Case Presentation: A 75–year–old male with CAD, CHF, DM, CKD, and anemia presents to the ER for leg pain. He injured his left knee in a fall a day prior to presentation and in the ER was noted to have a fever of 102f. Two weeks prior to admission, he had consumed several raw oysters […]

Background: Recent research shows that inpatient continuity has been declining. Little is known about the association between continuity during hospitalization and important outcomes such as cost and hospital readmission. Methods: We conducted a retrospective data analysis of inpatient care provided exclusively by hospitalists from the Northwestern University Feinberg School of Medicine. Quantile regression models were […]

Background: Early readmission is considered to be an indicator of healthcare quality as well as of utilization. Characterizing sub–groups among readmitted patients can guide quality improvement efforts. Methods: We conducted an IRB–approved mixed–methods study of readmitted adults at a 365 bed teaching hospital. 1) We prospectively screened all admissions to identify patients who had been […]

Background: Numerous research studies and anecdotal experience show that in health care, a small percentage of patients account for a disproportionate number of ED visits and hospital admissions. For some of these patients, their visits are routinely for medically unnecessary reasons. This behavior places them at risk for uncoordinated care from providers who don’t know […]

Background: Computerized provider order entry (CPOE) systems can be configured to generate warnings when medications are ordered, which could promote safer patient care. Many CPOE systems generate numerous warnings, however, which may lead to alert–fatigue and overriding of potentially important warnings. Understanding the factors associated with accepting a warning may assist in tailoring these systems […]

Background: The decision to admit a patient to the intensive care unit (ICU) is complex, reflecting both patient factors and available resources. Previous work has shown that ICU census and flow do not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is not […]

Background: Starting in October 2012, Medicare will base part of its hospital payments on how hospitals perform on patient experience metrics. Given the inpatient expertise of hospitalists and their 24/7 presence, increasing hospitalist staffing may be one approach to enhancing patient satisfaction. Methods: Using 2009 national Medicare data we examined the association between hospitalist staffing […]

Background: Bronchiolitis is the current leading cause of hospitalization in children. Based on the available literature, waste and unnecessary variation in bronchiolitis care are common. Significant work has gone into developing evidence–based guidelines for inpatient bronchiolitis management, though successful strategies for large–scale dissemination outside of academic medical centers are rarely reported. Methods: We formed a […]

Background: Pneumonia is associated with an inflammatory cascade that adversely affects clinical outcomes. As statins mitigate inflammation, they may improve pneumonia outcomes. We conducted a systematic review and meta–analysis of the effects of statin treatment on mortality after pneumonia to explore this association. Methods: Relevant studies were identified by serial searches of eight databases (MEDLINE, […]

Background: Preventing unplanned readmissions within 30 days of hospital discharge is a major focus of quality improvement and payment reform. Identification of patients at high risk for 30–day readmissions is an important step towards improving care and reducing readmissions. The growing adoption of electronic health records (EHR) may prove to be an important component of […]