Background: Outside Medical Records are essential for accurate continuity of care when patients are transferred from one healthcare system to another. Despite their importance, obtaining records in a timely manner is a notoriously difficult process. At Stanford Hospital, the medicine teams were burdened with 5 pages of paperwork per record request for a single patient. [...]

Background: Hospitals across the country struggle with improving patient experience and there is limited data on factors that drive positive or negative scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey.  We sought to better understand which predictors may lead to a top box score.  Methods: Administrative and clinical data were [...]

Background: Discharge checklists may reduce medical errors. Traditional paper checklists do not fit into the current workflow in centers that utilize electronic medical records (EMRs). In an era where team-based care is becoming widespread, defining each person’s role in discharge practices is increasingly important.  Methods: Our aim was to develop and implement a standardized discharge [...]

Background: A LEAN principle is that front line staff provide value as defined by the customer (the patient). Within a LEAN framework, an A3 is both a way to understand your problem and a tool to organize multiple PDSA cycles into one cohesive and visible structure. While the literature cites many examples of PDSA cycles [...]

Background: Physician burnout poses a critical threat to the United States health care system.  Finding a solution to this problem is a leadership imperative, as studies report that nearly half of physicians in the U.S. experience burnout. Emotional exhaustion, depersonalization, and decreased personal accomplishment are characteristics of burnout and can lead to dire consequenses if [...]

Background: Critical lab values are those results that require rapid notification to clinical staff so that urgent interventions can be made to avoid morbidity or mortality. The Joint Commission requires that hospitals have an effective critical lab value process in place.  The process is a time-consuming multi-step progression of phone calls with associated documentation.  The [...]

Background: Delirium is an acute decline in attention and cognition that is potentially preventable among elderly population. Occurrence of delirium is followed by a sequence of events including loss of independence, increased risk of morbidity and mortality and increased health care costs. Development of delirium involves an interrelationship between vulnerable patients (with predisposing factors) and [...]

Background:   The Institute of Medicine estimates that there are 44,000-98,000 preventable deaths per year.  However, there is a paucity of literature regarding preventable death rates, despite its importance as a quality measure.  Methods:   All deaths in the general medicine service from 2010-2012 at an academic hospital underwent an independent retrospective chart review by [...]

Background: Adult patient populations are not effectively vaccinated in United States, which contributes to increased rates of hospitalization, cost of medical care and disease complications. Though physicians’ understanding of vaccination measures should be comprehensive, many studies have indicated that adult patients are not receiving their vaccinations as they should. One study during a pertussis outbreak [...]

Background: Sepsis is a systemic host response to infection that may result in significant morbidity with mortality rates from severe sepsis or septic shock reaching over 20% in most studies.  Research on sepsis has focused on use of groups of sepsis specific interventions (termed care bundles) that are given in response to the declaration of [...]