Background: The use of hospice care has increased in the United States over the past decade. However, data for hospitalizations preceding hospice remains sparse. The objective of this study is to examine the clinical and demographic characteristics of United States hospitalizations that result in hospice transfers, and to determine distinctive factors associated with discharges to […]

Background: C. difficile is a predominant cause of nosocomial diarrhea. It is most commonly associated with prior antibiotics use, and seen in conjunction with other risk factors such as increasing age, severe underlying illness, impaired gastrointestinal motility, tube feedings, and proton pump inhibitors. Recently, the emergence of a hyper–virulent strain, NAP–1, and its increased severity […]

Background: Implementation of computerized provider order entry (CPOE) with drug–drug and drug–allergy checking is an important patient safety measure. The most commonly used CPOE systems, however, generate numerous warnings, which may lead to “alert fatigue.” Understanding the epidemiology of medication warnings is warranted when considering ways to increase provider attention to potentially valuable warnings. Methods: […]

Background: Cellulitis is a common reason for admission to the hospital. The disease is often over–diagnosed due to difficultly in differentiating it from chronic venous stasis and stasis dermatitis. The natural history and etiology of cellulitis is also often misunderstood. This can result in inappropriate antimicrobial use, increased length of stay, and high rates of […]

Background: Although sleep is important for recovery from acute illness, it is often hampered by noise in hospitals. Interestingly, some patients are more vulnerable to noise disruptions, which is now a publicly reported quality measure for hospitals. Perceived control over sleep, or the belief of personal ability to bring about a health outcome, could be […]

Background: Laboratory testing accounts for a significant percentage of the direct costs of hospitalization. Testing also imposes burdens on the patient due to phlebotomy, which not only causes pain, leads to anemia, and may necessitate placement of indwelling catheters after prolonged hospitalization. Efforts at limiting laboratory testing reduces the direct costs of hospitalization, decreases the […]

Background: The increasing use of central venous catheters in hospitalized patients has led to a rising incidence of upper extremity deep venous thrombosis (DVT). The use of venous thromboembolism (VTE) pharmacoprophylaxis in hospitalized patients has been shown to be effective in decreasing the incidence of pulmonary embolism and overall deep venous thrombosis but its effect […]

Background: Atrial fibrillation represents one of the leading diagnoses for hospitalized patients. Patients with atrial fibrillation are five times more likely to have a stroke than those without this condition and approximately 60% of these strokes are preventable with aspirin or effective prophylactic anticoagulation. Despite the presence of well validated tools for stroke risk assessment […]

Background: New guidelines by the American College of Physicians (ACP) recommend assessment of the risk of bleeding in medical patients prior to initiation of prophylaxis for venous thromboembolism (VTE). Thus, a routine pharmacoprophylaxis approach for all medical patients without the evaluation of bleeding has been postulated to result in a greater risk of anticoagulation related […]

Background: Timely access to primary care follow–up is an important factor in preventing hospital readmissions. Patients that lack primary care follow–up within four weeks of discharge are more likely to be readmitted. Moreover, resident clinics are often understaffed and have poor continuity of care which may further aggravate post hospitalization follow up. Understanding patient attitudes […]