Case Presentation: A 67‐year‐old male presented with a 4‐week history of productive cough and shortness of breath. Because he developed weakness and could not walk for the last two days, he was transferred to our [...]

Case Presentation: A 45 year‐old woman presents with 2 weeks of weakness and fatigue. The patient has no past medical history except for depression, and her only medication is an SSRI. The patient denies any [...]

Case Presentation: A 70 year old woman with no known past medical history presented to a district hospital in Hinche, in Haiti’s Central Plateau, with symptoms of dyspnea and lower extremity edema. Her family reported [...]

Case Presentation: A forty‐three year‐old woman presented with three days of progressive dyspnea and chest pain. The chest pain was band‐like, constant, non‐pleuritic, non‐positional and unrelieved by pain medications. The dyspnea initially was with exertion [...]

Case Presentation: A 64‐year‐old woman presented with acute onset right lower extremity pain and swelling. She had a history of moderate car travel one week prior to admission and described decline in stamina, generalized fatigue, [...]

Case Presentation: A 30‐year‐old man visiting from Russia presented to our public hospital with two days of a progressive, descending erythematous rash. He also complained of four days of fevers to 40°C, myalgias, conjunctivitis, and [...]

Case Presentation: A 59‐years‐old female presented with progressive muscle weakness of arms and legs, together with parasthesia in both hands and feet for one‐month duration. Her medical history was remarkable for depression, hypertension, and gastro [...]

Case Presentation: A 75 YOM was admitted with leg pain due to aorto‐iliac occlusion. Aortobifemoral bypass was performed under full dose heparin followed by SC heparin. Five days later the patient developed a right gastrocnemius [...]

Case Presentation: A 59‐year‐old African American woman with type 2 diabetes mellitus presented with left‐sided weakness and dysarthria for 18 hours. Her medical history was significant for hypertension, hyperlipidemia, coronary artery disease with bypass surgery [...]

Case Presentation: A 42 y/o Hispanic female with a history of IV drug abuse and dermatitis since 2005 with recurrent episodes of cellulitis presented to the hospital with severe edema, erythema and pain of the [...]

Case Presentation: A 46‐year‐old woman presented to the referring hospital with uncontrolled high blood pressure for the preceding several weeks. Two months prior, she underwent an outpatient ablation for supraventricular tachycardia. At that time, she [...]

Case Presentation: A 53 year old man with a history of HIV, CD4 count of 20, pulmonary aspergillosis, history of pulmonary stenotrophomonas maltophilia, and bronchus intermedius stenosis presented with fever, dyspnea, and cough of two [...]

Case Presentation: A 65‐year‐old man with a medical history significant for hypertrophic cardiomyopathy presented with a 3‐week history of mid‐sternal chest pain, fevers, and sweats. His primary care physician sent him to the emergency department [...]

Case Presentation: A 36‐year‐old Caribbean male with a past medical history of type 2 diabetes mellitus and hypertension presented acutely to the hospital with syncope along with muscle aches, fevers to 104 degrees Fahrenheit (F) [...]

Case Presentation: An 82‐year‐old woman with chronic kidney disease was admitted to the hospital with a one day history of confusion, fever, and acute on chronic renal failure. She was empirically treated with vancomycin, cefepime, [...]

Case Presentation: A 58‐year‐old African American male presented to the ED complaining of bilateral lower extremity edema with a medical history significant for metastatic testicular seminoma. He had undergone a right orchiectomy approximately 13 days [...]

Case Presentation: An 18‐year‐old woman without previous medical history on oral contraceptives (OCP) presented to the emergency department with headache and vomiting. The headache first appeared 4 days ago; it was moderate in intensity, bitemporal [...]

Case Presentation: A 27‐year‐old woman with reported sickle‐cell disease, protein C deficiency, pulmonary embolism (PE), and recent methicillin‐resistant Staphylococcus aureus (MRSA) bacteremia was admitted for sickle cell crisis. She was flying between the east and [...]

Case Presentation: A 63‐year‐old male nonsmoker with monoclonal gammopathy of undetermined significance and prostate cancer presented with 2.5 months of dysphagia, odynophagia, hoarseness, and midline neck swelling. Computed tomographic (CT) scan of the neck revealed [...]

Case Presentation: An 87‐year‐old woman presented with one year of progressively worsening left‐sided hearing loss and left ear fullness, 6 months of hoarseness, and 1 month of dysphagia. She also reported an abnormal appearance of [...]

Case Presentation: LB is a 51 year‐old man who presented for fever and shortness of breath for one week. Associated symptoms included fatigue, weakness, chills, and night sweats. There is no weight loss or hemoptysis. [...]

Case Presentation: A 60 year‐old woman presents with a 3 day history of weakness and shortness of breath. Associated symptoms include pain in her back, occiput, and chest, as well as subjective fevers and presyncope. [...]

Case Presentation: A 65‐year‐old man with a 50‐pack‐year smoking history but no known chronic medical problems presented to the emergency department with eight days of left retro‐orbital pain and frontal headache and five days of [...]

Case Presentation: A 58 year old woman is transferred to our Intensive Care Unit for septic shock, acute renal failure, and acidemia. She was well until 3 days ago where she was weak, had nausea [...]

Case Presentation: A 54 year‐old man with a history of multiple myeloma presented with ten weeks of nausea and vomiting with associated anorexia and a 50‐pound weight loss. His symptoms began five days after receiving [...]

Case Presentation: A 43‐year‐old female was admitted to our hosipital experiencing fever, cough, dyspnea, generalized lymphadenopathy and weight loss. She had been examined previously in another hospital and subsequently treated for community acquired pneumonia for [...]

Case Presentation: This 67‐year‐old Caucasian MS female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a non‐tender, cyst‐like mass fixed in the midline. Pelvis [...]

Case Presentation: A 52‐year‐old man presented with 4 weeks of dry cough, dyspnea, weight loss, chills, subcutaneous nodules, fatigue, and generalized weakness. His past medical history was significant for myasthenia gravis, metastatic thymoma to lungs, [...]

Case Presentation: This is a 58 year old male with no known past medical history was transferred to our facility with a chief complaint of worsening purpura on the bilateral lower extremities, chest, back, face [...]

Case Presentation: A 23 year old Caucasian man was admitted to the hospital with a five day history of progressively worsening parasthesias and numbness of the feet which spread to his legs, arms and hands. [...]

Case Presentation: A 51year‐old male presented to medical ICU with hemoptysis, acute blood loss anemia and acute hypoxic respiratory distress. Bronchoscopy with transbronchial biopsy revealed diffuse alveolar hemorrhage (DAH) with bronchoalveolar lavage negative for infectious [...]

Case Presentation: , A 21 year‐old Caucasian man with no significant past medical history was referred for night sweats and fatigue. The patient denied foreign travel, sick contacts, dental appointments and risky sexual encounters. Physical [...]

Case Presentation: A 42‐year‐old woman presented to the Emergency Department with intermittent sub‐sternal heaviness, shortness of breath and vomiting. Review of systems was negative for chills, fever, cough, sore throat, headache, abdominal pain, diarrhea, dysuria, [...]

Case Presentation: A 41 year‐old man with a past medical history of AIDS CD4 count of 2 cells/ml was found in the subway complaining of generalized weakness and a tender lesion on his left leg. [...]

Case Presentation: 62 year old male from Arizona was admitted at an outside hospital with a 3 week history of headaches, fever and arthralgias. Patient was exposed to desert flora and surrounded by wild life, [...]

Case Presentation: We report a case of non‐syndromic familial thoracic aortic aneurysm and aortic dissection (FTAAD) discovered in a 31‐year‐old man presenting with heart failure secondary to a 9.5cm ascending aortic aneurysm. He underwent urgent [...]

Case Presentation: A 49‐year‐old man was admitted to our institute with a 5‐day history of profuse watery diarrhea without any associated abdominal pain or fever. His past medical history was significant for adult‐onset asthma that [...]

Case Presentation: A 34 year old African American female presented to the ED after developing abdominal pain, repeated nausea and emesis of six hours duration. Of note, the patient had a thyroid nodule removed 10 [...]

Case Presentation: A 54 year‐old woman with a history of Nissen Fundoplication presented with two weeks of worsening chronic epigastric pain and one day of fever. For two years, she had recurrent episodes of epigastric [...]

Case Presentation: Eighty one year old female was brought to the emergency department by Emergency Medical Service because of the complaints of nausea, vomiting and dizziness. En route she became unconscious and was found to [...]

Case Presentation: An 88 year‐old Hispanic man with non‐insulin dependent diabetes, whose oral anti‐hyperglycemic agents were discontinued a week prior to admission due to hypoglycemia, re‐presented with hypoglycemia. He also reported progressive fatigue and poor [...]

Case Presentation: A previously healthy 51‐year‐old man presented to our institution with a 6‐month history of intermittent rash. He described his rash as 2‐3 centimeter raised, red, pruritic lesions occurring on the face, extremities, back [...]

Case Presentation: 2A 19 year old Bulgarian G2 P1 at 35 weeks by last menstrual period confirmed by ultrasound was found to have a platelet count of 40,000/µL during an admission for pyelonephritis. Past medical [...]

