Repeat Thoracenteses: To Talc or Not to Talc?

Background: Thoracentesis is a commonly performed procedure to remove fluid from the pleural space. When repeat thoracenteses are required, patients are often referred to thoracic surgery to undergo more definitive treatment in the form of [...]

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Advance Directives: The Best Predictor of Congruence Between Preferred and Actual Site of Death

Background: Death in the United States frequently occurs in institutions, despite the majority of persons indicating a preference to die at home. Little research has examined how well individual preferences compare with actual site of [...]

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Discharge Location Disagreements and Rehospitalization Risk among Frail and Elderly Adults

Background: Rehospitalizations are costly and can be disruptive for patient cane. To our knowledge, no study has examined the impact of patient agreement with recommendations for the place of discharge as a cause of rehospitalization. [...]

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Identifying Pediatric Patients at High Risk for Failure to Achieve Continuity of Care at Hospital Discharge

Background: Increasing numbers of hospitalized infants and children are cared for by pediatric hospitalists. Transitions in care and transfer‐of‐care providers at the time of hospital discharge place patients at risk for failure to achieve postdischange [...]

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Utilizing Audit and Feedback to Improve Hospitalists' Performance in Tobacco‐Dependence Counseling

Background: Cigarette smoking is the leading cause of preventable death in the United Stales, accounting for approximately 440,000 deaths from smoking‐attributable illness each year. Smokers hospitalized for acute illnesses may be more receptive to smoking [...]

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Acute Changes in N‐Terminal Probrain Natriuretic Peptide During Hospitalization and the Risk of Readmission and Mortality in Patients with Congestive Heart Failure

Background: Congestive heart failure (CHF) is characterized by multiple hospital readmissions and increased risk of death. Some studies suggest using serial changes in N‐terminal probrain natriuretic peptide (NT‐proBNP) as a predictor of adverse events in [...]

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Implementation of a Structured Electronic Tool to Improve Patient Handoffs and Resident Satisfaction

Background: The handoff of patient information and care is a vulnerable time during hospitalization. Inadequate communication during handoffs is associated with adverse events and near misses. Although recent guidelines from both the Institute of Medicine [...]

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Practice Patterns for Antibiotic De‐escalation in Culture‐Negative HCAP

Background: Published guidelines for treatment of health care‐associated pneumonia (HCAP) recommend initial broad‐spectrum antibiotic therapy with appropriate de‐escalation based on culture results. Guideline recommendations are heavily based on data from intubated patients, in whom cultures [...]

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Hand Hygiene Practices among Hospitalists in 3 Different Practice Settings

Background: Proper hand hygiene is one of the simplest interventions to reduce spread of infectious diseases in the hospital setting. CDC currently recommends hand washing with soap and water or alcohol‐based gel before and after [...]

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Reducing Inappropriate Variability in Coding Through the Use of a Stepped Feedback System

Background: Proper coding is an essential skill necessary to capture the appropriate level of care provided by the physician. Both undercoding and overcoding are problematic, and few residency programs adequately educate trainees in this skill. [...]

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A Novel Financial Incentive Program for Residents to Improve Communication with Primary Care Physicians

Background: Financial incentive programs have been successfully used lo encourage performance improvement, but until now. few such programs have engaged physicians‐in‐training. UCSF Medical Center and Office of Graduate Medical Education implemented a novel group financial [...]

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A Patient Hotline: Developing a Postdischarge Telephone Triage System

Background: Adverse events tallowing hospital discharge are common and represent a vulnerable time for patients. Unlike ambulatory practices That provide contact mechanisms for patients who have questions about their care, hospital medicine groups are faced [...]

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An Electronic Dashboard to Improve Compliance with Inpatient Quality Measures

Background: Inpatient quality measures, such as compliance with multidisciplinary ventilator bundles to prevent ventilator associated pneumonia and venolhromboembolism (VTE) prophylaxis have been linked to reduced morbidity and mortality. However, at many hospitals not all suitable [...]

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HSV in Older Children

Case Presentation: This is a 2‐year‐old female who presented in status epilepticus with a fever. She had no previous history of seizures. She was stabilized and loaded with AEDs, and treated with empiric antibiotic therapy [...]

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What Lies Beneath…

Case Presentation: An 18‐year‐old African American male brought in by his guardian with chief complaints of bizarre behavior for 10 days. The patient had (not unusually) “disappeared” for several days with friends. However, he had [...]

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