Background: Hospital systems are increasingly focusing on health equity, including identifying and addressing social drivers of health and healthcare disparities. Conventional quality improvement (QI) approaches have been used to address disparities with varying success. In our health system, using QI to increase use of interpreters has been the primary intervention for improving outcomes in patients [...]

Background: Cardiac arrhythmias pose a significant risk to hospitalized patients, with the potential for increased morbidity and mortality. Rapid recognition of clinically significant arrhythmias is crucial for timely intervention. Cardiac telemetry monitoring offers a means of remote heart rhythm surveillance in the hospital setting. However, limited availability of telemetry beds in many hospitals and the [...]

Background: Communication between team members is fundamental to providing high quality care to hospitalized patients (1). Breakdowns in communication lead to compromised patient safety, delays in care, and poor utilization of resources (2). Our Veterans Affairs (VA) hospital has about 200 inpatient beds, primarily staffed by resident physician teams. Bedside nurses use the admission order [...]

Background: Though the ACGME dictates that Internal medicine residents should be exposed to the domains of quality improvement (QI) and medical education (Med Ed), most residency programs provide limited opportunities to develop these skills. Furthermore, most existing hospital medicine electives which attempt to cover these topics are 4 weeks in length. Purpose: We sought to [...]

Background: The traditional Morbidity and Mortality Conference (MMC) is known for its punitive aspects. Some programs have met the ACGME Internal Medicine (IM) requirement for MMC or Quality Improvement (QI) conferences by focusing on general principles of patient safety. We describe the impact of a QI-based MMC on resident perceptions of psychological safety and the [...]

Background: Daily lab (DL) overuse in hospitalized patients leads to increased costs and resource utilization, iatrogenic anemia, and patient discomfort. Those awaiting discharge to post-acute care, who experience frequent non-medical delays in discharge, may represent an important group of patients at risk of receiving unnecessary DL, especially labs on day of discharge (LOD). Best Practice [...]

Background: Medication reconciliation (MR) is foundational to patient safety during and after a hospital admission. Frequently, MR can be delayed at the time of hospital admission due to incomplete records, patient health literacy, barriers to patient communication such as language or mental status, and unavailability of family or primary care providers. Electronic health records (EHR) [...]

Background: Improving the quality and safety of the care provided is the some of the most essential and critical work done in hospitals today. In the current system of health care education, health care professionals are often trained on improvement methodology. Several methodologies are provided as improvement frameworks in our health care professional schools around [...]

Background: Direct acting oral anticoagulants (DOACs) have been approved for conditions such as non-valvular atrial fibrillation and venous thromboembolism. High quality randomized controlled trials have demonstrated the safety and efficacy of DOACs as compared to warfarin with exceptions in specific patient populations (such as those with mechanical heart valves). DOACs are more convenient and generally [...]

Background: The STAT priority is understood across the medical community to communicate a medical emergency however misuse of the STAT priority is also widespread1. Previously reported studies have shown that inappropriately ordered STAT radiology images could have a negative impact on patient care2. At our institution, qualitative surveys found that the STAT priority was used [...]