Case Presentation: An otherwise healthy 36‐year‐old male presented to our institute with a 4‐day history of low‐grade fever accompanied by sore throat and myalgia. Physical examination was remarkable for an injected pharynx without any neck [...]

Case Presentation: 72 year old Caucasian man who presented to the emergency department with sudden onset severe upper abdominal pain. Pain radiated to the back, with associated vomiting. No history of alcohol use. Past medical [...]

Case Presentation: A 57 year‐old female with a history of a perianal abscess presented with fevers and chills for seven days. Two weeks prior the abscess had drained spontaneously. On admission, temperature 100.9°F, BP 104/70, [...]

Case Presentation: A 55 year old obese black male with a history of Diabetes mellitus type 2 of more than 15 years, hyperlipidemia, hypertension, and recurrent CVA with residual right hemiparesis admitted for rehab. He [...]

Case Presentation: A 23‐year‐old Chinese woman with a 5‐year history of Graves’ disease (GD) was admitted for a newly diagnosed ovarian tumor. During workup for the tumor, computed tomography (CT) of the chest incidentally showed [...]

Background: While the majority of children with unplanned admissions are admitted through the emergency department (ED), direct admissions constitute a significant proportion of hospital admissions nationally. Despite this, past studies among children have not characterized [...]

Background: It is unknown whether major changes in population insurance coverage are associated with changes in thirty‐day hospital readmission rates, despite the Affordable Care Act’s coverage expansions coming into effect this year. Methods: To evaluate [...]

Background: There is growing recognition that engaging patients/caregivers in self‐management will improve outcomes and lower costs. This is particularly important in the acute care and post‐discharge setting–new treatments have been initiated, conditions require close monitoring, [...]

Background: Balancing academic work with expanding clinical demands is a challenge for many academic hospital medicine programs (AHMs). Understanding the infrastructure that best positions successful programs to thrive academically is important to facilitate broader maturation [...]

Background: Hospitalized medical patients are known to be at increased risk for venous thromboembolism (VTE) but the ability to ascertain VTE risk in this patient population is limited. Although several risk assessment models (RAMs) exist, [...]

Background: Pediatric Hospital Medicine (PHM) programs have grown dramatically in the last 10 years. The last national American Academy of Pediatrics (AAP) survey of pediatricians’ attitudes towards and experiences with pediatric hospitalists was conducted in [...]

Background: The American Recovery and Reinvestment Act subsidizes hospitals’ implementation of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries due to medication errors (preventable adverse drug events, pADEs). Effects [...]

Background: Since July 2007, hospitals are required to notify hospitalized Medicare and Medicaid beneficiaries of their rights to appeal their discharge. Should a patient decide to appeal the care team’s discharge decision, federally appointed Quality Improvement Organizations [...]

Background: Reducing hospital readmissions has been the focus of much attention recently. Patients who readmitted may have been ill‐prepared for discharge. One measure of preparedness has been endorsed by the National Quality Forum, but other [...]

Background: The Joint Commissions’ core measure on VTE prevention has added more pressure to increase the rate of VTE prophylaxis in hospitalized medical patients. One potential unintended consequence of this is an increase in the [...]

Background: Front‐line hospitalists report that excessive hospitalist workload adversely affects quality of patient care. However, there is a paucity of research examining the direct impact of variation in workload on patient outcomes. We determined the [...]

Background: Reducing hospital readmissions is a target for improving quality and reducing costs of health care. We studied whether a structured, post‐discharge follow‐up call at 48 to 72 hours by the same physician who cared [...]

Background: Delirium is common in the intensive care unit (ICU) and associated with increased length of stay, cost, and long‐term mortality and cognitive impairment. Disrupted sleep is common in critically ill patients and a potentially [...]

Background: The term “STAT” is meant to convey a sense of urgency, yet can be interpreted differently by inpatient care providers across disciplines. We found the current STAT order process for medications at one VA [...]

Background: Hospital admission is a critical point in care transition for patients and is prone to errors impacting patient safety and quality of care. We identified a lack of coordination between individuals in various disciplines [...]

Background: Hospitals face significant challenges and opportunities related to the quality of care received by patients who are transferred from hospitals to SNFs. Ongoing pressure on hospitals to contain length of stay and the growing [...]

Background: Preventing avoidable readmissions has become a national healthcare priority. Patients discharged to skilled nursing facilities (SNFs) are a particularly high‐risk population, with an estimated 25% of all Medicare patients discharged to SNFs being readmitted [...]

Background: The Pediatric Hospital Medicine Strategic Planning Roundtable mandated the creation of a dashboard to enable programs to monitor their clinical practice and make continuous improvements. A subcommittee then proposed the specific metrics to include. [...]

Background: With the advent of electronic medical records (EMR), hospitalists now have access to large data sets and can harness Big Data techniques to study practice variation and optimize clinical behavior. Purpose: To use innovative [...]

Background: Improving patient satisfaction is a major focus of hospitals and is a widely reported, public hospital quality measure. Satisfaction could be driven by many factors, including patient perceptions of communication and continuity of care [...]

Background: Effective patient‐physician communication is associated with improved patient experience and superior clinical outcomes. Designing interventions that have a measurable impact on physician communication scores, however, has been challenging. The aim of this study was [...]

Background: As the hospital workforce becomes increasingly interdisciplinary in recognition of the different skillsets required for effective patient care, high quality communication will become ever‐more critical. How often various team members communicate, and the paths [...]

Background: As of July 2010, there were more than 30,000 hospitalists in the United States. The quality of care rendered by hospitalists is not uniform. Although patient satisfaction metrics like Press Ganey attempt to measure [...]

Background: Undiagnosed and uncontrolled hypertension are prevalent public health issues. Their relationship with low health literacy, which affects approximately 36% of adult Americans, is not well studied. We evaluated the relationship between low health literacy [...]

Background: The patient‐physician relationship is complex, often infused with a number of intangible factors. Several studies have reported that physician attire may be an important and modifiable determinant of a patient’s trust, confidence and satisfaction [...]

Background: Strong physician communication skills can enhance the patient experience and improve patient satisfaction but data consistently reveal dissatisfaction with physician‐patient interactions with little evidence examining specific deficiencies among physicians. Further, few communication improvement strategies [...]

Background: Teamwork is essential to providing safe hospital care. In a prior study involving 2 medical units in our hospital, Structured Inter‐Disciplinary Rounds (SIDR) improved teamwork climate and reduced adverse events (AE). Methods: We sought [...]

Background: The care delivery in a teaching hospital depends on effective communication amongst multiple healthcare providers. Adverse outcomes and patient care delays are often caused by communication failure. Several hospitals utilize a paging system to [...]

Background: Although physicians are increasingly being trained in communication best practices, improving HCAHPS (hospital consumer assessment of healthcare providers and systems) patient experience scores remains challenging. As faculty engagement in and resulting adoption of communication [...]

Background: Surveys such as the Press Ganey Survey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) provide quantitative performance data regarding patient perceptions of and satisfaction with care. Hospitals use this data to [...]

Background: Discharge (DC) communication processes should be driven by the preferences of primary care providers (PCP) who follow‐up patients post‐discharge. Despite the growth of hospital‐affiliated primary care networks, many practices remain independent. Network affiliation provides [...]

Background: Teamwork is essential to providing safe and effective care. However, research shows that physicians and nurses in the hospital do not communicate consistently about their patients. Discrepant views on quality of collaboration among physicians [...]

Background: COPD is the 3rd leading cause of death in U.S. In 2006, 1,254,703 hospitalizations (NIS) were attributed to COPD and had a mean cost of $9545 +/‐ 12,700. Predicting mortality in COPD has proven [...]

Background: Physostigmine is used to treat anticholinergic toxicity and education on its use is relevant for physician training. In fact, the American Boards of Pediatrics and Emergency Medicine specifically list toxicology or poisoning on their [...]

Background: For healthcare providers, volunteerism and service education are important aspects of professional development and public leadership. While several research studies have examined volunteerism among physicians, we know little about such activities among Hospitalists compared [...]

Background: The number of Hospitalists Trained in Family Medicine (HTFM) has tripled in the past 6 years, now comprising 10% of Society of Hospital Medicine (SHM) membership. There are no ACGME guidelines or required pathways [...]

Background: Cross‐cultural care focuses on the ability to communicate effectively and provide quality health care to diverse patients. Studies have shown that cross‐cultural care issues may detract from the delivery of high quality health care [...]

Background: The clinical goals of medical school are to ensure that graduating students have the capacity for disease management, coordination of care, and effective communication for multiple patients. A specific skillset is needed to successfully [...]

Background: Entrustable Professional Activities (EPAs) have highlighted entrustment of autonomy by attending physicians to housestaff as a measure of assessment in graduate medical education. Entrustment is a key concept in understanding housestaff readiness to progress [...]

Background: Bedside rounding (BR) on inpatients has decreased over time. BR has many potential benefits that include increased shared medical decision making and a better understanding of the patient’s medical problems as well as plan [...]

Background: Acute pancreatitis as a complication of vaccinations has been described for measles, mumps, rubella and others but none has been described for the inactivated influenza vaccine. We present a case of recurrent episodes of [...]

