Background: Healthcare delivery has become divided into discrete silos of care. With a growing separation between inpatient and outpatient services, transitions of care have become an increasingly vulnerable time for patients. For patients at San Francisco General Hospital (SFGH), a large safety net institution, these transitions often include the added complexities of limited ambulatory health [...]

Background: High–quality communication is required for safe hospital discharge and is accomplished primarily through the discharge summary. Clear, concise, and meaningful correspondence between providers is essential and yet, first year medical residents are generally charged with completing discharge summaries with little or no training. While prior studies have described didactic curricula with direct feedback, we [...]

Background: Approximately 20% of hospitalized patients are rehospitalized within 30 days of discharge. The presence of depression, anxiety, and substance abuse in a hospitalized patient increases the patient’s risk for rehospitalization. By identifying and treating these risk factors in hospitalized patients, we may be able to reduce unnecessary rehospitalizations. Purpose: We aim to use an [...]

Background: Congestive heart failure (CHF) affects nearly 5 million people in US. Thirty day re–hospitalization rate for Medicare beneficiaries hospitalized for congestive heart failure is 27% of which 90% are unplanned. The reimbursement by CMS for these readmissions may be limited, placing a premium on improvement efforts in this area. Purpose: A pilot initiative aimed [...]

Background: Hospital discharge represents a “voltage drop” in care that can lead to unexpected problems including costly readmission. Post–discharge phone calling is a strategy advocated by national and local organizations to improve the quality of care transitions. A recent review concluded that post–discharge phone calling is a component of successful discharge bundles. Our hospital’s Safe [...]

Background: A mentored Project BOOST pilot was undertaken at North Memorial Medical Center, a level I trauma center serving north Minneapolis and the northwestern metropolitan area on the A6 cardiac telemetry unit. BOOST target tool triggers of medications, patient support status, and prior hospitalization within 3 months were identified for weekday interdisciplinary rounds by the [...]

Background: Patients with a prior hospitalization in the last 6 months are at increased risk of readmission. However, given our current system of care, providers may be unaware that a patient was previously admitted to the hospital. Increasing awareness of readmissions can allow providers to focus on known strategies for reducing preventable readmissions. Purpose: (1) [...]

Background: Patients often struggle with managing their medications after hospital discharge, and it is estimated that up to 40% of discharge prescriptions go unfilled. For institutions without an in–house discharge pharmacy, novel solutions are needed to provide patients with better access to discharge medications. Purpose: To implement a multi–disciplinary medication pick up and delivery program, [...]

Background: Communication between hospitalists and nurses can lead to frustration on both sides when it is fragmented, incomplete and complicates patient care. As part of a year long LEAN project at our institution to improve multiple facets of the hospital medicine program, we decided to spend time on improving hospitalist and nursing communication. In particular, [...]

Background: With the many workflow changes that the inpatient EHR will require of the clinical staff, the EHR Device Committee determined there was a potential need for a device that is more portable and has better battery life than a laptop computer. This is especially necessary for those colleagues who work in multiple hospital units [...]