Case Presentation: This is the first case report in the literature of a pediatric patient with psychosis attributed to therapeutic doses of intrathecal (IT) baclofen. We present a case report of a pediatric patient treated [...]
Case Presentation: A 60‐year‐old white woman with a history of sarcoidosis (remote and in remission), asthma, chronic obstructive pulmonary disease (COPD), and emphysema presented to the emergency department with a 1‐week history of worsening dyspnea, [...]
Case Presentation: A 24‐year‐old previously healthy man presented with sudden left‐hand weakness that lasted 6 days before complete resolution. This was followed a week later by simultaneous development of right‐hand and left‐foot weakness and numbness. [...]
Case Presentation: A 14‐year‐old boy with mental retardation, seizure disorder, and spastic quadriplegia was admitted with a 5 day history of lethargy, constipation, and reddish urine. He also had increased seizure frequency, which was usually [...]
Case Presentation: A 19‐year‐old woman with a history of sickle cell disease (HgbSC) presented to the hospital with an acute pain crisis. Initial vital signs were stable with normal oxygen saturation. Examination was unremarkable. The [...]
Case Presentation: A 55‐year‐old man with a history of peptic ulcer disease, status post‐Bill roth I gastrectomy in 1997, presented with a 15‐day history of fevers, chills, night sweats, weight loss, productive cough, and progressive [...]
Case Presentation: A 20‐year‐old woman from Honduras presented with a 4 × 3‐cm mass on her left neck that had been gradually enlarging over the past 3 years. The mass was well defined, mobile, and nonerythematous. She [...]
Case Presentation: LC is a 17‐year‐old HIV‐positive male on dapsone for PCP prophylaxis. He was admitted to the ICU after ingesting 6 g of dapsone in a suicide attempt. Initial ABG showed PO2 saturation of [...]
Case Presentation: A 27‐year‐old woman with sickle cell disease presented with acute bilateral leg, abdominal, and chest pain accompanied by nausea, nonbloody vomit, and a productive cough. The woman stated that the pain was consistent [...]
Case Presentation: Rhizobium spp are aerobic gram‐negative bacilli widely distributed in soil and commonly known as tumorigenic plant pathogens. R. radiobacter is an uncommon cause of human infection. Immunocompromised patients with indwelling vascular devices are [...]
Case Presentation: Mr. B is a 45‐year‐old man with a history of depression, anxiety, and severe gastroesophageal reflux disease who presented to the emergency department for evaluation of a rash on his right ankle. He [...]
Case Presentation: A 17‐year‐old female was admitted to the surgical ICU after a motor vehicle accident. Her Glasgow coma score was 4. She had multiple traumatic injuries and required intubation. CT of the brain showed [...]
Case Presentation: A 34‐year‐old man was admitted for evaluation of elevated blood glucose despite extreme subcutaneous (SQ) insulin requirements. He had a 12‐year history of type 2 diabetes mellitus without episodes of ketoacidosis, managed initially [...]
Case Presentation: A 44‐year‐old African American man without a significant medical history presented to an outside hospital with 10 days of nausea, vomiting, weakness, and confusion. He was hydrated, stabilized, and subsequently discharged. Over the [...]
Case Presentation: A 67‐year‐old man presented to the emergency room with progressive bilateral lower extremity edema for 3 weeks. He denied any dyspnea, oliguria, or chest pain. His medical history was significant for an intestinal [...]
Case Presentation: A case of malabsorption syndrome secondary to primary amyloidosis is presented here. A male in his forties presented with intermittent rectal bleeding, watery diarrhea, steatorrhea, dizziness and weight loss of 30 pounds over [...]
Case Presentation: A 31‐year‐old man with AIDS and disseminated MAC presented with 2 weeks of pruritic rash. Rash was associated with fever, cough, and weight loss. The patient lived in southeastern Louisiana but had recently [...]
Case Presentation: A 67‐year‐old man presented to the emergency department with a complaint of a presyncopal episode associated with persistent hiccupping and vomiting for 3 weeks. He also reported decreased oral intake, although he denied [...]
Case Presentation: A 39‐year‐old man with no medical history presented to the emergency department with a 2‐month history of urinary incontinence, constipation, and erectile dysfunction. He also reported paraesthesias, bilateral lower extremity weakness, and jerking [...]
Case Presentation: A 30‐year‐old African American woman with an unremarkable medical history presented to the emergency room with 14 days of progressive sore throat, high fever, malaise, voice changes, and dysphagia to solids. Positive findings [...]
Case Presentation: A 54‐year old African American man with history of dialysis‐dependent renal failure secondary to diabetes, presented with a large, painful swelling in his right buttock. Three years ago, his primary physician noted it [...]
Case Presentation: A 41‐year‐old woman with a medical history significant for gastroesophageal reflux was admitted for atypical chest pain and dyspnea on exertion for 2 months. She also reported recent low‐grade fevers, drenching night sweats, [...]
Case Presentation: A 73‐year‐old man with a history of hypertension was admitted for the evaluation of progressive, generalized weakness and fatigue of several months' duration. Aside from significant weight loss and lack of appetite, the [...]
Case Presentation: A 17‐year‐old Korean female presented to the emergency department with a 6‐month history of intermittent dizziness and bilateral vision loss with activity. She described loss of vision as whiteness for 30 seconds on [...]
Case Presentation: A 6‐year‐old girl presented to an outside ED with 2 days of fever (Tmax 104°F) and vomiting. She had recently returned from a 2‐year stay in Sierra Leone 2 weeks prior to admission. [...]
Case Presentation: A 66‐year‐old woman presented with 3 days of shortness of breath. He also reported a productive cough, fever, and chills. Prior to 3 days the patient reported no dyspnea and reported excellent exercise [...]