Background: Academic hospital medicine groups frequently work in clinical care, quality improvement (QI), and medical education, but may not emphasize or have the training to conduct traditional clinical research. However, dissemination of scholarly work is [...]

Background: Avoiding missed opportunities to provide guideline recommended care through hospital‐based self‐management education is becoming increasingly common. To avoid preventable re‐hospitalizations it is important to know if and when post‐hospital discharge educational reinforcement is needed. [...]

Background: Residency training is grounded in experiential learning, or having residents assume care for a set of patients. Restricted residency duty hours have reportedly led to inpatient attendings playing a larger role in direct patient [...]

Background: Undergraduate medical education is a unique experience with significant time commitment, multiple stressors, and challenges with long lasting personal and professional impact. It has been shown that medical students are vulnerable to certain poor [...]

Background: The number of hospitalists in the US grew from 1000 in 1996 to 30,000 in 2010. In 2013, 70% of hospitals with over 200 beds are served by hospitalists. Driving forces behind hospital medicine’s [...]

Background: Giving feedback to learners is an essential tool in medical education. Despite feedback seeming so ubiquitous in the teaching environment, formal instruction on how to give relevant and timely feedback seems to be lacking. [...]

Background: Research into post discharge risk has emphasized medical comorbidity with less consideration of patient functional status and social support. The Patient‐Reported Outcome Measurement Information System (PROMIS) is an inventory of NIH‐funded, publicly available measurements [...]

Background: Advanced age is one of the predictors of the development of neutropenic fever in oncology patients. We hypothesize that older cancer patients with age ≥65 years are more likely to have bacteremia during neutropenic [...]

Background: Today, up to 90% of rehospitalizations from long term care facilities appear to be unplanned. The presence of dehydration in the rehospitalization process has rarely been specifically explored. The study’s objective was to identify [...]

Background: Despite evidence of high burden of disease, higher costs, and worse outcomes of care of older adults with acute illness, there is limited understanding of the presentation, diagnostic strategies, and management of these patients. [...]

Background: Global payment contracts are increasingly common agreements between insurance payers and healthcare providers that incorporate aspects of risk‐adjustment, capitation and pay‐for‐performance. While industry surveys suggest that healthcare organizations view physicians as a significant obstacle [...]

Background: Despite the fact that there are rather equal numbers of men and women entering and graduating from medical school, disparities still exist for women in medical leadership roles and academic productivity. Some studies have [...]

Background: Little is known about the ability of physicians to predict death in hospitalized patients over the subsequent year. Accurate prediction of death can facilitate discussions for end‐of‐life planning. Methods: The study was part of [...]

Background: Acute pulmonary embolism (PE) is a common and frequently fatal disease. Mortality could be reduced by early diagnosis and management. The clinical presentation of PE is variable and nonspecific and thus the diagnostic delay [...]

Background: Pneumococcal infection accounts for many cases of community‐acquired pneumonia. Patients with pneumococcal bacteremia (PB) are at risk for developing sepsis, severe sepsis or septic shock. Moreover, patients with post‐splenectomy, congenital asplenia or hyposplenia are [...]

Background: While an increasing literature describes and assesses resident work activities in the hospital, no data focus on the post‐call day. On this day, interns are responsible for managing diagnostic and treatment plans for a [...]

Background: When patients present to emergency departments too sick to be sent home, hospitals increasingly provide observation services, meaning extended outpatient visits expected to last under 48 hours during which patients are treated and reassessed. [...]

Background: Platelets play an important role in arterial thrombosis, acute coronary syndrome, and cardiovascular disease. Some epidemiological studies have suggested that high serum selenium levels may be associated with decreased risk of thrombosis and cardiovascular [...]

Background: Anemia is a common medical problem in hospitalized patients. For several decades parenteral iron was available only as high molecular iron dextran preparations which were associated with frequent serious adverse reactions including anaphylaxis. Despite [...]

Background: The Centers for Medicare and Medicaid Services (CMS) recently changed observation and inpatient status determination from a decision based on clinical criteria to one based on time spent under care. Effective October 1, 2013, [...]

Background: Care following cardiac arrest includes therapy to support the patient as well as identification of the cause of arrest. It is unclear whether or not a screening cranial computed tomography (CT scan) is necessary [...]

Background: Current guidelines recommend stress ulcer prophylaxis (SUP) to reduce the risk of an upper gastrointestinal bleed (GIB) in hospitalized patients with coagulopathy, defined as an international normalized ratio (INR) > 1.5 or a platelet [...]

Background: Research from the Health Protection Agency identified 394 surgical site infections among 4,107 women followed up after a Caesarean section (C‐section) operation (9.6%). The majority of these infections were minor (88%) and the risk [...]

Background: Proper wound fluid management is key in the management of a wound. The purpose of this study is to evaluate a hydroellular foam with a silicone adhesive for a variety of parameters on wide [...]

Background: In 2010, there were approximately 26 million people in the US with diabetes and ranked as the seventh leading cause of death. Over 85% of lower limb amputations in patients with diabetes are preceded [...]

Background: The HEART (History, ECG, Age, Risk factors and Troponin) score was recently shown to be potentially useful in identifying patients presenting with chest pain with a very low pretest probability of acute coronary syndrome [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbation is a common clinical condition that requires hospitalization. However, identifying which patients would be appropriate for a short stay in an observation unit versus an inpatient admission has [...]

Background: The observation unit is a growing part of many hospitals and is typically where most patients from the emergency department (ED) are referred to evaluate low‐risk chest pain. Various tools for risk stratification of [...]

Background: Congestive heart failure has been used to identify high‐risk patients in acute pulmonary embolism. Diastolic dysfunction is one of the major causes of congestive heart failure but has been poorly understood. The implications of [...]

Background: It is well known that peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism (VTE). While most PICC VTE studies have focused on upper‐extremity deep vein thrombosis (DVT), some [...]

Background: Growing use of peripherally inserted central catheters (or, “PICCs”), has led to increasing recognition of the risk of bloodstream infection (BSI). Despite increasing awareness of this outcome, limited data regarding risk factors associated with [...]

Background: In the United States, survival in patients experiencing out‐of‐hospital cardiac arrest varies significantly between and within hospitals. Many studies have shown less favorable outcomes for cardiovascular disease entities on weekends relative to weekdays. We [...]

Background: Enoxaparin, a low‐molecular weight heparin (LMWH), is frequently used in place of unfractionated heparin (UFH) for anticoagulation. LMWH have been favored by expert groups in many clinical settings given their advantages over UFH, including [...]

Background: Previous studies have shown that coffee consumption is protective against hepatic fibrosis, cirrhosis, and hepatocellular carcinoma. However, few have examined the relationship between coffee/caffeine and nonalcoholic hepatic steatosis (NAFLD). Aim: To assess the association [...]

Background: Early or 30‐day hospital readmission rates are used to measure quality of inpatient hospital care. Consequences of early readmission often include duplication for much of the assessment, diagnosis, and treatment from the previous admission. [...]

Background: In an era of healthcare reform, an important priority to reduce costs and produce savings is to decrease and avoid hospital stay since hospital admissions account for a large proportion of healthcare spending. Our [...]

Background: A recent study showed that many hospitalized women, particularly those who are low income and at high risk for developing breast cancer, are non‐adherent with breast cancer screening recommendations. This same study found that [...]

Background: Lower rates for breast cancer screening persists among low income and uninsured women despite the proven mortality benefit. This study explores the amount of money that hospitalized women, most of whom were low income [...]

Background: To assess the effect of oral nutrition supplements (ONS) on 30‐day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients, aged 65 and over, with diagnoses affected by new Medicare [...]

Background: Over the past decade, there have been great interests in eliminating the LAA as a source of emboli through a catheter based approach. A novel epicardial‐deployed percutaneous LAA ligation device called the LARIAT® (SentreHeart, [...]

Background: To examine the impact of Hurricane Sandy and the subsequent blackout in southern Manhattan on emergency room (ER) visits of patients with a diagnosis of cancer, as 4 neighboring hospitals (2 private, 1 city [...]

Background: Congestive Heart failure (CHF) is a contributor/risk factor for osteoporosis. The hypothesis is that due to renal insufficiency there is an activation of the renin‐angiotensin‐aldosterone system, increased parathyroid hormone levels, and hence decreased bone [...]

Background: It is estimated that severe sepsis /septic shock is one of the most common causes of mortality in the ICU and a large percentage of those cases are identified in the emergency room. Rivers, [...]

Background: Red blood cell (RBC) transfusion is a common procedure in hospitals, with approximately 14 million units transfused in the U.S. in 2011. Although direct transmission of infectious agents via allogeneic RBC transfusion is now [...]

Background: Current VTE prophylaxis guidelines strongly promote risk assessment on the individual level. The IMPROVE VTE risk assessment model (RAM) is a composite score formulated to predict individual VTE risk during hospitalization. It is developed [...]

Background: Pre‐renal replacement therapy (RRT) patient education leads to reduced central venous catheter use, increased uptake of peritoneal dialysis, and improved access to transplant for patients with end‐stage renal disease. Yet many patients with advanced [...]

