Background: Healthcare costs are the #1 cause of personal bankruptcy in the United States, and cost reduction is a major focus of current health policy. Data demonstrate the majority of medical costs are directly related to tertiary care, 20% of which results from diagnostic testing, and 30% of overall cost does not result in improved [...]

Background: Patients with chronic and progressive illnesses are vulnerable to long length of stays (LOS) and readmission. Often, these readmissions reflect fragmentation of health care and poor transitions of care leading to substandard patient outcomes and higher health care costs. In our hospital medicine practice, only a small percentage of patients have an extended LOS [...]

Background: Ionized calcium (iCal) is an expensive lab test that is frequently ordered for hospitalized patients. A lab technician manually performs each iCal test, and therefore at our institution it costs 40 times more than a serum calcium lab (Lab Estimated Direct Variable Cost: $20.20 vs 0.49 cents). While iCal is a more accurate measure [...]

Background: Hospitalists have recently been charged with teaching about healthcare value. To understand how to teach value in ways that are impactful, sustainable, and scalable, the best ideas need to be shared. Due to the rapidly growing field and long delay of publication, we used a crowdsourcing effort, “The Teaching Value & Choosing Wisely Competition,” [...]

Background: Overuse of telemetry monitoring is a target of the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which recommends that hospitals develop a protocol to limit telemetry use. The American Heart Association has published guidelines on appropriate indications and duration for telemetry. Despite these efforts, telemetry overuse persists. It is associated with ER [...]

Background: Inefficient hospital operations at large public teaching hospitals result in late discharge times, bottle necks in patient flow, poor anticipation of discharges, and significant out of network costs related to ambulance diversion. Purpose: The purpose of the Physician On Duty (POD) pilot was to dedicate a daytime hospitalist to ensure judicious utilization of limited [...]

Background: Questionnaires administered to the house staff has identified a lack of high value care as a suggestion area of improvement for the program. Additionally, the attending staff has identified the practice of high value care as an area of improvement among our residents. A number of curricula have been developed to help address these [...]

Case Presentation: An 11 year old boy with a history of repaired congenital diaphragmatic hernia (CDH) presented with 6 months of intermittent abdominal pain, and non‐bilious emesis. On examination, his abdomen was soft, non‐tender, and bowel sounds were normal. Abdominal plain films showed multiple air levels. He was transferred to a tertiary facility where he [...]

Case Presentation: A 6 year‐old previously healthy male presented with altered mental status following a 4‐day history of vomiting and diarrhea. He had significant lethargy and dehydration with an otherwise non‐focal exam. Labs revealed glucose of 52 mg/dL and high anion gap metabolic acidosis with bicarbonate of 7 mEq/L. Head CT was normal. Over the [...]

Case Presentation: An 18‐month old Hispanic female was brought to the emergency department of El Paso Children’s by her mother with a chief complaint of inability to bear weight. A detailed history revealed the child had no significant past medical history but had developed an abnormal right‐sided limp 6 weeks prior. The limp had started [...]