Background:   The overall national patient satisfaction scores have improved since the HCAHPS reporting began. However, it is unknown whether the improvement trends are different between teaching and non-teaching hospitals. Therefore, our objective was to compare long-term changes in patient satisfaction between teaching and non-teaching hospitals. Methods:   We used three datasets; HCAHPS data (2008 [...]

Background: Late discharges are a known barrier to patient flow.  Our project was to identify barriers to early discharges and develop processes to increase early discharges from the inpatient medicine teams.   Purpose:  “Daily afternoon multidisciplinary team huddles will increase the % of discharge orders before 10am by 10% on the medicine teams by June 2015” Description: We initially analyzed reasons [...]

Background: Unnecessary delays in patient discharges can lead to overcrowding, redundant handoffs, and increased inpatient unit and Emergency Department lengths of stay.  Therefore, timely discharge of ready patients is essential to optimizing patient flow.  Our hospital continued to see a large number of afternoon discharges from Medicine units despite employing multidisciplinary rounds and afternoon discharge [...]

Background:  Delirium affects 20-60% of the general hospitalized patients, and up to 85% of intensive care unit (ICU) patients. Its occurrence is associated with higher morbidity and mortality, long-term institutionalization, worse long-term cognitive outcomes, and increased hospital length of stay and costs. It is often missed due to lack of standardization in assessment and diagnostic [...]

Background: Thrombocytopenia is common in hospitalized patients. Heparin Induced thrombocytopenia (HIT) is a life threatening condition which can lead to extensive thrombosis. Diagnosis of HIT relies on clinical suspicion determined by 4T score, and the immunoassays through testing for anti PF4/Heparin antibodies. Clinical practice guidelines published by the American Society of Hematology (2013) recommended to [...]

Background: The Lean-Kaizen approach of implementing patient-centered systems change by reducing waste and adding value has been widely used in health systems in the US to provide incremental process improvement. This approach to streamlining health care processes has been under-utilized in resource-poor regions of the world, even though the Lean-Kaizen approach was developed in under-resourced [...]

Background: Inpatient hospitalization represents a key time for patients who use tobacco to quit smoking, and inpatients who receive smoking cessation counseling, nicotine replacement, and referral to outpatient resources have increased quit rates six weeks after hospital discharge. However, in 2014, only 34.5% of tobacco users admitted to our 600-bed academic hospital were documented as [...]

Background: Medication discrepancies, such as incorrect doses, schedules or omitted medications, during hospital admission are common, with studies indicating they occur in over half of admissions.   Such errors can result in serious consequences during hospitalization and can be perpetuated at the time of discharge.  A medication list is frequently available to admitting providers in the [...]

Unnecessary Transfusions: Hospital Medicine Leading Institution Wide Change Lesley Schmaltz MD, Shalini Bhattacharya MD, Jisu Kim MD, Amir Jaffer MD MBA, Amanda Tosto RN MS, Scott Hasler MD, Manya Gupta MD Background: It is well known that excessive blood transfusions can cause harm without improving clinical outcomes.  As such, an evidence based restrictive transfusion guideline [...]

Background: Strategies to reverse the effect of warfarin, a vitamin K antagonist (VKA), may be necessary for patients who are actively bleeding, asymptomatic with markedly elevated INR values, or requiring urgent invasive procedures. The purpose of this quality improvement activity (QIA) was to evaluate adherence to the 2012 CHEST guidelines for use of vitamin K [...]