Background: Secondary prevention of stroke in patients newly diagnosed with carotid artery stenosis remains a challenge. Several studies have reported the use of single as well as dual antiplatelet therapy in patients with stroke, but [...]

Background: Atrial fibrillation (AF) represents one of the leading diagnoses for hospitalized patients and is a common cause of cardioembolic stroke. Patients with AF are five times more likely to have a stroke than those [...]

Background: An individual’s risk of atrial fibrillation‐related stroke can be estimated with the use of a CHADS2 score with higher scores correlating with a greater risk of cardioembolic stroke. Current clinical guidelines recommend the use [...]

Background: Osteoporotic fractures are a significant health issue and create a heavy economic burden. Initial studies suggest that diabetes mellitus (DM) could be a risk factor for increased fractures. One of the main mechanisms could [...]

Background: Due to restrictions on resident duty hours, increasing numbers of patients at academic hospitals are being cared for by hospitalists paired with advanced practice providers (H‐APP teams). Hospitals are held accountable for their patient’s [...]

Background: Unplanned hospital readmission is a complex process, particularly if the patient is readmitted to an acute‐care institution other than their original hospital. This study tested the hypothesis that alternate‐hospital readmission is associated with increased [...]

Background: Streptococcus anginosus group is a subclass of viridans streptococci that consists of three distinct species: S. anginosus. S. constellatus, and S. intermedius. Organisms in this group are commonly found as commensal flora but have [...]

Background: Many hospitals emphasize the importance of hand hygiene, which is one of the most important ways to prevent hospital‐acquired infections. However, relatively little attention is paid to stethoscope hygiene, although they can transfer dangerous [...]

Background: Central venous catheters (CVCs) provide reliable venous access for infusion, phlebotomy, and hemodynamic monitoring. With the advent of the peripherally inserted central catheter (PICC), their use has grown significantly in hospitalized patients. However, CVCs [...]

Background: Incidental findings on diagnostic imaging may require follow‐up to exclude malignancy or other conditions. Previous studies have documented the prevalence of such findings, but an observational study of notification of patients and primary care [...]

Background: Severe hypoglycemia in the hospital is associated with adverse patient outcomes. Many factors alter glycemic status, including corticosteroids, diet, enteral or parenteral feedings, surgical procedures, cardiac, renal or hepatic failure, and sepsis. These patient‐associated [...]

Background: Since 2005, Mayo Clinic, Rochester, performs a formal multidisciplinary mortality review on all inpatient deaths. The vision of the Mortality Review System (MRS) is to eliminate suffering from process or systems of care failures. [...]

Background: Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS ™) is an evidence‐based system aimed at creating a culture of safety in any healthcare delivery system. Developed by the Department of Defense (DoD) and [...]

Background: Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs. This randomized, controlled study was designed to evaluate whether an automated clinical deterioration alert sent to the [...]

Background: Interventions to reduce inappropriate urinary catheter use are implemented using lists of appropriate and inappropriate criteria (e.g., CDC’s 2009 catheter‐associated urinary tract infection guideline), informed by limited evidence without substantial multidisciplinary input. Implementation is [...]

Background: Peripherally inserted central catheters (PICCs) play a key role in providing venous access for medication and fluids, laboratory testing, and hemodynamic monitoring. Despite standardization of insertion practices, little is known about nursing knowledge and [...]

Background: Medical errors are common and interventions to address vulnerabilities may fail due to a weak organizational safety culture. To transform hospitals and develop a culture of safety and high reliability, an assessment of the [...]

Background: No studies in Japan have described the perceived strength of evidence supporting practices to prevent common healthcare‐associated infections and the actual use of these practices. In the current study, we conducted a nationwide survey [...]

Background: Medication reconciliation is crucial for patient safety. Patients are often uncertain of the medications they are taking and physicians may not have time to take thorough medication histories. A pharmacy technician (PT), by conducting [...]

Background: Pediatric Hospital Medicine (PHM) has grown rapidly over the last 15 years. There is little information about the characteristics of the PHM workforce. Our objective was to describe the PHM workforce and note implications [...]

Background: Circumcision is the most common neonatal surgical procedure in the world. There is regional variation in circumcision providers which includes obstetricians, pediatricians, family practitioners and non‐medical personnel. Pediatric hospitalists (PH) in many hospitals provide [...]

Background: Over the past two decades, pediatric hospitalist programs have become a common part of inpatient care in many health care markets. However, many primary care pediatricians may still include inpatient care in their practices. [...]

Background: Children with leukemia, cancer, and chronic anemia require a Central Venous Catheter (CVC) for administration of medications and blood products. Because of the need for frequent access, CVCs are susceptible to a high incidence [...]

Background: Pediatric Hospital Medicine (PHM) has grown rapidly over the last 15 years. Previous studies of PHM work focused on reports from group leaders. To date, there is no published report describing job tasks and [...]

Background: It is common for total parenteral nutrition (TPN) bags for children to be custom made, starting with a base dextrose solution and then amino acids (AA) and other nutrients added. This process allows for [...]

Background: Children undergo painful procedures in hospitals and deserve appropriate procedural sedation (PS). Pediatric hospitalists (PH) are increasingly providing PS. We hypothesize that variability in PS practices impact resource utilization and patient care and that [...]

Background: Pulmonary embolism (PE) is a common complication after orthopedic surgery. As symptoms are variable and may be absent, decisions regarding which post‐surgical patients to evaluate with CT pulmonary angiography (CTPA) may not be straightforward. [...]

Background: The use of novel oral anticoagulants (NOACs) such as dabigatran and rivaroxaban has been rapidly increasing. However, there is limited experience with the periprocedural management of these agents, and uncertainty about the safety of [...]

Background: Handoffs have received increased scrutiny due to changes in ACGME guidelines for resident work hours. Studies have shown that a combination of standardized written format and face‐to‐face modalities are ideal for facilitating the handoff [...]

Background: Transitions of care between the inpatient ward and outpatient primary care setting are an essential process in ensuring quality patient care. One of the most important aspects of this process is communication between the [...]

Background: Acute decompensated heart failure (ADHF) that develops during hospitalization is a potentially preventable problem that has not been well studied. A significant proportion of ADHF cases during hospitalization has been attributed to intravenous fluid [...]

Background: Hospital mortality rates are frequently used as indicators of quality. Patients undergoing inter‐hospital transfer represent a unique subset of patients that contribute to hospitals’ overall mortality rates. Factors associated with mortality rates following inter‐hospital [...]

Background: Hospitalized patients often have multiple care providers and physicians frequently fail to introduce themselves and their role to patients. Patients’ lack of awareness of their medical providers may lead to decreased quality of care [...]

Background: CHF is the most common cause of hospital admission in the Medicare population. CMS has instituted policies penalizing Hospitals that have a high readmission rate. This has lead institution to focus on methods to [...]

Background: Initial studies demonstrate that locating the majority of a physician’s patients on a designated unit (geographic rounding) can enhance physician efficiency and facilitate physician nurse communication. Further benefits can include better patient satisfaction, improved [...]

Background: Few studies have examined the effect of a computerized order entry (CPOE) clinical pathway on clinical outcomes in hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Reducing readmission rates for AECOPD is [...]

Background: Traditional interdisciplinary rounds are unstructured and take place in a conference room. To promote optimal communication among all team members and engage patients in the daily plan and disposition process, we transformed our rounds [...]

Background: The Joint Commission has identified lapses in communication as one of the leading root causes of sentinel events. Although there has been literature published surrounding the handoff of patient information among members of the [...]

Background: Hospitalization for acute medical illness is associated with an increased risk of venous thromboembolism (VTE). While pharmacologic prophylaxis has been shown to reduce the incidence of VTE, rates of prophylaxis are low in many [...]

Background: Chronic hepatitis C virus (HCV) infection is a major cause for liver transplant and liver‐related deaths in the United States. Roughly 75% of those infected were born between 1945 — 1965 – the baby [...]

Background: Patients hospitalized for acute medical illness may be at increased risk for venous thromboembolism (VTE). Identifying those medical patients most at risk for VTE is of increasing importance and emphasized in recent guidelines. Several [...]

Background: Telemetry monitoring is often overused in inpatient setting. This has led to overcrowding of telemetry beds, increasing boarding time in emergency department, and inefficient distribution of limited hospital resources. Furthermore, telemetry has impact on [...]

Background: Treating asymptomatic bacteriuria -- a positive urine culture in the absence of symptoms -- in hospitalized patients is a key driver of excess antimicrobial use. Decreasing overuse of antimicrobials in hospitalized patients will require [...]

Background: Adverse events are common following hospital discharge. To assist patients in their transition from hospital to home, healthcare systems have established several methods for patients to interact with the healthcare system following discharge. However, [...]

Background: Individual physician‐to‐physician tutoring with learners in their real environment during rollouts of new electronic health records (EHRs) can identify specific barriers and provide opportunities for ‘just in time’ educational interventions that may improve physician [...]

Background: Diabetic ketoacidosis (DKA) represents an acute complication associated with increased morbidity, mortality, multiple readmissions, and a significant financial burden for healthcare institutions. General inpatient management of DKA may differ according to practice preference, allowing [...]

