Background: Healthcare institutions face a narrow operating budget to provide patient care. Centers for Medicare and Medicaid Services (CMS) evaluate healthcare institutions based on efficiency, quality and customer experience–in other words: length of stay, readmission rate and patients’ perception of the care they received. The effectiveness of decreased readmission is based on multiple variables, and [...]

Background: Ideal care pathways (ICPs) are tools that aim to align clinical practice with evidence-based guidelines through diagnosis-specific standardized care algorithms within the electronic medical record (EMR). Various studies have demonstrated that ICPs are effective in reducing length of stay, in-hospital costs, clinical variation and hospital complications. These benefits, however, are difficult to quantify within [...]

Background: Work schedules are an important contributor to clinician satisfaction and wellbeing. Following increased work demands from the pandemic, we implemented a change to our hospitalist service structure from a “standard model” with 12-hour, 7-day on, 7-day off shifts including both rounding and admitting duties to an “admitter rounder model” which consisted of primarily 10-hour [...]

Background: Sound Hospital Medicine (HM) and Sound Emergency Medicine (EM) staff a 385-bed hospital in California. The Utilization Review (UR) nurses in the ER were not following the hospital’s Utilization Management (UM) Plan of doing initial InterQual reviews before the hospitalist wrote the initial admission order because of the focus on disposition from the ER. [...]

Case Presentation: A 68-year-old male with osteoarthritis, status post bilateral knee replacement in 2014, presented with two weeks of flu-like symptoms, generalized weakness, and shortness of breath. Upon admission, the patient was noted to have a tender, swollen right knee with laboratories revealing neutrophilia with bandemia. Computed tomography (CT) of the joint revealed punctate gas [...]

Case Presentation: Mr. A is a 48-year-old male with a past medical history of end-stage heart failure. He was transported from prison due to worsening dyspnea and was admitted to the hospital with acute kidney injury. He rapidly deteriorated, requiring transfer to the Intensive Care Unit (ICU) due to worsening shock requiring vasopressors. Mr. A’s [...]

Case Presentation: A 28-year-old Middle Eastern male, previously diagnosed with Systemic Lupus Erythematosus (SLE) and biopsy-proven Lupus Nephritis at the age of 18 in Egypt, had been managing his condition with a daily dose of mycophenolate mofetil at 250 mg. During a routine clinic follow-up, laboratory tests were conducted, revealing concerning results. His 24-hour urine [...]

Case Presentation: A 67-year-old male with a past medical history of peripheral arterial disease, a chronic left lower extremity wound, and type 2 diabetes mellitus was admitted from vascular surgery clinic for osteomyelitis of the left lower extremity. He underwent multiple procedures by the podiatry service including a trans-metatarsal amputation. Intraoperative bone cultures returned positive [...]

Case Presentation: Chronic mesenteric ischemia (CMI) is defined as a gradual reduction of perfusion to the bowels. While bowel infarction is the primary concern with CMI, there may be a relationship between CMI and acute acalculous cholecystitis (AAC). We present the case of a 60-year old female with acute onset right upper quadrant (RUQ) abdominal [...]

Case Presentation: A 91-year-old male with a known history of benign prostatic hyperplasia (BPH), diastolic heart failure, pulmonary embolism, hypertension, and previous extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) urinary tract infection (UTI) presented with encephalopathy. He was not tachypneic nor tachycardic, but his bicarbonate was low at less than 8, and his lactic acid [...]