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HM2014 Abstract Number: 650

Occam’s Razor or Hickam’s Dictum

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 [...]

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HM2014 Abstract Number: 651

When Plenty of Candy Is No Good

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 [...]

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HM2014 Abstract Number: 649

Seeing to the Heart of the Matter

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 [...]

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HM2014 Abstract Number: 648

Dapsone Adverse Effect: A Diagnosis to Leave You Breathless

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 [...]

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HM2014 Abstract Number: 647

An Unexpected Case of Venous Thrombolembolism

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, [...]

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HM2014 Abstract Number: 646

A Visitor with a Virus

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 [...]

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HM2014 Abstract Number: 644

Guillain‐Barre Syndrome As Presenting Feature in Patient with Lupus Nephritis

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 [...]

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HM2014 Abstract Number: 645

A Miss and a Hit

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 [...]

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HM2014 Abstract Number: 688

Diabetic Striatopathy: An Uncommon Cause of Hemiparesis

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 [...]

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HM2014 Abstract Number: 689

Necrolytic Acral Erythema Associated with Hepatitis C

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 [...]

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HM2014 Abstract Number: 691

Hypertension: Going More Than Skin Deep

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 [...]

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HM2014 Abstract Number: 690

Shortness of Breath Giving You the Blues?

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 [...]

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HM2014 Abstract Number: 682

Endocarditis, an Uncommon Complication in Hypertrophic Obstructive Cardiomyopathy

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 [...]

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HM2014 Abstract Number: 687

The Fever and Collapse of a Returning Traveler

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) [...]

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HM2014 Abstract Number: 686

Cefepime: A Covert Culprit of Confusion?

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, [...]

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HM2014 Abstract Number: 683

Successful Therapeutic Intervention of a Pulmonary Embolism Transversing a Patent Foramen Ovale

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 [...]

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HM2014 Abstract Number: 685

An Unusual Cause of Cerebral Venous Thrombosis

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 [...]

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HM2014 Abstract Number: 684

Trust but Verify: When Believing the Patient Leads the Doctor Astray

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 [...]

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HM2014 Abstract Number: 681

A Tricky Pain in the Neck: Histoplasmosis Masquerading As Thyroglossal Duct Cyst

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 [...]

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HM2014 Abstract Number: 680

Unusual Etiology of Lower Cranial Nerve Deficits: Glomus Jugulare Tumor (Paraganglioma)

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 [...]

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HM2014 Abstract Number: 676

When You Hear Hooves, Count the Horses

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. [...]

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HM2014 Abstract Number: 677

Down the Rabbit Hole

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. [...]

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HM2014 Abstract Number: 679

The Eyes Have It: Rare Presentation of a Common Malignancy

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 [...]

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HM2014 Abstract Number: 678

Occupational Whoas!

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 [...]

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HM2014 Abstract Number: 675

A Case Report of Gastrointestinal Graft‐Versus‐Host Disease Following Autologous Hematopoietic Cell Transplantation

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 [...]

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HM2014 Abstract Number: 674

Disseminated Mac Infection in a Patient with Anti Ifn Gamma Autoantibody

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 [...]

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HM2014 Abstract Number: 670

Pelvic Pain and Genital Prolapse from a Giant Tarlov Cyst in a Patient with Marfan Syndrome

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 [...]

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HM2014 Abstract Number: 671

The Tale of a Diagnostically Bumpy Ride

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, [...]

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HM2014 Abstract Number: 673

Levimasole Induced Thrombotic Vasculopathy

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 [...]

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HM2014 Abstract Number: 672

Nitrous Oxide Abuse Leading to Hyperhomocysteinemia and Pulmonary Emboli

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. [...]

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HM2014 Abstract Number: 668

Diffuse Alveolar Hemorrhage Due to Pulmonary Capillaritis As Initial Presentation of Antiphospholipid Syndrome

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 [...]

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HM2014 Abstract Number: 656

Cardiobacterium Hominis Subacute Endocarditis

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 [...]

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HM2014 Abstract Number: 669

Dissociated Heart of a Septic Patient

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, [...]

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HM2014 Abstract Number: 665

Leg Abscess Caused by Mycobacterium Kansasii

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. [...]

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HM2014 Abstract Number: 666

Headache and Fever of Unknown Origin — a Case of Primary Cytomegalovirus (Cmv) Infection

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, [...]

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HM2014 Abstract Number: 667

Genetically‐Linked Large Ascending Thoracic Aortic Aneurysm with Dissection in a Young Male Without Syndromic Connective Tissue Disease

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 [...]

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HM2014 Abstract Number: 664

Diarrhea with Eosinophilia; Not Always a Parasitic Infestation!

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 [...]

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HM2014 Abstract Number: 657

Deadly Plant Used for ‘Curing Cancer’. Oleander Toxicity

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 [...]

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HM2014 Abstract Number: 655

Sarcoidosis Masquerading As Biliary Colic

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 [...]

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HM2014 Abstract Number: 653

A Novel Case of Monomorphic Ventricular Tachycardia Induced by Citalopram

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 [...]

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HM2014 Abstract Number: 654

Doege — (Potter) the Bullet with a Knife

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 [...]

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HM2014 Abstract Number: 662

Deeper Than Skin; What Lies Beneath the Chronic Urticaria?

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 [...]

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HM2014 Abstract Number: 652

Did You Look at the Smear?

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 [...]

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HM2014 Abstract Number: 663

Lemierre’s Syndrome: A Forgotten Life‐Threatening Infection

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 [...]

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HM2014 Abstract Number: 661

A Case of Severe Acute Pancreatitis Secondary to Duodenal Diverticulum

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 [...]

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HM2014 Abstract Number: 658

Endocarditis and Disseminated Infection Caused by Streptococcus Anginosus

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, [...]

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HM2014 Abstract Number: 660

Scleredema Adultorum Diabeticorum‐A Rare Cause of Chest Tightness in Adult Male

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 [...]

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HM2014 Abstract Number: 659

A Case of Persistent Anterior Mediastinal Mass in a Patient with Graves’ Disease

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 [...]

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HM2014 Abstract Number: 692

Variation and Outcomes Associated with Direct Admission Among Children with Pneumonia in the United States

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 [...]

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HM2014 Abstract Number: 693

Readmission Penalties and Health Insurance Expansions: A Cautionary Dispatch from Massachusetts

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 [...]

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HM2014 Abstract Number: 694

Transforming the Acute Care Environment: A Web‐Based Patient‐Centered Toolkit

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, [...]

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HM2014 Abstract Number: 695

Features of Successful Academic Hospitalist Programs: Insights from the Scholar (Successful Hospitalists in Academics & Research) Project

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 [...]

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HM2014 Abstract Number: 696

Validation of the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

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, [...]

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HM2014 Abstract Number: 697

Pediatricians’ Experiences with Pediatric Hospitalists: A 10‐Year National Comparison

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 [...]

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HM2014 Abstract Number: 698

The Effectiveness of Computerized Order Entry at Reducing Preventable Adverse Drug Events and Medication Errors in Hospital Settings: A Systematic Review and Meta‐Analysis

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 [...]

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HM2014 Abstract Number: 699

Characteristics of Patients Who Engage the Discharge Appeals Process

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 [...]

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HM2014 Abstract Number: 700

Preparedness for Discharge: A Comparison of Two Measures in Predicting Readmission

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 [...]

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HM2014 Abstract Number: 701

Unintended Consequences of Increasing Pharmacologic Venous Thromboembolic Prophylaxis in Hospitalized Medical Patients

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 [...]

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HM2014 Abstract Number: 702

Impact of Hospitalist Workload on Patient Outcomes: An Analysis of 2 Academic Medical Centers

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 [...]

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HM2014 Abstract Number: 703

Problems in Care Identified in Post‐Discharge Telephone Follow Up by Hospitalists

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 [...]

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HM2014 Abstract Number: 704

Risk Factors for Delirium Transition During an Icu Sleep Quality Improvement Project

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 [...]

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HM2014 Abstract Number: 705

Using A3 Lean Methodology to Improve the Stat Medication Process

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 [...]

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HM2014 Abstract Number: 706

Patient Centered ‐Synchronized Admission Team

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Patient Centered ‐Synchronized Admission Team

HM2014 Abstract Number: 707

The Enhanced Care Program—improving Care Transitions from Hospital to Skilled Nursing Facilities and Reducing Readmissions

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 [...]

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HM2014 Abstract Number: 708

Mitigating the Risks of Adverse Medication Events During Care Transitions from Hospital to Skilled Nursing Facilities

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 [...]

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HM2014 Abstract Number: 709

The Creation of a Pediatric Hospitalist Medicine Dashboard Across a Four Hospital Network: Performance Assessment for Improvement

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. [...]

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HM2014 Abstract Number: 710

Innovations in Data Visualization to Drive Down Unnecessary Transfusions

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 [...]

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HM2014 Abstract Number: 1

A Missed Opportunity to Improve Patient Satisfaction? Patient Perceptions of Inpatient Communication with Their Primary Care Physician

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 [...]

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HM2014 Abstract Number: 2

Face Cards Improve Patient Perception of Physician Communication

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 [...]

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HM2014 Abstract Number: 3

Social Network Analysis of Interactions Between Providers Using Carewebmessenger, a Novel Communication Tool

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 [...]

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HM2014 Abstract Number: 4

Clinical Excellence in Hospital Medicine: Insight Gleaned Through Observation

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 [...]

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HM2014 Abstract Number: 5

Association of Health Literacy with Elevated Blood Pressure in Hospitalized Patients

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 [...]

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HM2014 Abstract Number: 6

Understanding the Role of Physician Attire on Patient Perception: A Systematic Review

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 [...]

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HM2014 Abstract Number: 7

Use of Standardized Patients to Assess and Improve Hospitalist Communication

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 [...]

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HM2014 Abstract Number: 8

Implementation of Unit Based Interventions to Improve Teamwork and Patient Safety on a Medical Service

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 [...]

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HM2014 Abstract Number: 9

Nursing‐Physician Paging Communication: How Effectively Is It Working?

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 [...]

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HM2014 Abstract Number: 10

Training Hospitalists in Communication: Do They Buy It?

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 [...]

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HM2014 Abstract Number: 11

In Their Own Words: Exploring Patient Reflections of Physician Communication Using Press Ganey Surveys

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 [...]

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HM2014 Abstract Number: 12

Variation in Discharge Communication Preferences of Primary Care Providers and Hospitalists in a Hospital‐Affiliated Health Network

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 [...]

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HM2014 Abstract Number: 13

Assessing Collaboration and Teamwork on Inpatient Oncology Units

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 [...]

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HM2014 Abstract Number: 14

Improving Palliative Care Referrals in End Stage Copd

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 [...]

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HM2014 Abstract Number: 15

Physostigmine: A Survey of Clinician Knowledge

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 [...]

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HM2014 Abstract Number: 16

Exploring Trends in Volunteerism Among Hospitalists and Non‐Hospitalists at Academic and Non‐Academic Centers

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 [...]

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HM2014 Abstract Number: 17

Employment Opportunities for Hospitalists Trained in Family Medicine

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 [...]

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HM2014 Abstract Number: 18

Is There an Association Between Cross‐Cultural Care Training and Hospital Length of Stay?

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 [...]

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HM2014 Abstract Number: 19

Assessing the Role of Msiii and Msiv in Patient Care: Better Training While Maintaining Patient Safety

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 [...]

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HM2014 Abstract Number: 20

Can I Entrust You? The Association of Entrustment of Autonomy to Housestaff with 30‐Day Readmission

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 [...]

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HM2014 Abstract Number: 21

Bedside Rounding Appreciated but Not Preferred

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 [...]

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HM2014 Abstract Number: 22

Recurrent Pancreatitis Following Inactivated Influenza Vaccination

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 [...]

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HM2014 Abstract Number: 23

A “Works in Progress” Session to Promote Scholarship in an Academic Hospitalist Group

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 [...]