Background: Unless bleeding risk outweighs the risk of thrombosis, current guidelines recommend pharmacologic prophylaxis for hospitalized medical patients who are at high risk of venous thromboembolism (VTE). The IMPROVE bleeding risk score was developed to [...]

Background: There is a need for structured communication among hospital providers to improve efficiency and to provide patient‐centered care through collaboration in the hospital setting. A concise Multidisciplinary Rounds (MDR) model was designed and implemented [...]

Background: Patients with sickle cell disease utilize hospital emergency room (ER) for treatment of acute pain crisis. American Pain Society placed a guideline that pain medication be given within 20 minutes of entrance to ER. [...]

Background: Hospital‐acquired anemia(HAA) is associated with worse health status, higher hospitalization rates, increased length of stay, need for blood transfusions, greater medical costs, lower quality of life, and higher mortality. Therefore, there has been a [...]

Background: Unnecessary treatment of asymptomatic bacteriuria (AB) is an individual and public health problem and a target for antibiotic stewardship. Although there is clear evidence against treating AB in most patients, the definition of “asymptomatic” [...]

Background: Hyperglycemia in hospitalized, non‐critically ill patients is associated with poor outcomes including increased length of hospital stay, infection, disability after discharge from hospital, and death. Current guidelines for the management of inpatient hyperglycemia suggest [...]

Background: Proton pump inhibitors (PPIs) are indicated to treat a variety of diseases, including gastroesophageal reflux disease, peptic ulcer disease, and Helicobactor pylori infection. Studies have shown that, despite being linked to an increased risk [...]

Background: Preventable readmission for Heart Failure (HF) was estimated to be 27.1%. HF readmission may suggest inadequate treatment during a previous stay. For example, only 50% of patients have complete resolution of their congestive symptoms [...]

Background: High utilizers of health care services are psychosocially complex patients with significant medical and psychiatric co‐morbidity and higher mortality rates. They account for a disproportionately high number of emergency department (ED) visits, inpatient admissions, [...]

Background: The Joint Commission cited suboptimal communication as one of the root causes in 82% of sentinel events reported on 2010. Face‐to‐face communication is the richest form of communication and is superior to asynchronous modes [...]

Background: Attending rounds, defined as ward rounding with an attending physician, take place every day at teaching hospitals around the country with remarkably little consensus around best practices. At our institution, there is also no [...]

Background: Geographic localization consist of the co‐localization of physician providers and their patients on the same inpatient units. Structured Interdisciplinary Rounding (SIDR) consists of daily, template‐driven interdisciplinary rounding on patients among care providers. Both geographic [...]

Background: Pressure ulcer prevention in hospitals is a critical issue since Centers for Medicare and Medicaid Services (CMS) established nonpayment policy for hospital‐acquired conditions in 2008. The objective was to determine the comparative effectiveness of [...]

Background: In 2008, the Center for Medicare and Medicaid Services (CMS) enacted nonpayment policy for hospital‐acquired pressure ulcers (HAPUs). Hospitals responded to policy by increasing HAPU prevention efforts. To quantify adoption patterns of quality improvement [...]

Background: A new order set addressing sedation, analgesia, and delirium was developed referencing the updated Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit (PAD [...]

Background: Late afternoon patient discharges create admission bottlenecks in the Emergency Department, slow elective admissions, delay transfers out of the Intensive Care Unit and Post Anesthesia Care Unit, and are a major dissatisfier for patients. [...]

Background: The evaluation of syncope remains challenging, costly, and in many instances, does not clarify the etiology. Evidence‐based guidance for efficient evaluation and risk stratification is often not followed. We designed a study to assess [...]

Background: Overutilization of ECG monitoring (EM) can negatively impact patient flow and increase healthcare costs. In 2004, an American Heart Association (AHA) consensus statement detailed indications for EM in hospital settings. Monitoring was suggested for [...]

Background: Over 60% of hospitalized patients receive antibiotics. Unfortunately, up to 50% of inpatient antibiotic use has been judged as inappropriate. With the increasing presence of hospitalists, combined with their focus on patient safety and [...]

Background: In October 2012, the Hospital Readmissions Reduction Program allowed CMS to reduce payments to hospitals with excess 30‐day re‐hospitalization rates for patients discharged after a hospitalization for pneumonia. As such, the accuracy of identification [...]

Background: Unplanned patient readmissions are undesirable from both a clinical quality and a financial perspective. Identifying patients at risk of readmissions allows targeting of interventions aimed at reducing readmission rates. Several algorithms for predicting readmission [...]

Background: A significant number of patients die every year in United States hospitals due to medical error or delay in emergent patient care. One important source of medical errors or delay in care is lack [...]

Background: While one out of every four Americans is estimated to suffer from obstructive sleep apnea (OSA), the prevalence of OSA in medical inpatients may be even higher. OSA is associated with many chronic medical [...]

Background: At an average, about 50% of elderly hospitalized patients experience some kind of complication related to hospitalization. About 23.3% of them are at risk of being unable to return home and require nursing home [...]

Background: A productive healthcare organization needs an integrated teamwork and engaged physician leadership to successfully manage costs and improve quality. Lean daily management (LDM) is considered an effective tool for achieving cultural change, with better [...]

Background: Hospital admission usually leads to blood draw for diagnostic laboratory tests which can help in patient care. Providers routinely order daily blood tests including complete blood count, basic metabolic panel or comprehensive metabolic panel [...]

Background: Central lines are commonly used in the care of hospitalized patients. Each day a central line is in place the risk of complications such as bloodstream infection rises. Yet central lines often remain in [...]

Background: The notorious weekend effect compromises quality of care. However, the implementation of hospitalist system with a 24 hour/7 day coverage may erase the adverse weekend effect. Methods: A quasi‐experimental study with propensity score matching [...]

Background: The effect of clinical alert system (CAS) and medical emergency team (MET) for hospitalized patients is controversial. Failure to timely activate MET and ineffective MET function after activation have been criticized. The study aims [...]

Background: Hip fracture patients are now routinely cared for by hospitalists with orthopedic consultation. Demographically, these patients tend to be elderly and frail with multiple medical comorbidities. Much has been published about minimizing the use [...]

Background: Immobilization is known to be an important contributing factor to venous thromboembolism (VTE). However, the currently available risk assessment models for VTE in hospitalized medical patients use variable definitions of reduced mobility that are [...]

Background: Altered mental status is one of the strongest predictors of clinical deterioration in the hospital, yet it often goes unrecognized. Current tests to assess mental status in the hospital lack the sensitivity to capture [...]

Background: Online personal health records (PHR) can provide opportunities for hospitalized patients to engage in their care during and after discharge but patient use of PHRs in these settings has not been studied to date. [...]

Background: Ownership of mobile computing devices has been rapidly increasing in the general population prompting increased clinical uses in outpatient settings. To date, however, we know very little about ownership, type of device, and usage [...]

Background: The Yale New Haven Hospital adapted the Sunrise Clinical Manager (SCM) by Eclipse Corporation as its Electronic Medical Record (EMR) in 2007. The Hospitalist Service (HS) created a program extension that generated personalized daily [...]

Background: Point of care resources have become readily available making it potentially possible to make clinical decisions at the bedside with the best evidence‐based medicine. Several factors are important when selecting a decision‐supporting source; these [...]

Background: The use of transthoracic echocardiograms (TTEs) has increased dramatically, particularly over the last ten years. There is a perceived lack of harm in performing a non‐invasive TTE, though high cost and overdiagnosis are important [...]

Background: Federal meaningful use programs continue to accelerate the adoption of electronic health records (EHRs) by U.S. hospitals. With increasing use of EHRs, it is likely that more hospitals will transition from paper to electronic [...]

Background: Hospital throughput and discharge coordination are strategic priorities for the hospital to ensure patients are safely transitioned across episodes of care and to predict bed availability for patients being admitted. Coordinating bed flow and [...]

Background: Cancer patients are particularly at risk for being readmitted within 30 days after discharge. However, many of these readmissions are either related to elective chemotherapy or are not avoidable. In order to identify the [...]

Background: Despite the high prevalence of functional limitations in community‐dwelling Medicare patients and Medicare penalties for “excessive” readmission rates, there is limited information on effects of these functional limitations on readmission for hospitalized Medicare patients. [...]

Background: Compliance with the 2011 Accreditation Council for Graduate Medical Education work hour restrictions has led to increased numbers of hand‐overs. As a result, there is a renewed focus to maximize patient safety in this [...]

Background: Several care transition interventions have proposed that post‐discharge phone calls reduce adverse events, and decrease costly return visits to the hospital. However, given the multi‐faceted nature of most care transitions interventions, the true relationship [...]

Background: Transition of care from the weekday hospitalist to the weekend hospitalist is typically not performed at the bedside, a model which leads to provider reluctance to discharge on the weekend and poor patient satisfaction [...]

Background: Information exchange is critical to high‐quality care transitions, yet little is known about the quality of information transfer from hospitals to post‐acute care facilities. To evaluate the quality of information transfer from a tertiary [...]

