Background: Close outpatient follow up is a key element of a safe and effective transition to home after hospitalization. For a wide variety of patients, including those with myocardial infarctions, heart failure, and other conditions, interventions that encourage follow up can reduce readmissions and in some cases mortality. However, competing demands by the clinical team [...]

Background: Since the creation of Hospitalists in 1995, there has been much written about the importance of communication with primary care physicians (PCPs) as a routine staple of hospitalization. In practice, the inconsistent nature of hospitalist-PCP communication is well established. National surveys estimate the rates of communication to be between 20-40%. Amidst multiple barriers identified, [...]

Background: As hospital medicine looks to the future, we carry forward achievements and lessons learned from the past three years. In our large and diverse health system (with 14 acute care hospitals that serve adult inpatients from a populous catchment area, ranging in type from quaternary/academic to community based) we found we can best support [...]

Background: Upon hospitalization, patients are assigned to an inpatient or an outpatient status for the hospital stay. Failure of this status to match the requirements of the Centers for Medicare & Medicaid Services may lead to lost revenue or increased risk of audits and penalties. Timely ordering of observation services for patients with an outpatient [...]

Background: Federally Qualified Health Centers (FQHCs) are community-based primary care centers serving those in medically underserved areas (MUAs) regardless of barriers. Academic Medical Centers (AMCs) are often similarly located and serve as the population health manager for their local communities. AMCs, however, often struggle to deliver care to these communities in a financially sustainable way. [...]

Background: Family and patient-centered rounds (FPCR) are standard practice on inpatient pediatric care teams. FPCR involves the patient and an additional support person (e.g. family member) in the rounding process. FPCR benefits patient care through improved patient satisfaction; increased provider-patient communication; more frequent care-coordination and discharge planning; and decreased errors and episodes of low-value care. [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. More recently, HaH models have evolved to include transitional care solutions to improve patients’ post-acute outcomes. Meanwhile, services which were traditionally provided only in the inpatient setting, such as elective arthroplasty, have begun to shift to same-day and [...]

Background: Nearly 80% of adults will experience non-specific low back pain at some point in their life.(1) In the absence of concerning features such as saddle anesthesia, imaging studies are not indicated and can lead to a downstream cascade of services which can result in undue physical, emotional, and financial harm to the patient.(2-6) As [...]

Background: Reducing hospital length of stay (LOS) for patients who are medically ready for discharge is both an operational necessity and a shared patient goal given fixed hospital capacities and rising costs of care. Presently, there is no readily identifiable time-point in the electronic medical record (EMR) denoting when patients become medically ready for discharge. [...]

Background: Electronic medical records (EMR) often allow automated recurring orders of different components of hospital care, including lab tests, vital signs, and telemetry monitoring. However, as patients clinically stabilize during a hospital admission the frequency and intensity of these recurring orders may be unwarranted (1). Well-designed EMR order sets have shown potential to decrease inappropriate [...]