Case Presentation: A 58‐year‐old Laotian man with a medical history of diabetes mellitus, hypertension, and asthma presented with confusion, fever, and a rash. Review of systems was remarkable for abdominal discomfort in the preceding days [...]
Case Presentation: An 18‐year‐old man with a history of GERD transferred to our institution from an outside hospital for evaluation of refractory nausea, projectile bilious emesis, and abdominal pain. He had been in his usual [...]
Case Presentation: A 3‐year‐old boy with PDD, keratosis pilaris, and gingivitis presented to a New York City ED with limping after a fall. Initial evaluation was negative for fracture, and he was discharged with follow‐up [...]
Case Presentation: Rapidly progressive glomerulonephritis (RPGN) is a well‐known cause of acute renal failure. However, its abrupt presentation with anti‐GBM antibodies in the setting of membranous nephropathy is quite uncommon, A 73‐year‐old man presented with [...]
Case Presentation: This is a case of a 62‐year‐old white man with a history of cirrhosis secondary to hepatitis C, currently on treatment. His chief complaint was sore throat for 1 week, now with SOB [...]
Case Presentation: A 93‐year‐old man presented following acute onset of substemal and epigastric pain that progressed to crushing pressure over the course of 4 hours. He described a sensation of fullness in his throat, dysphagia, [...]
Case Presentation: A 78‐year‐old man with hypertension, diabetes mellitus, and hyperlipidemia presented to the ER for a 3‐day history of generalized malaise and fever. He denied headache, cough, abdominal pain, nausea, or vomiting. Medications included [...]
Case Presentation: A 65‐year‐old woman was transferred to us with 3 weeks of bandlike, nonexertional lower chest tightness associated with severe dizziness on standing and palpitations. She had difficulty ambulating because of leg weakness and [...]
Case Presentation: A 17‐year‐old boy was in his usual state of health until 3 weeks prior to admission, when he developed intermittent abdominal pain, vomiting, arthralgia, and skin rash. He started with localized, sharp, continuous [...]
Case Presentation: A 52‐year‐old man with a history of heavy alcohol use was admitted for cellulitis and chronic edema attributed to cirrhotic liver disease. Exam findings included significant peripheral edema, ascites, and jugular venous distention. [...]
Case Presentation: A 58‐year‐old white man underwent primary percutaneous transluminal intervention (PCI) with 2 stents for acute coronary syndrome (ACS). On the second day he developed fever. Antecubital thrombophlebitis was noted, and the peripheral catheter [...]
Case Presentation: A 33‐year‐old obese woman presented in respiratory distress 4 weeks after an ovarian cystectomy. She reported a 30‐pound weight gain in the month prior to admission. She had recently been treated with antibiotics [...]
Case Presentation: A 76‐year‐old white woman with type 2 diabetes (DM), hypothyroidism, coronary artery disease, and atrial fibrillation on oral anticoagulation was transferred to our institution with a 3‐month history of painful ulcerative lesions of [...]
Case Presentation: A 36‐year old previously healthy hairstylist presented with a 3‐day history of fever, dry cough, and “throbbing” headache with mild photophobia. She reported generalized weakness and lethargy, but no confusion. She had no [...]
Case Presentation: A 7‐month‐old healthy female infant presented to the emergency room with a 10‐day history of no stools. Her mother noted that she had a decreased activity level, decreased appetite, and abdominal distention and [...]
Case Presentation: A 58‐year‐old African American man presented to our hospital with 1‐month history of anorexia with a 20‐pound weight loss and progressive painless jaundice. He denied significant alcohol use and admitted to 25 pack‐year [...]
Case Presentation: A 24‐year‐old man with a history of IgA nephropathy, hypertension, and gout presented to the hospital with complaints of fevers for 3 weeks and rash for 3 days. He reported daily fevers to [...]
Case Presentation: A 28‐year‐old woman presented with an acute exacerbation of chronic, intermittent abdominal pain. The patient described intense cramping and colicky periumbilical pain lasting 1‐2 days and occurring 2‐3 times per year for 9 [...]
Case Presentation: A 65‐year‐old Middle Eastern man with a history of coronary artery disease, chronic renal failure stage III, diabetes mellitus, and gout was admitted with hematuria and a purpuric rash on his upper and [...]
Case Presentation: A 75‐year‐old white man with a medical history significant for fibromyalgia and self‐medication with chronic acetaminophen use for 2 years presented with bilateral knee pain and a flulike illness. On presentation his vital [...]
Case Presentation: A 65‐year‐old man presented to the emergency department in late summer complaining of fever, cough, and decreased oral intake for the past 7 days. His symptoms were associated with blurry vision and nausea. [...]
Case Presentation: A 27‐year‐old man with no prior medical history presented to the emergency department (ED) for a 2‐day history of sore throat, nonproductive cough, and fever. Physical exam revealed pharyngeal erythema and cervical lymphadenopathy. [...]
Case Presentation: A 53‐year‐old man presented with new‐onset pedal edema and memory loss of 1 month's duration. He also complained of a 1‐year history of generalized weakness, joint pains, neck stiffness, watery diarrhea, and significant [...]
Case Presentation: A 37‐year‐old man with a significant family history of systemic lupus erythematosus presented with cellulitis and bilateral chronic leg ulcers. While hospitalized, he became hemodynamically unstable and was diagnosed with deep venous thromboses [...]
Case Presentation: This is a 55‐year‐old woman who presented to our facility with worsening dyspnea and a productive cough. She was hospitalized more than 4 times recently for the same symptoms and was managed as [...]
Case Presentation: A 48‐year‐old man was hospitalized with fatigue, dyspnea, mild confusion, and faint lower extremity petechiae that followed an upper respiratory infection. At admission, his blood pressure was normal, and his temperature was 100.8°F. [...]
