Background: Limited diagnostic capacity in resource-constrained hospitals leads to delayed diagnoses and inequitable outcomes. At Hospital Nacional Juan José Ortega de Coatepeque in Guatemala, internists frequently manage conditions such as decompensated cirrhosis and pleural effusions with only plain radiography available and no access to a radiologist. A needs assessment of 36 providers showed limited prior [...]

Background: A large academic safety-net hospital has experienced surges in hospital patient volumes resulting in inpatient strain. Strain is defined as a mismatch between supply and demand of hospital resources1. Inpatient strain led to a growing number of admitted patients boarding in the Emergency Department (ED) for several days, physically distant from their inpatient providers [...]

Background: Despite decades of standardized sepsis protocols, fluid resuscitation practices remain variable across hospital settings. At our community hospital, compliance with the 30 mL/kg fluid requirement for severe sepsis and septic shock patients lagged behind national benchmarks, driven by inconsistent documentation, variable order set use, and lack of confidence in assessing fluid responsiveness. Standardized bundles [...]

Background: Clinical documentation is a major contributor to hospitalist burnout due to the time spent on note writing and chart review. Generative artificial intelligence (AI) may help reduce this burden, yet most tools offer limited control over source information or output structure. Additionally, little is known about how clinicians actually use these tools in practice [...]

Background: Hospitals nationwide increasingly shoulder the cost of unaddressed social determinants of health (SDOH). Preventable readmissions and prolonged hospital stays among patients experiencing homelessness increase healthcare expenditures and highlight unmet social needs linked to poorer outcomes. Every county in the United States administers housing assistance – including Permanent Supportive Housing, rapid rehousing, and emergency shelter [...]

Case Presentation: A 60-year-old woman with type 2 DM, hypothyroidism, and Stage IVB cervical squamous cell carcinoma presented for progressive fatigue and anorexia. During her hospitalization, she had recurrent episodes of hypoglycemia with fingerstick glucose readings as low as 33 mg/dL in spite of discontinuing all diabetic medications several months prior due to excellent glycemic [...]

Case Presentation: A 50-year-old woman with hypertension presented repeatedly to the emergency department over one year with cough, wheezing, and exertional dyspnea. She was treated on multiple occasions for presumed asthma exacerbations with steroids, antibiotics, and bronchodilators without improvement. Chest radiographs and EKGs were unremarkable.On her sixth visit, she reported progressive throat tightness and hoarseness [...]

Case Presentation: A 52-year-old man with hypertension, type 2 diabetes (HbA1c 8%), BMI 17 presented with progressive dyspnea and orthopnea. Examination showed jugular venous distension, bibasilar crackles, and pitting edema. Laboratory studies revealed BNP >5000 pg/mL, and troponin 133 ng/L. Transthoracic echocardiography showed reduced left-ventricular systolic function (EF 40–45%) consistent with new HFrEF. Evaluation for [...]

Case Presentation: A 30-year-old man presented with five days of progressive holocephalic headache, posterior neck pain, and photophobia. He denied fever, focal weakness, sensory disturbances, or recent trauma. He emigrated from rural Guatemala ten years prior. Meningeal signs were present, including nuchal rigidity and pain with neck flexion, but his exam was otherwise normal. Non-contrast [...]

Case Presentation: A 60-year-old female with type 2 diabetes, depression, and hyperlipidemia presented with a week of nausea, vomiting, abdominal discomfort, and fatigue. She denied fever, diarrhea, chest pain, or dyspnea. Since starting Tirzepatide 7.5 mg weekly three weeks prior, she had reduced oral intake and unintentional weight loss. Her diabetes was previously managed with [...]