Background: Potentially avoidable deaths occur each year among hospital patients. A death is considered potentially avoidable when warning signs were present hours prior to death and when it was a result of a potentially reversible condition such as sepsis. In an effort to eliminate avoidable deaths, many hospitals have instituted rapid response teams (RRT). One […]

Background: Readmission rates are an increasingly important indicator of quality hospital care. Understanding the characteristics of readmissions may help to reduce unnecessary readmissions. We evaluated characteristics of readmissions to our general medicine service and reviewed case management readmission assessments in order to inform efforts to improve the discharge process and reduce avoidable readmissions. Methods: We […]

Background: Treatment of dehydration in the Emergency Department (ED) presents special challenges in infants and children. Their veins can be too small or fragile to allow easy intravenous (IV) access, especially if the vessels are collapsed. In patients who need parenteral fluid therapy, subcutaneous (SC) hydration has been a safe and effective option. Hyaluronidase is […]

Background: The reduction of venous thromboembolism (VTE) via VTE prophylaxis practice improvement is a major health care goal for national quality initiatives, such as those of the Joint Commission. We assessed the rate of appropriate VTE prophylaxis, according to the 7th ACCP guidelines. We previously reported the rates in surgical patients (ASH annual meeting 2007), […]

Background: Prior research suggests that elevated BP in hospitalized patients represents true hypertension (HTN) and that HTN and cardiovascular risk factors are prevalent among inpatients. Providers often fail to recognize and intensify treatment regimens for uncontrolled hypertension, and nongeneralist providers generally do not perform as well as internists. Hospitalist consultation for surgical patients has the […]

Background: Central venous catheter (CVC) insertions are frequently performed by internal medicine residents. Research shows that complications including pneumothorax and arterial puncture diminish when operators require fewer needle passes and use ultrasound. We demonstrated previously that a simulation‐based mastery learning model improved thoracentesis and advanced cardiac life support (ACLS) skills and associated clinical care. In […]

Background: General pediatric hospitalists are increasingly relied on to manage patients with subspecialty and/or complex medical conditions. Resident duty‐hour restrictions have limited resident coverage of these patients, prompting the proliferation of staff‐only pediatric hospitalist models. A staff‐only pediatric hospitalist model caring for medically complex subspecialty patients has never been studied in the United States. Our […]

Background: Simulation is increasingly being incorporated into cardiopulmonary resuscitation (CPR) training. This educational method has been shown to improve trainee performance in simulated settings, but the effect on actual patient care remains unknown. Methods: Matriculating residents were randomized to participate in a 4‐hour resuscitation leadership course using a high‐fidelity simulator (Human Patient Simulator, Medical Education […]

Background: At the time of a major surgery, patients requiring chronic oral anticoagulation therapy must have had this treatment either stopped and restarted or “bridged,” substituting heparin or low‐molecular‐weight heparin (LWMH) except during and shortly after the procedure. It is not clear how these patients are currently being managed and how frequently bleeding and thrombotic […]

Background: To facilitate maintenance of certification (MOC) of hospital‐based physicians, the American Board of Internal Medicine (ABIM) developed the Hospital‐Based Practice Improvement Module (Hospital PIM). The Hospital PIM is one of a series of data‐driven, self‐evaluation instruments whose goal is to facilitate physician involvement in quality improvement (QI). The objective of this qualitative study is […]