Case Presentation: Choriocarcinoma accounts for 1% of testicular carcinomas. Choriocarcinoma primarily spreads hematogeneously into viscera and lungs and involves retroperitoneal lymph nodes and liver. Human chorionic gonadotropin (HCG)‐induced hyperthyroidism in germ‐cell cancers is rare, and [...]
Case Presentation: This is an 18‐year‐old white man with no prior medical history who had been taking the acne treatment isotretinoin for several months before deciding to start power lifting to build muscle mass. He [...]
Case Presentation: A healthy 47‐year‐old man presented with pain and swelling of multiple joints. Four months prior to admission he had a sinus infection, for which he was treated with trimethoprim‐sulfamethoxazole (Bactrim). After 7 days [...]
Case Presentation: A 27‐day‐old Asian female infant was admitted for a fever of 102°F and a subsequent neonatal sepsis workup. A CBC with differential, blood, urine, and CSF cultures was performed. She was started on [...]
Case Presentation: A 32‐year‐old Korean man presented to the emergency room with 4 hours of progressive weakness of his upper and lower extremities following an elective cervical epidural steroid injection done 12 hours earlier. He [...]
Case Presentation: A 62‐year woman was admitted for evaluation of recent‐onset, moderate‐intensity headaches. The headaches began 2 weeks prior, shortly after starting sertraline (a selective serotonin reuptake inhibitor) to treat depression. Waxing‐waning headaches persisted, accompanied [...]
Case Presentation: A 39‐year‐old white woman presented to the emergency department with complaints of weakness and fatigue. On physical examination, the patient had orthostatic changes, and lung examination revealed bibasilar crackles. Laboratory data were significant [...]
Case Presentation: A 37‐year‐old woman with an unremarkable medical history was admitted with sudden onset of dizziness, aphasia, and right arm numbness and weakness. The patient's symptoms lasted approximately 45 minutes and then slowly resolved, [...]
Case Presentation: A 28‐year‐old white man was transferred to our facility from an outside hospital for 1 week of fatigue and cough. He smoked half a pack a day and had a history of asthma [...]
Case Presentation: A 59‐year‐old man with a medical history significant for congestive heart failure and diabetes mellitus presented with a new right upper lobe nodule (positive on PET scan), for which he underwent a CT‐guided [...]
Case Presentation: A 34‐year‐old woman presented with 2 days of headache, nausea, vomiting, and bilateral eye pain. The headache was describes as throbbing and radiated from the base of her skull down the back of [...]
Case Presentation: A 51‐year‐old man with a new diagnosis of HIV/AIDS complicated by cryptococcemia and toxopSasma brain abscess, with a CD4 count of 17 cells/μL, presented to our hospital 2 months after his initial diagnosis [...]
Case Presentation: A 49‐year‐old African American woman presented to the emergency room (ER) with a 3‐day history of high‐grade fevers, chills, and generalized muscie aches after returning from a 3‐week trip to Nigeria without malaria [...]
Case Presentation: This is a case of an 8‐year‐old girl who presented with a 2‐day history of abdominal pain, vomiting, and fever. She subsequently developed cough, lethargy, and “sniffing” paroxysms consisting of arm and leg [...]
Case Presentation: A 22‐year‐old previously healthy woman presented in May 2008 describing fever, fatigue, diarrhea, and dysuria for 1 week. She recalled a tick bite 3 weeks prior to her illness. She was prescribed trimethoprim‐sulfamethoxazole [...]
Case Presentation: Chest pain is the second most common reason for visiting an emergency department in the United States. Ruling out medical emergencies is crucial. We are presenting a case of chest pain due to [...]
Case Presentation: A 51‐year‐old woman with a medical history of congestive heart failure, hepatitis B, and hypothyroidism was transferred from an outside hospital for a workup of an abdominal mass. The patient had presented several [...]
Case Presentation: A 92‐year‐old woman with a medical history of recurrent urinary tract infections (UTIs) presented with progressive dyspnea, a dry cough, and low‐grade fevers for 6 weeks. She was taking nitrofurantoin for prophylaxis of [...]
Case Presentation: A 26‐year‐old man with a history of hypertension and end‐stage renal disease (ESRD) on hemodialysis for the past 8 months was sent to the hospital from the hemodialysis center for complaints of a [...]
Case Presentation: The patient was a 14‐month‐old male presenting with feeding intolerance and failure to thrive with associated vomiting and diarrhea. His medical history was significant, including chronic emesis and poor weight gain with a [...]
Case Presentation: A 61‐year‐old man presented with progressively worsening nausea and nonbloody vomiting for 9 weeks. He reported thirst, polyuria, and polydipsia accompanied by weakness, lethargy, palpitations, and shortness of breath. He denied recent illness, [...]
Case Presentation: A 38‐year‐old diabetic presented to the emergency room with 2 days of worsening bitemporal headache, diplopia, left facial weakness, and partial left temporal numbness. This constellation of symptoms began while the patient was [...]
Case Presentation: A 72‐year‐old woman with rheumatoid arthritis presented with confusion and fever. She had visited an urgent care 2 days prior to admission for fevers and low back pain. She was transferred to a [...]
Case Presentation: A 44‐year‐old woman with history of SLE on chronic prednisone presented to the ED with complaints of severe headaches and neck stiffness. A CT scan revealed acute communicating hydrocephalus and bilateral cerebellar lesions. [...]
Case Presentation: A 54‐year‐old woman presented to the ED with 6 months of right lower extremity swelling and intermittent pain. The swelling began after 3 international flights and had progressively worsened since. The pain was [...]
Case Presentation: A 75‐year‐old man with a history of chronic myeloid leukemia presented to the emergency room with bifrontal headache, syncope, and double vision of the right eye. Physical examination was unremarkable. He was afebrile, [...]
