Background: To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. We aimed to test the effects of hospitalist physicians rounding on discharging patients first. Methods: Prospective, multi-center randomized controlled trial at three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians […]

Background: Individualized Learning Plans (ILPs) are standardized forms that allow graduating students to self-identify goals, strengths, and weaknesses prior to starting residency. The Coalition for Physician Accountability has advocated for their use in the undergraduate (UME) to graduate medical education (GME) transition. A pilot of ILPs in pediatrics demonstrated moderate usefulness. However, within internal medicine […]

Background: Healthcare disparities have existed for decades, yet it took a global pandemic to put this emergency into the spotlight. The Joint Commission states “health related social needs” (HRSN) are the root cause of many disparities. HRSN encompasses a wide spectrum including inability to pay bills, poor access to transportation, and lack of housing. At […]

Background: Diagnostic errors are common, costly, and harmful. Cognitive biases and suboptimal clinical reasoning are contributing factors for diagnostic error. A diagnostic time-out (DTO) is a structured tool to optimize clinical reasoning, prioritize the differential diagnosis, and communicate diagnostic uncertainty in high-risk situations susceptible to diagnostic error. Purpose: To design and implement an interactive educational […]

Background: Delirium, a highly morbid condition affecting significant numbers of hospitalized adults, is under-recognized due to challenges in monitoring patients’ waxing and waning symptoms. In addition, precipitating environmental factors such as light, sound, and sleep are difficult to observe. Computer vision cameras that can generate continuous observations of patients and their in-room care environment have […]

Background: Since 2010, 130 rural hospitals have closed, leaving only 2,250 rural hospitals remaining in the United States. Of the remaining facilities, outmigration and/or the bypassing of the local hospitals to a larger facility remains problematic and impacts a community’s access to healthcare while affecting the long-term business viability of the city. In December of […]

Background: Mortality prediction models are increasingly being adopted in the clinical setting, both to retrospectively assess quality of care and to prospectively inform clinical practice. An open question is whether a particular hospital should employ a model trained using a diverse nationwide dataset or use a model developed primarily from local data. The Veterans Affairs […]

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk of heart failure (HF) hospitalizations and cardiovascular mortality among patients with HF and left ventricular ejection fraction (LVEF) ≤40%. There is emerging evidence of the benefits of SGLT2i in HF patients with a higher LVEF (>40%). We aimed to evaluate the benefits of SGLT2i in different subgroups […]

Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by […]

Background: Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Methods: We conducted a pooled cohort study using data from three acute heart failure trials (DOSE, ROSE, and ATHENA-HF). […]