Background: It is estimated that 30% of US healthcare cost is wasteful spending. In order to reduce this cost, there have been initiatives by SHM (evidence based recommendations), ABIM (Choosing Wisely campaign), and ACP (High Value Cost Conscious Care curriculum). In line with these measures a Cost Conscious Care Committee (CCCC) was created at Hofstra [...]

Background: Increasing the value of health care, typically regarded as maximizing quality of care while minimizing unnecessary costs, has been an increasing focus of hospitals nationwide.  Ways of reliably measuring unnecessary utilization, however, have not been well-studied. Hospital Compare is a consumer-oriented CMS.gov website that provides information on how well hospitals provide evidence-based care. It [...]

Background: Avoiding repeated complete blood count (CBC) tests in the face of clinical and lab stability is a focus of the Choosing Wisely initiatives endorsed by the Society of Hospital Medicine. The goal of this study was to identify situations in which routine CBC testing can be avoided. Methods: This was a retrospective study of [...]

Background: In 2014 we recognized that the pace of admissions frequently exceeded our ability to assign a hospitalist. Long patient wait times occurred at admission, especially for patients arriving in the late afternoon when hospitalist day shifts were ending. Purpose: To redesign hospitalist schedules, duties, and method of distributing admissions to match demand. Description: We [...]

Case Presentation: A 67 year old woman presented to the emergency department with worsening shortness of breath. On admission the patient was hemodynamically stable, tachypneic and tachycardic, with desaturation to 80% on room air. She was found to have bilateral pulmonary infiltrates on chest x-ray and was started on antibiotics for pneumonia. It was noted [...]

Case Presentation: An 83 year old woman presented with acute anemia on outpatient testing. One week prior, during hospitalization for a pelvic fracture, she had been started on antibiotics for a suspected urinary tract infection. When this failed to resolve her symptoms, she was discharged on oxybutinin and phenazopyridine. Hemoglobin on admission was found to be 5.9. Due to recent change of [...]

Case Presentation: A 60 year old woman was seen in our primary care clinic with a long history of unusual symptoms. For the past 15 years she has been experiencing intermittent outbreaks of oral and genital ulcers for which she received multiple courses of acyclovir with good clinical response. In addition she has intermittent erythema [...]

Case Presentation: This is a case of a 73-year-old male with a history of CKD stage 4 and left total knee arthroplasty in 2006, who had a recent hospital admission for left knee septic arthritis with left knee prosthesis removal and placement of an antibiotic spacer. Joint fluid cultures grew Serratia marcescens, and the patient [...]

Case Presentation: A 19-year-old Caucasian female with hypothyroidism on synthroid was transferred from an outside emergency department for evaluation of psychosis. The patient’s father first noted changes in her behavior several months prior to admission when she developed rapid onset of excessive cleaning and organizing behavior, which was inconsistent with her prior messy behavior.  In [...]

Case Presentation: A 62 year old male with past medical history of DVT, prostate cancer diagnosed 2 years ago, presented to the hospital complaining of 1 day weakness in his left upper and lower extremities. Head CT revealed a sub-acute right side ischemic infarct. Physical exam was significant for jaundice, left facial droop, left tongue [...]