Case Presentation: A 32‐year‐old man with no significant medical history presented with complaint of dark‐colored urine, jaundiced skin, and fatigue for the last 4 weeks. He also reported having diarrhea mixed intermittently with blood for [...]
Case Presentation: A 56‐year‐old man presented with 2 days of severe diffuse abdominal pain and diarrhea. CT scan of the abdomen and pelvis revealed diffuse colitis in the transverse, descending, and sigmoid colon. Admission labs [...]
Case Presentation: A 50‐year‐old Chinese woman with a medical history of hepatitis B was brought to the emergency department by her family for a 6‐week history of hypersomnolence, irritability, and confusion. Other presenting symptoms included [...]
Case Presentation: The patient is a 45‐year‐old Mexican‐American from South Texas. He is a construction worker who fell from a ladder lacerating his left ankle on a jagged brick. He was initially treated at home [...]
Background: Our institution's rapid response team (RRT) data regarding interventions during RRT visits indicated a trend for increased Narcan administration for patients on our orthopedic surgery unit. Purpose: To identify the root cause of increased [...]
Background: The advancement of academic hospital medicine requires that academic hospitalists receive training that allows them to become leaders in research, education, quality improvement, and other scholarly aspects of academic medicine. However there are few [...]
Background: Although surgical comanagement is a rapidly expanding role for hospitalists, the growing challenge is to create a clinical experience that is rewarding to hospitalists long term particularly in academic medical centers. Purpose: To implement [...]
Background: High‐quality discharge summaries are a key component of a safe transition in care from the inpatient to the outpatient setting. However, the best ways to incorporate resident training in discharge summary creation into clinical [...]
Background: Hospitals still have no readily transferable strategy to deliver optimal care consistently. Moreover, the regular data flow necessary to track and drive better performance is typically not available. Pilot work from our hospital medicine [...]
Background: The Agency for Healthcare Research and Quality (AHRQ) has adopted iatrogenic pneumothorax (IAP) as a zpatient safety indicator. From 2006 to 2007 our institution was ranked within the lowest United Healthcare Consortium performance quartile [...]
Background: The culture of academic medicine lends itself to compulsory laboratory testing and the overutilization of tests. Physicians in training constitute the primary cohort of testers, and a certain tolerance is afforded their ordering behaviors [...]
Background: Pressure ulcers cause pain, disfigurement, and infection and often require months to heal. Many patients commonly cared for by hospitalists (elderly, malnourished, and immobile) are at risk. Traditionally, pressure ulcers have been viewed as [...]
Background: Starting in October 2008, the Center for Medicare and Medicaid Services (CMS) mandated no longer paying for treatment costs of certain conditions deemed preventable unless documentation and coding reflecting that those conditions were present [...]
Background: The discharge process is consistently rated among the lowest components of patient satisfaction markers in surveys. Discharge delays and late discharges can also negatively affect throughput by preventing bed availability for new admissions. Barriers [...]
Background: Creating a culture of safety to support clinicians and improve the quality of patient care is a goal for nearly all health care organizations. However, it can be difficult to envision specific efforts that [...]
Background: Pediatric hospital medicine is a rapidly growing field. The growth occurring at academic institutions reflects a rise in the number of pediatricians who are choosing careers in academic pediatric hospital medicine. As this number [...]
Background: Current research supports the fact that early recognition of vital sign deterioration provides the opportunity for early intervention and subsequent reduction of cardiac and respiratory arrest risk for non‐ICU patients. MEWS, or Modified Early [...]
Background: The discharge process is increasingly being studied as an area of quality improvement. Patients can inadvertently be discharged home with critical laboratory values or abnormal trends because of cognitive or non‐cognitive errors. Previous studies [...]
Background: The Institute of Medicine (IOM) report released in 1999 estimated between 44,000 and 98,000 inpatient hospital deaths resulted from medical errors within the United States annually. Although we have made advances during the past [...]
Background: Hospitalized patients with diabetes or hyperglycemia are typically monitored through finger‐stick glucose checks 4 times a day. Intermittent monitoring of blood glucose can miss many glucose excursions, particularly in the postprandial and nocturnal periods. [...]
Background: In the internal medicine clerkship, students are required by the Liaison Committee on Medical Education (LCME) to see patients with each of the conditions that the clerkship director identifies as core to the clerkship [...]
Background: Congestive heart failure (CHF) is the leading hospital admission diagnosis for patients over 65. It carries with it a significant toll on the quality of life and mortality of the patients diagnosed with it. [...]
Background: One of the greatest frustrations for health care providers is obtaining timely follow‐up appointments. Hospitalists often feel compelled to extend a patient's length of stay because of their concern for patients being lost to [...]
Background: Hospitalists in the United States continue to increase. The scope of their practice has also evolved over time. Of this growing cadre of hospitalists, >80% are internal medicine–trained. Residency in internal medicine (IM) provides [...]
Background: Discharge summaries at the study institution are currently completed by house staff using a computerized system in place of a handwritten summary or dictation. The system was conceived in 1997 as a handoff tool [...]
Background: Patient handoffs increase the likelihood of miscommunication — and ultimately medical errors — among hospitalized patients. The Joint Commission has recommended a standardized approach to patient handoff as part of its National Patient Safety [...]
Background: JHCME.com is a free consultative medicine curriculum created for the 20,000 hospitalists in the profession. Now in its second year, the Web site is a response to the growing role that hospitalists play in [...]
Background: Although it is important for physicians to be involved with initiatives to enhance patient safety, little training is devoted to this area. In addition, the topic is challenging to teach, as house staff may [...]
Background: The UHS Hospitalist Program of Pitt County Memorial Hospital in Greenville, North Carolina, began in 2001 with 4 physicians and 1 nurse‐practitioner. Since that time, our hospitalist program has grown to 23 physicians and [...]
