Background: Timely initiation of therapy evaluations is critical for optimizing patient outcomes and hospital throughput. At our institution, approximately 80% of initial therapy evaluations were completed within 24 hours of order placement—a rate that remained unchanged for several years. Recognizing this as an opportunity for improvement, we aimed to increase the proportion of evaluations completed [...]

Background: Venous thromboembolism (VTE) prophylaxis is a critical component of inpatient care, butinappropriate or unnecessary pharmacologic administration can expose patients to avoidablerisks, such as bleeding, and increase healthcare costs. At our institution, there has been shownto be an unnecessary amount of prophylaxis used on patients that don’t meet criteria forneeding VTE prophylaxis. For low-risk non-ICU [...]

Background: As hospitalists we manage patients with a wide range of problems and an unplanned hospitalization might be the patient’s best opportunity to establish a healthcare connection. While our primary focus is stabilizing the patients and optimizing them for discharge, there is a significant opportunity to improve the quality of care they receive and enhance [...]

Background: Emergency Department (ED) boarding is a widely recognized problem(1). Over two decades of published research has demonstrated a link between ED boarding and an increase in patient mortality(2), as well as decreased patient, family and staff satisfaction(3). A common solution is a capacity command center, which centralizes the various functions of patient flow, including [...]

Background: Severity of illness documentation is essential in capturing the complexity of patients to justify their hospital admission and inpatient level of care resources. Additionally, systems-based practice is a core competency for the ACGME. Residency programs do not typically have formal curriculum for items such as clinical documentation improvement. As such, residents in our system [...]

Background: Emergency Department (ED) boarding and delayed admissions contribute to overcrowding, prolonged inpatient stays, adverse clinical outcomes, and physician burnout. At our large tertiary care, Level I trauma center, hospitalists traditionally managed both inpatient rounding and new ED admissions. This dual responsibility often resulted in delayed consult-to-bed request times, care fragmentation, and workflow inefficiencies, collectively [...]

Background: Central line–associated bloodstream infections (CLABSIs) are preventable yet associated with high morbidity and mortality. Literature review highlights that patients with CLABSI had higher mortality rates, readmission rates, and longer length of stay. Local institutional Vizient data showed 65% of CLABSIs occurred within 20 line-days, prompting adoption of a structured central venous access device (CVAD) [...]

Background: Hypoglycemia is a serious medical condition that can lead to adverse patient outcomes, including mortality and increased length of stay. As in-patient hypoglycemia is often iatrogenic, every effort should be taken to avoid its occurrence from a systems-based perspective. Purpose: Memorial Hermann Hospital (MHH) has higher rates of inpatient hypoglycemia when compared to similar [...]

Background: Substance use disorders (SUD) are a major public health concern and a major cost to the healthcare system. Patients with SUD experience higher rates of readmission, higher emergency department (ED) visits, and are less likely to receive follow up care (Peterson et al., 2021). Among veterans, only 5% of about 2.8 million diagnosed with [...]

Background: Rest is essential for healing, yet hospital environments frequently disrupt sleep due to noise, clinical care interruptions, and inconsistent nighttime routines. Although evidence-based strategies to improve rest exist (1,2, 3), there is limited guidance on how to prepare clinical teams for the coordinated, system-wide implementation of Quiet at Night practices to enhance rest across [...]