Background: Nearly one-third of laboratory tests in hospitalized patients and up to 60% of routine, repeat lab tests are unnecessary. Unnecessary testing results in excess venipuncture, iatrogenic anemia, patient discomfort, excess costs, wasted lab resources, and a potential cascade of additional tests and interventions. Few academic medical centers, including our institution, have systematic lab stewardship [...]

Background: Vanderbilt University Hospital continues to experience a capacity crisis, leading to a focus on strategies to improve patient flow and length of stay. Other institutions have demonstrated improved throughput by geographically cohorting patients and their respective care teams. Purpose: To reduce hospital length of stay and increase early discharges through the implementation of a [...]

Background: Insurance companies are issuing more denials and causing financial instability for hospitals. On average, hospitals are paid $6,000 less for a patient in outpatient observation status as compared to inpatient status. According to Kaiser Family Foundation Health, the average expense in 2022 for a hospital per inpatient day was $3,025 and is only increasing. [...]

Case Presentation: A two-day old exclusively breastfed male born at term (no prior medical history; routine prenatal care) was discharged at 36 hours of life from the nursery, 5% down from birth weight. He had difficulty latching to feed post discharge and at 45 hours of life, presented to an outside emergency room in cardiorespiratory [...]

Case Presentation: A 20-day-old female former full-term, appropriate for gestational age infant presented to the pediatrician’s office for her first checkup. She was born via uncomplicated vaginal delivery following a normal pregnancy and had normal newborn screening results. She was exclusively breastfed. She was found to be 27% below birth weight and was therefore urgently [...]

Case Presentation: A 15-year-old male with autism spectrum disorder (ASD), depression, and anxiety presented to the emergency department (ED) with aphasia, agitation, and unusual gait. His mother reported stuttering, decreased oral intake, and difficulty with daily activities. He visited the ED for similar symptoms over the past few months. His outpatient provider trialed lorazepam, which [...]

Case Presentation: 7-year-old male with asthma presented with an 8-month history of knee, hip, buttock, and back pain. Pain was worse in the morning and made it difficult for the patient to get out of bed. He was initially referred to physical therapy (PT) by his pediatrician. Pain worsened despite PT, and he was referred [...]

Case Presentation: An 8-year-old boy presented with 8 days of lip swelling, crusting, peeling, and bleeding, causing poor oral intake and dehydration. Initial symptoms included cough, nasal congestion, and fever (100.4°F). He developed lip ulcerations and was seen multiple times with diagnosis of oral herpes and impetigo superinfection. After 4 days of adequate herpes/impetigo therapy, [...]

Case Presentation: A healthy 21-year-old female presented to the children’s hospital with a one-week history of worsening bilateral calf pain, unilateral right lower extremity (RLE) swelling, and cool extremities. Symptoms began after a 12-hour work shift, accompanied by a diffuse erythematous papular rash and intermittent asymmetric joint pain. Her medical history included streptococcal pharyngitis treated [...]

Case Presentation: An 8-year-old female with a history of Guillain-Barre syndrome (GBS) presented with chronic weight loss and constipation for seven months. Exam revealed a small for age, developmentally delayed female with aphasia, inability to ambulate, and a distended but non-tender abdomen. CBC revealed normocytic anemia (Hgb 11.1) and iron deficiency. Additional laboratory testing showed [...]