Background: The patient population at tertiary hospitals is increasingly complex due to advancements in healthcare and more aggressive management of comorbidities. This complexity is particularly evident in the patients on medicine services that have a tracheostomy. Patients with tracheostomies on general medical floors often experience prolonged lengths of stay and multiple inpatient complications, such as [...]

Background: Sodium-glucose transport protein 2 inhibitors (SGLT-2i) are antidiabetic drugs that have shown to aid in all-cause/cardiovascular mortality along with progression of renal disease. ​Though SGLT2i have many benefits, there are many instances where these medications need to be held or discontinued; preoperatively (72h-92h prior to surgery), hypotension, reduced oral intake, decrease in eGFR, urinary [...]

Background: Since 2020, UNC Hospitals has increasing numbers of patients who no longer require acute level of care. A portion of these patients have longer length of stay exceeding 30 days while awaiting disposition. This is noticeable in our percentage of long length of stay patients hospitalized 31-60 days (6.8% in 2022 vs 6.0% in [...]

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital readmissions, with national 30-day readmission rates reaching as high as 22.6% [1]. These readmissions place a significant financial burden on healthcare systems, with one study showing that the cost of a COPD readmission can exceed that of the initial admission by 18% [2]. [...]

Background: Quality incentive programs are increasingly used in hospitalist groups and can drive improvement in focus metrics (1,2). Due to the nature of hospitalist work including frequent signout and handoffs, group rather than individual metric attribution can be considered for certain metrics and incentive targets set for either individual or group performance. Purpose: We investigated [...]

Background: With increasing subspecialization in the field of Internal Medicine, the role of the hospitalist has metamorphosed, and the expectation for certification in specialized procedures, such as paracentesis, has diminished. Many hospitalist groups have traditionally relied on procedure services to manage specialized procedures. As a result, the majority of hospitalist faculty, and to a greater [...]

Background: Over 1 million patients are hospitalized in the United States yearly for pneumonia, of which 40% develop parapneumonic effusion. Left untreated, these effusions can progress to complex effusions requiring more invasive treatment, including tube thoracostomy and surgical decortication, increasing hospital length of stay and overall morbidity. In patients with complex parapneumonic effusion, intrapleural lytic [...]

Background: One way academic organizations recognize staff achievements and scholarly activities is through four levels of academic appointments (AA): Instructor, Assistant Professor, Associate Professor, and Professor.1 Nurse Practitioners (NPs) and Physician Assistants (PAs) employed by the Mayo Clinic are highly encouraged to pursue AA.1 While NPPAs commonly participate in a wide range of academic activities, [...]

Background: Traditional Length of Stay (tLOS) is commonly used in Hospital Medicine to assess hospital resource utilization and to incentivize reductions in patient stays. However, tLOS is often attributed to the discharging physician, which can lead to attribution errors and fairness concerns. These limitations can reduce the metric’s utility. In response, Pierce, Harrison, and Patel [...]

Background: Patients with sickle cell disease (SCD) often face frequent emergency department (ED) visits and hospital readmissions, primarily driven by challenges in pain management, stigma, and system-level barriers. Existing interventions at the CU Division of Hospital Medicine, such as cohorting patients with specific teams, multidisciplinary care conferences, and implementing care plans for high-utilizer patients, have [...]