Background: Early, yet safe hospital discharges are a constant area of focus at tertiary care centers in order to maintain efficiency and patient flow. This is especially true at our institution, which acts as a referral center for 3 regional hospitals and 3 outpatient clinics, routinely carrying an inpatient census of 85-100%. Failure to complete [...]

Background: Discussing and determining a patient’s code status is an integral part of the initial patient encounter upon admission to the hospital.  Code status orders are frequently integrated into admission order sets and direct critical care that is often provided by other members of the healthcare team. The depth of that discussion, who participated and [...]

Background: Approximately one-third of hospitals in the United States have observation units, which are increasingly being staffed by internists rather than emergency medicine physicians. However, there is limited understanding of this effect on patient outcomes.  The available literature suggests that this transition may decrease patient length of stay within the observation unit. The objective of [...]

Background: A do-not resuscitate (DNR) order prohibits use of cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest. It should not be applied to any other interventions other than CPR. However, we reported that DNR status altered physicians’ decision making pertaining to use of non-CPR procedures in Japan (reported in ACP Japan chapter 2014, data [...]

Background: Neutropenic Fever (NF) is a common complication for patients on myelosuppressive chemotherapy. Despite guidelines by the Infectious Diseases Society of America (IDSA), however, there is variability in physician compliance. There are limited prior studies assessing compliance in this realm and those studies do not fully assess drivers of poor compliance. Poor compliance can result in increased [...]

Background: Hospitalized vascular surgery patients typically have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk and thus may be ideal patients for a collaborative care model.  Methods: During the 2-year pre-post study, 2431 patients were admitted to the vascular surgery service; 944 before comanagement and 1487 after, where a hospitalist actively participated [...]

Background: Studies have linked the use of anti-secretory agents to nosocomial complications including Clostridium difficile–induced pseudomembranous colitis and hospital acquired pneumonia. In the outpatient setting, the Federal Drug Administration has issued warnings regarding increased risk of hypomagnesemia as well as fractures of the hip, wrist, and spine with the use of proton pump inhibitors. Although [...]

Background: Ambulation is significantly reduced when patients are hospitalized, which leads to decreased muscle strength and aerobic capacity. A recent study of geriatric inpatients found daily median step counts of 478 to 846, much lower than the recommended 7,000 to 10,000 a day to maintain cardiovascular and musculoskeletal fitness. Interestingly, daily step count is not [...]

Background: Malnutrition affects up to 30% of inpatients, but is rarely diagnosed. This leads to under-treatment and poor patient outcomes including: infections, pressure ulcers, and poor wound healing. In the MS-DRG system, malnutrition is considered either a major complication/comorbidity (MCC) or a complication/comorbidity (CC), depending on specificity and severity. Therefore, missed diagnoses significantly impact patient [...]

Background: Pay-for-performance incentives allow for engagement and motivation of participating physicians. Hospitalist compensation structure commonly combines base salary with performance and/or productivity-based incentives. Frequently used quality measures are value based purchasing metrics, patient satisfaction scores, adherence to guidelines and quality of medical documentation. Selection of metrics is strongly influenced by what is measurable and available. [...]