Background: The incidence of new or recurrent acute pulmonary embolism in patients on warfarin with an INR of = 2 is unknown. Also, the utility of using a modified Wells score in diagnosing acute pulmonary embolism in these patients has not been assessed. Methods: We performed a retrospective observational study on patients aged 18–89 presenting [...]

Background: Hospitals are focusing more on patient admission status as inpatient or observation due to changes in reimbursement and increased scrutiny from regulatory agencies. Observation units allow for more efficient and appropriate care for patients admitted under observation status. Implementation of these units may decrease resource utilization, length of stay (LOS) and costs. Methods: We [...]

Background: Hospitals vary in their procedures for assigning patients to “observation” status (OBS). This outpatient designation has a number of implications including reduced hospital payments, lower patient co–payments, and often results in OBS time not being included in inpatient risk adjustment and hospital performance measures. Thus, variation in OBS use may bias inter–hospital comparisons. Our [...]

Background: Severe sepsis, defined as infection causing new organ dysfunction, is the most common non–cardiac reason for ICU admission. Interventions to remedy the dismal outcomes related to severe sepsis have focused primarily in the ICU. However, more than half of patients with severe sepsis initially receive care outside of the ICU, and many never require [...]

Background: Opportunities exist to re–create hospital units as effective and reliable microsystems. We used specific structure, process, and management design features to re–launch a hospital medicine unit: 1. Unit–based physician teams, 2. Structured Interdisciplinary Bedside Rounds (SIBR) 3. Unit–level performance data and 4. Unit co–management by nurse and physician co–directors. Unit–based physician teams were hospital [...]

Background: Failure to resume perioperative statins after high–risk or vascular surgery is known to increase the risk of postoperative cardiac events. The effect of statin withdrawal on outcomes after moderate risk surgery is unknown. We performed a retrospective cohort study to understand this phenomenon. Methods: 443 patients undergoing major (duration at least 2.5 hours) head [...]

Background: Health care reform has had a focus on access to care. For pediatrics this usually means access to ambulatory services. Hospitalization is an uncommon pediatric event but access to pediatric beds may be a growing issue. Surveys by the AAP and AHA indicate a loss of community hospital pediatric units and crowding at children’s [...]

Background: Recent studies report the incidence of C. difficile infections (CDI) in children is increasing across the nation and that CDI may occur outside the traditional risk factors.Our objective: To describe clinical factors associated with CDI in the hospitalized pediatric population. Methods: Retrospective chart review over a 2 year period at an academic free–standing children’s [...]

Background: Background: Social media is a powerful tool for providing specialized information to large target audiences. Parents and teens now frequently turn to social media as a quick method of obtaining health information. Objective:Introduce a strategy for a hospital based integrated social media plan that is based on a flagship blog. –Illustrate strategies to use [...]

Background: Hospital Medicine (HM) has become one of the fastest growing U.S. medical specialties, and many academic medical centers have developed HM programs. Concerns have been raised regarding the challenges that face HM researchers, particularly a lack of adequate mentoring and institutional support for academic pursuits. Little is known about the strengths and weaknesses of [...]