Background: Pneumonia remains the foremost cause for hospitalization.  The objective of our study was to look at the predictors of longer length of stay (LOS) in patients admitted in the hospital with community acquired pneumonia (CAP) based on a recent large nationwide database.   Methods: We identified patients aged ≥18 years with a primary discharge [...]

Background: A large percentage of cancer diagnoses emerge from the emergency setting yet limited literature is published describing this phenomenon in detail. Our study aims to identify the number of patients who present to a large county hospital with symptoms suspicious for malignancy and quantify their compliance with our internal referral clinic (IRC) system for [...]

Background: Consensus supports the use of corticosteroids in acute exacerbation of COPD (AECOPD), but route of administration and dosage still vary considerably. In one study comparing lower dose oral (PO) prednisone to higher dose intravenous (IV) methylprednisolone, the prednisone regimen was associated with comparable improvement in lung function and oxygenation but a trend toward significantly [...]

Background: Medical overuse, defined as the provision of services for which harms outweigh benefits, is increasingly recognized as a driver of high cost and poor clinical outcomes in the U.S. health care system. Despite increasing attention to overuse, methods for reducing it are unclear. In contrast, methods of identification, analysis, and prevention of medical errors [...]

Background: Cardiac monitoring (CM) is often overused, hindering patient mobility, triggering unnecessary cardiac testing, delaying appropriate discharge, and expending resources.  Purpose: To reduce the days that medical and surgical ward patients spend on CM without an indication specified in the 2004 American Heart Association (AHA) guidelines for CM.  Description: At Cedars-Sinai, only 59% of patients [...]

Background: Cardiac telemetry allows hospitalists to monitor for dangerous arrhythmias. The American Heart Association has published indications on which patients are likely to benefit from telemetry.  The Society of Hospital Medicine highlighted this issue through the Choosing Wisely campaign and recommended protocols to limit overuse of telemetry. Our hospital does not require an indication to [...]

Background: Many institutions struggle with educational structure in the wake of ACGME duty hour restrictions, and concerns have been raised that there has been a net negative impact on quality of education. Efforts to balance service and education are continuously in flux. At our institution efforts to address this balance have included a redesign of [...]

Background:   Telemetry monitoring is known to be over-utilized outside of the ICU, rarely leads to a change in management, and has never been shown to improve clinical outcomes. Telemetry monitoring increases cost and is associated with numerous potential harms, including frequent false positives. As part of the ABIM’s Choosing Wisely campaign, the Society of [...]

Background: Studies have shown that overutilization of labs is common and can cause adverse health outcomes.  No study to date has compared whether variation in lab ordering tendencies exists between different services within the same hospital.       Methods: This observational study combined a survey of internal medicine residents and hospitalists and a retrospective [...]

Background: In the outpatient setting, untreated obstructive sleep apnea (OSA) is associated with myriad adverse clinical outcomes including myocardial infarction, heart failure, arrhythmias, and cerebrovascular disease.  However, little is known about the impact of treated versus untreated OSA on short-term outcomes in patients hospitalized with acute illness. We propose that the recurrent hypopnea and apnea [...]