Background: Literature supports the positive impact of timely outpatient primary care follow‐up on reducing hospital readmissions. A post‐acute care clinic, staffed by hospitalists, housestaff or mid‐level providers, has emerged as a model for augmenting community [...]

Background: The transfer of patients between acute care hospitals (inter‐hospital transfer, IHT) is becoming increasingly common. However, lack of evidence‐based guidelines to direct high quality patient transfer creates variability in the quality of the transfer [...]

Background: In the United States, 21‐23% of the adult population have low literacy, and an additional 27% have low health literacy (difficulty understanding written health education materials). Written materials are commonly used to communicate with [...]

Background: Handoffs are key events in the care of hospitalized patients. Failures in communication at the time of patient handoff have been implicated as contributing factors to preventable adverse events. Standardization of handoff has been [...]

Background: Impaired vision is a risk factor for poor health outcomes, such as falls and delirium, during hospitalization. Additionally, hospitalized patients with poor vision may be unable to read critical documents such as consent forms. [...]

Background: More than one‐quarter of older patients with diabetes are readmitted to the hospital within three months of discharge. As a result of patients with diabetes’ increased risk for retinal disease and vision loss, those [...]

Background: Improving patient satisfaction and reducing hospital readmissions are both considered important quality improvement goals. However, the relationship between 30‐day readmission and patient satisfaction is not well understood. For example, it is unknown if low [...]

Background: Transfer of care between healthcare providers is a vulnerable time for patient safety, and ED admission handoffs are subject to unique structural and contextual challenges. The ED admission process involves changes in provider, department, [...]

Background: Failure to synthesize and make available critical information about patients and care plans to cross‐covering physicians represents a predominant cause of decreased quality of care and communication breakdowns. Trainee duty hour restrictions and increased [...]

Background: Failure to transition from acute care to outpatient care has been well studied without regard to insurance status. Common experience suggests that underserved patients face unique barriers to effective post‐hospital care. These patients may [...]

Background: ORI is a lipoglycopeptide with rapid bactericidal activity against Gram‐positive bacteria including MRSA. Its concentration‐dependent activity and long half‐life allow for single dose administration. Methods: SOLO I and SOLO II were Phase 3, multicenter, [...]

Background: Voriconazole is a triazole antifungal medication used for prophylaxis in transplant patients or to treat invasive fungal infections. Inflammation of the periosteum causing skeletal pain, known as periostitis, has been an infrequently observed side [...]

Background: Pediatric oncology patients are at a higher risk of developing febrile neutropenia. Likewise an advanced age ≥65 years is one of the predictors of the development of neutropenic fever in adult oncology patients. We [...]

Background: Early diagnosis of tuberculous pleural effusion (TPE) remains difficult, especially in hospitalization. While some inflammatory markers in pleural effusion (PE) are helpful in diagnosis, the implication of anti‐inflammatory cytokines and effector molecules of cytotoxic [...]

Background: Cardiac Troponins (cTn) are sensitive and specific diagnostic and prognostic markers of myocardial injury. The third Myocardial Infarction (MI) Global Task Force in 2012 de‐emphasized the use of other cardiac biomarkers. Creatine Kinase‐Myocardial fraction [...]

Background: Rising health care expenditures in the United States encourage physicians to provide quality patient care while eliminating wasteful spending. Reference laboratory tests represent a small percentage of a hospital’s total test volume, but a [...]

Background: There has been a growing emphasis on increasing the value of healthcare by reducing unnecessary testing to decrease costs, though physician behavior has proven difficult to change. An event leading to reduced inpatient resources, [...]

Background: Clinicians check complete blood counts (CBC) multiple times over a hospitalization and sometimes multiple times in a single day, often with the goal of detecting a drop in the hemoglobin level. However, phlebotomy is [...]

Background: Step‐down units, also known as transitional care or intermediate care units, are designed to care for patients with needs that fall between the intensive care unit and the general ward. Such units are capable [...]

Background: Nighttime care of general medicine patients at University Hospital utilizes a night float cross‐cover system, with a single physician‐intern as the primary coverage. On average, this night float physician cares for 85 to 90 [...]

Background: Paracentesis, thoracentesis, and lumbar puncture are three of the most commonly performed inpatient medicine procedures (MP). Our hospital has no specific resource to outline safe practices and standardization of MP performance and documentation. As [...]

Background: Hospitalist training tracks have been integrated into some internal medicine residency programs to help educate future hospitalists about Quality Improvement (QI), patient safety, and transitions in care. However, few educational programs exist for undergraduate [...]

Background: Competency in practice‐based learning (PBL) requires deliberately and rigorously questioning current practice, locating and accurately interpreting relevant literature and incorporating evidence into clinical decision‐making. Purpose: Our hospital medicine faculty, in collaboration with the internal [...]

Background: Educators are increasingly aware of the importance of preparing students for our new healthcare system and the value of teaching concepts around quality improvement (QI) and patient safety as part of the medical school [...]

Background: Medical residency training is a challenging period when residents make important decisions that steer the direction of their careers. It can be difficult to determine which experiences serve as validation of career goals and [...]

Background: Medical students receive limited exposure to quality improvement (QI) at most medical schools, largely due to time and cost constraints. However, there is increased emphasis on QI in residencies and clinical practice and exposure [...]

Background: Interprofessional collaboration is key for both student education in geriatrics and in the care of older adults, but is often underemphasized in medical education. Falls are a source of significant morbidity and mortality in [...]

Background: Patient‐centered medical care remains a primary goal of all health care providers and medical centers. Although the majority of providers believe they practice patient‐centered care, patients frequently do not understand their condition or care [...]

Background: Increasingly restrictive ACGME supervision requirements for PGY‐1 residents in the inpatient setting have been interpreted by some as a reflection of insufficiently prepared medical school graduates. Purpose: Curricular enhancement to fourth medical school curriculum [...]

Background: Our hospitalist group designs and delivers the inpatient lecture series for our residency program and we strive to ensure the topics are applicable to inpatient medicine. This non‐clinical responsibility is an increasingly common situation [...]

Background: Hospital Medicine represents the fastest growing career choice of graduating residents from Internal Medicine training programs. Glasheen, et al have noted deficiencies in current Internal Medicine training for the growing role of hospitalists as [...]

Background: As new residents start their Internal Medicine training in July, many studies have raised concerns about patient safety associated with inexperienced residents, also termed the “July effect.” Based on surveys conducted at our Internal [...]

Background: Leading healthcare improvement requires skills not often taught in undergraduate medical education (UME). While teaching quality and safety is required in resident education, inadequate emphasis exists in UME to ingrain skills needed to lead [...]

Background: Adverse events and medical errors have important implications for the physicians involved, who are often “second victims” affected by medical errors. Having committed an error is positively associated with subsequent distress and burnout and [...]

Background: Interprofessional healthcare teams enhance care coordination for individual patients. However, such teams do not typically have a mandate or design which promotes vision‐setting, innovation, or leadership beyond immediate clinical care delivery. Purpose: To describe [...]

Background: Many hospital medicine groups have hospitalists with individualized job descriptions who work variable types and numbers of shifts. This creates challenges in crafting a universally applicable productivity metric, as different shifts target different types [...]

Background: At the University of New Mexico Hospital inpatients with cystic fibrosis were previously admitted to the on‐call general medicine ward team. The team would round on these patients on their own, often with the [...]

Background: Inpatient care of Oncology patients is a specialized field with care typically provided by Oncologists. These patients are usually very sick with multiple co‐morbidities, high case mix indices, long lengths of stay and high [...]

Background: Indwelling vascular and urinary catheters are critical in the care of hospitalized patients. However, they can also lead to potentially life‐threatening infectious and non‐infectious complications, such as bloodstream and urinary infections and thromboembolism. A [...]

Background: Electronic Health Records (EHRs) have enabled significant progress in the area of medication safety. However, there remain challenges in optimizing medication titrations and adjustments in high risk medications such as insulin, heparin, and antibiotics. [...]

Background: In the landmark 1999 publication To Err Is Human, the Institute of Medicine documented the problem of patient harm in US hospitals. They estimated up to 98,000 deaths per year in US hospitals were [...]

Background: Adverse events are common in the high‐risk work of neurosurgery and improvement of outcomes has been hindered by a lack of resources and time devoted to quality improvement (QI) activities. Because many hospitalists have [...]

Background: Patient satisfaction with pain management in the inpatient setting is an important quality improvement measure. Patient‐Controlled Analgesia (PCA) order sets have been shown to reduce adverse events without negatively impacting satisfaction. Such protocols are [...]

Background: The Modified Early Warning System (MEWS) is a validated tool that aids in the identification of hospitalized patients at risk for clinical deterioration. With rapid response team involvement, the MEWS has demonstrated reduced in‐hospital [...]

Background: Safety Event (SE) reporting is a critical element for health care organizations striving for continuous quality improvement. It provides a medium for staff to engage in the quality improvement process, and serves as a [...]

Background: Sudden Infant Death Syndrome (SIDS) is the death of an infant younger than one year of age with the cause of death being unknown even after a complete autopsy and investigation. SIDS is the [...]

