Background: Effective health care requires a delivery system that is fully coordinated. To achieve this requires structured communication between physicians and nurses yet an increasingly recognized barrier to efficient care is the geographic dispersion of these primary team members. Utilization of systems engineering and simulation modeling can provide a data-driven alternative to evaluate these complex […]

Background: A 42 year old male with know stage IV rhabdomyosarcoma of the neck presented to the ED from subacute rehab with severe dyspnea.  He had already undergone chemotherapy and radiation therapy, and had planned for home hospice after discharge from subacute rehab.  He had previously signed a DNR/DNI, but rescinded, and was intubated.  CT […]

Background: Post-hospitalization follow-up is an important phase of care transitions.  However, it continues to be a challenge for patients to keep office visit appointments made at the time of discharge, particularly if the visit is with a primary care physician that is new to the patient.  Directly involving patients in the appointment scheduling process may […]

Background: Structured, interdisciplinary plan of care (IPOC) rounds appear to augment coordination of care and communication among health care workers and may offer additional benefits to patients, their families, and providers in the inpatient setting. However implementation of IPOC rounds in a large, busy tertiary center with a high acuity of illness is challenging. Purpose: […]

Background: Hospitalists have become national leaders in quality and safety, and the Division of Hospital Medicine has spearheaded many safety and quality improvement initiatives in our institution.  However, for faculty directly involved in patient care, our institution did not offer formal instruction in Safety, Quality and Efficiency that was readily adaptable to clinical schedules. Purpose: […]

Background: “Hospitalist” is a relatively new and evolving specialty field within modern medicine, dedicated to the delivery of comprehensive medical care to hospitalized patients. Unfortunately, few primary care and emergency department physicians inform patients about hospitalist coverage during their hospitalization. This knowledge gap can impede the therapeutic relationship and in turn negatively affect the patient’s […]

Background: Children with medical complexity experience repeated hospitalizations into young adulthood. At the University of Wisconsin, approximately 3 patients per week between ages 18-21 years are hospitalized at the children’s hospital, with over half of these patients having more than 3 chronic conditions as defined by the Agency for Healthcare Research and Quality. These patients […]

Background:             Eight million women and two million men in the US suffer from osteoporosis, with the cost of fragility fractures an estimated $10-15 billion annually. Methods: Two osteoporosis fracture risk assessment tools were used. The FRAX (Fracture Risk Assessment Tool), and a simpler tool, the OST (Osteoporosis Self-Assessment Tool), a calculation using only age and weight. An […]

Background: Palliative care improves quality of life and mortality outcomes in individuals with terminal cancer diagnoses. Yet palliative care is often not made available to these patients in a timely manner, either due to lack of available resources, or physician and patient misconceptions about its purpose and utility. Baseline evaluation at Salem Hospital showed that […]

Background: The use of copy-paste in the medical record is ubiquitous, potentiated by the explosive increase in use of electronic health record systems. Copy-paste events (CPE) decrease the readability of the medical record (e.g. “note-bloat”) and have safety (e.g. perpetuation of outdated information) and professionalism implications. The potential utility of CPE (e.g. a reminder to […]