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HM2014 Abstract Number: 24

Effectiveness and Durability of a Patient‐Centered Hospital‐Based Approach to Provide Instruction on Inhaler Technique for Patients with Asthma or Copd: A Randomized Comparative Effectiveness Tria

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. [...]

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HM2014 Abstract Number: 25

Patient Perceptions of Who Is Most Involved in Their Care with Successive Duty Hour Limits

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 [...]

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HM2014 Abstract Number: 26

Stress and Depression Among Medical Students During Four Years in Medical School

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 [...]

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HM2014 Abstract Number: 27

Embarking on a Hospitalist Career: Residents’ Views and Perspectives

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 [...]

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HM2014 Abstract Number: 28

Curriculum Emphasizing Feedbback Improves Medical Students’ Comfort and Perception Surrounding Feedback

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. [...]

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HM2014 Abstract Number: 29

Risk of Rehospitalization Among Elders with Limited Function and Social Support

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 [...]

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HM2014 Abstract Number: 30

Are Geriatric Neutropenic Oncology Patients at Higher Risk of Bacteremia?

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 [...]

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HM2014 Abstract Number: 31

Prevalence of Dehydration in Older Adults Rehospitalized from a Long Term Care Facility

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 [...]

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HM2014 Abstract Number: 32

Results of the Acute Care of Older Persons Priority Setting Partnership: A Patient‐Centered Research Agenda at the Intersection of Hospital Medicine and Geriatric Medicine

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. [...]

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HM2014 Abstract Number: 33

Global Payment System Attitudes and Comprehension Among Internists

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 [...]

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HM2014 Abstract Number: 34

Gender Disparities in Hospital Medicine

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 [...]

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HM2014 Abstract Number: 35

How Well Can Physicians Anticipate Death and Initiate Early Palliative Care Discussions in Readmitted Patients?

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 [...]

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HM2014 Abstract Number: 36

Factors Associated with Delayed Diagnosis of Pulmonary Embolism

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 [...]

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HM2014 Abstract Number: 37

A Retrospective Study of Fulminant‐Type Pneumococcal Sepsis in a Tertiary Care Emergency Community Hospital in Japan

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 [...]

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HM2014 Abstract Number: 38

What Are Interns Doing on Their Post‐Call Day?

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 [...]

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HM2014 Abstract Number: 39

Factors Associated with Failure of Observation Care

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. [...]

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HM2014 Abstract Number: 40

Serum Selenium Levels Are Associated with Blood Platelet Count in Us Adults

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 [...]

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HM2014 Abstract Number: 41

Safety and Practice Patterns of Intravenous Iron Therapy in Hospitalized Patients: A Single‐Center Experience

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 [...]

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HM2014 Abstract Number: 42

Early Impact of the Ipps 1599‐F Medicare Rules Change on Inpatient and Observation Encounters at an Academic Medical Center

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, [...]

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HM2014 Abstract Number: 43

The Effect of Cranial Computed Tomography Results on Care Withdrawal Decisions After Out‐of‐Hospital Cardiac Arrest

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 [...]

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HM2014 Abstract Number: 44

Evaluation of Stress Ulcer Prophylaxis for Patients with Coagulopathy Secondary to Chronic Liver Disease

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 [...]

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HM2014 Abstract Number: 45

Changing Wound Care Protocols to Reduce Post‐Operative Caesarean Section Complications

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 [...]

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HM2014 Abstract Number: 46

An Open, Prospective, Non‐Comparative Clinical In‐Market Evaluation of a Soft Gel Adhesive Hydrocelluar Foam Dressing*

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on An Open, Prospective, Non‐Comparative Clinical In‐Market Evaluation of a Soft Gel Adhesive Hydrocelluar Foam Dressing*

HM2014 Abstract Number: 47

Can Advance Wound Care Healing Response Be Predicted Based on Wound Area?

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 [...]

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HM2014 Abstract Number: 48

Evaluation of the Modified Heart Score in Predicting Outcomes in Patients with Low‐Risk Chest Pain

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 [...]

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HM2014 Abstract Number: 49

Clinical Characteristics of Patients Admitted for Acute Exacerbation of Copd That Predict Shorter Length of Stay

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 [...]

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HM2014 Abstract Number: 50

Application of the North American Chest Pain Rule in the Observation Unit Setting

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 [...]

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HM2014 Abstract Number: 51

Diastolic Dysfunction As a Poor Prognostic Factor in Patients with Acute Pulmonary Embolism

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 [...]

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HM2014 Abstract Number: 52

The Association Between Upper and Lower Extremity Deep Vein Thrombosis and Peripherally Inserted Central Catheters: Think Below the Waist

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 [...]

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HM2014 Abstract Number: 53

Peripherally Inserted Central Catheter‐Related Bloodstream Infection: Prevalence, Patterns and Predictors

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 [...]

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HM2014 Abstract Number: 54

Survival from Non‐Traumatic Out‐of‐Hospital Cardiac Arrest Is Worse on Weekends Compared with Weekdays: A Report from the 2010 Nationwide Inpatient Sample

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Survival from Non‐Traumatic Out‐of‐Hospital Cardiac Arrest Is Worse on Weekends Compared with Weekdays: A Report from the 2010 Nationwide Inpatient Sample

HM2014 Abstract Number: 55

Analysis of Enoxaparin Dose Titration at a Large, Tertiary Teaching Facility

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 [...]

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HM2014 Abstract Number: 56

The Association of Coffee and Caffeine Consumption with Nonalcoholic Hepatic Steatosis

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 [...]

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HM2014 Abstract Number: 57

Opportunities for Improvement: 30‐Day Readmission Rates in Patients with Chronic Liver Disease

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. [...]

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HM2014 Abstract Number: 58

Rising Us Hospital Admissions for Gram+ Acute Bacterial Skin and Skin Structure Infections (Absssi)

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 [...]

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HM2014 Abstract Number: 59

What Do Hospitalists Think About Getting Inpatient Mammography for Hospitalized Women Who Are Overdue for Screening?

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 [...]

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HM2014 Abstract Number: 60

Hospitalized Women’s Willingness‐to‐Pay Towards the Cost for Inpatient Screening Mammogram: A Contingency Valuation Analysis

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Hospitalized Women’s Willingness‐to‐Pay Towards the Cost for Inpatient Screening Mammogram: A Contingency Valuation Analysis

HM2014 Abstract Number: 61

Oral Nutrition Supplements’ Impact on Hospital Outcomes in the Context of the Affordable Care Act

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 [...]

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HM2014 Abstract Number: 62

Retrospective Evaluation of Percutaneous Left Atrial Appendage Closure Ligation and Exclusion (Replace)

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, [...]

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HM2014 Abstract Number: 63

“When You Are Old, Have Cancer and a Storm Is Approaching” – the Effects of Hurricane Sandy on Cancer Patients and Proposals on Potential Interventions

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on “When You Are Old, Have Cancer and a Storm Is Approaching” – the Effects of Hurricane Sandy on Cancer Patients and Proposals on Potential Interventions

HM2014 Abstract Number: 64

Prevalence of Osteoporosis and Osteoporotic Related Fractures in Young Adults with Congestive Heart Failure

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 [...]

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HM2014 Abstract Number: 65

Initial Review of an Early Goal Directed Therapy for Septic Shock at Grant Medical Center: Is There a Reduction in Mortality and Morbidity?

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, [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Initial Review of an Early Goal Directed Therapy for Septic Shock at Grant Medical Center: Is There a Reduction in Mortality and Morbidity?

HM2014 Abstract Number: 66

Healthcare‐Associated Infection After Red Blood Cell Transfusion: A Systematic Review and Meta‐Analysis of Randomized Trials

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 [...]

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HM2014 Abstract Number: 67

Validating the Improve Venous Thromboembolism (Vte) Risk Score: Retrospective Analysis of Electronic Data from a Large Health System

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Validating the Improve Venous Thromboembolism (Vte) Risk Score: Retrospective Analysis of Electronic Data from a Large Health System

HM2014 Abstract Number: 68

Hospitalized Patients Lack Knowledge About Their Advanced Chronic Kidney Disease

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 [...]

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HM2014 Abstract Number: 69

Dual Anti‐Platelet Therapy for Carotid Artery Stenosis Has No Significant Advantage Over Monotherapy for Prevention of Stroke – Results from a Large Electronic Database

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Dual Anti‐Platelet Therapy for Carotid Artery Stenosis Has No Significant Advantage Over Monotherapy for Prevention of Stroke – Results from a Large Electronic Database

HM2014 Abstract Number: 70

Stroke Prophylaxis in Atrial Fibrillation Is Underutilized‐ an Academic Medical Center Experience

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 [...]

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HM2014 Abstract Number: 71

Severity of Stroke Risk in Atrial Fibrillation Does Not Correlate with the Use of Stroke Prophylaxis

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 [...]

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HM2014 Abstract Number: 72

Association of Hemoglobin A1C and Non‐Traumatic Osteoporotic Fractures in Diabetic Patients

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 [...]

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HM2014 Abstract Number: 73

Effect of Hospitalist – Advanced Practice Provider Teams on Patient Experience

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 [...]

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HM2014 Abstract Number: 74

Site of Hospital Readmission and Mortality: A Population‐Based Retrospective Cohort Study

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 [...]

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HM2014 Abstract Number: 75

Emerging Risk Factors for Pyogenic Streptococcus Anginosus Infections: A Review of 25 Cases

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 [...]

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HM2014 Abstract Number: 76

Practice of Stethoscope Hygiene in a University Based Academic Medical Center

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 [...]

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HM2014 Abstract Number: 77

Do Physicians Know Which of Their Patients Have Central Venous Catheters? A Multi‐Center, Cross‐Sectional Study

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 [...]

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HM2014 Abstract Number: 78

Communication and Follow‐Up of Incidental Lung Nodules Found on Chest Ct in a Hospitalized and Ambulatory Patient Population

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 [...]

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HM2014 Abstract Number: 79

Retrospective Analysis of Systemic Level Factors Associated with Severe Inpatient Hypoglycemia

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 [...]

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HM2014 Abstract Number: 80

Every Inpatient Death Creates an Opportunity to Save Lives: The Mayo Clinic Mortality Review System

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. [...]

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HM2014 Abstract Number: 81

Does Team Training Enhance the Culture of Safety in the Operating Room?

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 [...]

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HM2014 Abstract Number: 82

A Randomized Trial of Real‐Time Automated Clinical Deterioration Alerts Sent to an Acute Care Team

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 [...]

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HM2014 Abstract Number: 83

Refined Appropriateness Criteria for Urinary Catheters in Hospitalized Patients

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 [...]

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HM2014 Abstract Number: 84

Nursing Practice, Concerns and Knowledge Gaps Related to Peripherally Inserted Central Catheters: A Survey‐Based Study

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Nursing Practice, Concerns and Knowledge Gaps Related to Peripherally Inserted Central Catheters: A Survey‐Based Study

HM2014 Abstract Number: 85

Perceptions of Patient Safety Culture Among Hospitalists and Nurses in a Medicine Unit

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 [...]

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HM2014 Abstract Number: 86

Low Regular Use of Practices to Prevent Healthcare‐Associated Infection Despite the High Degree of Perceived Strength of Evidence: A National Study in Japan

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 [...]

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HM2014 Abstract Number: 87

A New Role for Pharmacy Technicians in Medication History Taking and Management

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 [...]

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HM2014 Abstract Number: 88

Growing Strong: Findings from the American Academy of Pediatrics Hospital Medicine Workforce Survey 2012‐13

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 [...]

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HM2014 Abstract Number: 89

Pediatric Hospitalist Circumcision Service: Analysis of Rate of Complications

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 [...]

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HM2014 Abstract Number: 90

Ambulatory Pediatricians Providing Hospital Care: Data from a National Survey

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. [...]

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HM2014 Abstract Number: 91

Central Venous Catheter Failure in Pediatric Patients at a Community Hospital

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 [...]