Background: Communication between members of the medical team — MDs, RNs, PAs, and house staff — has traditionally relied on a 1‐way paging system. Although effective, this medium has significant limitations including a 1‐way flow [...]
Background: Emergency department (ED) overcrowding has become a common problem in U.S. hospitals, resulting in increasing numbers of patients admitted to the medicine service being “boarded” in the ED. These patients are typically remote from [...]
Background: Interest in internal medicine (IM) has substantially decreased over the last decade. Although hospital medicine (HM) is currently the fastest‐growing specialty, many premedical and medical students are not aware of this field. With an [...]
Background: Many hospitals have instituted rapid response teams (RRTs) to prevent potentially avoidable deaths in general medical surgical unit patients. However, studies to date have not found consistent improvement in clinical outcomes as a result [...]
Background: Various agents are recommended bv Drofessional societies for venous thromboembolism (VTE) prophvlaxis followina total hio replacement (THR) or total knee replacement (TKR), but the cost effectiveness of individual agents is poorly understood. Although multiple [...]
Background: Most pediatric patients admitted to inpatient wards require peripheral intravenous (PIV) access for the administration of fluids, medications, or other intravenous therapy. Even though peripheral intravenous insertion can be painful, time‐consuming, and often difficult, [...]
Background: Complications from venous thromboembolism (VTE) kill more Americans each year than AIDS and breast cancer combined. Despite evidence‐based knowledge regarding the benefits of venous thromboembolism (VTE) prophylaxis in hospitalized medical patients, as well as [...]
Background: Emergency department (ED) access block is rapidly becoming a significant problem for children. ED access block is defined by total ED time > 8 hours because of an insufficient number of inpatient beds and [...]
Background: An accurate prediction model for perioperative outcomes of patients who have been clinically optimized prior to elective noncardiac surgery has not been well studied. We sought to develop a nomogram that would help physician [...]
Background: Pain control is a key part of care for hospitalized patients. Despite calls from major health care organizations to improve provider awareness and training about pain control, pain management remains inadequate for many hospitalized [...]
Background: Observational studies conducted prior to the hospitalist movement demonstrate improved patient outcomes in intensive care units (ICUs) staffed by intensivists compared with those staffed by nonintensivists. A large and growing nationwide intensivist shortage, however, [...]
Background: Quality measurement is increasingly important for medical centers. Regulatory organizations and payers are demanding quality care and quality improvement initiatives. Measurement is a foundation for all improvement methodologies but can be costly. Administrative data [...]
Background: Blood glucose (BG) control is difficult to achieve in the hospital setting, and the best approach to BG control in non‐critically ill patients is unclear. A few quality improvement studies have demonstrated improvements in [...]
Background: Hospitalization of older persons is accompanied by a disproportionate risk of poor outcomes and adverse events such as functional decline, delirium, and falls. Several process measures potentially associated with increased quality of care for [...]
Background: Research shows that continuity of care in the outpatient setting improves care and reduces risk of rehospitalization. However, the effects of continuity of care in the inpatient setting have not been studied. We know [...]
Background: Assessments of intensive care unit (ICU) performance currently rely on risk‐adjusted rates of in‐hospital mortality. These rates do not account for deaths occurring shortly after hospital discharge that may be attributable to the quality [...]
Background: Time‐motion studies have been used since the early 20th century to provide minute‐by‐minute accounts of how time is spent in factories and office settings alike. More recently, time‐motion methodology has been used in the [...]
Background: The combination of increasing numbers of hospitalists and their growing responsibility for the care of patients at the end of life (EOL) requires hospitalists to have palliative care skills. Although previous surveys have documented [...]
Background: Performance data in hospitals is typically derived from retrospective sampling, significantly restricting its relevance for active inpatients. If performance data could be relayed electronically in real‐time to the nursing unit, members of the frontline [...]
Background: Patients are vulnerable during care transitions, and adverse patient events occur frequently after hospital discharge. The incidence and impact of such events has primarily been studied at single institutions. We sought to evaluate the [...]
Background: Weight loss is a surrogate marker of volume changes with therapy in acute heart failure. Large drops (>50%) in B‐type natriuretic peptide (BNP) levels correlate with changes in wedge pressures. Wedge pressures correlate strongly [...]
Background: Literature on measurement of symptomatic improvement in ADHF admitted to telemetry is sparse. Visual analog scales (VASs) are valid measures of dyspnea in ADHF. Because dyspnea is a complex psychobiologic phenomenon and the Minnesota [...]
Background: Venous thromboembolism (VTE) is the third‐leading cause of cardiovascular death. Approximately 60,000 people die from VTE each year; however, VTE is the most common preventable cause of hospital death. Without prophylaxis, VTE occurs in [...]
Background: The Joint Commission requires that U.S. hospitals be smoke free, creating a valuable opportunity for hospitalized smokers to quit. Smoking cessation counseling is also a quality measure for Medicare patients hospitalized with heart failure, [...]
Background: Health care‐associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community‐acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug‐resistant organisms such as methicillin‐resfstant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. [...]
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. Previous research has suggested various approaches to improving [...]
Background: Acquired inpatient venous thromboembolism (VTE) accounts for significant morbidity and mortality and is considered largely preventable with pharmacologic prophylaxis. Appropriate VTE prevention has emerged as an important hospital quality measure and has become a [...]
Background: Health care–associated infection (HAI) is a common and costly patient safety problem. As of October 2008, U.S. hospitals will no longer receive Medicare reimbursement for certain types of HAI, thereby heightening the need for [...]
Background: Community‐acquired pneumonia (CAP) is the most common infectious cause of death in the United States and has thus been the target of numerous quality initiatives. Early administration of guideline‐concordant antibiotics, influenza and pneumo‐coccal vaccination, [...]
