Background: Optimizing hospital care transitions continues to be a quality improvement focus for hospitals and hospitalists. As accountability for patient outcomes spreads beyond hospital walls, collaborative partnerships between hospital and community based providers are increasingly important to transition patients safely and effectively from hospital to home and sub‐acute care settings. The Michigan Transitions of Care [...]

Background: New Mexico is geographically large, rural and medically underserved. Thirty of New Mexico’s 33 counties are designated as Medically Underserved Areas and Health Professions Shortage Areas. Many New Mexico patients are transferred from urban hospitals to skilled nursing facilities (SNFs), often in other parts of the state. When compared to all states using the [...]

Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The advent of the Patient‐Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs) provide an opportunity for true collaboration in which both inpatient and outpatient providers have a vested interest in promoting safe transitions and in which each can contribute appropriate [...]

Background: Hospital discharge is a high risk transition for patients during which deficits in transfer of information between hospital providers and the primary care providers (PCPs) are common and lead to adverse events following discharge. Purpose: Consistent communication between hospital providers and PCPs at discharge may improve patient care. Description: Our hospital is a 500 [...]

Background: An estimated 1 in 5 patients discharged to skilled nursing facilities (SNF) is readmitted within 30‐days. In 2012, the rate was 25‐30% for SNF discharged post‐acute care patients of the Cleveland Clinic Department of Hospital Medicine. The Patient Protection Act and Affordable Care Act had mandated Medicare to enact penalities to hospitals based on [...]

Background: Atrial fibrillation is a common etiology for ischemic stroke. Numerous studies have supported that after an ischemic stroke, extended outpatient cardiac monitoring detects paroxysmal atrial fibrillation in patients in whom atrial fibrillation was not detected on in‐hospital EKG or telemetry. Anticoagulation in these patients offers significant potential for secondary stroke prevention. Implementing this on [...]

Background: As health systems seek to reduce spending and improve care quality in response to changing payment schemes, one key strategy is to substitute lower‐intensity care settings (e.g. outpatient care) for more expensive ones (e.g. hospitals and emergency departments) whenever possible. Caring for patients at home can allow for a quicker return to independence at [...]

Background: We are a 29 member academic hospitalist group at a large urban/suburban academic tertiary care center. Like other health systems, we are under tremendous pressure to decrease length of stay (LOS) and excess days (EDs). While patients with LOS greater than 15 days comprise only 5.52% of our total admissions, they contribute to greater [...]

Background: As hospitals face increasing pressure to provide safe and high‐value care, quality improvement initiatives that address both evidence‐based care and cost mitigation will produce significant impact. Trainee engagement in such initiatives can address ACGME QI educational requirements as well as augment trainee understanding of value in healthcare. Moreover, as immersed experts in hospital workflow, [...]

Background: With increasing focus on healthcare value, both patients and providers have much to gain from enhancing how trainees learn to disburse a precious healthcare resource: time. However, efficiency is rarely an educational objective. Rather, it is assumed to be an asset inherent to the individual or acquired through passive experience. This forces trainees to [...]