Background: Night time hospital coverage presents persistent challenges in balancing provider workload, efficiency, and maintaining timely clinical response. Traditional onsite coverage limits flexibility, contributes to provider fatigue, delays task completion with variability in nurse to provider communication. To address these barriers, the Hospital Medicine (HM) service implemented a telehealth-connected care model to optimize after hours [...]

Background: The timing of holding direct acting oral anticoagulants (DOACs) prior to surgery and restarting after surgery is crucial to minimize the risks of thromboembolism and bleeding. To reduce these risks hospitals and practices often implement protocols based on the best available evidence and guidelines, such as by the American College of Chest Physicians (1-3). [...]

Background: Hospital at Home (HaH) programs aim to deliver high-quality, patient-centered acute care in the comfort of a patient’s home. However, the decentralized nature of HaH introduces unique operational complexities that can limit both scale and efficiency, particularly within large multi-site health systems. Our system operates a Clinical Command Center (CCC), a 24/7 centralized hub [...]

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent symptoms and partially irreversible airflow limitation, leading to reduced exercise capacity, respiratory failure, and death 1. COPD affects over 16 million Americans and is a major cause of morbidity and mortality worldwide. In the US, it is the 5th leading cause [...]

Background: Continuity of care is a cornerstone of high quality, patient-centered care. In high-volume hospitals, rapid bed placement and minimizing Emergency Department wait times often take precedence, making consistent team-patient alignment difficult, particularly in geographically based unit models. This reduces continuity and limits residents’ experience of longitudinal care and team ownership. At our tertiary academic [...]

Background: Advance care planning (ACP) has been shown to improve patient quality of life, ensure end of life wishes are known, increase earlier hospice referrals, and decrease aggressive medical interventions at end of life. It has also been shown to decrease caregiver stress, anxiety, and depression. The Surprise Question, “Would you be surprised if this [...]

Background: Observation care is intended for short-stay hospitalizations requiring diagnostic clarification or brief therapy; however, prolonged observation stays contribute to operational inefficiency and revenue loss. Between June 2024 and May 2025, 25.1% of Overlook Medical Center (OMC) discharges were in observation status, with an average length of stay (LOS) of 35.49 hours (including ED hold [...]

Background: Telemetry is frequently utilized in hospitalized patients for continuous cardiac monitoring but its inappropriate use has been linked to high healthcare costs, alarm fatigue, reduced mobility and extended emergency room boarding. A resident driven multimodal intervention including education on American Heart Association (AHA) 2017 guidelines was implemented to improve guideline-based telemetry use, telemetry duration [...]

Background: The increased demand for healthcare has greatly exacerbated the need for open hospital beds. While many patients may be medically able to leave the hospital, they are often still in need of assistance to manage their pain, comorbidities, complex medication regimes, and acts of daily living. These patients are often discharged to Skilled Nursing [...]

Background: The management of hospitalized patients is becoming increasingly complex due to aging population, rise in multimorbidity, polypharmacy, and the increasing fragmentation of care systems¹. At the same time, inpatient bed occupancy rates in the US are projected to reach 85% as early as 2032² and patient safety events remain stubbornly high. Given these pressures, [...]