Background: Today’s healthcare industry is in transition, moving from paper based processes to highly customizable electronic medical records (EMR). This technology opens new opportunities to provide clinical staff information to develop treatment plans, ensure consistent application of best practices, improve medical coordination and communication, reduce opportunities for errors or unintentional omissions, and improve patient outcomes. [...]

Background: Christiana Care Health System (CCHS) is a 1100–bed hospital system with all telemetry enabled beds. Continuous cardiac monitoring (CCM) is ordered for a default period of 72 hours at the time of admission on patients by admitting physicians even if the intention is to monitor only for the first 24–48 hours. Physicians are not [...]

Background: Medical simulation training has rapidly emerged as an effective model of clinical skill development. A validated educational approach, this technique allows practitioners the ability to gain proficiency and confidence in ongoing professional practices such as clinical decision making, procedural techniques, teamwork performance and complex patient interactions. Techniques acquired in medical simulation are directly linked [...]

Background: Communication failures are frequently cited as contributing to patient care errors and delays, specifically with regards to discharge planning. The common medical model, usually structured as a physician service team, houses patients across multiple nursing units throughout the hospital. This geographical distribution impairs physician to nurse communication and the ability to effectively co–ordinate the [...]

Background: Process improvement projects often lack the structure and buy–in to achieve their goals. The Rapid Process Improvement Workshop (RPIW) is one quality improvement tool to make QI projects more effective. Purpose: To utilize RPIWs to address QI issues on inpatient medicine: blood culture contamination, the macro discharge process, and the micro discharge process. Description: [...]

Background: Approximately two million neurons are lost every minute during an ischemic stroke. University of Colorado has a median time of 71 minutes for door to tissue plasminogen activator (t–PA) administration. The American Stroke Association (ASA) sets a goal of 60 minutes or less from initial Emergency Department (ED) triage to intravenous thrombolysis for patients [...]

Background: Approximately 795,000 strokes occur each year in the United States; Stroke is a leading cause of death nationally and remains the leading cause of long–term disability. Only ten percent of the hospitals in the US have Stroke Centers certified by the Joint Commission. A critical barrier to stroke care is the shortage of neurologists [...]

Background: High–volume, high–cost patients pose a challenge to healthcare institutions due to fragmented care, socioeconomic issues,and lack of outpatient resources. Recently, New York’s Medicaid program adopted a measure to reduce payment to hospitals with a potentially preventable readmission rate higher than a state benchmark, leading hospitals to explore new methods for preventing readmissions. To this [...]

Background: Clinical decision support systems are useful tools to discourage the use of potentially inappropriate medications (PIMs) in the geriatric inpatient population. These interventions have had variable success, in large part because geriatric medication decisions are difficult and not always amenable to resolution via a computerized prompt. Purpose: To develop an electronic PIMs dashboard which [...]

Background: Many providers find E/M coding rules confusing and frustrating. Tasking hospitalists with completing charge tickets often leads to delinquent or inaccurate charges. Hospitalist groups have incorporated various education methods and incentives to improve documentation, billing and collections with varying success. Conversely, systems in which coders retrieve and code notes may be subject to delays [...]