Background:  Most patient discharges(DC) from hospitals occur in the afternoons, thus creating patient flow and potentially patient safety issues. This creates increased ER boarding hours and delays interunit patient transfers between ICU, stepdown and medical units. Sick patients may not be getting the appropriate level of care due to lack of higher level of care beds. Purpose:  To increase [...]

Background: Provider engagement is a key component of improving healthcare delivery in any healthcare setting. Characteristics of burnout are prevalent among healthcare providers and have been associated with lower engagement, increased errors and poor long term sustainability in the medical profession. In the era of increased quality, safety, experience and value measures, demands on providers are increasing, but [...]

Background: Pain remains a major concern for medically hospitalized adults, and pain treatment is a focus of hospital quality reporting and improvement efforts. Pharmacologic treatment during hospitalization for acute pain and cancer pain rest on some evidence, but as many as 1 in 3 adult medical inpatients suffer from chronic pain. Little is known about [...]

Background: The estimated total annual cost of syncope-related hospitalizations in the year 2005 was about $2.4 billion with a mean cost of $5,400 per hospitalization. Syncope of cardiac etiology has 18-33% mortality in comparison to 0-12% with non-cardiac etiology. We sought to evaluate the role cardiac biomarkers in patients presenting with syncope to evaluate their [...]

Background: Japan has the high incidence of tuberculosis with the rapid population aging in developed county. In acute care hospital, delaying in respiratory isolation for tuberculosis can cause serious hospital-acquired infections and subsequent delay in the initiation of treatment, which might be poor prognosis for not only the patient but also the around medical providers. [...]

Background: Polypharmacy is associated with numerous adverse outcomes in the elderly. To date, deprescribing interventions have been implemented in the outpatient setting. We studied the effect of a structured hospital-based patient-centered deprescribing protocol on reducing total medication burden, including medications associated with geriatric syndromes.  Methods: We performed a single-center deprescribing pilot trial (Shed-Med) that was [...]

Background: Regional differences in health care strategies, resource utilization and outcomes following Out-of-Hospital Cardiac arrest are not well studied. These differences may have significant implications on optimizing health care delivery and allocating expensive resources. Methods: We used the 2002 to 2012 Nationwide Inpatient Sample database to identify adults ≥ 18 years old, with an ICD-9 [...]

Background: Studies have shown that drug eluting stents outperform bare metal stents in the need for revascularization in myocardial infarction patients. We sought to identify the current practice in HIV positive patients presenting with ST elevation myocardial infarction. Methods: We used the 2012 National Inpatient Sample database, the largest publically available inpatient database in the [...]

Background: The Emergency Room departments and the Intensive Care Units (ICU) remain the main locations for the treatment of patients with severe sepsis and septic shock. Nevertheless, health-care systems may have limited resources and insufficient ICU beds for attending patients who might benefit from more intensive monitoring than in a general ward. In this context, [...]

Background: Correct inhaler technique for COPD medications is essential to achieving optimum delivery into the lungs. Evidence suggests that poor technique is widespread and linked to poor efficacy and adherence. However, the direct relationship between inhaler technique and health status has not been investigated.  Methods: Data from a 2013 US survey dataset of COPD patients [...]