Background: Acetaminophen has been well known as an effective analgesic and antipyretic for more than a century. IV acetaminophen (IV APAP) is approved for the short‐term treatment of acute pain and fever in nearly 70 [...]
Background: Acetaminophen has been well known as an effective analgesic and antipyretic for more than a century. IV acetaminophen (IV APAP) is approved for the short‐term treatment of acute pain and fever in nearly 70 [...]
Background: It is well known that there are disparities in health care for minorities in the United States. Multiple studies have shown that differences exist in all aspects of care including prevention, diagnosis, and treatment, [...]
Background: In‐hospital cardiac arrest is rarely sudden and may be preventable if interventions are performed when patients are in the early stages of clinical deterioration. However, identifying high‐risk patients remains a significant challenge. Scoring tools [...]
Background: The number of academic hospitalists in the United States has grown rapidly, but few data exist regarding this workforce. We describe the current demographics, academic productivity, and promotion rates among academic hospitalists. Methods: We [...]
Background: Outpatient management of UTI as a treatment option was firmly established by Hoberman's study in 1999 and confirmed in Cochrane reviews in 2003 and 2007. However, UTI remains a common cause of pediatric hospitalization [...]
Background: The transition from insulin infusion is problematic. A pilot study in our institution revealed that uncontrolled hyperglyce‐mia was the rule in the first 48 hours after discontinuing insulin infusion and that basal subcutaneous (SC) [...]
Background: Although communication with primary care physicians (PCPs) during patient hospitalization is recommended, it is unclear if this communication is related to patient outcomes. Communication with PCPs may be especially important for frail older adults [...]
Background: Medications delivered through respiratory inhalers are the mainstay of treatment for patients with obstructive lung disorders (OLDs) such as asthma and chronic obstructive pulmonary disease (COPD). Unfortunately, respiratory inhalers are often used incorrectly, reducing [...]
Background: Patient handoffs at physician shift changes are limited in their ability to convey the insight that the primary team has gained by longitudinal personal care of the patient. The Patient Acuity Rating (PAR) is [...]
Background: Hispanics are the fastest‐growing segment of the U.S. population. An observation that Hispanics have lower all‐cause cardiovascular morbidity and mortality despite increased risk factor rates has been termed the “Hispanic paradox.” The Framingham Heart [...]
Background: The relationship between a patient and his or her health care providers is fundamental in providing effective care. Studies in ambulatory settings have shown that agreement between patients and their physicians is associated with [...]
Background: A significant barrier to communication between providers on hospital units is the fluidity and geographic dispersion of team members. Geographically localizing physicians to specific units may improve collaboration with other unit‐based team members and [...]
Background: Medicare has selected 10 hospital‐acquired conditions for which it will not reimburse hospitals unless the condition is documented as being “present on admission.” This “no‐pay‐for‐errors” rule may have a profound effect on the clinical [...]
Background: We previously found that the prevalence of both methicillin‐resistant S. aureus (MRSA) and community‐associated me‐thicillin‐resistant 5. aureus (CA‐MRSA) among health care workers (HCWs) at an urban academic center in Camden, New Jersey, in 2004‐2005 [...]
Background: Previous studies suggest academic physicians with adequate mentorship conduct more research, write more papers, and are more likely to mentor others. Given the youth of their field, hospitalists may not appreciate or experience the [...]
Background: The transition between inpatient and outpatient settings is known to be a period of high risk for adverse events such as medication and laboratory‐monitoring errors. Readmission rates, up to 20% after 30 days among [...]
Background: General internists and other generalist physicians have traditionally cared for their patients both in the clinic and in the hospital. Over the past decade, hospitalists have been highlighted as undermining the role of generalist [...]
Background: Childhood obesity confers a substantial risk of adult obesity, lifelong health risks, and social and economic disadvantages. BMI has been the standard as a reliable indicator of overweight and obese children. In 2005, the [...]
Background: Staffing and resource availability in hospitals diminish from day to night. Also, patients admitted at night are often passed off to a new care team in the morning. The impact of this discontinuity on [...]
Background: Working without support from residents, hospitalists anecdotally spend a great deal of time and effort coordinating care planning among different physician specialties, nurses, ancillary staff, and other health care professionals. Ultimately responsible for the [...]
Background: Many large hospital medicine groups utilize nurse case managers to enhance efficiency and extend the capability of hospitalists to manage larger volumes of patients. As part of an ongoing time–work flow study, we evaluated [...]
Background: Hospitalists have the potential to interact with inpatient staff nurses more frequently than physicians who also provide ambulatory care. Despite the existence of this specialty for more than a decade and its burgeoning numbers, [...]
Background: Our tertiary‐care academic hospital allocates low‐risk chest pain admissions without evidence of acute coronary syndrome (ACS) to either a nonteaching observation service staffed by hospitalists and nurse‐practitioners or a teaching cardiology service staffed by [...]
Background: Vancomycin is commonly used in an empiric antimicrobial regimen. Clinical pharmacy at our institution has defined therapeutic vancomycin troughs in accordance with the existing literature. Still, there is no centralized protocol for initiation of [...]
Background: Patients often do not understand or recall information presented during their hospitalization. Poor physician–patient communication in the hospital setting is related to adverse events and readmissions. In outpatient research, health literacy is strongly associated [...]
Background: Low health literacy is associated with poor understanding of medication instructions and, in some studies, with lower medication adherence, We developed and evaluated a 3‐part system intervention intended to increase refill adherence through attention [...]
Background: Beyond the well‐known complication of gout and nephroiithiasis, there is a mounting body of evidence that hyperuricemia is associated with hypertension and chronic renal disease and is an independent risk factor for coronary artery [...]
