Background: Totally implantable venous access ports (“ports”) are a cornerstone of the treatment and survival of highly vulnerable patients, particularly those requiring chemotherapy for cancer. Because they are a lifeline for such patients, the ability to use ports for indications other than their primary use (e.g., chemotherapy) is often restricted. We sought to describe current [...]

Background: “Geographic rounding” describes physicians focusing on patient care in a single hospital unit. Studies have suggested that geographic rounding may improve efficiency and communication. Prior to our pilot, physicians at EUHM were seeing patients distributed across 13 units making rounding inefficient and care coordination challenging. Methods: We designed a geographic-based rounding system on unit [...]

Background: Self-directed discharges, also referred to as discharge “against medical advice” (AMA), comprise 1–2% of hospital discharges. Practice guidelines suggest avoiding the designation of “AMA” discharge as this is associated with adverse outcomes. The term “AMA discharge” persists, however, and characteristics of clinician documentation of self-directed discharges remain underexplored. We used retrospective chart review at [...]

Background: Professional billing is crucial for both division revenue and sustainable healthcare. However, provider knowledge on optimal billing for varied clinical scenarios is often lacking. Critical Care Current Procedural Terminology (CPT) Evaluation and Management (E/M) codes are often appropriate for Hospital Medicine (HM) providers to use when providing critical care services to patients during a [...]

Background: Hospital at Home (HaH) delivers hospital-level care to eligible patients in their homes, offering an alternative to traditional inpatient hospitalization. Longitudinal research has demonstrated that HaH can enhance patient outcomes, increase satisfaction, and decrease rates of hospital readmissions. Patients are first identified for HaH program enrollment through referrals by inpatient providers or our internal [...]

Background: Acute decompensated heart failure exacerbations remain a leading cause of morbidity and mortality and are associated with high rates of admissions and healthcare cost. Both the initial dose of intravenous (IV) diuretic and time to administration affect inpatient outcomes. Adequate diuresis prior to discharge is associated with a reduced likelihood of readmission. As part [...]

Background: Among all hospitalized patients with diabetes mellitus, about 40-50% require insulin at discharge. Insulin is a high-risk medication, associated with many errors including missed dosing, inaccurate dosing, or prescription of the wrong type of insulin. Many of these errors can occur during transitions of care including discharge and in patients with poor diabetes knowledge. [...]

Background: Improving efficiency and throughput in cancer patients with high acuity is challenging and requires a multi-disciplinary effort to coordinate care delivery. In The James Cancer Hospital, two separate Internal Medicine Divisions (Medical Oncology and Hospital Medicine) have historically provided inpatient oncology hospitalist care to an average daily census of 98 patients throughout The James, [...]

Background: Acute heart failure exacerbations are a leading cause of morbidity and mortality, with high rates of hospitalization and healthcare expenditure. Guideline-directed medical therapy (GDMT) has improved outcomes in heart failure with reduced ejection fraction (HFrEF), improved ejection fraction (HFimpEF), preserved ejection fraction (HFpEF), and moderately reduced ejection fraction (HFmrEF). Recent studies highlight the benefits [...]

Background: Patients admitted to hospitals often have impaired capacity and contribute to a significant number of prolonged non-acute hospital days, often due to requiring a guardian for decision-making.(1,2) This puts incapacitated, unbefriended patients at a disproportionately increased risk of healthcare associated complications, loss of functional ability, and impacts those people and systems that care for [...]