Background: Avoidable hospital readmissions may be reflective of poor quality of inpatient healthcare and may be used as a metric to guide reimbursement rates to hospitals. Most existing risk prediction models rely on administrative databases and have poor predictive ability. Physician chart reviews are necessary to identify both the cause and preventability of a readmission. [...]

Background: Despite much evidence and clearly elucidated expert guidelines, VTE prophylaxis remains underutilized, resulting in significant morbidity, mortality, and economic burden. Fear of bleeding has been identified as a barrier to optimal adherence. We hypothesized that overestimation of bleeding risk is an impediment to compliance with ACCP recommendations for VTE prophylaxis. The IMPROVE trial developed [...]

Background: Urinary tract infection (UTI) is the most frequent healthcare–associated infection in the US. Although bloodstream infection (BSI) secondary to nosocomial UTI occurs less often, it is associated with substantial morbidity, mortality, and additional costs. Despite renewed interest in nosocomial UTI, surprisingly little is known about the epidemiology of nosocomial urinary tract–related BSI. Given the [...]

Background: Though there is little evidence examining the use of intravenous heparin nomograms, concerns about difficulty maintaining therapeutic aPTT levels have led to the adoption of dose–adjustment nomograms at many hospitals. Nomograms can promote standardized practice and add convenience as they allow nursing staff to adjust the rate without requiring a physician to check lab [...]

Background: In a recent study, antimicrobial stewardship opportunitites in the treatment of skin and soft tissue infections (SSTIs) were identified. The authors reported that although Staphylococcus and Streptococcus were the only organisms identified in 97% of positive cultures, broad spectrum antibiotics were used in approximately 80% of patients. The most commonly used broad spectrum antibiotic [...]

Background: Compliance with the Centers for Medicare & Medicaid Services (CMS) core measures is a quality target for many hospitals. The discharge summary is an approved data source for auditing compliance with CMS core measures. Our health system performed below national averages with core measure compliance for the standard six component heart failure discharge instructions [...]

Background: The “July effect” refers to a drop in the quality of medical care due to trainees’ changeover at the beginning of academic year in July. Greater teaching team workload is associated with worse patient outcomes, but it is unknown if the association is the same in the early part of the academic year and [...]

Background: Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications. Numerous studies have shown that they are overused during inpatient admissions, despite being linked to an increased rate of pneumonia, Clostridium difficile infection, and fractures. We investigated the impact of an electronic indication–based order set in reducing overuse of proton pump inhibitors [...]

Background: Obtaining a urine culture in hospitalized patients is extremely common. Positive cultures frequently trigger antimicrobial therapy, but the appropriateness of this treatment remains unclear. We sought to describe physician management of positive urine cultures and the extent to which treatment contributes to antimicrobial overuse. Methods: We randomly selected patients admitted to a large academic [...]

Background: While graduated supervision is necessary for residents to progress to independence, it is currently unclear what factors influence housestaff autonomy. This study examined if attending factors and secular trends predicted faculty perceptions of housestaff autonomy. Methods: General medicine teaching attendings from 2001 to 2008 were administered end–of–month surveys which provided professional demographic data and [...]