Background: Venous thromboembolism (VTE) prophylaxis is an important aspect of patient safety for the hospitalized population; however prophylaxis administration is hindered by a variety of factors, including patient refusal. Bedside nurses have the opportunity to educate patients and to encourage them to receive VTE prophylaxis. We sought to determine if training nurses on the importance of [...]

Background: Despite widespread awareness of best practices in the early management of sepsis, sepsis continues to burden our healthcare systems with high mortality, prolonged length of stay and excessive cost.  Early recognition of sepsis and adherence to evidence-based initial resuscitation protocols is known to reduce both mortality and costs associated with care.  In 2013, a [...]

Background: The daily progress note is the foundation of inpatient documentation and communication for healthcare providers. With the advent of the electronic medical record, copy-and-pasting, note bloat, inconsistencies, erroneous data, and lack of cognitive processing have become widespread leading to difficult to read and inaccurate progress notes.  Purpose: At Bassett Medical Center, it was determined [...]

Background: Inpatient telemetry monitoring began over 4 decades ago. However, recently hospitals have started to implement programs that aim to improve the appropriateness of telemetry use. Quality initiatives take the American Heart Association (AHA) guidelines for practice standards for EKG monitoring in hospital settings to reduce the numbers of patients on telemetry inappropriately.  Our residency [...]

Background: Troponin assays are an important diagnostic tool, often for the evaluation of potential acute coronary syndrome.  Current guidelines recommend using the assay a maximum of twice in the initial triage period if both values are negative and there is relative clinical stability. However, additional assays are often ordered to reassure the provider.  Since this [...]

Background: Patients admitted to our hospital with possible Acute Coronary Syndrome (ACS) have a length of stay exceeding the community average. We postulated that the admitting residents were deferring the decision to order a stress test to the attending of record or cardiology consult. We hypothesized that implementation of a clinical decision support tool (CDST) [...]

Background: Acute hospitalization can precipitate insomnia- the insomnia being related to the underlying illness, medications, change from usual nighttime routines and a sleep disruptive hospital environment.  Both insomnia and the drugs used to treat it may contribute to delirium, increased fall rates, increased restraint use, increased length of stay and lower patient/ customer satisfaction. In [...]

Background: Current national guidelines recommend using mechanical methods for venous thromboembolism (VTE) prophylaxis in hospitalized medical patients at elevated risk for thrombosis who have a contraindication to pharmacologic prophylaxis. Additionally, it is recommended to avoid the use of mechanical prophylaxis for patients who are at low risk for VTE. The Michigan Hospital Medicine Safety Consortium, [...]

Background: It is widely accepted that hospitalized patients warrant risk assessment for venous thromboembolism (VTE) upon hospital admission. Although many VTE risk assessment models include a patient mobility element for calculating risk, a standardized method of determining mobility is lacking. We sought to determine if physician assessment of anticipated patient mobility upon hospital admission using [...]

Background: Despite the importance of sleep to recovery from acute illness and the patient experience, hospitalizations are far from restful. Currently, Medicare focuses on noise, but other disruptions to patient sleep such as lab draws, vitals and pain must also be considered. In order to improve in-hospital sleep via a patient-centered approach, it is important [...]