Background: Patients are often discharged from the hospital with active medical issues needing outpatient follow-up (AINF) – including recommended labs, imaging, procedures, follow-up appointments, and follow-up of incidental findings – but patients and their outpatient providers often fail to complete these recommended workups [1]. Primary care physicians strongly recommend that discharging providers include a brief [...]

Background: Each year, over 5 million hospital-to-skilled nursing facility (SNF) transitions occur; of these patients, 20% are readmitted within 30 days. SNF transitions can be complex and error-prone, with hospital medicine teams noting unfamiliarity with key handoff information and SNF providers reporting incomplete or inconsistent discharge information. While effective communication between hospital and SNF providers [...]

Background: Since the 1960s, benzodiazepine therapy has been the standard of care for alcohol withdrawal syndrome (AWS) [1]. Recently, phenobarbital-based withdrawal has re-emerged as a potentially safer and more effective option that can decrease admission rates when given in the emergency department (ED) [2-7]. Thus, many academic medical centers (AMCs) have switched to phenobarbital for [...]

Background: Iron deficiency is the most common cause of anemia and a common comorbidity in hospitalized patients. Iron deficiency is present in up to 50% of patients with heart failure and intravenous (IV) iron can improve symptoms, functional capacity, and quality of life1. Inflammatory bowel disease has a prevalence of iron deficiency in 25% of [...]

Background: Improving hospital throughput and capacity is a challenge that many health systems face. Specifically, emergency room overcrowding leads to delayed access to treatment and increased mortality, thereby negatively impacting patient safety (Franklin, et al., 2023). Health systems strive to employ multiple strategies to tackle the issues around patient flow. One such strategy includes the [...]

Background: The use of advanced practice providers (APPs) is increasingly prevalent throughout all levels of healthcare. However, there is no standard of practice regarding onboarding these providers to their new positions. This is in part due to the vast range of roles and responsibilities that APPs can contribute to the workforce. Although methods for initiating [...]

Background: There are mounting evidence that the clinical outcomes of conservative blood utilization strategy are equal or superior to liberal blood utilization in patients with anemia in the absence of severe acute hemorrhage, hemodynamic instability, or acute ischemia. However, practice variations among clinicians continue to create a challenge to effective blood utilization stewardship. Hospital Medicine [...]

Background: Carotid artery Doppler ultrasound is a valuable diagnostic tool for patients with neurological symptoms suggestive of cerebrovascular disease, such as transient ischemic attack (TIA), stroke, or focal neurological deficits. However, its diagnostic utility is limited in patients presenting with non-specific symptoms such as syncope, dizziness, or headache. Unnecessary Doppler orders in these cases can [...]

Background: As a strategy to address its ongoing capacity crisis, our hospital has focused on reducing length of stay and improving throughput. Our hospitalists care for patients on >20 nursing units across four buildings, which creates inefficiencies that may prolong length of stay. Although other institutions have demonstrated improved patient flow by geographically cohorting patients [...]

Background: Violence towards healthcare workers represents a critical threat to safe and effective care delivery. United States Bureau of Labor statistics demonstrate disproportionately higher rates of violence towards healthcare staff than workers in other industries, with healthcare accounting for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018 (1). The [...]