Background: Choice of agent for venous thromboembolism prophylaxis (VTEP) after joint arthroplasty is a complex decision, the difficulty of which has been compounded by divergent guidelines. Specifically, the adequacy of aspirin monotherapy (ASA) for VTEP has long been debated between the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). [...]

Background: Bridging anticoagulation is commonly prescribed to patients with atrial fibrillation who are initiating therapy or require interruption of anticoagulation for procedures. Current guidelines recommend bridging for patients at high risk of stroke, but no data guide this recommendation. Among patients with atrial fibrillation and one or more risk factors for thromboembolic stroke, the recently [...]

Background: Worldwide, 200 million adults undergo non-cardiac surgery annually, and completing pre-operative assessments is a major role of today’s hospitalists. In previous years, decisions regarding anti-platelet agents were less evidence-based and often fell to provider preference. With the release of POISE-2 in 2014, there is now stronger evidence to support holding aspirin before elective surgery [...]

Background: Venous thromboembolism (VTE), both pulmonary embolism (PE) and deep vein thrombosis (DVT), causes morbidity and mortality in hospitalized patients. The duration of VTE risk in trauma, particularly after discharge, is not well understood, especially in the context of shortened hospital stays. Although guidelines provide recommendations for extended VTE prophylaxis after major orthopedic surgery, such [...]

Background: Hyperglycemia is directly associated with increased risk for infection, delayed healing, increased morbidity, mortality and increased length of stay following orthopedic surgery.  A process was developed to identify these patients pre-operatively to proactively intervene before surgery and more aggressively after surgery to control glucose levels. Purpose: Retrospective chart reviews and root cause analysis identified [...]

Background: Medication discrepancies, defined as unexplained differences between documented medication regimens, are highly prevalent in the hospital setting and an important contributor to adverse drug events.  In the hospital setting, 27% of all prescribing errors occur as a result of inaccurate medication histories at the time of admission. Pharmacist-recorded medication histories have been shown to result [...]

Background: The incidence of Clostridium difficile infection (CDI) and its associated mortality have increased markedly across North America and Europe during the last decade; making CDI one of the most common preventable healthcare-associated conditions. In order to decrease morbidity and mortality and to prevent transmission of CDI within healthcare facilities, clinicians must maintain a high [...]

Background: Appropriate documentation of Congestive Heart Failure (CHF) specificity is still a major documentation problem in most hospitals in the United States despite the frequent presence of Clinical Documentation Improvement Specialists (CDIs) to assist with chart reviews and appropriate documentation/coding.  We are a large hospitalist division providing care at 2 large tertiary care facilities in [...]

Background: The Physician Orders for Life-Sustaining Treatment (POLST) form is an important tool to elicit and document patients’ treatment preferences in a way that is valid across health care settings. Studies on its efficacy have found high rates of consistency between patients’ treatment preferences for cardiopulmonary resuscitation (CPR), medical interventions, and artificial nutrition documented on POLST [...]

Background: Keeping admitted patients in the emergency room (ER) carries negative operational and clinical consequences. Prolonged stays reduce ER bed turnover, thereby limiting access for other patients. Furthermore prolonged ER length of stay (LOS) has shown to be an independent risk factor for 30 day mortality for admitted patients. For these reasons, Veterans Affairs (VA) [...]