Background: Increasing use of EHRs has generated widespread interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have thus far had mixed results due to poor test characteristics, development from administrative data which cannot identify the onset of sepsis, and often use of outside software which limits [...]

Background: Driven by meaningful use (MU) incentives, many safety net systems have adopted patient portals, which offer patients online access to their health information. Portal use correlates with increased engagement and better health outcomes, but there are many challenges to effectively engage patients and meet MU metrics in safety net settings. Purpose: We implemented a [...]

Background: Growing use of peripherally inserted central catheters (PICCs) has led to the development of certification programs for PICC operators. Much like the debate regarding certification in medicine, whether such certification influences clinical care is unknown. This knowledge gap is relevant for health systems that hire operators based on certification status and for hospitalists who [...]

Background: While CT imaging has become an invaluable tool for expedited medical evaluation, its use has been associated with an increasing number of incidental findings, the handling of which creates both medical and logistical challenges.  Pulmonary nodules are among the most frequent and medically relevant incidental findings, but are easily overlooked – especially when discovered [...]

Background: The ACGME duty hour standards have led to an increased frequency of transitions of care, necessitating a need to improve communication skills to prevent adverse events related to handoffs. The ACGME also requires residency programs to provide training in communication and safe transitions of care. At UCSD we implemented the I-PASS handoff bundle, an [...]

Background: The Hospital Discharge Day Management Service (CPT code 99238 or 99239) is a face-to-face evaluation and management (E/M) service provided to the patient by his/her attending physician on the day of discharge. The two codes differ based on the amount of documented time physicians spend in coordinating care and discharge services of either 30 [...]

Background: The number of older adults discharged to post-acute care (PAC) facilities (such as skilled nursing facilities) after hospitalization is increasing rapidly, but their clinical course in PAC is uncertain.  More than 25% will be readmitted, and some may not successfully rehabilitate and return to the community.  Clinicians and patients currently lack data to inform [...]

Background: Healthcare organizations are currently devoting significant resources to efforts to reduce hospital readmission after discharge.  Multiple factors have been linked to readmission, including an absence of outpatient follow-up care, inadequate understanding of discharge instructions and medication errors.  Post-hospitalization home visits by physicians and mid-level providers are a potential mechanism for addressing these factors and [...]

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), affects one to two per one thousand persons annually in the US. Treatment of VTE consists of anticoagulation therapy, and evidence supports treating patients with low-risk VTEs as outpatients.  Novel oral agents such as rivaroxaban, an oral factor Xa inhibitor, require less [...]

Background: The Modified Early Warning Score (MEWS) was validated in 2001. In recent years hospitals across the US have implemented the MEWS as a Rapid Response Team activation trigger. In Geisinger Medical Center the MEWS was piloted and implemented in 2011.The patient’s admission disposition is based on clinical presentation but summative objective data, such as [...]