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HM2014 Abstract Number: 92

Pediatric Hospital Medicine Worklife: Findings from the American Academy of Pediatrics 2012‐13 Survey

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Pediatric Hospital Medicine Worklife: Findings from the American Academy of Pediatrics 2012‐13 Survey

HM2014 Abstract Number: 93

Commercial Premixed Parenteral Nutrition and Its Potential Role in Pediatrics

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 [...]

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HM2014 Abstract Number: 94

The Who, Where, and What of Procedural Sedation: Effects on Resource Utilization and Patient Care in the Hospital

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 [...]

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HM2014 Abstract Number: 95

Risk Factors for Pulmonary Embolism in Orthopedic Patients Undergoing Post‐Operative Ct Pulmonary Angiography

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. [...]

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HM2014 Abstract Number: 96

Perioperative Management of Novel Anticoagulants in Patients Undergoing Arthroplasty

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 [...]

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HM2014 Abstract Number: 97

Quality Assessment of Resident Handoffs in Transitions of Care

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 [...]

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HM2014 Abstract Number: 98

Transitions of Care Between Inpatient and Outpatient Setting: The Role of the Discharge Summary and the Discharge Process

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 [...]

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HM2014 Abstract Number: 99

Predictors for Developing Acute Decompensated Heart Failure During Hospitalization

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 [...]

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HM2014 Abstract Number: 100

Quality Measures and Institutional Factors Are Not Associated with Increased Inter‐Hospital Transfer Mortality

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 [...]

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HM2014 Abstract Number: 101

Doctor Who? A Study of Patient Provider Awareness

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 [...]

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HM2014 Abstract Number: 102

Implications of Anxiety, Depression, Poor Health Literacy and Caregivers Burden, on Thirty Day Hospital Readmission Rates in Patients with Congestive Heart Failure (Chf)

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Implications of Anxiety, Depression, Poor Health Literacy and Caregivers Burden, on Thirty Day Hospital Readmission Rates in Patients with Congestive Heart Failure (Chf)

HM2014 Abstract Number: 103

Impact of Geographic Rounding and Multi‐Disciplinary Rounds on Coordination of Care and Discharge Times

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 [...]

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HM2014 Abstract Number: 104

Impact of a Computerized Copd Inpatient and Transition Pathway on Clinical Outcomes

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 [...]

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HM2014 Abstract Number: 105

Mobile Interdisciplinary Care Rounds (Micro)

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 [...]

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HM2014 Abstract Number: 106

Perception of Communication Frequency and Satisfaction Between Primary Medicine Teams and Nephrology Consultants

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 [...]

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HM2014 Abstract Number: 107

The Impact of Increasing Pharmacologic Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: Results from the Michigan Hospital Medicine Safety Consortium

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on The Impact of Increasing Pharmacologic Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: Results from the Michigan Hospital Medicine Safety Consortium

HM2014 Abstract Number: 108

Improving Hepatitis C Screening Rates in a Resident Clinic: A Quality Improvement Project

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 [...]

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HM2014 Abstract Number: 109

Venous Thromboembolism Risk Assessment Models for Hospitalized Medical Patients

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 [...]

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HM2014 Abstract Number: 110

The Practice of Telemetry in Non‐Icu Beds at a Community Hospital,a Quality Improvement Study

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 [...]

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HM2014 Abstract Number: 111

Evaluating a Hospitalist‐Based Intervention to Reduce Treatment of Asymptomatic Bacteriuria

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 [...]

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HM2014 Abstract Number: 112

Assessing the Impact of Outpatient Resources on Congestive Heart Failure Readmissions: Is It Enough?

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, [...]

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HM2014 Abstract Number: 113

Interventions to Increase Physician Effectiveness and Acceptance of a New Electronic Order Entry and Electronic Medical Record System

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 [...]

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HM2014 Abstract Number: 114

Impact of Standardizing the Therapeutic Management of Diabetic Ketoacidosis Patients in a Community Hospital

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 [...]

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HM2014 Abstract Number: 115

Prediction of Bleeding in Hospitalized Medical Patients on Anticoagulant Prophylaxis

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 [...]

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HM2014 Abstract Number: 116

Let’s Work Together: The Positive Impact of Implementing Multidisciplinary Rounds in a Hospitalist Program

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 [...]

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HM2014 Abstract Number: 117

Management of Sickle Cell Pain Crisis at an Urban Community Hospital Emergency Room (Er). a Comparison of Two Periods

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. [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Management of Sickle Cell Pain Crisis at an Urban Community Hospital Emergency Room (Er). a Comparison of Two Periods

HM2014 Abstract Number: 118

The Incidence of Hospital‐Acquired Anemia and Its Impact in a Teaching Hospital

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 [...]

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HM2014 Abstract Number: 119

Inappropriate Initiation of Antibiotics for Asymptomatic Bacteriuria in Patients Admitted from the Emergency Deptartment

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” [...]

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HM2014 Abstract Number: 120

Dosing of Basal‐Bolus Insulin Regimens in Hospitalized Medicine Patients with Type Ii Diabetes

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 [...]

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HM2014 Abstract Number: 121

Clinical Predictors Associated with Proton Pump Inhibitor Guideline Adherence

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Clinical Predictors Associated with Proton Pump Inhibitor Guideline Adherence

HM2014 Abstract Number: 122

Using a Discharge Readiness Checklist to Reduce Heart Failure Readmissions

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Using a Discharge Readiness Checklist to Reduce Heart Failure Readmissions

HM2014 Abstract Number: 123

The Highest Utilizers of Care: Individualized Care Plans to Coordinate Care, Improve Health Care Service Utilization and Reduce Costs at an Academic Tertiary Care Center

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, [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on The Highest Utilizers of Care: Individualized Care Plans to Coordinate Care, Improve Health Care Service Utilization and Reduce Costs at an Academic Tertiary Care Center

HM2014 Abstract Number: 124

Effect of Geographic Structured Interdisciplinary Rounding on Interdisciplinary and Patient‐Perceived Communication

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Effect of Geographic Structured Interdisciplinary Rounding on Interdisciplinary and Patient‐Perceived Communication

HM2014 Abstract Number: 125

Roundly Debated: Building Best Practices for Attending Rounds at a Teaching Hospital

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Roundly Debated: Building Best Practices for Attending Rounds at a Teaching Hospital

HM2014 Abstract Number: 126

Length of Stay and Implementation of Geographic Structured Interdisciplinary Rounding

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Length of Stay and Implementation of Geographic Structured Interdisciplinary Rounding

HM2014 Abstract Number: 127

Comparative Effectiveness of Quality Improvement Interventions for Pressure Ulcer Prevention in Us Academic Medical Centers

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 [...]

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HM2014 Abstract Number: 128

Implementation of Quality Improvement Interventions for Pressure Ulcer Prevention in University Healthsystem Consortium Hospitals

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Implementation of Quality Improvement Interventions for Pressure Ulcer Prevention in University Healthsystem Consortium Hospitals

HM2014 Abstract Number: 129

Pain, Agitation, and Delirium Guidelines: Implications Within a Community Hospital

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Pain, Agitation, and Delirium Guidelines: Implications Within a Community Hospital

HM2014 Abstract Number: 130

Can We Really Discharge Medicine Patients by Noon? Exploring Barriers to Earlier Discharge

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. [...]

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HM2014 Abstract Number: 131

Hospital Admission and Diagnostic Tests Are Overused in Patients Presenting to the Emergengy Department with Syncope

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 [...]

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HM2014 Abstract Number: 132

Indication Based Ordering of Ecg Monitoring Reduces Inappropriate Utilization

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 [...]

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HM2014 Abstract Number: 133

A Hospitalist‐Centered Effort to Improve Antibiotic Use in Hospitalized Patients

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 [...]

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HM2014 Abstract Number: 134

The Accuracy of Identification of Patients with Pneumonia Through Administrative Data and Impact of Clinical Reclassification on Readmission Rates

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 [...]

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HM2014 Abstract Number: 135

Readmission Intuition: Can Physicians Accurately Predict Readmissions at the Time of Initial Admission?

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 [...]

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HM2014 Abstract Number: 136

Z136 — Closed Loop Communication Between Nurses and Physicians

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Z136 — Closed Loop Communication Between Nurses and Physicians

HM2014 Abstract Number: 137

The “Sleeping Giant”: Risk of Obstructive Sleep Apnea in Hospitalized Medical Patients

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 [...]

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HM2014 Abstract Number: 138

Bed Rest Is Not Always Therapeutic

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Bed Rest Is Not Always Therapeutic

HM2014 Abstract Number: 139

The Effect of Lean Daily Management and Gemba Walks in Quality‐Care Metrics

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on The Effect of Lean Daily Management and Gemba Walks in Quality‐Care Metrics

HM2014 Abstract Number: 140

Are Daily Blood Draws Necessary? Impact of Provider Education on the Frequency of Daily Blood Test Ordered in Hospitalized Patients

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Are Daily Blood Draws Necessary? Impact of Provider Education on the Frequency of Daily Blood Test Ordered in Hospitalized Patients

HM2014 Abstract Number: 141

Awareness of Central Venous Catheters: A Patient Safety Survey

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 [...]

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HM2014 Abstract Number: 142

Crossing the Chasm of Weekend Effect by Hospitalists: A Three‐Year Quasi‐Experimental Study

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 [...]

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HM2014 Abstract Number: 143

Active Implementation of Clinical Alert System and Management by Hospitalists Mitigate Night Shift Call Workload and Unexpected Cardiopulmonary Resuscitation

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 [...]

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HM2014 Abstract Number: 144

Outcome and Cost Ramifications of Delayed Enteral Nutrition and Medications in Hip Fracture Patients

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 [...]

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HM2014 Abstract Number: 145

Standardizing the Definition of Reduced Mobility When Assessing a Patient’s Risk of Venous Thromboembolism

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 [...]

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HM2014 Abstract Number: 146

Functional Assessment of Mentation: Piloting a Mobile Test of Memory & Attention

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Functional Assessment of Mentation: Piloting a Mobile Test of Memory & Attention

HM2014 Abstract Number: 147

Improving Inpatient Engagement Through Bedside Use of Personal Health Records

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. [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Improving Inpatient Engagement Through Bedside Use of Personal Health Records

HM2014 Abstract Number: 148

Use of Smartphones and Other Mobile Computing Devices in Hospitalized Patients

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 [...]

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HM2014 Abstract Number: 149

Foley Catheters and Daily Reminders

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 [...]

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HM2014 Abstract Number: 150

Tackling Effective Life‐Long Learning: Comparing Acp Smart Medicine to Other Point of Care Resources

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 [...]

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HM2014 Abstract Number: 151

Echo‐Ing Change: The Effect of an Electronic Medical Record on Transthoracic Echocardiogram Ordering

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 [...]

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HM2014 Abstract Number: 152

Preparing for Electronic Provider Documentation: A Survey of Physician Preferences About Dictation and Speech Recognition Capabilities at an Academic Medical Center

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Preparing for Electronic Provider Documentation: A Survey of Physician Preferences About Dictation and Speech Recognition Capabilities at an Academic Medical Center

HM2014 Abstract Number: 153

Cloudy with a Chance of Discharge: An Evaluation of General Medicine Discharge Prediction Forecasts

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Cloudy with a Chance of Discharge: An Evaluation of General Medicine Discharge Prediction Forecasts

HM2014 Abstract Number: 154

Risk Factors for Potentially Avoidable Readmission in Cancer Patients

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 [...]

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HM2014 Abstract Number: 155

Association of Functional Limitations with Readmission in Medicare Patients

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. [...]

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HM2014 Abstract Number: 156

Assessing Intern Hand‐Over Processes in an Era of Increased Transitions of Care

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 [...]

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HM2014 Abstract Number: 157

Is Phone‐Calling or Phone‐Answering Important in Post‐Discharge Follow Up Programs?

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 [...]

