randomized and observational trials in the past decade and the more recent ACC/AHA guidelines support the use of preoperative beta‐ers (PBB) in selected patients undergoing noncardiac surgery (NCS). National patient quality and safety [...]
Background: Even though some readmissions are unavoidable, there is an implicit concern that they represent a failure in the health care system or inappropriate wishful thinking. Readmissions are not only expensive but suggest we have [...]
Background: Surgeons in the perioperative management of their patients are increasingly involving hospitalist physicians. This relationship includes preoperative assessments and postoperative referrals or comanagement for medical conditions including fevers, diabetes, hypertension, and coronary artery disease. [...]
Background: The rise in prevalence of type 2 diabetes mellitus (T2DM) in children is well recognized; however, its effect on diabetes‐related hospitalization rates is not well characterized. The objective of this study was to examine [...]
Background: Hospitalized diabetic patients do worse than nondiabetic patients, and the level of inpatient hyperglycemia predicts some of this excess morbidity. However, little is known about the outcomes of diabetic patients undergoing elective joint arthroplasty [...]
Background: Hospitalized diabetic patients do worse than nondiabetic patients, and the level of inpatient hyperglycemia is associated with some of this excess morbidity. We endeavored to identify if preoperative hemoglobin A1c (HbA1c) could predict the [...]
Background: Effective collaboration between physicians and nurses is necessary to ensure the optimal care of hospitalized patients. The increasing number of hospitalists across the United States provides the opportunity to affect this working relationship. However, [...]
Background: Communication problems between hospital house staff are one of the most common causes of preventable medical adverse events. The process of signing out is a critical part of the communication process that takes place [...]
Background: Nurse‐practitioners (NPs) play an increasing role in the delivery of inpatient care, often within hospitalist programs. Work evaluating this collaborative relationship is limited. In other settings, qualitative studies have suggested there are role confusion [...]
Background: The resident work‐hour rules were implemented by the Accreditation Council for Graduate Medical Education to address the patient safety problems associated with physician fatigue, but they do not take into account the discontinuity of [...]
Background: Fluid management of patients can be challenging in the best circumstances. The relationship of total fluid input to total output is commonly used to guide therapeutic decisions involving the use of diuretics and/or fluids. [...]
Background: The National Quality Forum has advocated the use of board‐certified intensivists to deliver critical care in intensive care units (ICUs). However, the extent of intensivist staffing, the use of nonintensivist providers, and the role [...]
Background: Congestive heart failure (CHF) is one of the most prevalent clinical conditions seen by hospitalists. Therapy with angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin II receptor ers (ARBs) have been shown to reduce morbidity and [...]
Background: There has been increasing discussion on whether hospitalists should provide 24/7 in‐hospital staffing. There have been no data to date that have shown a clinical advantage to this coverage arrangement. The goal of the [...]
Background: Despite the widespread availability of defibrillators and advanced cardiovascular life support (ACLS)‐trained personnel, survival from in‐hospital cardiac arrest remains poor. We have previously shown that cardiopulmonary resuscitation (CPR) quality is highly variable and often [...]
Background: Patients discharged from a university hospital operating at full capacity are often delayed. Inpatient cardiology is already highly efficient, and length of stay has been maximally shortened. The addition of a nurse‐practitioner to a [...]
Background: Acute lower extremity (LE) cellulitis often presents with swelling and erythema. In many cases this leads hospitalists to work up the patient for concurrent deep venous thrombosis (DVT). No previous studies have looked specifically [...]
Background: Nurse‐practitioners (NPs) are increasingly utilized in the acute care setting. Prior qualitative studies suggest physician knowledge and attitude deficits create barriers to effective NP/physician collaboration. Little is known about hospitalists' knowledge and attitudes about [...]
Background: Perioperative outcomes of heart failure (HF) patients who have been clinically stabilized prior to noncardiac surgery have not been well studied. We sought to evaluate contemporary surgical outcomes in patients with compensated HF undergoing [...]
Background: Drug‐eluting coronary stents (DESs) pose a challenge in the perioperative setting. Sirolimus and paclitaxel may inhibit re‐endothelialization of the traumatized vessel, making it vulnerable to platelet‐mediated thrombosis. Given anecdotal evidence and case series suggesting [...]
Background: In‐hospital antibiotic approval policies are commonly implemented to curb the indiscriminant use of antibiotics and to prevent antibiotic resistance. These policies usually require written forms and/or direct phone/fax requests to an infectious disease specialist [...]
Background: The use of specialized orthopedic nursing units (SONUs) for patients undergoing elective total hip arthroplasty (THA) is a well‐established practice. Whether such units improve outcomes or are cost effective has not been evaluated. Our [...]
Background: Although internal medicine residents commonly perform bedside procedures, technical proficiency and knowledge regarding procedures such as thoracentesis may be lacking. The risk of complications from thoracentesis may also be increased when performed by physicians‐in‐training. [...]
Background: In patients with 3‐vessel coronary artery disease (3VD), perfusion defects in multiple vascular territories may not always be evident because of globally reduced perfusion. The diagnostic value of an exercise stress test (EST) versus [...]
Background: Percutaneous intravenous central catheters (PICCs) are increasingly the devices of choice for providing long‐term central venous access among medicine inpatients. However, hospitalists are not typically trained in PICC insertion and often rely on other [...]
Background: Patients admitted to academic teaching hospitals are often cared for by multiple physicians of different training levels. This study aimed to ascertain the ability of patients to identify their inpatient physicians and patient and [...]
Background: Despite increased focus on handoffs, the accuracy of information transferred using resident sign‐outs has not been well characterized. This study aimed to describe the frequency, types, and harm potential of medication discrepancies between patient [...]
Background: Admission hyperglycemia has been associated with adverse clinical outcomes of patients admitted with acute myocardial infarction, stroke, or trauma. The effect of admission or discharge glucose level on clinical outcomes, particularly readmissions in ADHF, [...]
Background: In a large tertiary‐care hospital, a quality improvement program was initiated to evaluate the current practices and trends in preoperative cardiac risk assessment and prescription of perioperative beta‐ers for patients undergoing elective, noncardiac surgery [...]
Background: This study evaluated whether clinicians are providing appropriate thromboprophylaxis to at‐risk medical and surgical patients in accordance with ACCP guidelines. Methods: Premier's Perspective™ inpatient administrative database was used to assess VTE prophylaxis rates in [...]
Background: Mortality data estimates show that there are about 400,000‐460,000 sudden cardiac deaths (SCDs) in the United States annually. Managing cardiac arrest patients with coma postresuscitation has been largely supportive. Following restoration of spontaneous circulation [...]