Background: The evaluation of syncope remains challenging, costly, and in many instances, does not clarify the etiology. Evidence‐based guidance for efficient evaluation and risk stratification is often not followed. We designed a study to assess our current evaluation of syncope compared to a best‐practice evaluation protocol, and to confirm the utility and safety of an [...]

Background: Overutilization of ECG monitoring (EM) can negatively impact patient flow and increase healthcare costs. In 2004, an American Heart Association (AHA) consensus statement detailed indications for EM in hospital settings. Monitoring was suggested for patients with Class I and II indications, but discouraged for Class III. We hypothesized that “indication‐based ordering”, which requires clinicians [...]

Background: Over 60% of hospitalized patients receive antibiotics. Unfortunately, up to 50% of inpatient antibiotic use has been judged as inappropriate. With the increasing presence of hospitalists, combined with their focus on patient safety and quality improvement, efforts designed to improve antibiotic use in the hospital would benefit if they are focused on and endorsed [...]

Background: In October 2012, the Hospital Readmissions Reduction Program allowed CMS to reduce payments to hospitals with excess 30‐day re‐hospitalization rates for patients discharged after a hospitalization for pneumonia. As such, the accuracy of identification of patients with the clinical diagnosis of true pneumonia during an index admission is critical. We sought to determine if [...]

Background: Unplanned patient readmissions are undesirable from both a clinical quality and a financial perspective. Identifying patients at risk of readmissions allows targeting of interventions aimed at reducing readmission rates. Several algorithms for predicting readmission exist, but are often inaccurate, too complex to use in the clinical setting or both. One promising model is being [...]

Background: A significant number of patients die every year in United States hospitals due to medical error or delay in emergent patient care. One important source of medical errors or delay in care is lack of effective communication between nurses and physicians. A common aspect of inpatient care that involves communication between physician, nurse and [...]

Background: While one out of every four Americans is estimated to suffer from obstructive sleep apnea (OSA), the prevalence of OSA in medical inpatients may be even higher. OSA is associated with many chronic medical conditions, such as cardiovascular and cerebrovascular disease, that are also prevalent in medical inpatients. Yet, the prevalence of undiagnosed in‐hospital [...]

Background: At an average, about 50% of elderly hospitalized patients experience some kind of complication related to hospitalization. About 23.3% of them are at risk of being unable to return home and require nursing home placement. About 35% of them decline in some basic activities of daily living. The aim of our study was to [...]

Background: A productive healthcare organization needs an integrated teamwork and engaged physician leadership to successfully manage costs and improve quality. Lean daily management (LDM) is considered an effective tool for achieving cultural change, with better physician engagement to take ownership of operational performance. We report 6 month experiences from the implementation of LDM and daily [...]

Background: Hospital admission usually leads to blood draw for diagnostic laboratory tests which can help in patient care. Providers routinely order daily blood tests including complete blood count, basic metabolic panel or comprehensive metabolic panel and coagulation panel in hospitalized patients even in the face of clinical and laboratory stability. Blood draw is invasive and [...]