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HM2014 Abstract Number: 158

Face‐to‐Face At‐the‐Bedside Weekend Signout: A Patient Centric Hospitalist Model That Decreases Length of Stay and Increases Weekend Discharges

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 [...]

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HM2014 Abstract Number: 159

Hospital to Post‐Acute Facility Transfers: A Gap Analysis of Targets for Quality Improvement

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 [...]

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HM2014 Abstract Number: 160

Attendance in a Post‐Acute Care Clinic and 30‐Day Readmission and Emergency Department Return Visit Rates

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 [...]

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HM2014 Abstract Number: 161

Physician Perspectives on Inter‐Hospital Transfer

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Physician Perspectives on Inter‐Hospital Transfer

HM2014 Abstract Number: 162

Comparison of Readability of Patient Discharge Instructions with and Without Use of Disease‐Specific Templates

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 [...]

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HM2014 Abstract Number: 163

Comparison of Patient Outcomes with and Without a Standardized Handoff Procedure

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 [...]

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HM2014 Abstract Number: 164

Seeing Is Believing: Vision‐Related Quality of Life Among Hospitalized Patients

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. [...]

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HM2014 Abstract Number: 165

Envisioned: Examining Vision Among Inpatients with Diabetes

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 [...]

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HM2014 Abstract Number: 166

30‐Day Readmission Related Patient Satisfaction

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 [...]

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HM2014 Abstract Number: 167

Ed to Hospital Handoffs: Physicians’ Experiences, Perceptions, and Attitudes

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, [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Ed to Hospital Handoffs: Physicians’ Experiences, Perceptions, and Attitudes

HM2014 Abstract Number: 168

Hospitalist Performance on Handoff Knowledge Test Similar to Students and Interns

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 [...]

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HM2014 Abstract Number: 169

Transitions of Care in Underserved Patients: A Literature Review

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Transitions of Care in Underserved Patients: A Literature Review

HM2014 Abstract Number: 170

A Single Dose of Oritavancin (Ori) Compared to 7‐10 Days of Vancomycin (Van) in the Treatment of Acute Bacterial Skin and Skin Structure Infections (Absssi): An Analysis of the MRSA Subpopulation in the Solo Non‐Inferiority Studies

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, [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on A Single Dose of Oritavancin (Ori) Compared to 7‐10 Days of Vancomycin (Van) in the Treatment of Acute Bacterial Skin and Skin Structure Infections (Absssi): An Analysis of the MRSA Subpopulation in the Solo Non‐Inferiority Studies

HM2014 Abstract Number: 171

Fluoride Level and Bone Pain As a Predictor of Voriconazole Induced Periostitis

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 [...]

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HM2014 Abstract Number: 172

Incidence and Comparison of Bacteremia in Pediatric and Adult Neutropenic Oncology Patients

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 [...]

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HM2014 Abstract Number: 173

The Diagnostic Implication of Cytokines for Tuberculous Pleural Effusion

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 [...]

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HM2014 Abstract Number: 174

Clinical Utility and Cost Analysis of Cardiac Enzymes Testing in a Community Hospital

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 [...]

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HM2014 Abstract Number: 175

The Effect of Cost and Turn‐Around Time Display on Inpatient Ordering of Reference Laboratory Tests

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 [...]

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HM2014 Abstract Number: 176

“Striking” Down Overuse: The Effect of an Employee Strike on Ordering Practices at an Academic Medical Center

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, [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on “Striking” Down Overuse: The Effect of an Employee Strike on Ordering Practices at an Academic Medical Center

HM2014 Abstract Number: 177

Utility of Repeating a Hemoglobin Level to Detect a Drop in a Single Day

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 [...]

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HM2014 Abstract Number: 178

Hospital Obstruction: Reduced Throughput and Increased Cost Associated with Discharge from Step‐Down Units

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 [...]

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HM2014 Abstract Number: 179

Communicating Laboratory Values to Night Float Physicians

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 [...]

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HM2014 Abstract Number: 180

A Comprehensive Inpatient Medicine Procedure Note Template Integrating a Pre‐Procedure Checklist, Technique Resources, and Specimen Order Entry

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on A Comprehensive Inpatient Medicine Procedure Note Template Integrating a Pre‐Procedure Checklist, Technique Resources, and Specimen Order Entry

HM2014 Abstract Number: 181

On the “Cuhsp” of Greatness: The University of Colorado Hospitalist Scholars Program

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on On the “Cuhsp” of Greatness: The University of Colorado Hospitalist Scholars Program

HM2014 Abstract Number: 182

A Multi‐Faceted Model to Achieve Competency in Practice Based Learning in Graduate Medical Education

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 [...]

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HM2014 Abstract Number: 183

What I Wish I Learned in Medical School: A Novel Elective Focusing on Health Policy, Quality Improvement, Patient Safety, and Value Based Care

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 [...]

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HM2014 Abstract Number: 184

Evaluating the Role of Compatibility Matching in a Combined Internal Medicine and Pediatrics Residency Mentoring Program

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 [...]

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HM2014 Abstract Number: 185

The Ann Arbor Va Hospitalist Quality Improvement Sub‐Internship

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 [...]

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HM2014 Abstract Number: 186

Geriward Falls: An Interprofessional Team‐Based Curriculum on Falls Assessment and Prevention in the Hospitalized Older Adult

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 [...]

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HM2014 Abstract Number: 187

How Patient‐Centered Are You? The Implementation and Assessment of a Train‐the‐Trainer Shared Decision Making Curriculum for Bedside Rounds

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 [...]

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HM2014 Abstract Number: 188

Preparing for Internship: Our Experience with Redesign of Our Capstone Course

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 [...]

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HM2014 Abstract Number: 189

Using Hospitalist Billing Data to Inform Didactic Lecture Series for Inpatient Residents

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 [...]

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HM2014 Abstract Number: 190

Impact of a Hospital Medicine Rotation During Internal Medicine Residency

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 [...]

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HM2014 Abstract Number: 191

Improving Inpatient Skills Through a Bootcamp for New Residents

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 [...]

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HM2014 Abstract Number: 192

Accelerating Change: Preparing Early Learners to Lead Health Systems Transformation

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 [...]

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HM2014 Abstract Number: 193

Incorporation of a Small Group Reflection on Adverse Events Into a Resident Quality Improvement Rotation

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 [...]

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HM2014 Abstract Number: 194

From the Bedside to the Boardroom: Development of an Inter Professional Leadership Team

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 [...]

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HM2014 Abstract Number: 195

Modest Incentive, Significant Impact: Implementation of an Individualized Productivity Incentive

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 [...]

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HM2014 Abstract Number: 196

Simultaneous Rounding with Subspecialist Team Improves Perceived Patient Care, Education and Provider Satisfaction for Inpatients with Cystic Fibrosis

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 [...]

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HM2014 Abstract Number: 197

Inpatient Management of Oncology Patients by Hospitalists: A Tertiary Center Experience

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 [...]

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HM2014 Abstract Number: 198

Introducing the Intelligent Safety Intervention System [Isis]

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 [...]

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HM2014 Abstract Number: 199

Thinking Outside the Box: An Integrated Calculator Within the Electronic Health Record Improves Reliability

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. [...]

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HM2014 Abstract Number: 200

The Daily Safety Check In: A Strategy for Reducing Serious Harm to Patients

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 [...]

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HM2014 Abstract Number: 201

Hospitalists Leading the Way: A Novel, Inter‐Disciplinary Approach to Improve Neurosurgical Patient Outcomes and Care Experiences

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 [...]

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HM2014 Abstract Number: 202

Implementation and Barriers of a Mandatory Pain Management Order Set in an Academic Medical Center

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 [...]

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HM2014 Abstract Number: 203

An Automated Early Warning System Reduces In‐Hospital Mortality

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 [...]

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HM2014 Abstract Number: 204

Enhancing the Patient Safety Movement by Increasing Resident Awareness and Participation in Patient Safety Event Reports

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 [...]

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HM2014 Abstract Number: 205

Pediatric Inpatient Safe Sleep Modeling

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 [...]

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HM2014 Abstract Number: 206

The Discharge Process: It Takes a Team

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 [...]

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HM2014 Abstract Number: 207

Pediatric Behavioral Emergencies — Stay Calm, Stay Safe

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 [...]

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HM2014 Abstract Number: 208

Implementation of a Hospitalist‐General Surgery Comanagement Service with an Emphasis on Hospitalist Satisfaction

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 [...]

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HM2014 Abstract Number: 209

Development of a Perioperative Anemia Management Service

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. [...]

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HM2014 Abstract Number: 210

Battling ‘Note Bloat’: An Intervention to Improve Electronic Documentation Accuracy, Readability, and Compliance, While Preserving Provider Efficiency

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 [...]

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HM2014 Abstract Number: 211

Taking the Pain Out of Quality Improvement: Improving Pain in Patients Seen by an Inpatient Palliative Care Service

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 [...]

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HM2014 Abstract Number: 212

Improving Patient Outcomes Through Implementation of a Vascular Surgery Co‐Management Service

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 [...]

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HM2014 Abstract Number: 213

E‐Dip: Early Discharge Initiation Project. an Innovative Model for 1‐Day Admissions and Throughput

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 [...]

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HM2014 Abstract Number: 214

Reducing 30 Day Readmission Rates on the General Internal Medicine Hospitalist Service at M.D. Anderson Cancer Center

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, [...]

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HM2014 Abstract Number: 215

Development and Evaluation of a Best Practice Discharge Checklist for Hospital Patients Using the Electronic Medical Record

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 [...]

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HM2014 Abstract Number: 216

Causes of Unexpected Deaths on Inpatient Medical Services at an Academic Medical Center — Are Some Cases Avoidable?

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 [...]

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HM2014 Abstract Number: 217

Leveraging Social Media to Accelerate It Innovation

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 [...]

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HM2014 Abstract Number: 218

A Method for Attributing Patient‐Level Metrics to Rotation Providers in an Inpatient Setting

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 [...]

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HM2014 Abstract Number: 219

Is Specialized Care Plan Work Sustainable? A Follow‐Up on Healthpartners’ Experience with Patients Who Are High‐Utilizers

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 [...]

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HM2014 Abstract Number: 220

Use of Topical Anesthetics in Improving Pain Control in a Pediatric Inpatient Population

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 [...]

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HM2014 Abstract Number: 221

Connecting with the Patient: An Innovative Training Workshop Designed to Help Hospitalists Improve Patient Satisfaction Scores

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 [...]

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HM2014 Abstract Number: 222

Studies That Are Pending at Hospital Discharge: A Tool to Improve Communication

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 [...]

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HM2014 Abstract Number: 223

Standardizing the Care of Hospitalist Patients with Sickle Cell Disease

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 [...]

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HM2014 Abstract Number: 224

Guidelines, Education, and Email Alerts Can Decrease Transfusions in General Medical Patients

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 [...]

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HM2014 Abstract Number: 225

Killing Two Birds with One Stone: Reduction of Thromboembolism (Vte) in the Hospital Setting Through Team‐Based Quality Improvement Including Continuing Medical Education

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 [...]

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HM2014 Abstract Number: 226

Beyond Hcahps: Exploring the Patient Experience to Inform Improvement Initiatives

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 [...]

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HM2014 Abstract Number: 227

Discharge Huddle: An Innovative Approach to Discharge Before Noon Initiative

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 [...]

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HM2014 Abstract Number: 228

Initiate? Indicate! Leading Change As Hospitalists Develop a More Informative Prescribing Practice

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 [...]

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HM2014 Abstract Number: 229

Analysis of High‐Utilizers’ Experience with Specialized Care Plans

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 [...]

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HM2014 Abstract Number: 230

The Palliative Care Quality Network: A Quality Improvement Initiative for Palliative Care Services

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 [...]

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HM2014 Abstract Number: 231

Use of a Report Card and Educational Intervention to Influence Routine Lab Ordering by Housestaff

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 [...]

