Background: Children often have small, poorly visible, or palpable veins, and are moving targets during peripheral intravenous catheter attempts. Landmark-based techniques are less than 50% successful, with further attempts leading to increased pain, anxiety, and delayed treatment. Baseline evaluation and our prior SHM poster identified high numbers of attempts, inconsistent escalation, and frequent cross-unit support. [...]

Background: Patients on long-term opioid therapy with acute-on-chronic pain are medically and psychosocially complex, frequently hospitalized, and incur substantial health care costs (1–3). Despite their prevalence, hospitalists report limited success improving pain and struggle with the competing demands of alleviating pain and ensuring patient safety (4,5). Methods: We conducted a national qualitative study within the [...]

Background: Inpatient care delays – processes that prolong hospitalization beyond medical necessity – negatively impact quality of care, patient experience, and hospital throughput. Although quality improvement initiatives often focus on optimizing workflows to reduce care delays, gaps remain in understanding how providers identify and manage these delays in routine practice. We aimed to characterize provider [...]

Background: Hospital medicine programs typically include a range of clinical shift types – direct care, teaching, consultative, triage, and admitting shifts – reflecting the diverse nature of hospitalist work. While workload has been identified as a significant determinant of hospitalist performance and well-being, less attention has been given to other factors influencing hospitalists’ preferences among [...]

Background: High-quality, accurate, and timely prior-to-admission (PTA) medication reconciliation, the process of establishing a complete PTA medication list, is an essential component of safe inpatient care. At many institutions, hospital medicine patients are often admitted by swing or night admitters, with care assumed by direct-care hospitalists the following day. Though prior qualitative studies have examined [...]

Background: High hospital occupancy can worsen emergency department (ED) boarding times and patient morbidity and mortality1. “Discharge before noon,” or the practice of discharging patients in the morning to make room for admissions in the afternoon, is a possible solution, despite concern that it might lead to higher LOS2. Interventions often incentivize early discharges via [...]

Background: General pediatrics residents often provide initial assessment in the management of pediatric emergencies in various clinical settings and, therefore, must demonstrate timely and accurate decision-making as well as procedural competence. Yet, many report lack of confidence in their ability to perform pediatric resuscitations efficiently due to limited hands-on opportunities in early years of training. [...]

Background: Patient experience is a core domain of healthcare quality, closely linked to safety, effectiveness, and readmission outcomes.1-5 Yet, hospital medicine units often rely on delayed, post-discharge surveys such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that limit timely and meaningful improvement and lack unit-level insights.6-9 These instruments suffer from recall/response bias, [...]

Background: Our institution serves counties where more than 10,000 people are currently unhoused. This is reflected in our patient population, where 6% of patients admitted to the hospital medicine service at any time are unhoused. These patients face challenges such as higher readmission rates, longer lengths of stay, limited access to critical medications, and difficulties [...]

Background: Communication between providers and consultants is an essential component of providing safe and effective patient care. Poor communication erodes patients’ confidence in their medical team, leads to medical errors, and contributes to physician burnout. There is a pervasive sentiment among clinicians that many consultant interactions are unpleasant or even adversarial. This survey was conducted [...]