Background: Treating asymptomatic bacteriuria — a positive urine culture in the absence of symptoms — in hospitalized patients is a key driver of excess antimicrobial use. Decreasing overuse of antimicrobials in hospitalized patients will require strategies targeting the treatment of asymptomatic bacteriuria. Therefore, we: 1) evaluated the rate of treating asymptomatic bacteriuria at a major [...]

Background: Adverse events are common following hospital discharge. To assist patients in their transition from hospital to home, healthcare systems have established several methods for patients to interact with the healthcare system following discharge. However, little is known about how these methods are utilized. The Veterans Health Administration (VHA) is an integrated healthcare system that [...]

Background: Individual physician‐to‐physician tutoring with learners in their real environment during rollouts of new electronic health records (EHRs) can identify specific barriers and provide opportunities for ‘just in time’ educational interventions that may improve physician acceptance and efficiency. Methods: Randomized, controlled trial of inpatient general medicine physicians stratified by level of computer usage, allocated to [...]

Background: Diabetic ketoacidosis (DKA) represents an acute complication associated with increased morbidity, mortality, multiple readmissions, and a significant financial burden for healthcare institutions. General inpatient management of DKA may differ according to practice preference, allowing for significant variations in therapy. At our institution, the Pharmacy and Therapeutics Committee recently approved the utilization of a standardized [...]

Background: Unless bleeding risk outweighs the risk of thrombosis, current guidelines recommend pharmacologic prophylaxis for hospitalized medical patients who are at high risk of venous thromboembolism (VTE). The IMPROVE bleeding risk score was developed to predict in‐hospital bleeding based on risk factors present at admission in hospitalized medical patients and a score of < 7 [...]

Background: There is a need for structured communication among hospital providers to improve efficiency and to provide patient‐centered care through collaboration in the hospital setting. A concise Multidisciplinary Rounds (MDR) model was designed and implemented with goals of improving efficiency, length of stay (LOS), collaboration, communication and teamwork. Methods: Interviews were conducted pre‐implementation to assess [...]

Background: Patients with sickle cell disease utilize hospital emergency room (ER) for treatment of acute pain crisis. American Pain Society placed a guideline that pain medication be given within 20 minutes of entrance to ER. In our previous study (unpublished) in 2007 and 2008 (1st period) [a retrospective review of ER visits at Hurley Medical [...]

Background: Hospital‐acquired anemia(HAA) is associated with worse health status, higher hospitalization rates, increased length of stay, need for blood transfusions, greater medical costs, lower quality of life, and higher mortality. Therefore, there has been a strong focus on HAA as it can potentially be prevented. Prior studies showed almost half of the patients hospitalized with [...]

Background: Unnecessary treatment of asymptomatic bacteriuria (AB) is an individual and public health problem and a target for antibiotic stewardship. Although there is clear evidence against treating AB in most patients, the definition of “asymptomatic” is unclear when applied to acutely ill patients in an Emergency Department (ED) where a broad range of presenting symptoms [...]

Background: Hyperglycemia in hospitalized, non‐critically ill patients is associated with poor outcomes including increased length of hospital stay, infection, disability after discharge from hospital, and death. Current guidelines for the management of inpatient hyperglycemia suggest the use of basal‐bolus insulin regimens over sliding‐scale insulin regimens. In recent clinical trials, basal‐bolus insulin regimens were superior to [...]