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HM2014 Abstract Number: 232

Getting Hip to Vitamin D: A Hospitalist Project for Improving Assessment of and Treatment for Vitamin D Deficiency in Elderly Patients with Hip Fracture

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 [...]

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HM2014 Abstract Number: 233

Impact of Bedside Ultrasound Guided Pigtail Chest Tube Placement: A Hospitalist Procedure Team‐Based Trial

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, [...]

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HM2014 Abstract Number: 234

Working Your Core (Measures): Exercises to Improve Heart Failure Discharge Documentation

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 [...]

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HM2014 Abstract Number: 235

Two Birds with One Stone: A Peer Mentor Program to Align On‐Boarding with the Drive to Improve Quality

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 [...]

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HM2014 Abstract Number: 236

Developing and Implementing a Novel Medication Reconciliation Tool for Use at Key Transitions During Inpatient Care

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 [...]

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HM2014 Abstract Number: 237

An Innovative Strategy to Improve Hospitalist Engagement Through Social Networking

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, [...]

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HM2014 Abstract Number: 238

Impact of Health It and Clinical Decision Support on the Use of Ct Pulmonary Angiography in Hospitalized Patients

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 [...]

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HM2014 Abstract Number: 239

From Paper to Web: Implementation of a Database to Manage Team Assignment

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 [...]

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HM2014 Abstract Number: 240

Careweb Messenger: A Facebook/twitter/paging Hybrid for Collaborative Care

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 [...]

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HM2014 Abstract Number: 241

Hospital Continuity Teams

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 [...]

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HM2014 Abstract Number: 242

Hospitals and Primary Care Physicians Partnering on Care Transitions: Lessons from a Statewide Multi‐Site Learning Collaborative

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 [...]

By | 2014-05-24T01:00:45-04:00 May 24th, 2014|Uncategorized|Comments Off on Hospitals and Primary Care Physicians Partnering on Care Transitions: Lessons from a Statewide Multi‐Site Learning Collaborative

HM2014 Abstract Number: 243

Statewide Collaboration to Improve Transitions of Care: Developing a Universal Transfer Form

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 [...]

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HM2014 Abstract Number: 244

The Pcori Transitions Project: Developing a Multi‐Faceted Intervention to Improve Care Transitions Within a Pioneer Accountable Care Organization

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 [...]

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HM2014 Abstract Number: 245

Standardized Discharge Summary Deployment Across All Inpatient Specialties in an Academic Medical Center: Preliminary Results

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. [...]

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HM2014 Abstract Number: 246

Transitions of Care Models: Connected Care Program Is Associated with Reduced 30‐Day Readmission Rates2

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 [...]

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HM2014 Abstract Number: 247

A Hospitalist‐Run Post‐Stroke Cardiac Monitoring Program

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 [...]

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HM2014 Abstract Number: 248

Reducing Low‐Acuity Hospital Admissions Through an “Observation Unit‐at‐Home”

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. [...]

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HM2014 Abstract Number: 249

A Prospective Approach to Evaluate Patients with a Very Long Length of Stay

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 [...]

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HM2014 Abstract Number: 250

When Good Isn’t Wells Enough: A Resident‐Driven Ehr Decision Support Tool for Appropriate Ct‐Pa Ordering

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 [...]

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HM2014 Abstract Number: 251

Better, Stronger, Faster: A Novel Model for Coaching Residents in Clinical Efficiency

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, [...]

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HM2014 Abstract Number: 252

Can Less Be More? A Practical Cost‐Conscious Experience for Residents

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 [...]

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HM2014 Abstract Number: 253

A Multidisciplinary Approach to Treating Hospitalized Complex Patients: Does This Have Value?

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 [...]

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HM2014 Abstract Number: 254

Reducing High Cost Ionized Calcium Testing

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 [...]

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HM2014 Abstract Number: 255

Wisdom of the Crowd: Bright Ideas and Innovations from the Teaching Value and Choosing Wisely Competition

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 [...]

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HM2014 Abstract Number: 256

A Resident‐Led Campaign to Reduce Telemetry Waste on a Teaching Service

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 [...]

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HM2014 Abstract Number: 257

The “Physician on Duty” — a Non‐Traditional Hospitalist Role to Improve Patient Flow and Resource Utilization

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 [...]

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HM2014 Abstract Number: 258

Interactive Implementation of High Value Care

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 [...]

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HM2014 Abstract Number: 259

Twisted Tummy: Another Enigma in Pediatric Abdominal Pain

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 [...]

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HM2014 Abstract Number: 260

When It Doesn’t Smell Like Rotavirus; Maple Syrup Urine Disease in the 21St Century

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 [...]

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HM2014 Abstract Number: 261

A Child with an ‘Abnormal Gait’ and Much More

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 [...]

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HM2014 Abstract Number: 262

S/p Pyloromyotomy and Vomiting Again

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 [...]

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HM2014 Abstract Number: 263

Just Another Bronchiolitic….Or Not

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 [...]

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HM2014 Abstract Number: 264

Symptoms, Symptoms Everywhere, but What Diagnosis to Make? Systemic‐Onset Juvenile Idiopathic Arthritis

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 [...]

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HM2014 Abstract Number: 265

Recurrent Stridor — a Deviation from the Norm

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 [...]

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HM2014 Abstract Number: 266

This Baby Has the Teething Blues

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 [...]

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HM2014 Abstract Number: 267

The Cold Truth About This Child’s Obesity

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 [...]

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HM2014 Abstract Number: 268

Factor X Deficiency Presenting As Intracranial Hemorrhage in a Newborn

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) [...]

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HM2014 Abstract Number: 269

On Second Exam: Forward to a Diagnosis Chest Pain in an Adolescent with Cystic Fibrosis

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. [...]

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HM2014 Abstract Number: 270

A Case Report of Neonatal Diabetes, Exocrine Pancreatic Insufficiency, Congenital Heart Disease and Growth Hormone Deficiency

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 [...]

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HM2014 Abstract Number: 271

The Phaces of Stridor

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 [...]

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HM2014 Abstract Number: 272

A “Palpable” Conundrum: Delayed Manifestation of Classic Findings

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. [...]

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HM2014 Abstract Number: 273

Child with Altered Mental Status

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 [...]

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HM2014 Abstract Number: 274

Prenatal Unilateral Testicular Torsion

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 [...]

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HM2014 Abstract Number: 275

Vascular Ring: An Uncommon Presentation of Alte and Feeding Intolerance in Infancy

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. [...]

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HM2014 Abstract Number: 276

The Abc’s of Scedosporium : An Aggressive, Budding, and Challenging‐to‐Treat Fungal Pathogen

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 [...]

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HM2014 Abstract Number: 277

Why Can’t a Previously Healthy Child Be Weaned Off the Ventilator?

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 [...]

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HM2014 Abstract Number: 278

Therapeutic Phlebotomy for Secondary Polycythemia Due to Obesity Hypoventilation Syndrome in a 12 Year Old Child

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 [...]

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HM2014 Abstract Number: 279

Getting to the Heart of the Matter: Restrictive Cardiomyopathy Presenting As Failure to Thrive

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 [...]

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HM2014 Abstract Number: 280

Tough Slough

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 [...]

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HM2014 Abstract Number: 281

Painful Spasms and a Cognitive Bias

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 [...]

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HM2014 Abstract Number: 282

A Case of Non‐Febrile Seizures Due to Chronic Salicylate Intoxication Following Prolonged Household Exposure to Incense Stick Fumes

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 [...]

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HM2014 Abstract Number: 283

Coexistent Human Immunodeficiency Virus Infection and Systemic Lupus Erythrematosus in a Pediatric Patient: A Case Report with Review of the Literature

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 [...]

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HM2014 Abstract Number: 284

A Newborn with Bilateral Shoulder Dimples: Case Report and a Review of Literature

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 [...]

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HM2014 Abstract Number: 285

Disseminated Candida Tropicalis Infection in an 11‐Year‐Old Patient with Medulloblastoma

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 [...]

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HM2014 Abstract Number: 286

I’m Too Sexy for My … Receptor? A Curious Case of Hypersexuality in a 9 Year Old

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 [...]

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HM2014 Abstract Number: 287

Tick‐Borne Illness: Beyond Just a Headache

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 [...]

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HM2014 Abstract Number: 288

A Stroke Against Migraine: The Girl Who Could Not Walk or Talk

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 [...]

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HM2014 Abstract Number: 289

A Tale of Two Vasculitides

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 [...]

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HM2014 Abstract Number: 290

A Case of Teenage Weekend Confusion

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 [...]

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HM2014 Abstract Number: 292

A Rare Diagnosis in the Post‐Haart Era

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 [...]

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HM2014 Abstract Number: 293

A Curious Case of Heart Failure

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 [...]

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HM2014 Abstract Number: 294

Crt Optimization Utilizing Gas Exchange: A Case Report

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 [...]

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HM2014 Abstract Number: 295

A Nonhealing Wound That Is Not Skin Cancer!

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 [...]

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HM2014 Abstract Number: 296

Renal Infarction in Association with Hemoglobin C Trait

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 [...]

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HM2014 Abstract Number: 297

A Rare Diagnosis — It Actually Can Be That

Case Presentation: A 70 year‐old woman presented with progressive weakness over 3‐4 months. Initially, she noticed problems with balance, followed by tremors, forgetfulness and dysphagia. Her husband said recently she became bed bound, difficult to [...]

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HM2014 Abstract Number: 298

Disseminate the Diagnosis

Case Presentation: A 26 year old man presented with 3 weeks of abdominal pain accompanied with diarrhea, nausea, and vomiting. His past medical history was significant for HIV/AIDS (CD4 170 cells/mm3) and on anti‐retroviral therapy [...]

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HM2014 Abstract Number: 299

A Heart Got High

Case Presentation: Our patient was a 60‐year‐old male with no significant past medical history. He was brought to the ED after persistent retrograde memory loss of 4 days duration. He denied any other complaints. He [...]

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HM2014 Abstract Number: 300

A Rare but Curable Cause of Common DVT

Case Presentation: A 37 yr old black Woman with past medical history of latent TB (on INH Rx) presented to a NC Hospital with complaints of left leg pain& swelling of 10 day duration. Swelling [...]

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HM2014 Abstract Number: 301

Abdominal Pain Following Lap‐Sleeve Gastrectomy: A Case of Post‐Operative Portal Vein Thrombosis

Case Presentation: A 25‐year‐old female with a history of polycystic ovarian syndrome, obesity and laparoscopic sleeve gastrectomy two weeks prior presented to the Emergency Department with complaints of lower groin pain and flank pain x [...]

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HM2014 Abstract Number: 302

A Curious Case of Confusion

Case Presentation: We present a 43 year old man with history of neuro‐sarcoidosis resulting in generalized tonic‐clonic seizures and ischemic stroke with residual aphasia and left sided forearm weakness. The patient presented to the emergency [...]

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HM2014 Abstract Number: 303

Adult Onset Recurrent Respiratory Papillomatosis (Rrp): A Case Report and Literature Review

Case Presentation: A 29‐year‐old African American hypertensive male smoker presented with hoarseness and dyspnea. He was noted to be hypoxic and was intubated. Bronchoscopy and laryngoscopy were performed with excision of extensive tracheal papillomas. Pathology [...]

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HM2014 Abstract Number: 304

A Matter of the Heart

Case Presentation: A 20 year old woman originally from Ethiopia presented to a Chicago hospital with complaints of one month of left sided pleuritic chest pain and two weeks of cough and shortness of breath. [...]

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HM2014 Abstract Number: 305

Acalculous Candida Glabrata Cholecystitis: A Rare and Life‐Threatening Disease

Case Presentation: 34 year‐old female presented from an Extended Care Facility with tachycardia, hypotension and leukocytosis. Medical history included morbid obesity (BMI 40) with secondary pulmonary hypertension, obesity hypoventilation syndrome, and diabetes mellitus. She had [...]

