Background: Rapid dosing of adequate intravenous diuretics for heart failure (HF) exacerbations saves lives; specifically, a door-to-diuretic (D2D) time < 60 min had an odds ratio of 0.39 for inpatient death. As part of a hospital-wide push for improved heart failure management, baseline D2D time was measured in August 2024, showing an average of 4.03 [...]

Background: Heart failure is common and confers high mortality and morbidity. Our system sought to improve heart-failure-patient care, working to reduce mortality index (MORTi) and 30-day readmission. The effort included a combination of education and incentives followed by EHR-based clinical decisions support systems (CDSS) within order sets, notes, and more. At our recently-merged hospitals none [...]

Background: Heart failure (HF) affects nearly 7 million United States patients. Despite evidence that guideline-directed medical therapy (GDMT)—comprising renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors—reduces mortality and hospitalizations, GDMT prescribing remains suboptimal. There is limited research on optimizing electronic health record (EHR) clinical decision support systems (CDSS) to improve GDMT [...]

Background: Heart failure affects 7 million United States adults. It remains a major contributor to morbidity, mortality, and hospital readmission. Optimizing a guideline-directed medical therapy (GDMT) regimen—particularly initiation and up-titration during the index hospitalization—has been shown to reduce rehospitalization rates, improve survival, and lower healthcare costs. There is also emerging evidence that the type of [...]

Background: The electrolyte order set (“hub”) at our institution encourages electrolyte repletion based on evidence-based guidelines for patients at risk of arrhythmias, their renal function, and preference of oral over IV repletion. The hub has successfully improved repletion efficacy and route. Replacement, however, often starts at night, leading to potential sleep disturbance. The latest hub [...]

Background: It is well-known that goal-directed medical therapy (GDMT) for congestive heart failure (CHF) improves mortality. One component of GDMT is sodium-glucose cotransporter 2 inhibitors (SGLT2-i), which have been shown to decrease cardiovascular death and heart failure hospitalizations by 33%. A three-month retrospective review of all Medical Teaching Service (MTS) teams at our institution revealed [...]

Background: Syphilis cases in the United States increased by 42% from 2020 to 2024. In San Francisco, between 2019 and 2023, syphilis diagnoses increased by 18% among women, and congenital syphilis cases increased by 425%. The San Francisco Department of Public Health (SFDPH) recommends annual syphilis screening for all sexually active individuals between 15 and [...]

Background: Point-of-care ultrasonography (US) is routinely used during thoracentesis to identify a safe fluid pocket and assess for complications such as pneumothorax. Although US has higher diagnostic accuracy than chest radiography (CXR)—meta-analysis estimates pooled sensitivity and specificity of 0.87 vs 0.46—post-procedure CXRs remain common. Most post-thoracentesis pneumothoraces are small, clinically insignificant, and rarely require intervention. [...]

Background: Hospitals nationwide are implementing throughput initiatives to optimize bed capacity and reduce avoidable length of stay. A common strategy involves asking interdisciplinary team members to identify and escalate barriers to discharge in real time. Although prior studies describe common types of discharge barriers, little is known about how different inpatient team members conceptualize and [...]

Background: Large academic medical centers are increasingly partnering with or acquiring community hospitals to expand capacity, improve resource allocation and hospital throughput, and enhance patient care. Although studies have assessed clinical outcomes in community settings, data exploring patient experiences at academically affiliated community hospitals remains limited. Our study aims to characterize patient experiences at a [...]