Background: Internal Medicine physicians are increasingly involved in Perioperative care. Medicare claims data in colectomy & total hip arthroplasty patients shows >50% had a medicine consult (1) Surgeons, when surveyed, felt Internist’s role in preoperative risk stratification and medication management were vital (2).In one study, 82.2% of medical consultations came from surgical services commonly from [...]

Background: Addiction medicine services are a critical component of care for patients suffering from opioid use disorder. Previous research has indicated that opioid use disorder patients have higher lengths of stay (LOS) and higher hospital readmission rates than patients admitted for a different medical condition. Even though the presence of a specialized team of addiction [...]

Background: At the time of hospitalization, a physician must place an admission status order designating inpatient, outpatient, or observation care. If a patient requires medically necessary hospital care for at least 2 midnights, an inpatient admission order is appropriate. If care is expected to last fewer than 2 midnights or if there is uncertainty about [...]

Background: Blood gas analysis should be performed within 30 minutes of collection to ensure accurate results. Venous blood gas (VBG) data can help evaluate critically ill patients, but it has little role in routine use in non-critically ill hospitalized patients. Nonetheless, we noted that at our urban safety-net hospital, many general medicine patients had VBGs [...]

Background: Hospital-at-Home (HaH) is a novel care model providing inpatient care for patients in their home through a combination of home visits and virtual care. Advanced Care at Home (ACH), UNC Health’s HaH program, launched in 2021, has facilitated over 2,000 admissions to date. The majority of HaH care is provided under the terms of [...]

Background: Hospital medicine has expanded significantly over the last two decades but faces a higher physician turnover rate compared to other specialties1 and a critical shortage of providers. A survey conducted in 2019 and again in 2022 showed a reduction in the number of hospitalists identified as being “very satisfied” with their career (from 55% [...]

Background: Transthoracic echocardiography (TTE) is a valuable diagnostic tool widely used for cardiac patients, but its accessibility and convenience have contributed to overuse. Although Appropriate Use Criteria (AUC) were developed to address this, inpatient TTE use continues to rise, with 5–8% annual increases. Studies reveal that while most TTEs meet AUC standards, fewer than one-third [...]

Background: High hospital readmission rates have both clinical and financial consequences which are associated with worse healthcare outcomes for our patients and costly financial penalties for the hospital. The average cost of a readmission estimated to be at $15,200 and adds burden on hospital systems, resources, and cause further harm to our patients, leading to [...]

Background: Diagnostic errors (DE) are common in hospitalized patients, especially those with an unintended escalation of care, and cause substantial harm. However, individual hospitals currently lack methods to analyze local diagnostic process failure patterns to identify targets for quality improvement efforts. Purpose: The AHRQ funded UPSIDE study identified key diagnostic process failures across a national [...]

Background: Prior studies have described the negative collateral effects of a hospital’s closure on the efficiency, access, and quality of care delivered at nearby hospitals that bear the brunt of care transfers and patient dispersion. However, few studies have addressed quality at the institution that is closing, as it is closing, and when the closure [...]