Background:  The Affordable Care Act (ACA) has recently enabled millions of U.S. adults to acquire healthcare coverage.  The differential shift in payer mix in Medicaid-expansion versus non-expansion states after ACA implementation may be relevant to hospitals beyond reimbursement.  Medicaid has historically been associated with longer hospitalizations and higher mortality in diverse patient populations, more so [...]

Background: Heart failure is a common condition characterized by recurrent exacerbations. Medication and dietary nonadherence are associated with readmissions. Telling smokers their lung age significantly improves the likelihood of successful smoking cessation.  We hypothesized that using hand-carried ultrasound (HCU) to share with patients their own images of inferior vena cava (IVC) measurements would serve as [...]

Background: Urinary tract infection (UTI) is the most common infection associated with antibiotic misuse. Catheter-associated UTI (CAUTI) is the largest reservoir of nosocomial antibiotic-resistant pathogens, including Pseudomonas aeruginosa. Health-care associated urinary tract infection is also a known risk factor for antibiotic-resistant bacteria, and an important entity that has yet to be characterized. The aim of [...]

Background: Early diagnosis and treatment of sepsis improves patient outcomes. Diagnosis requires an objective component (currently at least two Systemic Inflammatory Response Criteria, SIRS) and a subjective, clinical suspicion of infection.  While much attention has been placed recently on the ideal objective criteria to accurately identify sepsis, little is known about the agreement among providers [...]

Background: The Centers for Medicare & Medicaid Services (CMS) have sought to reduce readmissions through penalties applied to hospitals with readmission rates that are higher than expected, as calculated from models that use patient-level administrative data to account for case mix. Similar approaches are used to determine expected morality rates. Currently, CMS disseminates hospital-level adjusted [...]

Background: Diagnostic MR imaging of osteomyelitis in the hospital setting continues to guide patient care and treatment when plain films are inconclusive. However, even MRI with gadolinium can be non-specific in patients with other forms of sterile inflammation, leading to overtreatment in the form of invasive procedures and lengthy antibiotic regimens. Ferumoxytol is an iron [...]

Background: The 2015 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the use of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Although prior guidelines did not recommend a dose or route, current guidelines recommend oral (PO) prednisone over intravenous (IV) methylprednisolone for non-ICU AECOPD hospitalizations, given [...]

Background: Successful treatment of bacterial pneumonia often requires intravenous antibiotic therapy. Although peripherally inserted central catheters (PICCs) are often used to deliver such treatment, hospital practice patterns related to PICC use have previously not been reported. Methods: Premier’s Inpatient database was used to identify patients hospitalized with pneumonia between 1 July 2007 and 30 November [...]

Background: Peripherally inserted central catheters (PICCs) are increasingly used in hospitalized patients. Yet, little is known about the vascular access nurses who often place them.  Methods: We conducted a web-based survey to assess vascular access nursing experience, practice, knowledge and beliefs related to PICC insertion and care in 47 Michigan hospitals. Results: The response rate [...]

Background: We previously found that red blood cell (RBC) transfusion was a trigger for hospitalization for venous thromboembolism (VTE) in a Medicare population. As peripherally inserted central catheters (PICCs) are both associated with VTE and often used for RBC transfusion, we assessed the prevalence of VTE in patients with PICCs. Methods: We used data from [...]