Background: Renal ultrasound (RUS) is frequently used as part of the routine work-up for acute kidney injury (AKI) for the hospitalized patient.  Society guidelines and previous literature suggest that RUS should be ordered when an obstructive cause of AKI is suspected.  While RUS is a non-invasive, low-cost imaging modality that does not expose patients to [...]

Background: Efforts to improve value within hospitals must engage frontline clinicians to enhance organizational culture. Culture surveys have been used to drive improvements, but currently no such tool exists for measuring high-value care culture. We aimed to develop a High-Value Care Culture Survey (HVCCS) that can be used by hospitalist leaders and residency programs to [...]

Background: By 2022 health care spending is expected to climb to 19.9% of the US GDP and is forecasted to continue rising with no end in sight[1]. The patient (or consumer) is completely detached from the reimbursement system and thus unaware of the distribution of health care dollars. The purpose of this study is to [...]

Background: To facilitate interdisciplinary collaboration targeting specific quality improvement (QI) and patient safety goals, the Armstrong Institute of Johns Hopkins Medicine has facilitated development of “clinical communities”—interdisciplinary groups of clinicians and administrators from across the health system with a shared interest in a  specific patient type or clinical issue. Within this framework, the hospitalist clinical [...]

Background: It is known that blood product transfusions can be harmful to some patients and should be administered only in medically justified circumstances (Ferraris, et al. 2015). In keeping with current recommendations set forth by multiple medical societies, we designed and deployed an electronic medical record (EMR) based Restrictive Blood Transfusion Program as part of [...]

Background: The ABIM’s Choosing Wisely campaign targets daily phlebotomy in medical inpatients as an area of potential wasteful care.  Unnecessary phlebotomy increases labor and costs while negatively impacting patient’s through hospital-acquired anemia, intravenous access issues, and false-positive results.  While previous interventions have attempted to reduce overall labs ordered, few studies have examined educational attempts  to reduce unnecessary lab [...]

Background: Misdiagnosis of catheter associated asymptomatic bacteriuria as CAUTI leads to inappropriate use of antibiotics and related consequences, including medication side effects, antibiotic resistance, C. difficile infection, and potential financial penalties to hospitals. Purpose: To develop and implement an evidence-based pathway to improve evaluation of CAUTI in our academic health system. Description: Health system leadership [...]

Background: There is a huge desire to have hospitalist program in smaller community and rural hospitals. Few hospitals will be reluctant to have their own hospitalist program due to multiple issues. Bothwell Regional Health Center (BRHC) is a general medical and surgical hospital in Sedalia, MO, with 132 beds, located 68 miles west of Columbia, [...]

Background: Syncope is a common diagnosis for hospitalists and often accompanied by extensive and unnecessary diagnostic workup. Neurally-mediated syncope and orthostatic hypotension account for over 75% of causes. Most causes of syncope can be diagnosed with a good history and physical.  Unfortunately, costly and harmful testing such as head CTs are ordered, while simple and [...]

Background: Telemetry is overused in hospitals and continues to be a source of health system waste. Although there have been studies on the cause as well as efforts to reduce telemetry overuse, the extent to which physicians are aware that their patients are on telemetry has not been studied. Unawareness of telemetry status has both [...]