Background: Inappropriate antibiotic use is a major clinical problem in hospitals. The initial prescribing choices made by emergency department (ED) providers may be partially responsible for this situation. Unlike hospitalists, ED providers do not have [...]
Background: Improving discharge planning is a high priority in hospital medicine. There are numerous studies on discharge checklists, follow‐up phone calls, standardization of communication between inpatient and outpatient physicians, and links between improved follow‐up and [...]
Background: Medically “unnecessary” hospital days pose a great concern to patients, payers, hospitals, and care providers. Increasing length of stay from delays increases costs and potentially nosocomial complications. Hospitalists at our academic medical center (AMC) [...]
Background: Numerous studies have shown that hospitalists in community settings reduce hospital costs primarily through reducing length of stay. Although some research in the academic setting indicates that hospitalist teaching attendings reduce mortality, little research [...]
Background: Increasing work‐hour restrictions, older and sicker patients, and fragmented care may result in poorer quality care by inpatient medicine house staff. Recognizing this, the Accreditation Council for Graduate Medical Education proposes reducing noneducational work [...]
Background: Obstructive sleep apnea (OSA) has become a recognizable disorder among medical specialists but remains a relatively unexplored topic for surgeons, anesthesiologists, and their patients in the perioperative period. Recent studies have begun to describe [...]
Background: Fresh‐frozen plasma (FFP) is commonly used to correct intraoperative coagulopathies (believed to be secondary to clotting factor depletion, platelet consumption, and/or volume replacement strategies) but is associated with significant fluid volume if multiple units [...]
Background: Increased mortality has been observed for patients admitted on weekends to hospitals in several studies. The reasons for this “weekend effect” are unclear but may be related to reduced staffing levels, increased handoffs, or [...]
Background: Readmission to hospital soon after discharge is a significant burden to patients and our health care system. Centers for Medicaid and Medicare services are proposing to add hospital readmissions as a quality measure by [...]
Background: Venous thromboembolism, unstable angina, and atrial fibrillation are diseases that utilize parenteral anticoagulant therapy, which is often associated with bleeding and thrombocytopenia that require management and a prolonged hospital stay and pose an economic [...]
Background: In 2005, the Infectious Diseases Society of America and the American Thoracic Society published guidelines regarding treatment of health care–associated pneumonia (HCAP). These guidelines recommend MRSA coverage as well as 2 antipseudo‐monal antibiotics for [...]
Background: Coordination is a critical aspect of care involving multiple interdependent providers. The characteristics of care coordination among providers in a comanagement model have never been examined. Methods: Between April and October 2008, hospitalists, midlevels, [...]
Background: Although comanagement models of care are proliferating, the management structures of comanaging providers have not been characterized. Methods: Between April and October 2008, all eligible providers on a novel medical comanagement service (described elsewhere) [...]
Background: The Joint Commission's National Patient Safety Goals for 2008 and 2009 include numerous anticoagulation elements requiring hospitals to use approved protocols for the initiation and maintenance of anticoagulant therapy. Additionally, at our hospital, patients [...]
Background: Although substantial effort has been made to understand uptake of evidence‐based practice among participants in national quality campaigns, little attention has been directed toward hospitals that elect not to join these efforts. Methods: We [...]
Background: Few studies have investigated how to optimally educate physicians on the cognitive skills required for effective clinical handoffs. Methods: A single‐institution, prospective, randomized, controlled trial was conducted to explore the effectiveness of different educational [...]
Background: Increasing hospital efficiency has resulted in lower hospital length of stay (LOS); however, the impact of reduced LOS and hospital readmission rates has not been well described. Our objective was to determine trends in [...]
Background: Care by hospitalists has, in general, been associated with improved or similar cfinical outcomes and improved efficiency. However, less is known about the affect of hospitalists on conditions that may be dependent on consultants [...]
Background: The number of hospitalists in academic medical centers has grown rapidly. We evaluated the rates of satisfaction and burnout and the predictors and consequences of each in academic hospitalists. Methods: We performed a cross‐sectional [...]
Background: Effective communication among physicians during the hospital discharge process is critical to patient care. Since 2004 the Joint Commission has provided a set of necessary information to be included in all discharge documentation. Beyond [...]
Background: Effective communication between a hospitalist and his or her patients is essential. In the United States, the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties have recognized interpersonal and [...]
Background: There is an increased focus on measuring and improving quality of care for hospitalized older patients. Ideally, adherence to quality measures is associated with improved outcomes for these patients. This study aimed to assess [...]
Background: Effective communication and interpersonal skills are essential for delivering quality patient care and have been identified as a core competency for physicians. The Communication Assessment Tool (CAT) is a psychometrically validated instrument for patient [...]
Background: Peripherally inserted central catheters (PICCs) have become an increasingly attractive option for short‐term vascular access in hospitalized patients. PICC placement is a minimally invasive procedure and provides a convenient, dependable intravenous access. These advantages, [...]
Background: Since our program conducted a time study to see how hospitalists spend their time 4 years ago, we have significantly increased our daytime coverage as well as our average daily census (more than doubled). [...]
Background: Central line placement is a common ICU procedure that aids in hemodynamic monitoring, as well as delivery of medical treatment and nutritional support. In the United States alone, more than 5 million central venous [...]
Background: Tagged white blood cell scans (TWBCSs) are often used as a diagnostic study when searching for an occult infection after most other studies have been performed. These studies are not inexpensive, averaging near $400 [...]
Background: Patients are often discharged from hospitals before test results are finalized. Physician awareness of test results finalized after hospital discharge is poor and is an important patient safety concern. We aimed to determine the [...]
Background: It is estimated that 7%–15% of all strokes occur in the hospital, yet these strokes have slower response times and longer time to thrombolysis compared with strokes that occur outside the hospital. We initiated [...]
