Case Presentation: A 46-year-old male with Type 2 DM presented with 2 weeks of malaise, 3 days of cough, dyspnea, and fatigue. His wife noted his breath smelt different over the last 2 weeks. He had a thyroidectomy for multinodular goiter 2 weeks prior and started a ketogenic, intermittent fasting diet after. Medications include empagliflozin [...]

Background: Identifying COVID-19 patients at risk for long lengths of stay (LOS) may help hospitals anticipate resource limitations. There are no large representative studies from US hospitals assessing factors associated with LOS. This information is vital for resource allocation for the current and potential future pandemics. In this study, we examine factors associated with longer [...]

Background: Medical providers are often hesitant to perform bedside procedures in patients with an INR >2 or in patients who have received chemoprophylaxis or therapeutic anticoagulation, despite previously conducted studies suggesting cirrhotic patients with elevated INRs are not at higher risk for complications from a paracentesis or thoracentesis (1)(2). The Hospital Medicine Advanced Practice Provider [...]

Background: While the electronic health record (EHR) provides many benefits, its use can easily allow for incomplete documentation of relevant historical information. The EHR is designed to store documentation of a patient’s past medical history (PMH), surgical history (PSH), family history (FH), and active hospital problems in the History tab. When the information is in [...]

Background: Missed doses have been associated with adverse outcomes and directly correlate to time off the floor. Pharmacist-assisted administration has decreased omitted doses. At Eskenazi Health, most patients requiring intermittent hemodialysis move to the dialysis unit for hemodialysis which occurs during standard medication administration times. As it relates to antihypertensives, some patients benefit from holding [...]

Background: Timely treatment of sepsis is the cornerstone of reducing sepsis-related morbidity and mortality, and a large body of work has demonstrated improved patient outcomes with initiation of early empiric antibiotics. Time to antibiotics after first sepsis recognition has increasingly gained attention as a quality of care metric with Surviving Sepsis Guidelines recommending initiation of [...]

Background: The SARS-CoV-2 pandemic has required healthcare systems around the world to rapidly innovate and adapt to unprecedented operational and clinical strain. Anticipated limitations in healthcare resource allocation is coupled by the strife caused by the variable clinical course of COVID-19 and the isolation of families inevitable with an inpatient admission. Many healthcare systems have [...]

Background: Up to 45% of Americans do not fill prescriptions because of cost. Medication non-adherence annually leads to $100-$300B in excess morbidity and mortality. To better inform medication cost effects on a potentially vulnerable patient population, our primary aim was to measure annual patient out-of-pocket outpatient medication cost for patients without prescription drug insurance coverage [...]

Background: Telemetry is widely used in hospitalized settings for the detection of cardiac arrhythmias. Our hospital uses an electronic telemetry to curb unnecessary telemetry use. The AHA has identified the utility of telemetry in non-cardiac conditions as an area of future research. We studied the telemetry ordering patterns of patients admitted with diagnosis of COVID-19 [...]

Background: Residents receive little feedback on their clinical reasoning (CR) documentation due to time constraints of supervisors and lack of a shared mental model. We developed an innovative workplace-based assessment tool using machine learning (ML) to provide feedback on CR documentation. Here, we describe the impact of feedback using this assessment tool. Methods: In earlier [...]