Background:   In line with the American Board of Internal Medicine’s (ABIM) Choosing Wisely® initiative, the Society of Hospital Medicine (SHM) recommends not performing repetitive complete blood count (CBC) and chemistry (CHEM7) testing in the face of clinical and lab stability.  In addition to decreasing the risk of hospital acquired anemia (HAA), reducing unnecessary routine blood work can ultimately result in significant [...]

Background: The need to improve patient satisfaction (or patient experience) is increasing dramatically. Patient satisfaction is not only a direct indicator of quality of care but it is also an important component of pay for performance metrics. We started a standardized process of admitting patients by developing dedicated admission teams called Patient Centered Admission Teams [...]

Background: Continuous intravenous infusions – or “drips” – can be burdensome for patients and clinicians. With this in mind, we identified three scenarios for which providers could safely “skip the drip” in favor a therapeutic alternative: 1) continuous proton pump inhibitor (PPI) infusions for patients with gastrointestinal bleeding; 2) continuous intravenous diuretic therapy in congestive [...]

Background: Regionalization of medical teams has the potential to improve interdisciplinary communication and efficiency but this must outweigh any logistical downsides and resource requirements. For example, full regionalization must be paired with some method of daily admitting; however the impact of regionalization and daily admitting on intern workflow is not known. We hypothesized that regionalization [...]

Background: Traditional readmission case review processes at our tertiary-care academic institution failed to identify obvious target processes for readmission reduction.  Looking for a more nuanced method of readmission review, we turned to our patients.   We conducted over 300 readmitted patient interviews and a focus group to learn from our patient’s experiences.   We then developed a [...]

Background: The observation unit is frequently a destination for patients with yet undifferentiated conditions.  The goal of the observation stay is to complete a crucial diagnostic test or treatment trial that should help specify the diagnosis, but that is not always the case.  Understanding the frequency of diagnoses that remain unspecified after an observation visit [...]

Background: Clinical situations require the timely acquisition of venous blood samples. For certain patients, acquisition of venous blood samples is technically challenging and phlebotomists are unsuccessful. Physicians are then responsible for sample acquisition. The response of physicians who encounter this scenario has been largely unexamined.  Methods: We surveyed 93 physicians who serve as primary providers [...]

Background: Paracentesis is associated with decreased mortality in patients with advanced liver disease. The prevalence of paracentesis related complications is not well characterized, but prior studies suggest improved safety outcomes when ultrasound guidance is employed.  The Agency for Healthcare Research and Quality utilizes patient safety indicator (PSI) 27 to identify postoperative bleeding complications. Our aim [...]

Background: Peripherally inserted central catheters (PICCs) are essential devices used to provide central venous access. However, they are often placed inappropriately, leading to unnecessary risk of PICC-related complications. Vascular access operators typically place the majority of PICCs, yet little is known about these specialists and their beliefs regarding PICCs. We therefore conducted a national survey [...]

Background: Patient pass-offs represent a known vulnerability in patient care.   The Hospital Medicine Unit at Massachusetts General Hospital has several specialized roles including an admitting hospitalist, a rounding hospitalist, and a nocturnist.  Our on-service time is typically four or five days in a row.  Our hospitalists and nocturnists work in six hour, ten hour and [...]