Background: Despite recent improvement in knowledge of sepsis physiopathology, severe sepsis, and septic shock still represent a leading cause of death among inpatients all around the world. Although bundled care of sepsis has shown to improve patients outcome, sepsis protocols are difficult to implement due to their time–dependence and multidisciplinary features. Hospitalist model, which focuses […]

Background: Most systems for measuring medical errors rely on voluntary reporting of errors and near–miss events. The IHI Global Trigger Tool (IHIGTT) is a manual retrospective review of a random sample of inpatient hospital records using validated set of triggers to detect adverse events and measure their rate over time. The IHIGTT focuses on those […]

Background: Treatment of non–purulent cellulitis and cellulitis associated with an abscess is a common reason for hospital admission. Methicillin resistant staph aureus (MRSA) is well documented be a common cause of purulent skin infections, while its relationship to non–purulent infections is much less clear. Based on this data, recent guidelines recommend use of anti–MRSA agents […]

Background: Despite recommendations by the American Academy of Pediatrics against routine imaging in acute bronchiolitis, chest radiography (CXR) is often performed during admission for bronchiolitis. There have been no studies in the United States that have identified clinical predictors of imaging results. By identifying such predictors, the use of CXR in a subgroup of patients […]

Background: Acute viral bronchiolitis is responsible for over 150,000 pediatric admissions per year in the United States. Respiratory syncytial virus (RSV) testing is frequently performed in this population. However, there are few studies addressing whether the results of this test impact the management of patients hospitalized with bronchiolitis, specifically regarding the rate of chest imaging […]

Background: Structural measures of hospital quality describe the characteristics of resources, including people, geographic locations, information technology, organizations, and systems of care. Accountable day–to–day management of inpatient unit process and performance represents a potential opportunity to improve unit outcomes. In an 18–bed long–term acute care unit, we created a physician unit medical director position with […]

Background: According to the guidelines of the American Society of Chest Physicians, medical, and surgical oncology patients continue to be at increased risk for venous thromboembolic events (VTE). Undiagnosed and untreated pulmonary embolism is a major cause of hospital acquired death. Hospitalists have begun to assume primary responsibility of these patients or serve to co–manage […]

Background: Rapid Response Teams (RRT) were created with the concept of bringing intensive care management to the bedside during medical emergencies on the wards. Despite widespread use, their overall benefit has been controversial. Although some studies have shown reduction in cardiac arrest outside of the intensive care units, overall hospital mortality has not improved. Although […]

Background: The most effective strategy for administration of loop diuretics in patients hospitalized with acute decompensated heart failure (ADHF) still needs to be determined. Delivery of optimal dosing for rapid and safe diuresis must include an understanding of the pharmacokinetics of loop diuretics and the complexities of health care delivery. This study aimed to evaluate […]

Background: In–hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in resuscitation practice as a potential etiology. However, little is known about the actual standard of resuscitation practice across the US. Methods: We conducted a nationally representative survey, targeting a stratified random sample of 1,000 hospitals from […]