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HM2014 Abstract Number: 306

Cocaine: One More Cause of Transaminitis in the Thousands

Case Presentation: 51 y/o male with history of hypertension and substance abuse (alcohol, marijuana and tobacco) was found unresponsive lying down in a hotel room by EMS and brought to the Hospital. In the ED [...]

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HM2014 Abstract Number: 307

Do You Need a Brain Biopsy to Diagnose Creutzfeldt‐Jakob Disease?

Case Presentation: A 47 year old female was brought to our regional medical center by her son. She was aphasic, increasingly agitated, and markedly confused according to her son. Prior to arrival, she had been [...]

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HM2014 Abstract Number: 308

Nmdar Encephalitis :an Unusual Cause of Encephalopathy, Seizures and Respiratory Failure

Case Presentation: An 18 year‐old African American woman with a distant history of seizures presented with two weeks of progressive bizarre behavior and memory loss, followed by refractory status epilepticus requiring mechanical ventilator support. She [...]

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HM2014 Abstract Number: 309

Chondrosarcoma Presenting As a Fatal Pulmonary Tumor Embolism

Case Presentation: An 18 year old man with a history of asthma presented to the ER complaining of sudden onset dyspnea and cough. Lung examination and a CXR were normal. He was given IV solumedrol [...]

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HM2014 Abstract Number: 310

What Is the Cause of This?

Case Presentation: A 39‐year‐old African American male newly diagnosed with AIDS (CD4 75 cells/mm3), viral load 336,000 copies/mL) presented with three months of bloody diarrhea. Each bowel movement was preceded by intense, cramping abdominal pain. [...]

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HM2014 Abstract Number: 311

Pulmonary Talc Granulomatosis: A ‘Particle‐Ularly’ Quirky Case

Case Presentation: A 29‐year‐old Romanian male with history of aseptic meningitis complicated by cerebral venous thrombosis 1 year ago, presented with 3 days of recurrent fevers, chills and debilitating joint pain in his lower back, [...]

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HM2014 Abstract Number: 312

Light Chains Gone Loose — the Final Link in a Mysterious Case of Diarrhea

Case Presentation: A 58 year old female with a past medical history of diabetes mellitus and proteinuria presented with a chief complaint of profuse, non‐bloody diarrhea, post‐prandial epigastric pain, and a 20 pound weight loss [...]

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HM2014 Abstract Number: 313

Flavocoxide (Limbrel) Induced Hypersensitivity Pneumonitis

Case Presentation: This is a 56 year old woman with hypertension, diabetes, hyperlipidemia, asthma and osteoarthritis, who presented with of abdominal pain and diarrhoea, associated with significant increase in ALT and AST. She had a [...]

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HM2014 Abstract Number: 314

Invasive Nocardiosis in an Immune‐Competent Patient with an Implanted Pacemaker

Case Presentation: A 78‐year‐old Caucasian female with a history of hyperlipidemia and pacemaker placement about 2 years prior presented with a chest mass. She noticed a small, non‐tender nodule on the left side of her [...]

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HM2014 Abstract Number: 315

Another Case of Simple Idiopathic Deep Vien Thrombosis

Introduction: An association between venous thromboembolism (VTE) and cancer has been recognized for over 100 years [1]. Nevertheless, VTE remains under diagnosed under treated in patients with cancer [2]. The relationship between the two is [...]

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HM2014 Abstract Number: 316

Newly Diagnosed Granulomatosis with Polyangiitis and Factor V Leiden in a Patient Presenting with a Pulmonary Embolism

Case Presentation: A 63 year‐old Female presented with a one day history of shortness of breath and pleuritic chest discomfort associated with a throbbing headache, hearing loss, rhinorrhea and nasal congestion. Of note, the patient [...]

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HM2014 Abstract Number: 317

A Rare Case of Post‐Infarct Ventricular Septal Defect with Ventricular Pseudoaneurysm

Case Presentation: A 67‐year‐old female with end stage renal disease on hemodialysis was admitted for evaluation of hypotension. Review of systems was unremarkable except for worsening lower limb edema and exertional dyspnea. The patient was [...]

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HM2014 Abstract Number: 318

The “Permanent Patient”: Undocumented, Uninsured, and Unable to Be Discharged

Case Presentation: A 72‐year‐old Hispanic woman with advanced Alzheimer’s dementia presented with failure to thrive. Vitals signs were stable. Body mass index was 17.7 kg/m2. The patient had severe contractures and multiple stage 2‐4 pressure [...]

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HM2014 Abstract Number: 319

Is Ignorance Bliss?: A Case Report of Psychosis and Capacity Determination in Terminal Illness

Case Presentation: A 77‐year‐old male with paranoid schizophrenia was admitted with recurrent ascending cholangitis and gram‐negative bacteremia. Three months earlier, he was diagnosed with pancreatic adenocarcinoma with wide metastases to the liver. Prior to his [...]

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HM2014 Abstract Number: 320

Acute Aortic Intramural Hematoma: A Rare Initial Presentation of Undiagnosed Hypertension

Case Presentation: A 52 year‐old male with no significant medical history presented with sudden onset of severe sharp interscapular pain. On examination, temperature was 33.1°C, and the blood pressure was 211/138 mmHg. ECG showed normal [...]

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HM2014 Abstract Number: 321

Stop Pressing on My Carotid Sinus: Neurally Mediated Syncope in Invasive Head and Neck Cancer

Case Presentation: A 60 year‐old man with history of tongue cancer 28 years prior and recent diagnosis of new oropharyngeal squamous cell carcinoma (T4N1M0) presented with weakness, fatigue and altered mental status. Patient was afebrile, [...]

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HM2014 Abstract Number: 322

Retiform Purpura As a Clue to Diagnosis

Case Presentation: A 50 year‐old asplenic man with a history of hypertension presented with four days of nausea, vomiting and diarrhea and one day of lower extremity burning pain and numbness. Two days prior to [...]

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HM2014 Abstract Number: 323

Don’t Call the Oncologist: Right Atrial and Anterior Mediastinal Mass

Case Presentation: A 19 year old African American female with no known past medical history presented to the ED with 3 months of dyspnea and dry cough. In the emergency department, the patient was afebrile, [...]

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HM2014 Abstract Number: 324

Intramural Hematoma, a Rare Complication of Colonoscopy

Case Presentation: A 60‐year old man was admitted because of acute alcohol intoxication with altered mental status and ataxia. He was treated initially for Wernicke encephalopathy. Patient underwent physical therapy. Laboratory results revealed mild iron [...]

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HM2014 Abstract Number: 325

Diagnosing Granulomatous Disease: When a Zebra Is in Fact a Unicorn

Case Presentation: A 37 year old man with sarcoidosis was referred to a rheumatology clinic at a large tertiary level referral center for complaints of diffuse right hand and left elbow swelling with digital ulcerations. [...]

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HM2014 Abstract Number: 326

My Intestinal Dismals

Case Presentation: A 52 year‐old man presented with six months of abdominal pain and fifty‐pounds of weight loss. He had coronary artery disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, and remote tobacco use. His pain only [...]

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HM2014 Abstract Number: 327

Don’t Cease Until You Find the Yeast

Case Presentation: A 45‐year‐old woman presented with a chief complaint of severe lower back pain and intractable vomiting. She had a complicated medical history: mitochondrial neurogastrointestinal encephalopathy (MNGIE) disease and short bowel syndrome secondary to [...]

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HM2014 Abstract Number: 328

Rare but Classic — a Case of Pheochromocytoma

Case Presentation: A 49 year old male with no past medical history of hypertension, presented to the ER for evaluation of headache associated with nausea and vomiting. Patient reported that he developed throbbing headache over [...]

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HM2014 Abstract Number: 329

Rare Manifestations of Acute HIV Infection

Case Presentation: A 20 years old bisexual male presented after collapsing at the airport, where he worked. Bladder and bowel incontinence occurred during the episode, and confusion and lethargy followed. Several days prior to admission, [...]

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HM2014 Abstract Number: 330

If Looks Could Kill: A Case of Anorexia Nervosa and Thrombocytopenia in a Young Male

Case Presentation: A 28‐year‐old Italian male with anorexia nervosa diagnosed 9 years ago, obsessive‐compulsive disorder (OCD), and hypogonadotropic hypogonadism, presented after he collapsed at work and was taken to a local emergency room for IV [...]

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HM2014 Abstract Number: 331

Unexpected Cause of Fever in a Patient with Hiv/aids

Case Presentation: A 45 year old HIV+ Honduran man without previous diagnosis of AIDS presented with fever, shaking chills, malaise, nausea and diarrhea for 1 week. He reported 100% compliance with his anti‐retrovirals. Social history [...]

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HM2014 Abstract Number: 332

An Unusual Case of Pulmonary Embolism

Case Presentation: A previously healthy 61‐year‐old woman presented with three weeks of progressive shortness of breath, bilateral lower extremity swelling, fatigue, fevers, chills and nonproductive cough. On physical exam, vitals were notable for tachycardia to [...]

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HM2014 Abstract Number: 333

How Deep Should Your Fundoscopic Exam Go? A Rare Case of Endogenous Endophthalmitis Due to Klebsiella Pneumoniae

Case Presentation: A 60‐year‐old Japanese man with DM type II presented to the emergency department for left eye blindness. One day prior, he experienced fevers, chills, and left eye flashes of light that quickly progressed [...]

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HM2014 Abstract Number: 334

Thinking Outside the Box for Dyspnea. Pulmonary Chemodectomas Are Not As Rare As We Think. a Case Report

Case Presentation: A 69 year old female presented with intermittent dyspnea associated with mild bilateral ankle swelling for 6 months. Her physical examination was significant for bibasilar fine crackles with some trace pedal edema. Her [...]

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HM2014 Abstract Number: 335

Severe Atopic Dermatitis with Elevated Igg Levels Masquerading Job’s Syndrome. a Case Report

HIES/Job’s syndrome is a rare immune disorder characterized by skin lesions, elevated IgE‐levels, recurrent skin/sinopulmonary infections, and skeletal abnormalities. We report a case of severe atopic dermatitis with elevated IgE levels mimicking HIES/Job’s syndrome. Case [...]

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HM2014 Abstract Number: 336

Hydrochloric Acid Therapy Can Be Life Saver in Baking Soda Induced Life Threatening Acute Onset Metabolic Alkalosis

Case Presentation: A 65 year old male with oxygen dependent COPD, alcohol abuse and CHF presented to the ER with asymptomatic hypotension. On the day in question, he consumed approximately 2‐3 tablespoons of baking soda [...]

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HM2014 Abstract Number: 337

Uncommon Presentation of Digoxin Toxicity Which Requires Urgent Treatnent in the Setting of Chronic Kidney Disease and Diuretic Use

Case Presentation: An 85 year old man with past medical history of dilated cardiomyopathy (Ejection Fraction 15%), non sustained ventricular tachycardia (VT) status post automatic implantable cardioverter defibrillator (AICD) placement in 1997 and 2004, atrial [...]

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HM2014 Abstract Number: 338

Antibiotics Non‐Responsive Foot Ulcer, Returned Traveller from Bolivia

Case Presentation: My patient was a 64‐year‐old man with no significant past medical history who presented to Emergency department with a progressively worsening right dorsal foot soft tissue infection with a painless ulcer formation over [...]

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HM2014 Abstract Number: 339

An Unusual Cause of Abdominal Pain

Case Presentation: 86 year‐old woman presented with nausea, vomiting and upper abdominal pain for 3‐4 days. Pain was crampy in nature, of moderate intensity (6‐7/10 in intensity on a scale of 0‐10) and radiating to [...]

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HM2014 Abstract Number: 340

Whipple’s Endocarditis– an Elusive Diagnosis

Case Presentation: A 51 year old male with long standing alcohol abuse and presumed cirrhosis presented with a 6 month history of worsening right heart failure symptoms, a 1 year history of diarrhea, weight loss, [...]

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HM2014 Abstract Number: 341

In a Patient with Hairy Cell‐A, Should We Consider Varicella?

