Background: Accurate clinical documentation is essential for capturing patient severity of illness (SOI) and risk of mortality (ROM). These metrics directly influence hospital quality reporting, including rankings like Vizient and metrics such as Observed-to-Expected Mortality (O:E) ratios. Traditional documentation methods rely heavily on manual input, which in busy clinical practices, results in underrepresented patient risk [...]

Background: The Joint Commission (TJC) defines a sentinel event as one related to patient safety resulting in death, permanent, or severe harm.(1) In TJC Sentinel Event Data Annual Review for 2022, communication breakdowns were identified as the root cause for these events. With stricter duty hour restrictions in hospitals nationally, the number of patient caregivers [...]

Background: Communication failure during patient handoffs is a common cause of harmful medical errors. Therefore, the Joint Commission recommends that healthcare facilities standardize communication during this process. Intrahospital patient transport represents an instance in which it is crucial to have a standardized handoff approach – as patients are monitored less closely, may experience interruptions in [...]

Background: Patients with substance use disorders (SUDs) are at high risk for blood borne viruses (BBV) and sexually transmitted infections (STIs).1 Syphilis infections, in particular, have dramatically increased over the past decade. More patients with syphilis infections are reporting injection drug use.2 Hospitalization is considered a “reachable moment” for this vulnerable patient population.3 Yet, screening [...]

Background: Patients with limited English proficiency (LEP) have a primary language other than English. During the hospital discharge process, patients with LEP may experience challenges communicating with members of the healthcare team and in our division, they have increased readmission rates and reported increased difficulty understanding discharge instructions compared to English proficient patients. Purpose: To [...]

Background: In 2023, UVA Health’s Catheter-Associated Urinary Tract Infection (CAUTI) Coalition identified diagnostic stewardship as a contributing factor in 57% of all CAUTI events. An independent review of all CAUTIs involving hospitalist physicians from 2022-2023 found that diagnostic stewardship was a key driver. Inappropriate urine testing can lead to treating asymptomatic bacteriuria with antibiotics, which [...]

Background: Patients hospitalized for vaso-occlusive crisis (VOC) frequently report dissatisfaction with pain management, which is exacerbated by variability in treatment approaches across healthcare providers. Negative provider perceptions, stigmatized language in the electronic medical record, and misperceptions of appropriate pain management are associated with undertreatment of pain, prolonged hospitalizations, and worse disease-specific outcomes. Effective management of [...]

Background: Tracheostomies are commonly performed on critically ill patients requiring prolonged respiratory support. Managing them in intermediate care units (IMCU) presents challenges, as complications such as tube displacement, infection, and airway obstruction can pose significant risks. Structured safety protocols like checklists have been successfully used in other high-risk healthcare settings to mitigate these risks. Thomassen [...]

Background: Ultrasound guided peripheral IV (USGPIV) placement is a critical skill that currently requires placement by providers or critical care nurses at Yale-New Haven Hospital. In particular, our Liver and Kidney Transplant unit requires frequent support for IV access placement from our Hospitalist Procedure Team (HPT) and critical care nursing intervention (SWAT team). There are [...]

Background: Physician/Bedside Nurse (RN) communication is at the center of care delivery and patient experience for patients admitted to any Hospital Medicine service. While efficient communication within the healthcare team is the hallmark of high quality care, it is highly variable in terms of timing and quality. Inadequate communication between physicians and nurses, as perceived [...]