Background: Efficiently identifying clinically appropriate patients is integral to the operation and growth of a hospital at home program. Given the nuances of a home-based care delivery model, this task typically relies on a specifically trained small group of experienced providers, significantly limiting the number of patients able to be screened. The Hospital at Home [...]

Background: Providing patient centered care is a core value of all healthcare systems in our nation. However, having a code status discussion with patients and their families continues to be a challenging endeavor due to multiple factors such as competing priorities and time constraints, especially in the hospital setting. To improve code status discussion and [...]

Background: Medicine procedure services (MPS) have been shown to increase procedure volume, procedure completion rate, adherence to best practice safety measures, resident involvement, and resident satisfaction within Internal Medicine (IM). Despite these benefits, widespread deployment of MPSs has proved challenging, partly because the impact of MPSs on non-IM services is unknown, including MPSs’ impact on [...]

Background: The delay or failure to follow-up test results pending at discharge (TRPAD) is a well-documented safety concern occurring in 20-61% of inpatients. Driving factors include ambiguity in the physician responsible and variable handoff practices between the inpatient and outpatient provider. Test result management encompasses many contextual factors such as clinical workflow, user behaviors, and [...]

Background: Inpatient telemetry monitoring is a limited resource. The value of telemetry monitoring in hospitalized patients with high risk for cardiac arrhythmia is high. However, telemetry monitoring is often ordered for inpatients at low risk for cardiac arrhythmia. The SHM’s Choosing Wisely campaign recommended avoiding continuous telemetry monitoring in non-ICU patients without a protocol. Ordering [...]

Background: Patients with delirium are at risk for increased mortality, length of hospital stay, and cognitive impairments for up to one year. In addition, it is estimated that healthcare costs are 2.5 times higher in patients with delirium than in those without. Purpose: Our quality improvement project aims to reduce the incidence of delirium. We [...]

Background: Patients undergoing induction chemotherapy for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) often experience prolonged hospital stays due to the length of induction therapy, follow-up bone marrow biopsies, and count recovery. While the average length of stay (LOS) for these patients may exceed 30 days, most diagnosis-related groups (DRGs) assign a LOS [...]

Background: Stepdown units were introduced to provide an alternative for patients with needs not met by a general ward unit but did not require an intensive care unit. Current research indicates that these beds promote greater flexibility in patient triage, increase accessibility to limited intensive care resources, and provide a cost-effective alternative for patients. The [...]

Background: POCUS is rapidly becoming an important tool in Hospital Medicine (HM) and is endorsed by the Society of Hospital Medicine (SHM).​Many medical schools and physician residency programs have recognized the clinical value of POCUS and subsequently come to incorporate competency as a core clinical skill for graduation.APP programs, however, have lagged behind with only [...]

Background: Electronic medical record (EMR) chart notes are primary tool through which providers communicate their thought processes, clinical decision making and care plans. Our health system consists of 11 hospitals ranging from large academic medical center to small hospitals in Minnesota and Western Wisconsin. Hospital Medicine team represent over 250 providers across all the sites. [...]