Background: Delirium is an acute, fluctuating confusional state that commonly develops in older and acutely ill hospitalized patients. This condition contributes to patient morbidity and mortality and substantial financial burden to the healthcare system through prolonged hospitalization and increased resource utilization. Clinical decision support within the electronic medical record (EMR) has shown potential to improve [...]

Background: For more than a decade, researchers and institutions have been exploring the phenomenon of “high utilizers” – a small percentage of the population that accounts for a disproportionate amount of healthcare spending, often through frequent and/or lengthy hospitalizations. There is very little information, however, on how this population’s needs affect those who provide care [...]

Background: Discharging complex patients at an academic tertiary care center requires comprehensive evaluation, interprofessional coordination, and meticulous planning to address what is needed to ensure safe and timely discharges. Misalignment across care team members on discharge needs and barriers can lead to a delayed discharge which may result in poor patient satisfaction, increased task burden [...]

Background: Inpatient diabetes guidelines recommend insulin therapy for persistent hyperglycemia, defined as ≥ 2 glucose values ≥ 180 mg/dL, with a target glucose range of 140–180 mg/dL (1). However, there is no guidance on point of care glucose (POC-G) testing frequency for patients receiving routine four-times-daily tests without meeting persistent hyperglycemia criteria. Our prior study [...]

Background: Under the Hospital Readmissions Reduction Program (HRRP), a value-based quality initiative by the Centers for Medicare and Medicaid Services (CMS), the 30-day readmission rate is a critical metric for determining financial penalties for hospitals. However, this metric only accounts for patients readmitted to inpatient units, excluding those who return for observation unit stays or [...]

Background: Improving hospital throughput is critical to optimizing patient flow and capacity, particularly during periods of high census and ED boarding which can adversely impact patient experience and have downstream safety implications. Prolonged length of stay may result from inadequate alignment among care team members on patients expected to discharge, insufficient communication of discharge barriers, [...]

Background: Routine transfusion of platelets and Fresh Frozen Plasma (FFP) prior to paracentesis is among the “things we do for no reason”, as recommended against by the American Association of Liver Disease and American Gastroenterology Association in patients with platelets over 20,000. We hypothesize that a Medicine Procedure Service (MPS), which has adopted this recommendation [...]

Background: Patient experience is critical in the quality of care delivered in hospitals and is closely linked to better clinical outcomes and patient satisfaction. Hospitalized patients under the care of hospitalists often face challenges related to communication, understanding their plan of care, and feeling connected to their healthcare team. Enhancing patient experience in this setting [...]

Background: As a strategy to improve throughput and efficiency, Vanderbilt University Hospital implemented geographic localization across several Hospital Medicine (HM) teams and units. This large-scale structural change presents an opportunity to not only improve efficiency and quality metrics, but to improve other patient-centered outcomes including patient experience. Purpose: To assess the impact of a hospital [...]

Background: Patient experience is a key indicator of healthcare quality, influencing both satisfaction and outcomes. Despite ongoing efforts to improve care, many patients continue to report unmet needs or concerns, particularly in the late afternoon and evening hours. Addressing these concerns before the end of the day is essential to enhancing overall patient experience. Purpose: [...]