Background: The Vulnerable Elders Survey (VES‐13) was developed to identify community dwelling elders at risk for functional decline or death. It consists of a 10‐point score based on age, self‐reported health status, and ability to [...]
Background: Medication errors represent an important hospital safety issue, yet patients are largely excluded from active involvement in detecting and preventing these events. The magnitude of the problem is staggering, with 1 review finding almost [...]
Background: Bedside teaching is the ideal venue for teaching interpersonal skills and physical examination techniques and modeling professionalism. Hospitalists have an increasing influence on the inpatient education of internal medicine residents and medicine clerkship students [...]
Background: There is an increase in opportunities for hospitalists to comanage hospitalized patients. The benefits in regard to LOS, costs, and utilization of manpower are still being evaluated. As the elderly population with multiple comorbidities [...]
Background: Medical errors commonly occur during patient handoffs. Discontinuous care results in medical complications, redundant testing, and prolonged hospital stays. Teaching of handoffs is underemphasized in most residency training programs, and few supervising physicians are [...]
Background: Central line‐associated bloodstream infections (CLABSIs) cause significant morbidity, mortality, and cost to patients and the health care system. Because duration of use is a major risk factor for infection, the rate of CLABSI could [...]
Background: The transition from hospitalization to ambulatory care can be a stressful and confusing experience for the nearly 10,000 patients who are discharged every year at our institution. The maturation of the hospitalist field has [...]
Background: Information is frequently lost during in‐hospital transitions of care. An effective and timely sign‐out between providers relaying critical information may reduce errors. However, little is known about provider preferences and practices (or sign‐out. We [...]
Background: Obesity has been identified by the World Health Organization as a global epidemic of adults and children. In 2003–2004, the NHANES found that 17% of all children ages 2–9 years were overweight/obese (BMI ≥ [...]
Background: Vitamin B12 deficiency is associated with variations in red blood cell and white blood cell morphologies. These changes are also reflected in automated red cell measures. Are such changes of sufficient strength to influence [...]
Background: Environmental exposure to other patients carrying an agent is an important risk for many serious infections. This so‐called “colonization pressure” has been implicated in the acquisition of Clostridium difficile‐associated disease (CDAD) in the ICU [...]
Background: Hyponatremia can be associated with substantial morbidity and mortality. Identification of elements associated with the development of symptomatic hyponatremia is important in determining preventive strategies. This research sought a comprehensive list of risk factors [...]
Background: Hyponatremia is a commonly identified electrolyte abnormality. In general, the lower is the serum sodium, the greater is the likelihood of serious sequelae. Published data on profound hyponatremia is lacking. The goal of this [...]
Background: Factor V Leiden (FVL) and prothrombin (PT20210A) gene mutations are common genetic polymorphisms that have been associated with first‐time venous thromboembolism (VTE). These mutations have been associated with recurrent thromboses in some but not [...]
Background: Cystatin C is a cysteine proteinase inhibitor that is produced by almost all cells of the human body and is freely filtered by the glomerulus. In some settings, it may be a better marker [...]
Background: Despite effective treatments, many hospitals lack systems to facilitate treatment for substance use disorders after hospital discharge. We provided infrastructure to increase substance dependence treatment after hospital discharge and evaluated predictors of addiction treatment [...]
Background: Invasive medical procedures are the second most common cause of preventable adverse events in hospitalized patients. Central venous catheter (CVC) insertion is associated with life‐threatening complications such as arterial puncture, pneumothorax, and catheter‐related bloodstream [...]
Background: Aggressive glycemic control using insulin infusion has been associated with decreased mortality in subsets of surgical and medical ICU patients. There has been little published on safety or efficacy for insulin infusion use on [...]
Background: Approximately 300,000 hip fractures occur in the United States each year with 1‐year refracture and mortality rates as high as 12% and 25%, respectively. Bisphosphonate use after hip fracture reduces morbidity and mortality. Expert [...]
Background: Hospitalization rates in Chicago are double the national average for asthma and triple that among African Americans compared with whites in Chicago. In 2009, to protect the ozone layer, the familiar easy‐to‐use metered dose [...]
Background: Hypertension (HTN) is a highly prevalent cardiovascular risk factor affecting more than 65 million Americans. Studies suggest that HTN is particularly prevalent among inpatient populations. Little is known about provider knowledge and practices regarding [...]
Background: Venous thromboembolism (VTE) is responsible for up to 600,000 hospitalizations per year in the United States. The appropriate use of evidence‐based VTE prophylaxis regimens, such as unfractionated heparin (UFH) or low‐molecular‐weight heparins (LMWHs), can [...]
Background: Readmissions cause significant distress to patients and caregivers in addition to considerable financial costs. A key component of reducing readmissions is identification of at‐risk patients prior to discharge. This determination currently is commonplace, as [...]
Background: The assessment of patients with acute chest pain (CP) remains a continuing clinical problem, with major logistic and financial implications for health care providers. Although appropriateness criteria for stress echocardiography (SE) were unavailable at [...]
Background: Poor communication on hospital discharge between hospitalists and primary care physicians (PCPs) may result in worse patient outcomes, adverse medication events, decreased patient and physician satisfaction, and increased costs. Conversely, excellent communication may improve [...]
Background: Coronary care units (CCUs) are uniquely designed and staffed to care for critically ill patients with cardiovascular disease, whereas medical intensive care units (MICUs) are specially organized and staffed for the care of patients [...]
Background: Recognition of chronic kidney disease (CKD) may be improved by electronic glomerular filtration rate (eGFR) reporting. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) provides recommendations on quantitative evaluation for proteinuria, prescription [...]
Background: CA‐MRSA is a growing epidemic infection that has resulted in a transformation of the approach to skin and soft‐tissue infections. Although, CA‐MRSA differs from other MRSA infections in many ways, one difference that affects [...]