Background: Hospital admission presents an important opportunity to engage with patients about goals of care (GOC) and advanced care planning. The significant and sensitive nature of GOC conversations requires that documentation of a patient’s goals be accurate, clear, and easily found in the medical record. This has become increasingly relevant in the setting of frequent [...]

Background: The Joint Commission’s Surgical Care Improvement Project (SCIP)-9 recommended removing indwelling urinary catheters (IUC) before postoperative day 2 to decrease urinary infection (UTI) risk. Our center implemented a best practice alert (BPA) in the electronic health record to enforce SCIP-9 with near-100% compliance.  We sought to study the effect of the BPA on catheter [...]

Outcomes of an ‘Attending-Only’ Hospitalist Bedside Procedure Service Background: Patients admitted to the hospital frequently require bedside procedures including central venous catheter placement, paracentesis, thoracentesis, and lumbar puncture.  Procedure training varies across residency programs resulting in varying levels of competency among practicing physicians.1 In addition, the time consuming nature of these procedures has led to [...]

Background: Challenging patients exhibit disruptive behaviors that lack conformity with normal work flow. Examples of such behaviors include drug seeking, violence, non-compliance, exchanging drugs with visitors, unauthorized departure from hospital premises, etc. Patients engaging in these types of actions commonly over-utilize health care resources and create conflicts between different providers who are not adequately trained [...]

Background: Palliative care and geriatrics in hospital medicine have an established positive impact on patient experience and outcomes, however, these specialist care services remain underutilized. Recognizing an opportunity to improve the appropriateness of inpatient consultation on a large academic medical hospitalist service, we implemented a multi-disciplinary quality improvement intervention with the goal of increasing appropriate [...]

Background: In-hospital cardiac arrest (IHCA) is a devastating medical event that affects 200,000 patients every year and carries a high mortality rate, with only 54% surviving their arrest and 22% surviving to discharge.  Current research aims to identify risk factors associated with morbidity and mortality in these patients, but there is little research on the [...]

Background: Sepsis remains a serious worldwide health condition directly associated with high mortality rates, despite improvements in the ability to treat and manage infections.  Since 2002, the Surviving Sepsis Campaign (SSC) has been a global effort to reduce patient mortality from severe sepsis and septic shock.  The SSC has provided health care systems and providers [...]

Background: All hospitals strive for service excellence. In 2014, there were more than 40,000 hospitalists delivering the lion’s share of inpatient care in our nation’s hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients so as to establish norms and expectations. We set out to establish a metric [...]

Background: Inpatient telemetry monitoring is commonly used to identify arrhythmias, ischemia, and QT prolongation. The American College of Cardiology and American Heart Association (ACC/AHA) guidelines identify groups in which telemetry use (1) is indicated, (2) may be of benefit, and (3) is unlikely to benefit. Previous studies have determined that inappropriate usage of telemetry increases [...]

Background: New York State has identified a list of controlled medications that require frequent monitoring and review. New York State law dictates that these medications, when disbursed in a hospital setting, must be reviewed and re-ordered on a weekly basis. In order to maintain compliance with New York State law, the Electronic Medical Record (EMR) [...]