Background: Routine preoperative coagulation tests continue to be ordered despite the lack of evidence supporting their use or ability to predict bleeding complications. This may delay surgery, cause unnecessary concern if “abnormal”, and increase cost. It is also unclear whether prophylactic fresh frozen plasma (FFP) decreases bleeding risk. The hospitalists at our university preoperative assessment […]

Background:  Successful inpatient glycemic control programs achieve both improved glycemic control and low rates of hypoglycemia.  Using results from the analysis of performance in glycemic control and hypoglycemia, we identified top performers and those demonstrating the most improvement.   We sought to describe their key characteristics.  Methods :  Participating hospitals (84 for ICU, 94 for non-ICUs) […]

Background: Pediatric obesity is a major public health and economic burden in the US. Recent reports suggest a possible crest in the pediatric obesity epidemic. Many researchers have focused on childhood obesity epidemic and comorbidities associated with it. To identify the growing problem of pediatric obesity, we used national data to look at the number […]

Background: Patient safety relies in part on timely review of laboratory and other results by appropriate providers. At our quaternary care, free-standing children’s hospital, providers were directly notified only of “critical” results (<1% of all lab results). While inpatient labs resulted prior to discharge are actively reviewed in the electronic medical record (EMR) by inpatient […]

Background: Acute upper GI bleed (UGIB) is a major cause of hospital admissions, with peptic ulcers being the most common cause.  In addition to pre-endoscopic PPI and urgent endoscopic intervention, current consensus guidelines recommend intensive continuous PPI infusion for 72hrs to decrease the risk of re-bleeding in patients with high risk features. However, a recent […]

Background: Caring for patients involves multitudes of moving parts – from teams of physicians, nurses and radiologists to tests, medications and an array of electronic health record (EHR) systems. However, as medical care has evolved, instead of these components working together seamlessly, they often work in silos – both at the provider and patient data […]

Background: Emergency department (ED) crowding is a widespread national issue which has been shown to negatively impact patient experience and the quality and safety of care delivery.  A community hospital within our academic health system was experiencing significant ED crowding with long ED length of stay (LOS) and high left without being seen (LWBS) rates. […]

Background:  Per the 2014 State of Hospital Medicine Survey, 94% of adult hospital medicine groups (HMGs) reported financial shortfalls, with a mean of $169,886 in financial support per full time equivalent physician. In addition, many groups face recruitment challenges which lead to workforce shortage and physician burnout. To offset these problems, some groups employ increasing […]

Case Presentation: 6 month old former 35 week twin Hispanic girls presented to the ED for evaluation of bulging fontanelles for almost one week.  Both twins had been fussy for 24 hours, and Twin A also had rhinorrhea for 24 hours and high fever to 102.9 degrees Fahrenheit on the day of evaluation.  There was […]

Background: As a requirement of the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS) established the Hospital Readmissions Reduction Program (HRRP) and started reduced payments to hospitals with excess 30-day readmissions on October 1, 2012. Over the past three years, the maximum penalty has steadily increased from 1% to 3%; however, the […]