Background: Gastric Point-of-Care Ultrasound (POCUS), has been validated for perioperative pulmonary aspiration risk reduction, but data on medical inpatients is lacking (1). Inpatients often have multiple risk factors for delayed gastric emptying, but may need urgent surgery or procedures. According to the American Society of Anesthesiologists (ASA), a fasting period of 2, 6, and 8 [...]

Background: Chronic kidney disease (CKD) is associated with adverse perioperative outcomes, including mortality, with risk increasing with severity of CKD. (1) Long term dialysis is also associated with pneumonia, unplanned intubation, reoperation, and vascular complications. (2) Common preoperative practices for end stage renal disease (ESRD) patients include measuring day of surgery (DOS) potassium levels. Little [...]

Background: Current guidelines recommend continuing aspirin during elective non-cardiac surgery in 1) patients with prior percutaneous coronary intervention (PCI) if the bleeding risk allows and 2) patients without prior PCI if thrombotic risk outweighs bleeding risk. Comparing the risk of thrombosis and bleeding is frequently inexplicit, particularly in low and intermediate bleeding risk surgery. The [...]

Background: Geographic localization is the practice of assigning physician and advanced practice provider teams to patients located in the same inpatient unit. Poor localization of hospital medicine teams at our institution was identified as a top cause of increased Emergency Department boarding and Length Of Stay (LOS). The purpose of our process improvement project is [...]

Background: Inpatient utilization of Magnetic Resonance Imaging (MRI) is rapidly expanding, with potential effects on length of stay (LOS). At the same time, current hospital occupancy remains about 10 percentage points higher than before the pandemic and hospitalizations are projected to increase 11% by 2034. Hospital systems are striving to optimize processes to improve bed [...]

Background: Among bedside procedures, factors such as body mass index (BMI), prior spinal procedures, and complex spinal anatomy are known to affect the success of lumbar punctures (LP) [2, 3]. However, the phenomenon of a “dry tap,” where cerebrospinal fluid (CSF) cannot be obtained despite the needle tip being correctly positioned in the thecal sac, [...]

Background: While predictive analytics can help anticipate trends, the specific consequences of a national disaster on the healthcare system are often unpredictable. Recently, the East Coast suffered supply chain disruptions due to hurricane damage, leading to dramatic shortages of saline, intravenous (IV) fluids, and dialysate. The damage to Baxter’s North Carolina facility, which represents 60% [...]

Background: In July 2021, our institution launched the Better Flow Program, aimed at streamlining patient flow by documenting the Medically Ready for Discharge Date (MRDD) and the Discharge Delays (DDs) in the electronic medical record (EMR). The MRDD is the date at which a patient is deemed clinically stable for discharge by their medical team. [...]

Background: Multi-visit patients (MVP) tend to represent a small portion (< 5%) of all admitted patients, yet account for more than 40% of 30-day readmissions based on prior literature (1-2). Among our institution’s MVPs, Heart failure (HF) exacerbations are one of the top disease presentations accounting for 40% of 30-day readmissions in 2022. These patients [...]

Background: Palliative care (PC) is a multidisciplinary consult service aimed at ensuring goal-concordant medical care while optimizing patient/family support. Prior studies have illustrated that palliative care consultation can be associated with a significantly shorter length of stay but without significant change in mortality or disposition. Utilization of standard high-risk descriptive criteria or “triggers” that uniformly [...]