Background: The financial success of a hospital medicine practice is dependent on accurate billing and documentation practices. Academic hospitalists face the additional challenge of educating resident physicians on appropriate documentation. As most patients admitted to a tertiary care center are medically complex, initial inpatient E/M code 99221 often signifies a deficiency in documentation rather than […]

Background: Efficiently improving transitions in care requires hospitals to target discharge interventions at those patients at high risk of potentially avoidable readmission (PAR). We previously derived the “HOSPITAL” score, an easy to use prediction model for medical patients (Table 1). This score had good discrimination for determining PARs in the hospital in which it was […]

Background: To maximize its effectiveness, performance feedback must be personalized, accurate, timely, and visually appealing. In the clinical environment, effective feedback must therefore extract accurate data from an electronic health-record system, link patient care activity to care teams, and report on meaningful metrics. This requires a synthesis of EHR data, scheduling data, which is often […]

Case Presentation: Calciphylaxis is a rare cause of skin necrosis due to calcium deposition within the vasculature, most commonly seen in patients with end stage renal disease.  A 54-year-old male was transferred from a long-term acute care facility for evaluation of a 3 week history of bilateral proximal lower-extremity wounds.  His past medical history was […]

Background: Planning for safe discharge should optimally begin early in each patient’s stay, and focus on individual patient’s needs. The aims of our study were to, beginning at the start of hospitalization and continuing until discharge, collect patients’ self–reported barriers to discharge, describe the most prevalent barriers, and determine whether barriers were resolved between the […]

Case Presentation: A 55 year-old male with no known medical history presented to the emergency department after a fall on both knees. He was found to have bilateral patellar tendon ruptures and multiple femoral lytic bone lesions on radiographic imaging. Subsequent laboratory testing yielded an elevated creatinine (3.42 mg/dL) and hypercalcemia (15.2 mg/dL), concerning for […]

Background: Academic medical procedure services (MPS) arise from the continued need for procedural training in the setting of decreasing procedural opportunities, increasing safety awareness, and increasing demands on inpatient resident time. Prior research has shown that MPS can improve resident confidence, subjective patient and resident experience, and resident supervision. Little is known about the procedural […]

Case Presentation: A 75-year-old man with atrial fibrillation and no neurologic history presented to the emergency department with a one day history of somnolence, aphasia, and generalized weakness. He was nonverbal and minimally responsive to sternal rub. The patient had been diagnosed with herpes zoster in a thoracic dermatomal distribution two days prior to presentation […]

Introduction: Pneumonia in an immunocompromised host is unique with respect to the organisms involved. The emergence of new pathogens has significant impact on therapy. Achromobacter xylosoxidans (A.xylosoxidans) is an uncommon pathogen known to cause serious infections in immunocompromised hosts. Despite its ubiquitous existence, community acquired infections are rare. We report a case of A.xylosoxidans causing invasive cavitary pneumonia. […]

Background: Signout of newly admitted patients from a night admitting physician to a primary team is common, making up roughly 40% of admissions to the inpatient medical service at our hospital. Nevertheless, little is known about these “holdover” signouts, and there is no standardized format for ensuring they contain appropriate information transfer and maximize patient […]