Case Presentation: A 43 year old man with a history of hairy cell leukemia in remission with resulting leukopenia presented with one day of fever, headache, photophobia, neck stiffness, and mild confusion. One week prior [...]

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HM2014 Abstract Number: 342

An Odd ‘Path’ to Atrial Flutter

Case Presentation: A 78 year old man with history of ventricular bigeminy and intermittent dyspnea on exertion presented with new onset palpitations. No symptoms of heart failure were elicited. Physical exam revealed an irregular rhythm [...]

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HM2014 Abstract Number: 343

An Unusual Source of Abdominal Pain

Case Presentation: A sixty‐year old female presented to the Emergency Department with chest pain. She had a history of coronary artery disease and received three drug eluting stents. Her chest pain was similar to when [...]

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HM2014 Abstract Number: 344

An Unusual Cause of Severe Refractory Hypercalcemia

Case Presentation: An Unusual Cause Of Severe Refractory Hypercalcemia Hypercalcemia is commonly caused by hyperparathyroidism in the outpatient setting and is mostly asymptomatic. However, hypercalcemia in the inpatient setting is usually more severe and frequently [...]

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HM2014 Abstract Number: 345

Ana or Anca, Which Rash Is It in Sle?

Case Presentation: A 41‐year old man with DM type II and SLE not taking prescribed plaquenil, presented with painful rashes. These started 4 months ago as small purpuric papules that grew into large vesicles in [...]

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HM2014 Abstract Number: 346

Urinothorax As a Rare Cause of Dyspnea

Case Presentation: A 62‐year‐old female with a history of aortic valve replacement treated with warfarin presented with increased urinary frequency and hematuria; she was diagnosed with a right renal calculus by abdominal CT. She was [...]

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HM2014 Abstract Number: 347

Latent Tuberculosis Infection Causing Erythema Nodosum

Case Presentation: An 18‐year‐old female with a history of panniculitis presented with a painful rash. Two years prior to presentation, the rash initially appeared as painful, raised, dark red/purple “bruises” over her shins, thighs and [...]

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HM2014 Abstract Number: 348

Porn: Recalling the Complications of HIV in Today’s Era

Case Presentation: Ocular manifestations of opportunistic infection in HIV are rarely seen in the post HAART era, however, if left untreated it may result in permanent vision loss. Progressive outer retinal necrosis (PORN), acute retinal [...]

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HM2014 Abstract Number: 349

Can’t Find the Answer? Go Back to Basics

Case Presentation: A 72 year old Caucasian man presented to the emergency room (ER) with dyspnea on exertion and dry cough for two weeks. He had a remote smoking history. Physical examination was unremarkable. Arterial [...]

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HM2014 Abstract Number: 350

A Skip Before a Fall

Case Presentation: A 63 yo female was referred from an outside hospital with a right subtrochanteric femur fracture after a mechanical fall. Preoperative cardiac evaluation was requested. Her EKG showed a PR interval of 390 [...]

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HM2014 Abstract Number: 351

A Novel Case of Dress Syndrome Induced by Hydrochlorothiazide

Case Presentation: A 71 year‐old man presented with two days of a progressively worsening non‐pruritic, erythematous rash over his trunk and extremities. He also noted subjective fevers, fatigue, and decreased urine output. He had started [...]

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HM2014 Abstract Number: 352

Cocaine: Old Problem with New Complications

Case Presentation: A 47‐year‐old female with a history of cocaine and marijuana abuse presented to a New York hospital complaining of diffuse bilateral joint pains for one month duration, worse with movement and applied pressure. [...]

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HM2014 Abstract Number: 353

A Sinister Threat from an Unseen Adversary

Case Presentation: A 56‐year‐old woman presented to the Emergency Center (EC) complaining of dizziness and lack of balance. Neurology diagnosed her with peripheral vertigo and sent her home. Over the next 2 months she developed [...]

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HM2014 Abstract Number: 354

Caught in Transit. a Case of Paradoxical Embolism in Patient with a Pfo: The Role of Obstructive Sleep Apnea

Case Presentation: A 54‐year‐old male was hospitalized due to right femur fracture following a fall. Past medical history was significant for OSA, obesity and hypertension. Pelvic Computed Tomography (CT) scan demonstrated acute fractures of right [...]

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HM2014 Abstract Number: 355

Herbal Supplement Use in Cirrhosis: A Case of Acute Liver Toxicity

Case Presentation: A 69‐year‐old male with cirrhosis secondary to Hepatitis C virus (HCV) infection (acquired through blood transfusion), diagnosed 8 years ago, was referred for admission by his primary physician for evaluation of jaundice and [...]

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HM2014 Abstract Number: 356

Thinking Outside the Marrow: An Unusual Case of Pancytopenia in a Woman with Extrapulmonary Sarcoidosis

Case Presentation: A 30‐year‐old African American female diagnosed with biopsy‐confirmed hepatic sarcoidosis 10 years prior was admitted for asymptomatic pancytopenia and worsening transaminitis on routine outpatient testing. She had no other past medical history, and [...]

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HM2014 Abstract Number: 357

Multidisciplinary Approach to Treatment of Severe Klippel‐Trenaunay‐Weber Syndrome

Case Presentation: A 44‐year‐old male with a primary right lower extremity (RLE) hemangioma presented to our institution with fever and RLE tenderness. As a child, the patient underwent removal of scrotal and bladder hemangiomas and [...]

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HM2014 Abstract Number: 358

Keep Your Paws Off My Catheter: An Unusual Cause of Peritoneal Dialysis‐Associated Peritonitis

Case Presentation: A 42 year‐old man with end‐stage renal disease on automated peritoneal dialysis (PD) presented with acute onset, diffuse, stabbing abdominal pain. Pain was worst in the epigastric region, and he had associated mild [...]

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HM2014 Abstract Number: 359

Newer Isn’t Always Better

Case Presentation: A 59 year‐old man presented with three days of progressive dyspnea after right total knee arthroplasty. He had a history of Child‐Pugh class B alcoholic cirrhosis complicated by portal hypertension and encephalopathy and [...]

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HM2014 Abstract Number: 360

Hemoptysis and Fever in a Young Mexican Equals Tuberculosis? The Path to a Diagnostic Error

Case Presentation: A 30‐year‐old Mexican male, presented to the emergency department with a two‐month history of productive cough, fever up to 101.0 F, hemoptysis, night sweats, pleuritic chest pain, malaise and an unintentional weight loss [...]

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HM2014 Abstract Number: 361

A Headache of a Diagnosis: An Exotic Case of Fever Mimicking Meningitis

Case Presentation: A 32‐year‐old man was evaluated in the emergency department for fever. Earlier that day, he had awoken from sleep with a fever, severe generalized headache, neck stiffness, photosensitivity, and nausea. The headache was [...]

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HM2014 Abstract Number: 362

Too Much Too Soon? Delayed‐Onset Rhabdomyolysis After Intense Exercise

Case Presentation: A previously healthy 28‐year‐old woman presented with bilateral arm swelling. One week earlier, she had completed a high‐intensity exercise session that included 60 push‐ups, 30 shoulder presses, and 60 kettle bell swings. Within [...]

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HM2014 Abstract Number: 363

Saddle Pulmonary Embolism with Coexisting Giant Uterine Lipoleiomyoma and Endometrial Carcinoma

Case Presentation: A 60‐year‐old, morbidly obese woman presented with one week of worsening left lower extremity (LLE) edema. She was tachycardic, but in no respiratory distress. Physical exam revealed pitting edema, warmth and erythema of [...]

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HM2014 Abstract Number: 364

The Pancreas Can Be a Jerk!

Case Presentation: A 73 year old woman presented to an Arizona hospital with a 3 month history of weight loss with nausea and vomiting and a 6 week history of progressive “shaking” all over her [...]

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HM2014 Abstract Number: 365

An Uncommon Cause of Fever and Abdominal Pain

Case Presentation: A 39‐year‐old woman with a history of gastric bypass complicated by dysmotility, which led to choledochoduodenostomy and two loop jejunoduodenostomies with subsequent revision to standard gastric bypass anatomy, presented with increased abdominal pain. [...]

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HM2014 Abstract Number: 366

The Amazing Spiderman

Case Presentation: A 30 year‐old man presented with a one‐day history of a sudden painful rash on his left arm that began while sitting on a bench in his yard. Four hours after the rash [...]

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HM2014 Abstract Number: 367

Body Under Seige

Case Presentation: An 88‐year‐old Vietnamese man with a history of hypertension presented with one‐day of rigors, chills, and generalized weakness. Initial physical exam was unremarkable and his admission laboratory studies revealed platelets of 51,000/µL and [...]

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HM2014 Abstract Number: 368

I’ve Fallen and I Can’t Get Up!

Case Presentation: A 68‐year‐old man with history of bladder cancer and hypertension presented with gait ataxia and proprioception difficulties for one year. Social history was remarkable for alcohol consumption of 1.75 liters of vodka weekly [...]

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HM2014 Abstract Number: 369

Why Did I Wake Up with a Swollen Arm?

Case Presentation: A 20 year old female, presented with swelling, numbness and pain of her right arm for the past 2 days. She gave a history of competitive swimming in college. One morning she noticed [...]

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HM2014 Abstract Number: 370

Idiopathic Ventricular Tachycardia in Pregnancy

Case Presentation: A 30‐year‐old woman, G7P4115, 14 weeks pregnant came to the ED complaining of heart racing, lightheadedness, and “feeling about to pass out”. Never had these symptoms before, including her multiple previous pregnancies. PMH [...]

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HM2014 Abstract Number: 371

Distressing Dissection, Disguised

Case Presentation: A 54‐year‐old man with a history of hypertension and gastroesophageal reflux presented to the emergency department with a sore throat. He had sprinted up a flight of stairs and soon developed a severe, [...]

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HM2014 Abstract Number: 372

Too Few — What to Do?

Case Presentation: A 61‐year‐old man presented with episodic chest pain. He described the pain as a pressure and was associated with shortness of breath. He reported relief with sublingual nitroglycerin. He had a history of [...]

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HM2014 Abstract Number: 373

Held on Too Long

Case Presentation: A 60 year‐old man presented with 5‐days of nausea, vomiting, and abdominal pain. His family described him as having increased fatigue, decreased mental status, and poor urinary output over the past week. He [...]

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HM2014 Abstract Number: 374

A Hidden Heart‐Stopper

Case Presentation: A 59 year old woman with history of breast cancer in remission after chemotherapy and radiation presented with intermittent dizziness, palpitations, and chest pain to the emergency room. She developed ventricular tachycardia with [...]

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HM2014 Abstract Number: 375

Acute Pancreatitis with Fatal Intra‐Abdominal Hemorrhage

Case Presentation: A 49 year old woman presented to the Emergency Department with abdominal pain and vomiting. No pertinent information was found in her past history or review of systems. Vital signs and the rest [...]

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HM2014 Abstract Number: 376

Eggerthella Lenta Growth on Blood Culture‐ Not Just a Contaminant!

Case Presentation: A 63 year‐old Caucasian male presented to the emergency department with progressively worsening, sharp, non‐radiating, right‐sided pleuritic chest pain and right upper quadrant pain. Associated with flu‐like symptoms. Past medical history was significant [...]

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HM2014 Abstract Number: 377

Mycobacterium Kansasii Tenosynovitis — a Great Mimicker of Carpal Tunnel Syndrome; Case Report and Literature Review

Case Presentation: A 64‐year‐old Caucasian female with past medical history significant for RA on infliximab, sarcoidosis, and diabetes, presented to the clinic for an evaluation of a mass on the ulnar aspect of right thumb, [...]

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HM2014 Abstract Number: 378

Encephalopathy, Insomnia and the Internet

Case Presentation: A 57‐year‐old female presented to an emergency department after being found naked with confusion, insomnia, falls, tremors and an 80 pound weight loss of weeks to months duration. Past history consisted of hypertension [...]

