Background: Research suggests that COPD patients with low peak inspiratory flow rate (PIFR,

Background:  A small population of patients disproportionately consume an increasing share of medical resources.  These super-utilizers often have complex medical and psychosocial conditions that require carefully coordinated, individualized care.  As this population drives unplanned readmissions, programs to reduce readmissions may create unintended incentives to direct super-utilizers to another hospital system.   This study was designed to [...]

Background:  Transitions of care, whether between or within institutions, are an important source of errors, inefficiency, and unnecessary costs.  Inter-hospital transfers are complicated by incongruent information systems, indirect and asynchronous communication, and geographical distance all in settings of high patient complexity and acuity.  We developed a large database of patients transferred between hospitals to identify [...]

Background: Acute pancreatitis is among the most common and costly reasons for hospitalization in the United States. While bowel rest, pain control, and intravenous fluids are the cornerstone of treatment, recent evidence suggests that early rather than delayed feeding may be beneficial. Guidelines, however, continue to recommend waiting for clinical improvement before feeding. We thus [...]

Background: The In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule has been validated in a number of commercial and all-payer claims databases; classifying pulmonary embolism (PE) patients into low- and higher-risk in-hospital all-cause mortality categories with a sensitivity of 87% and specificity of 47%. We sought to directly compare the accuracy of IMPACT [...]

Background: Cachexia and anorexia occur in 50-80% of cancer patients. In cancer patients, it is associated with shorter survival, treatment failure, early treatment termination, declining functional status, and reduced quality of life. Megestrol acetate is a synthetic derivative of progesterone commonly used to treat cancer-related cachexia. Megestrol use is associated with thromboembolism among other adverse [...]

Background: Discharge against medical advice (AMA) occurs in up to 2% of all medical admissions.  These patients risk morbidity and mortality when being discharged AMA.  Given the frequency of AMA discharges and their potential consequences, we sought to evaluate provider opinions on AMA discharges.   Methods: A nine question survey was developed using SurveyMonkey (table).   One [...]

Background: Preventable medical errors are the third leading cause of death in the United States behind heart disease and cancer. In order to decrease the number of medical errors, it is vital to establish a culture of patient safety and encourage incident reporting. Methods: We completed a resident-led educational initiative to increase rates of incident [...]

Background: Alarm fatigue is a serious patient safety issue and represents a 2015 National Patient Safety Goal.  False alarms can mask true alarms, and may contribute to suboptimal patient care practices.  Cardiac telemetry monitoring in particular has been a focus in the Choosing Wisely campaign and at our institution. Purpose: A comprehensive, multidisciplinary approach was [...]

Background: Venous thromboembolism (VTE) is a serious and all too frequent hospital complication, therefore assessing each patient’s individual risk of VTE is an important part of their care.  Multiple models are available for risk assessment, however most not only include multiple data points requiring redundant entry, but can be labor intensive and time-consuming to complete on [...]