Background: To address dissatisfaction and inefficiency with the discharge process, in February 2013, we developed a change in our discharge process to focus on two discharge times. This plan was implemented on a general medical [...]

Background: Behavioral emergencies occur when patients act in a manner that poses a danger to themselves, family or hospital staff. Pediatric Hospitalists may encounter these events caring for patients with underlying psychiatric or behavioral disorders [...]

Background: A 2011 survey found that 85% of hospitalist groups had participated in some form of comanagement. Despite the widespread adoption of the comanagement model of care, there are few published data, mostly focused on [...]

Background: Preoperative anemia has been shown in multiple studies to be an independent risk factor for perioperative blood transfusion. Blood transfusions impart risks of transfusion reactions, increased infections, increased length of stay and hospitalization cost. [...]

Background: Hospitalist physicians rely on admission history and physicals and daily progress notes as important tools for communication regarding patient care and compliance with billing and coding requirements. While electronic health records facilitate ease of [...]

Background: The prevalence of pain in hospitalized adults is high and has been associated with reduced quality of life, lower patient satisfaction, and longer length of stay. Refractory pain is a common reason for hospitalization [...]

Background: Prior studies of surgical co‐management have shown marginal benefits and mostly focused on the care of orthopedic patients. Hospitalized vascular surgery patients typically have multiple severe co‐morbidities, poor functional status, and high peri‐operative cardiac [...]

Background: Improving throughput and length of stay (LOS) is essential for hospitals to operate efficiently and cost effectively. Patients who require 1‐day admissions who are not placed into observation status hold specific challenges, because the [...]

Background: Practitioners and policymakers have identified 30‐day readmissions as an important quality indicator to measure hospital care, with the premise that readmissions can be indicators of poor care or coordination of care. Among cancer centers, [...]

Background: Best‐practice checklists may help reduce medical errors during patient discharge. However, current paper checklists have poor physician support and limited integration with clinical workflows. No previous study has evaluated the impact of using a [...]

Background: Mortality in healthcare is the most unambiguous clinical outcome. Academic medical centers are ranked on the observed to expected mortality ratio developed by the University Healthcare Consortium (UHC). Emphasis on expected deaths, however, creates [...]

Background: Electronic Health Records (EHR) are increasingly becoming the standard of care in inpatient settings. Front line clinicians, including residents, frequently have innovative suggestions for inpatient EHR modifications that can enhance quality, safety and workflow [...]

Background: Individual provider performance drives group performance but appropriate attribution can be challenging, particularly when multiple providers care for a single patient. We sought to develop and operationalize individual provider scorecards that fairly attribute patient‐level [...]

Background: Numerous research studies and anecdotal experience show that in healthcare, a small percentage of patients account for a disproportionate number of ED visits and hospital admissions. For some of these patients, their visits are [...]

Background: Peripheral intravenous catheter placement is a common procedure in the pediatric inpatient setting and causes anxiety and pain in children. This can lead to anticipatory anxiety, needle phobia, and may lead to avoidance of [...]

Background: Hospitalists are positioned to play a key role as frontline providers in improving hospital patient satisfaction scores while simultaneously improving quality of care. Hospitalist communication skills are vital to improving patient compliance and adherence [...]

Background: Achieving safe transitions of care at the time of hospital discharge requires accurate and timely communication. Communication failures at these transitions of care can lead to medication errors, duplication of diagnostic testing, and delays [...]

Background: We are a large academic hospitalist group in a tertiary care center with a mixed urban/suburban catchment area. Despite representing only 4% of our total discharges, patients with sickle cell disease (SCD) account for [...]

Background: For many years, there has been awareness that excessive transfusions can cause harm to patients. Despite this, practice patterns have been slow to adapt to evidence suggesting restrictive transfusion policies result in better patient [...]

Background: Today’s busy physician is inundated with numerous demands, from maintaining compliance with various regulatory mandated quality initiatives to meeting state licensing continuing medical education requirements. Any initiative that can effectively “kill two birds with [...]

Background: Many industries and corporations have adopted user‐centered design methods to drive meaningful improvement in commercial products and customer experience. Healthcare has been slow to follow, relying on superficial quantitative surveys, such as HCAHPS for [...]

Background: Late discharges are a major problem across VCU Health Systems. Only 10% of pediatric patients are discharged before noon, and over 1/3 of patients are discharged after 5 PM. Late discharges delay admissions and [...]

Background: Many patients would like “indication” or diagnosis information included on their prescription labels. Such labeling may increase patient adherence, potentially improving important health outcomes. Additionally, many skilled nursing facilities require that a diagnosis be [...]

Background: Individual Care Plans were developed at a tertiary care center within the HealthPartners’ system to coordinate care for “high‐utilizers”–patients with frequent ED visits and hospital admissions often associated with high‐risk patterns of narcotic use [...]

Background: Palliative Care Services (PCS) increase the quality of care and improve resource utilization for patients with serious illness and those approaching the end of life. Because PCS increase value, many hospitals have established PCS [...]

Background: Laboratory testing plays a central role in inpatient diagnosis and treatment of disease However, laboratory testing can contribute significantly to health care costs and may incur potential risks to patients, such as additional testing [...]

Background: Vitamin D deficiency is common in elderly patients with low‐trauma hip fractures, and major practice guidelines recommend screening for deficiency in this population. Our hospitalist group admits all patients with acute hip fracture, with [...]

Background: 2Procedure teams led by hospitalists are successfully being launched at many academic institutions around the country. Many of them have shown both direct and indirect benefits. Commonly offered procedures by these teams include thoracentesis, [...]

Background: In recent years, our institution has faced challenges in meeting our health system’s rigorous targets for CMS Core Measures for Heart Failure (HF). Our overall Appropriate Care Score for HF, while exceeding the national [...]

Background: Hospitalists are increasingly an integral component of the programs, services, and quality improvement initiatives within their hospital system. The utilization of “peer hospitalists” during the orientation (i.e., on‐boarding) period may enhance adaptation of group [...]

Background: Previous research suggests that over 60% of patients have a prescription medication discrepancy on admission to the hospital. At discharge, most patients have at least one new medication change from their home regimen but [...]

Background: Many hospitalist groups struggle to maintain high engagement of providers. Poor provider engagement can create communication silos and inhibit collaboration. Since hospitalists are accustomed to decentralized networking via the Internet, we created a secure, [...]

Background: Reducing unnecessary high‐cost imaging has received increasing emphasis. With substantial financial investments in the Health Information Technology for Economic and Clinical Health provisions of the American Recovery and Reinvestment Act, there are great expectations [...]

Background: The House of Godimmortalized the capricious Medical Admitting Resident who decides on assignment of patients based on favors and grudges. In reality, this has always been a complicated role and it has evolved over [...]

Background: Hospital communication is an integral component of clinical care but is often inefficient and error‐prone. Specifically, sending and receiving pages is a burdensome process involving significant time that later must still be conveyed to [...]

Background: Many hospitals have a subset of patients who require extended inpatient care due to a combination of complex social and medical factors. Most traditional Hospitalist staffing models are suboptimal for providing continuity of care [...]

Background: Optimizing hospital care transitions continues to be a quality improvement focus for hospitals and hospitalists. As accountability for patient outcomes spreads beyond hospital walls, collaborative partnerships between hospital and community based providers are increasingly [...]

Background: New Mexico is geographically large, rural and medically underserved. Thirty of New Mexico’s 33 counties are designated as Medically Underserved Areas and Health Professions Shortage Areas. Many New Mexico patients are transferred from urban [...]

Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The advent of the Patient‐Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs) provide an opportunity for true collaboration in which [...]

Background: Hospital discharge is a high risk transition for patients during which deficits in transfer of information between hospital providers and the primary care providers (PCPs) are common and lead to adverse events following discharge. [...]

Background: An estimated 1 in 5 patients discharged to skilled nursing facilities (SNF) is readmitted within 30‐days. In 2012, the rate was 25‐30% for SNF discharged post‐acute care patients of the Cleveland Clinic Department of [...]

Background: Atrial fibrillation is a common etiology for ischemic stroke. Numerous studies have supported that after an ischemic stroke, extended outpatient cardiac monitoring detects paroxysmal atrial fibrillation in patients in whom atrial fibrillation was not [...]

Background: As health systems seek to reduce spending and improve care quality in response to changing payment schemes, one key strategy is to substitute lower‐intensity care settings (e.g. outpatient care) for more expensive ones (e.g. [...]

Background: We are a 29 member academic hospitalist group at a large urban/suburban academic tertiary care center. Like other health systems, we are under tremendous pressure to decrease length of stay (LOS) and excess days [...]

Background: As hospitals face increasing pressure to provide safe and high‐value care, quality improvement initiatives that address both evidence‐based care and cost mitigation will produce significant impact. Trainee engagement in such initiatives can address ACGME [...]

Background: With increasing focus on healthcare value, both patients and providers have much to gain from enhancing how trainees learn to disburse a precious healthcare resource: time. However, efficiency is rarely an educational objective. Rather, [...]

Background: Healthcare costs are the #1 cause of personal bankruptcy in the United States, and cost reduction is a major focus of current health policy. Data demonstrate the majority of medical costs are directly related [...]

