Background: Clinical documentation is essential for adequate representation of patient quality care metrics and accurate diagnosis capture but rarely taught in graduate medical education. Inaccurate capture of diagnoses leads to clinical documentation integrity (CDI) queries, which increase workload on busy providers. Implementation of a standardized note template for our resident physicians previously resulted in an [...]

Background: Approximately 12% of hospitalizations are related to substance use disorder (SUD), an estimated 20% of hospitalized patients may have SUD, and patients with SUDs are nearly twice as likely to be readmitted. Pharmacotherapies for SUD are underutilized in hospitals, especially in Texas, due to lack of training, structures, and organizational cultures to support evidence-based [...]

Background: The diagnostic process, inherently fraught with uncertainty and susceptible to errors, has been associated with adverse outcomes when physicians exhibit lower tolerance for uncertainty (1,2). The Diagnostic Time-Out (DTO) serves as a structured tool to outline a problem representation, prioritize the differential diagnosis, and communicate diagnostic uncertainty in high-risk situations for diagnostic errors. In [...]

Background: Hospital immobility is highly prevalent and known to cause various complications including deconditioning, pressure injuries, venous thromboembolism, readmissions and mortality(1). Due to the known consequences of immobility, there has been an increased emphasis on identifying patients at highest risk of immobilization and focusing efforts on maintaining function. Increasing patient mobilization has the potential to [...]

Background: Hospital admission is a complex process and more often than not workflows are not aligned leading to delays in patient care and safety issues. Purpose: Align and coordinate care between different disciplines from registration process to admission to the floor to improve patient care, efficiency and safety. Description: Over 100 hours of observation were [...]

Background: Care coordination during the patient’s hospitalization is one of the most important goals to achieve as it affects quality and efficiency outcomes, including length of stay. Multidisciplinary Rounds (MDR) aim to discuss each patient’s care plan in every unit. In our inner-city safety net hospital, each inpatient unit conducted MDR differently. The MDRs varied [...]

Background: People who inject drugs (PWID) are at high-risk for developing serious injection related infections requiring long-term IV antibiotic therapy. For infective endocarditis, current guidelines recommend at least 4 to 6 weeks of IV antibiotic therapy. In PWID, it is recommended this be completed in a supervised setting because discharge home with a PICC line [...]

Background: OSHA defines workplace violence (WPV) as any act or threat of physical violence, harassment, intimidation or disruptive behavior. Healthcare-related WPV is often under-reported and healthcare workers are five times more likely than other professionals to be affected.1 Beyond the immediate trauma, negative outcomes can include low morale and productivity, and increased job stress and [...]

Background: Between 5-30% of hospitalized patients screen positive for unhealthy alcohol use (UAU), and roughly 10-15% of patients have alcohol use disorder (AUD). Brief counseling and medications for AUD are shown to reduce alcohol consumption yet are underutilized in hospitals: over 90% of patients nationally are not screened and treated for UAU. Purpose: To increase [...]

Background: Urine culture testing should primarily be reserved for patients with clinical symptoms or other limited indications. Unfortunately, many admitted patients undergo unnecessary urine culture testing, leading to overdiagnosis and overtreatment of asymptomatic bacteriuria (ASB). Unnecessary antibiotic treatment for ASB does not improve outcomes and exposes patients to side effects. The negative implications may include [...]