Background: Continuous cardiac monitoring (telemetry) is a vital but resource intensive component of patient care, allowing providers to quickly respond to signs of cardiovascular instability. Despite its importance, and existence of American Heart Association (AHA) guidelines, overreliance of telemetry is common. Since telemetry is restricted to specific units, over-use creates a bottleneck in patient flow […]

Background: Medicare Advantage (MA) plans have strong incentives to reduce potentially wasteful healthcare, including costly acute care visits for ambulatory care-sensitive conditions (ACSC) [1-4]. It is unknown, however, whether MA plans lower acute care use relative to Traditional Medicare (TM) or instead shift patients from hospitalizations towards observation stays and emergency department (ED) direct discharges. […]

Background: Accurate coding is paramount to hospital revenue generation and is often supported by a clinical documentation integrity (CDI) team made up of registered nurses and non-clinical coding personnel. Physician-led coding initiatives have demonstrated improvement in case-mix index and clinical documentation. We hypothesized that physician integration into CDI would result in a more robust improvement […]

Background: Equity is an essential domain of healthcare quality [1] but is rarely addressed within quality measurement programs. Quality initiatives, without explicit equity focus, may exacerbate underlying disparities.[2]To address this historic lack of focus on equity, the Centers for Medicare & Medicaid (CMS) now provides confidential reports to hospitals on two disparity metrics for Medicare […]

Background: Unconscious bias within the U.S. health care system has been linked with disparities in the treatment of patients by age, gender, and race (1). While many factors contribute to these disparities, implicit bias may play a significant role. Stigmatizing language often reflects the implicit bias that healthcare providers possess toward patients (2). Recent research […]

Background: Not all residents pursuing an internal medicine subspecialty proceed directly to fellowship. Some trainees take one or more hospital medicine “gap years” prior to applying for fellowship. Residency program directors (PD), fellowship PDs, and faculty advisors spend substantial time advising residents on whether a gap year is the right choice for them. However, virtually […]

Background: Effective provider communication improves patients’ satisfaction, engagement, and health outcomes. Sitting at the bedside may improve communication; however, many providers do not regularly sit during inpatient encounters. We conducted a controlled pre-post evaluation of adding wall-mounted folding chairs inside the entrance of patient rooms, coupled with education, to increase sitting at the bedside by […]

Background: Family members and caregivers serve valuable roles at the hospitalized patient’s bedside as emotional support systems, patient advocates, and decision makers (1). Hospital visitation restrictions (such as those implemented during the COVID-19 pandemic) may come at a cost to patient and caregiver perceptions of care quality and patient safety. Congruent with CDC guidelines during […]

Background: As medical complexity of pediatric patients rises, inpatient family care conferences (FCCs) are increasingly utilized to discuss treatment decisions and goals of care with families and multiple care team members. Studies have shown that emotional connections with providers at a FCC increase family satisfaction with these conferences. Proposals for structuring FCCs suggest involvement of […]

Background: Transforming hospital operations to optimize patient experience begins with a collaborative care team. The geographic re-location of physicians into one unit with an entire care team, in addition to the implementation of Structured Interdisciplinary Bedside Rounds (SIBR), have been linked to multiple outcomes related to effective care team communication and collaboration, including patient safety […]