Background: Patients with chronic and progressive illnesses are vulnerable to long length of stays (LOS) and readmission. Often, these readmissions reflect fragmentation of health care and poor transitions of care leading to substandard patient outcomes [...]

Background: Ionized calcium (iCal) is an expensive lab test that is frequently ordered for hospitalized patients. A lab technician manually performs each iCal test, and therefore at our institution it costs 40 times more than [...]

Background: Hospitalists have recently been charged with teaching about healthcare value. To understand how to teach value in ways that are impactful, sustainable, and scalable, the best ideas need to be shared. Due to the [...]

Background: Overuse of telemetry monitoring is a target of the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which recommends that hospitals develop a protocol to limit telemetry use. The American Heart Association has [...]

Background: Inefficient hospital operations at large public teaching hospitals result in late discharge times, bottle necks in patient flow, poor anticipation of discharges, and significant out of network costs related to ambulance diversion. Purpose: The [...]

Background: Questionnaires administered to the house staff has identified a lack of high value care as a suggestion area of improvement for the program. Additionally, the attending staff has identified the practice of high value [...]

Case Presentation: An 11 year old boy with a history of repaired congenital diaphragmatic hernia (CDH) presented with 6 months of intermittent abdominal pain, and non‐bilious emesis. On examination, his abdomen was soft, non‐tender, and [...]

Case Presentation: A 6 year‐old previously healthy male presented with altered mental status following a 4‐day history of vomiting and diarrhea. He had significant lethargy and dehydration with an otherwise non‐focal exam. Labs revealed glucose [...]

Case Presentation: An 18‐month old Hispanic female was brought to the emergency department of El Paso Children’s by her mother with a chief complaint of inability to bear weight. A detailed history revealed the child [...]

Case Presentation: BB is a 4mo boy born FTNSVD with PMH of pyloric stenosis, s/p pyloroplasty at 20 do who presents with NB/NB emesis, abdominal discomfort, and decreased PO intake x 2d. No fever, no [...]

Case Presentation: A 5 month old female presented with a 3 day of history of nasal congestion, cough, and worsening respiratory status. Her past medical history was significant for three prior respiratory illnesses, one of [...]

Case Presentation: A 4 year‐old boy presented with fever, generalized joint pain, and scrotal edema. He reported emesis, chest pain, dyspnea, and non‐bloody diarrhea. Initial exam noted diffuse pulmonary crackles and a macular rash. He [...]

Case Presentation: A 16 month old ex‐term girl presented with nasal congestion, rhinorrhea, loud breathing, and cough for 5 days. She had decreased oral intake but no fever. Her history was significant for 8 episodes [...]

Case Presentation: A 19‐month‐old male with a history of neonatal spontaneous pneumothorax presented with cyanosis. He was in his usual state of health when, on the day of presentation, he began whimpering and coughing. Soon [...]

Case Presentation: A 5 year old boy with obstructive sleep apnea (OSA) and chronic constipation presented with unsteady gait and an episode of fecal incontinence. Upon initial evaluation he had a temperature of 91.5 degrees [...]

Case Presentation: A full term female neonate born out of consanguineous marriage with unremarkable prenatal labs and prenatal ultrasound (US) studies, was found to have a large cephalohematoma at birth. On day of life (DOL) [...]

Case Presentation: A 16 year‐old male with cystic fibrosis presented with chest pain. He had not been feeling well for two weeks, but attributed his dry cough and mild malaise to his usual allergy symptoms. [...]

Case Presentation: Our patient is the fourth child of non‐consanguineous parents, born to a 23‐year‐old mother at a 41 weeks gestational age via normal delivery. Birth weight was 1520 grams with a length of 39cm [...]

Case Presentation: A 45 day‐old ex‐term male presented with acute onset of progressively noisy breathing and respiratory distress unassociated with fever, rhinorrhea, or nasal congestion. On initial presentation, he had diffuse “wheezing” on exam with [...]

Case Presentation: A 10‐year‐old girl presented with acute‐onset, severe abdominal pain and vomiting. She was initially treated at an outside hospital for three days with non‐steroidal anti‐inflammatory drugs (NSAIDs) for symptomatic relief of presumed gastroenteritis. [...]

Case Presentation: A 3 year old boy was seen for one day of emesis, possible abdominal pain and somnolence. He had no trauma, fever, abnormal bowel movement, recent travels or immunizations. Review of systems was [...]

Case Presentation: A 2‐day‐old male, born at 40 weeks 5 days by emergent caesarean section due to umbilical cord prolapse (Apgar scores 4/9, birth weight 3,740g), was noted to have a right enlarged firm testicle [...]

Case Presentation: An 11 week‐old male born at 37 4/7 weeks gestation with a recent diagnosis of laryngomalacia was transferred to our institution following a four‐minute episode of cyanosis, apnea and limpness following a feed. [...]

Case Presentation: A 5 year‐old previously healthy boy presents following traumatic amputation of his left four digits in an accident involving a plane hanger doorway system. He required multiple operative procedures, including digital re‐implantation and [...]

Case Presentation: A 13‐mo girl was admitted to the pediatric intensive care unit for acute respiratory distress syndrome (ARDS). She presented to an ED with fever for 2 days and weakness. There she had a [...]

Case Presentation: A 12 year old obese male presented to the Pediatric clinic for evaluation of dyspnea on exertion. Mother reported snoring and restless sleep since 7 years of age. She reported declining school performance [...]

Case Presentation: A 33‐month‐old girl presented with failure to thrive. She initially presented to another hospital with cough and fever and was placed on azithromycin for presumed pneumonia. A history of poor weight gain prompted [...]

Case Presentation: A 1‐day‐old infant male presented from a referring hospital with skin sloughing. He was born via caesarean section at 34 and 6/7 weeks estimated gestational age due to maternal HELLP syndrome. The pregnancy [...]

Case Presentation: A 14‐year‐old boy with athetoid cerebral palsy (CP) and spastic quadriplegia presented with intractable pain and spasms. Four weeks prior to his presentation, he had a right proximal femoral resection for hip pain [...]

Case Presentation: The incidence of acute salicylate intoxication in children has declined (mortality reduction 34%) with limitation of the dose of aspirin in tablets and child resistant packaging. However, salicylate containing products like incense and [...]

Case Presentation: The coexistence of human immunodeficiency virus (HIV) infection and systemic lupus erythematosus (SLE) is unusual, but the occurrence of SLE after HIV infection in a child is even less common. We report a [...]

Case Presentation: A seven days old male neonate was routinely assessed in our newborn nursery. The baby was born at 38 weeks by vaginal delivery after an uncomplicated pregnancy. He is the firstborn child of [...]

Case Presentation: An 11‐year‐old female patient with a history of medulloblastoma presented with fever and vomiting. Shortly after admission, she developed tachycardia and had low blood pressures consistent with septic shock. CBC revealed neutropenia and [...]

Case Presentation: A 9‐year‐old previously healthy boy initially presented to an outside hospital with a generalized seizure after one week of subtle behavioral changes and prodromal illness with fever, vomiting, and diarrhea. He had a [...]

Case Presentation: A 16‐year‐old previously healthy male was transferred to our hospital with a two day history of fever, headache, rash, lethargy, nausea, and diarrhea, and one week of fatigue and anorexia. He resides in [...]

Case Presentation: A 12‐year‐old girl with history of migraines and seizures presented for evaluation of aphasia and right‐sided hemiplegia. The symptoms began five days prior to admission and preceded a migraine headache. A day later [...]

Case Presentation: A 3‐month‐old otherwise healthy girl presented with 5 days of fevers, decreased oral intake, and fatigue. She was treated with amoxicillin for a presumed streptococcus pharyngitis infection, but development of periorbital erythema and [...]

Case Presentation: A 17‐year old male with a past medical history of psoriatic arthritis presented at the hospital with an acute episode of altered mental status, slurred and slowed speech, tremor, and unsteady gait. This [...]

Case Presentation: Small Cell Carcinoma of the gallbladder is a rare aggressive malignancy with only 74 cases documented in the literature so far [1].We present a case of a 69 yr old lady who was [...]

Case Presentation: A 57 year old man with AIDS (CD4=27) was seen at this hospital because of progressive fatigue. He became less active for the past 3 weeks due to gradually worsening fatigue. This progressed [...]

Case Presentation: A 63‐year‐old female presented to the emergency department with two day history of shortness of breath and lower extremity edema. She reported progressive worsening of shortness of breath for last two to three [...]

Case Presentation: A 77 year old Caucasian male presented for further care of ischemic cardiomyopathy and ambulatory class IV heart failure symptoms. His past medical history included pacemaker placement for complete heat block, triple vessel [...]

Case Presentation: Mr. W is a 66 y.o white man who presented with a 6 month history of a rapidly growing abdominal wound and abdominal pain. He has a history of myeloproliferative disease (MPD) and [...]

Case Presentation: Twenty‐two year‐old Nigerian man was admitted with acute right‐sided flank pain. He denied fever, frequency, dysuria, hematuria, palpitations, similar episodes in the past, or use of medications. He reported history of sickle cell [...]