Background: Hospital readmissions within 30 days are a major quality and cost concern in healthcare. The 30-day all-cause readmission rate in the U.S. is approximately 14%, accounting for billions of dollars in health care expenditure (1,2). Evidence suggests a substantial portion of these readmissions are preventable (3). In response, hospitals are developing multifaceted interventions to [...]

Background: Large academic medical centers (AMCs) facing emergency department (ED) and inpatient capacity constraints are increasingly partnering with community hospitals to care for appropriate lower-acuity patients. Because regulations require patient assent for interfacility transfers, standardizing this process across a large group of hospitalists has proven difficult. Patients frequently decline transfer due to uncertainty about community [...]

Background: Academic medical centers (AMCs) face growing emergency department (ED) demand, higher ED boarding rates, and reduced capacity for complex community transfers. To “level load” capacity, many AMC’s parter with community hospitals (CH) to transfer lower-acuity patients, yet published transfer rates remain low. Purpose: To describe the impact of a hospitalist-led intervention to improve throughput [...]

Background: Hospital systems face increasing challenges in managing interfacility transfers and direct admissions, particularly in large, multi-hospital networks where capacity and capability vary across regions. Inefficient transfer processes can lead to care delays, inappropriate placement, and strain on system resources. To address these issues, our healthcare system created a virtual hospital medicine (VHM) program, leveraging [...]

Background: High-need, high-complexity (HNHC) patients experience frequent hospitalizations and drive a disproportionate share of healthcare costs. Fragmented care within large hospital medicine teams may exacerbate these challenges. Purpose: To improve inpatient continuity for this vulnerable population, we restructured one hospital medicine team at our academic medical center into a Primary Hospital Provider (PHP) Team. Description: [...]

Background: Length of stay (LOS) is a key performance indicator that drives continuous process improvement initiatives in the hospital setting. Case-mix index-adjusted resource length of stay (CARLOS), which adjusts hospital length of stay for case-mix index (CMI), is used at our institution as a measure of hospital efficiency and has been the focus of many [...]

Background: Health systems face many common challenges when implementing initiatives in clinical practice, such as how to tailor interventions to local contexts, develop and carry out an effective implementation plan, and monitor effects on care delivery and patient outcomes. Implementation science and learning health system (LHS) science offer rigorous approaches that can be applied to [...]

Background: It is challenging to optimize patient care, throughput, and length of stay (LOS) when hospital departments do not know which components of a patient’s care plan are time sensitive. In our institution, fragmented communication and delays in imaging hinder timely patient care and discharge, impacting both observation and inpatient LOS. This may also impact [...]

Background: Unnecessary lab testing in hospital medicine contributes to avoidable costs, patient harm, and downstream diagnostic cascades. Quality improvement (QI) interventions have targeted reductions in lab utilization with varied success and sustainability. Interventions are frequently grouped into education, EMR changes, cost display, audit/feedback, and policy changes with multipronged interventions showing the best outcomes. Our institution [...]

Background: Unnecessary routine lab testing is a persistent challenge in U.S. hospitals, driving costs, patient discomfort, and iatrogenic anemia. At Emory Saint Joseph’s Hospital (ESJH), chart reviews revealed that 30–40% of daily blood draws were unnecessary based on patient stability criteria. Purpose: To reduce unnecessary routine blood draws through transparent data sharing, education, and provider-specific [...]