Background: High-risk patients with hematuria often warrant an outpatient evaluation for bladder cancer; however the presence of microscopic hematuria may often be missed by primary care physicians after hospital discharge. Whether outpatient physician’s routinely follow-up incidental microscopic hematuria on urinalysis performed during inpatient visits is yet to be fully elucidated. Our aim was to assess [...]

Background: Hydroxyurea is an FDA approved medication for use in adults with sickle cell disease. Clinical guidelines, based on high quality evidence, recommend its use in all adults with sickle cell anemia and 3 or more moderate to severe pain crises within one year.  Studies suggest its use to be inappropriately low. We assessed local [...]

Background: “Post hospital” syndrome is a critical period after discharge when patients are at risk of functional decline and re-admission. Two factors implicated in the development of this syndrome are sleep disturbance and low physical activity; both of which are known hazards from hospitalization. To date, no study uses rigorous objective methods to describe how [...]

Background: Since the roll out of the Affordable Care Act in 2012 there has been an increased financial pressure to prevent 30-day hospital readmissions. Yet the readmissions rate has remained relatively unchanged despite myriad of health system interventions have been trialed. To approach this issue from a new perspective we decided to query the patient’s [...]

Background: Hospital medical groups use various staffing models which systematically affect care continuity during the admission process. Our service changed models of care from a “general model”, where hospitalists who perform hospital rounds and discharges also perform admissions on the same service day, to an “admitter-rounder model”, where service work is divided each day between [...]

Background: The principle that patients have the right to make choices about their healthcare, including the decision to leave the hospital against the advice of the medical staff, is a foundation of medical ethics.  Consistently, studies have found disproportionately higher rates of readmission and mortality for patients who leave against medical advice (AMA) as compared to patients who are conventionally discharged. This mixed-methods study aimed to: [...]

Background:  Direct hospital admissions from outside emergency departments and hospitals comprise a large proportion of admissions to tertiary medical centers. Clinical stability in these acutely ill patients can fluctuate, even during transport to a receiving medical center. Here, we report data obtained as part of an internal quality improvement initiative to identity clinical criteria present [...]

Background: Patients discharged to post-acute care facilities are at higher risk for re-admissions compared to those discharged home. Mount Sinai Hospital (MSH) discharges a significant number of patients to Terence Cardinal Cooke Health Care Center (TCC), a post-acute care nursing facility in Manhattan. In 2013, MSH discharges by the hospitalist service to TCC had an average [...]

Background:  As electronic health records (EHR) become ubiquitous, the impact on patient outcomes remains largely unknown.  One major communication barrier during patient transfers is the lack of interoperability between EHR systems.  Inter-hospital transfers involve transitioning high acuity patients between hospital systems that may not be able to directly communicate with one another, creating the ideal [...]

Background: At our medical center, there are 14,716 discharges annually from the general medicine services. Post discharge appointments are made by residents, nurse practitioners, and hospitalists. In a baseline survey, clinicians identified logistical barriers to successfully making appointments and revealed that patients are rarely involved in scheduling discharge appointments. Only an estimated 66% of attempted [...]