Background: BackgroundThe hospital environment is very often conducive to poor sleep. Factors contributing to this include environmental distractions such as noise and bright lighting, medical interventions, pain and anxiety.Studies of poor sleep in the general population suggest adverse effects on cognition, immune function, anxiety and pain. Methods: MethodsThe DRĒMS study was conducted between Feb 2025 [...]

Background: In long-term acute care (LTAC) facilities, catheter-associated urinary tract infection (CAUTI) incidence is high due to patients’ multiple critical medical problems and comorbidities. We sought to decrease CAUTI incidence, lowering the Standardized Infection Ratio (SIR) of observed over expected CAUTIs and the Standardized Utilization Ratio (SUR) to reduce overutilization of catheters.Previously, there was no [...]

Background: Effective after-hours communication is critical to patient safety, yet consensus on best practices among hospital staff remains poorly defined. This study sought to establish evidence-based standards for cross-cover communication and escalation in acute care settings. Methods: A cross-sectional survey of 105 nurses, physicians, and clinical staff at an academic community hospital assessed perceptions of [...]

Background: Electronic medical records have modernized healthcare by improving clinical efficiency, enhancing access to guidelines, and enabling decision-support tools. However, documentation features such as copy-forward and auto-population, while time-saving, can also perpetuate outdated or inaccurate information, contribute to “note bloat,” and obscure key clinical details (1). Prior studies demonstrate that standardized note templates and targeted [...]

Background: Previous research has demonstrated missed opportunities to de-escalate from intravenous (IV) to oral (PO) antibiotics. Patients often remain on IV antibiotics longer than needed, despite known benefits of de-escalation including reduced costs and decreased risk of antibiotic resistance and catheter-associated line infections. This medical and nursing student-led quality improvement (QI) project sought to transition [...]

Background: Discharges against medical advice (AMA) carry substantially higher risks of adverse outcomes, including a 2-fold higher 30-day readmission and 2–2.5-fold higher short-term mortality compared with planned discharges. Accurate assessment of decision-making capacity in these patients is essential, as inadequate evaluation or documentation can compromise patient safety and pose medicolegal and ethical risks. Capacity evaluations [...]

Background: Emergency department (ED) crowding leads to prolonged boarding times, delayed admissions, and decreased operational efficiency. Level loading (LL) in a multi-hospital organization is the intentional balancing of patient volume across all hospitals in the system, rather than allowing one hospital to become overloaded while others have capacity. A clinical expeditor (CE) is a patient [...]

Background: Heart failure affects millions of people worldwide and remains a significant health burden. Although there are great advances in Goal Directed Medical Therapy, the 30-day readmission rates for Acute Decompensated Heart Failure (ADHF) remain high with global estimates around 13.2%. Socioeconomic and non-medical factors, evaluated through the Social Determinants of Health (SDOH), play a [...]

Background: Healthcare has a significant environmental footprint, accounting for approximately 8.5% of U.S. carbon emissions1. Metered dose inhalers (MDIs) contribute to this footprint through hydrofluoroalkane propellants, which are potent greenhouse gases (GHGs). Compounding this issue, MDIs leak GHGs even when not in use, making their total volume, both used and unused, a factor in healthcare’s [...]

Background: The American Diabetes Association’s 2024 guidelines on diabetes care in the hospital setting advises performing A1c testing for all patients with diabetes or hyperglycemia upon hospital admission if an A1c value within 90 days isn’t available. Rationale for this testing includes diagnostic evaluation of hyperglycemia and guidance about appropriate modalities of pharmacologic therapy. For [...]