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HM2014 Abstract Number: 379

A Narrow Escape from the Deadly Dose of Opana

Case Presentation: 25 year‐old man was in his usual state of health until he chopped up Opana ER tablets in tap water, heated the solution, then filled a syringe and took “at least 5‐6 hits” [...]

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HM2014 Abstract Number: 380

The Early Bird Gets the Worm: When to Suspect Echinococcosis

Case Presentation: A 27 year‐old Ethiopian woman presented with indolent weight loss; 3 weeks of post‐prandial abdominal pain and vomiting; and 1 week of dark urine, diarrhea, and itching. The patient’s medical and social history [...]

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HM2014 Abstract Number: 381

Leptomeningeal Carcinomatosis

Case Presentation: A 33‐year‐old male with synchronous acute myeloid leukemia M7 (AML) and anterior mediastinal germ cell tumor treated with cytarabine, idarubicin, cisplatin, ifosfamide, and etoposide presented with several weeks of nausea, vomiting and headache [...]

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HM2014 Abstract Number: 382

Altered Mental Status: It’s All About the Amyloid

Case Presentation: A 75 year old male with a past medical history of myocardial infarction, hypertension and diabetes was brought to the emergency room for altered mental status. During a cross‐country trip, the patient was [...]

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HM2014 Abstract Number: 383

Pancreatic Fistula: A Case of Mistaken Cirrhosis

Case Presentation: A 41 year old male with a twenty year history of alcohol abuse presented to the emergency room with a chief complaint of abdominal pain and increasing abdominal girth over one year. His [...]

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HM2014 Abstract Number: 384

‘B’ Is for Bacteria: Fever, Night Sweats, and Unintentional Weight Loss

Case Presentation: A 48‐year‐old Hispanic man presented with 2 weeks of spiking fevers, night sweats, and unintentional loss of 10 pounds in 30 days. He denied diarrhea, abdominal pain, hematemesis, and melena. He endorsed one [...]

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HM2014 Abstract Number: 385

Cardiac Arrest in a Young Male Following Consumption of Energy Drink

Case Presentation: A 26‐year‐old male with a history of recent diagnosis of hypertension (HTN) was brought to the hospital after he had cardiac arrest while consuming alcohol with his friend. He had ventricular fibrillation (VF); [...]

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HM2014 Abstract Number: 386

A 45 Year Old Man with Fever, Weight Loss, Anemia and Peripheral Neuropathy

Case Presentation: A 45 year old man presented to our institution after a prolonged unidentified illness. Six months prior to presentation he had been started on atenolol for an “aortic stenosis murmur” and a small [...]

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HM2014 Abstract Number: 387

A Cautionary Tale

Case Presentation: A 77‐year‐old female presented with sudden onset hemoptysis and shortness of breath. She reported a slight cough the night prior that she treated with a cough drop. She went to bed without any [...]

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HM2014 Abstract Number: 388

Deciphering the Syndrome

Case Presentation: A 20 year‐old man presented to the emergency room (ER) in a state of agitated delirium. Review of electronic medical records showed a recent hospital discharge for bipolar disorder. His medications were olanazapine [...]

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HM2014 Abstract Number: 389

A Stretch of the Imagination

Case Presentation: A 79 year‐old man presented with a fracture of his left leg after a mechanical fall from an upright position. He was treated for a tibial plateau fracture with a non‐weight bearing splint. [...]

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HM2014 Abstract Number: 390

Nod‐Your‐Regular Disease

Case Presentation: A 74 year‐old Venezuelan man presented to the emergency room with a one‐year history of tender masses on both arms and legs. He had also experienced fever, night sweats, and thirty‐five pound weight [...]

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HM2014 Abstract Number: 391

A Rare Dress

Case Presentation: We report a case of Allopurinol induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. A 54‐year‐old male presented with toe pain due to gout. He was started on allopurinol. Two weeks [...]

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HM2014 Abstract Number: 392

Rare in Its Class, an Unusual Aids Brain Mass

Case Presentation: A 37‐year‐old male with AIDS (CD4 104) presented with progressive fatigue, associated with diarrhea, nausea, palpitations, and episodes of intermittent slurred speech for two months. Physical exam was unremarkable with the exception of [...]

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HM2014 Abstract Number: 393

New Onset Aortitis: The Many Presentations of Vasculitis

Case Presentation: A 73‐year‐old woman with a history of peptic ulcer disease and gastroesophageal reflux presents with severe sharp epigastric pain. Patient notes severe burning pleuritic substernal chest pain with radiation to the back and [...]

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HM2014 Abstract Number: 394

Bilateral Optic Disc Swelling Following Anastrozole Therapy

Case Presentation: We report a case of severe optic disc swelling in a patient on anastrozole therapy for breast cancer using Spectral Domain optical coherence tomography (OCT). A 56 y/o female with early stage breast [...]

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HM2014 Abstract Number: 395

An Adulterant and Anca: Levamisole‐Associated Vasculitis

Case Presentation: A 50‐year‐old male presented with two days of left lower back pain, vomiting, and dark urine. He described the pain as dull, persistent and extending from the left lower back to the upper [...]

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HM2014 Abstract Number: 396

Sepsis Most Unusual, in a Patient with Recent Spontaneous Abortion

Case Presentation: The Surviving Sepsis Campaign has defined the best approach to patients with suspected sepsis. The diagnosis of sepsis requires clinical and laboratory findings and a potential source of infection. Therapeutically, the approach focuses [...]

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HM2014 Abstract Number: 397

An Unusual Pelvic Infection Mimicking Malignancy

Case Presentation: A forty‐three year‐old woman presented with anorexia, fatigue, and a fifty‐pound weight loss over three months. She reported inability to tolerate food due to nausea, vomiting, and diarrhea with every meal. She denied [...]

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HM2014 Abstract Number: 398

Nitrofurantoin‐Associated Hepatoxicity

Case Presentation: A 57 year‐old female with a history of seizure disorder and of recurrent urinary tract infections on nitrofurantoin suppression regimen presented with three day history of increasing confusion and jaundice. She had no [...]

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HM2014 Abstract Number: 399

Doctor the Problem Is with My Legs Not My Asthma

Case Presentation: 68 year old man with history of hypothyroidism, hypertension and longstanding history of allergic rhinitis, and asthma who presented with a 4 day history of subjective fevers and lower extremity numbness. The numbness [...]

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HM2014 Abstract Number: 400

Lump in the Throat

Case Presentation: A 40‐year‐old woman with no past medical history presents to the hospital complaining of severe neck pain, headache, fever, malaise, and shortness of breath with pleurtic chest pain. Her symptoms were preceded by [...]

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HM2014 Abstract Number: 401

Can’t Think, Can’t Hear, Can’t See…There Are Snowballs in My Brain

Case Presentation: A 34‐year‐old previously healthy male presented to an outside facility with rapidly progressive ataxia and encephalopathy over several months. CSF analysis showed slightly elevated protein, with no oligoclonal bands. Brain MRI showed scattered [...]

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HM2014 Abstract Number: 402

A Curious Case of Kaposi’s Sarcoma

Case Presentation: AIDS‐related Kaposi’s sarcoma (KS) is an angioproliferative malignancy that typically presents as asymptomatic, hyperpigmented, raised lesions on the skin. The disease is uncommon in individuals with CD4 counts over 200 and less often [...]

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HM2014 Abstract Number: 403

Nbs: A Real Pain in the Rectum

Case Presentation: An 83‐year‐old female with chronic abdominal pain presented to the hospital with recurrent worsening of her abdominal pain. Her pain was cramping, intermittent and associated with constipation. Tylenol with codeine did not relieve [...]

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HM2014 Abstract Number: 404

Subcutaneous Panniculitis Like T Cell Lymphoma — a Case of Mistaken Identity

Case Presentation: The patient is a 27 year old male with no past medical history who presented to our Emergency Department, part of a large urban/suburban tertiary care center. He complained of left upper arm [...]

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HM2014 Abstract Number: 405

Beyond a Sore Throat: Haemophilius Influenza Aortitis

Case Presentation: A 54 year‐old woman presented with 4 days of sharp epigastric pain that radiated to her back. She reported a recent upper respiratory tract infection that resolved prior to admission. She was febrile [...]

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HM2014 Abstract Number: 406

Weight Loss and Ileal Mass in Immune‐Competent Female

Case Presentation: A 74‐year‐old woman resides in Ohio presented with intermittent dyspepsia, 30‐ lbs. weight loss and decreased appetite for 1 month duration. She denied any fever. EGD revealed duodenal ulcer and biopsy was positive [...]

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HM2014 Abstract Number: 407

Identifying Oxymorphone Hydrochloride Extended‐Release Tablets (Opana Er) Injection As Etiology for Thrombotic Thrombocytopenic Purpura (Ttp)

Background: A 26 year old male presented to the emergency department (ED) in western North Carolina with three day history of progressive shortness of breath, productive cough (of yellowish‐greenish sputum), chills, sweats, subjective fever and [...]

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HM2014 Abstract Number: 408

Jaw Claudication, Vision Loss and High Esr: Always Temporal Arteritis?

Case Presentation: A 66‐year‐old male with a past medical history of type II diabetes mellitus presented to the emergency room with one week of headache. He was initially diagnosed with sinusitis based on imaging results [...]

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HM2014 Abstract Number: 409

A Case of Kikuchi Disease with Prolonged Severe Symptoms Treated with Methylpredonisolone Pulse Therapy

Case Presentation: A 23 year‐old Japanese male with a past medical history of Kikuchi disease (Histiocytic Necrotizing Lymphadenitis) presented with fever, malaise and left axillary lymphadenopathy. 25 days before admission, he felt his left axillary [...]

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HM2014 Abstract Number: 410

Portal Vein Stent Placement: A Palliative Twist on an Old Concept

Case Presentation: A 71 year old female with a past medical history of diabetes, hypertension, and alcohol abuse presented with several months abdominal pain, increasing abdominal girth, weight loss and bilateral lower extremity swelling. An [...]

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HM2014 Abstract Number: 411

New Onset Hyperammonemic Encephalopathy Decades After Ureterosigmoidostomy: Is Gastrointestinal Flora to Blame?

Case Presentation: A 64 year old male with a past medical history of congenital bladder exstrophy and ureterosigmoidostomy at 5 years of age with multiple subsequent revisions, recurrent urinary tract infections and a hospitalization for [...]

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HM2014 Abstract Number: 412

“I Can’t Believe It’s Not Bovis”: A Case of Streptococcus Salivarius Related Endocarditis

Case Presentation: A 40 year‐old male presents with fever, severe fatigue, intermittent myalgias, migratory polyarticular pain and 18 kg unintentional weight loss over 4 months. He has no prior illnesses, and his social history is [...]

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HM2014 Abstract Number: 413

Khat Yellow‐Handed

Case Presentation: A 25 year‐old Yemini man presented with three months of progressively worsening jaundice. The patient had no past medical history and physical exam was negative for stigmata of chronic liver disease. Laboratories were [...]

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HM2014 Abstract Number: 414

An Acute Scrotum: Could It Be Fatal?

Case Presentation: A 65‐year‐old Caucasian male smoker with a past medical history of coronary artery disease, diabetes mellitus, hypertension and dyslipidemia, presented to the emergency department with the complaint of sudden onset right testicular pain [...]

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HM2014 Abstract Number: 415

Painful Skin Leions in an Elderly Women

Case Presentation: A 70 year old Caucasian women is admitted with a 2 week history of extremely painful large violaceous, indurated plaques on her inner thighs bilaterally. She has a past medical history of hypertension, [...]

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HM2014 Abstract Number: 416

Severe Diarrhea in a Patient with Hypertension

Case Presentation: A 61year old female with hypertension treated with olmesartan and recently diagnosed stroke was admitted for a one month history of recurrent non‐bloody emesis and watery diarrhea. Her symptoms started 1 month prior [...]

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