Introduction: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires accredited hospitals to collect and submit performance data on three diagnoses: Acute Myocardial Infarction (AMI) Heart Failure (HF) Community Acquired Pneumonia (CAP) These are evidence‐based measures designed to improve the quality of care provided to patients, while providing a system with which to compare […]

Background: Management of hyperglycemia in hospitalized patients has historically relied upon the “insulin sliding scale” (SSI). In connection with persistent hyperglycemia, it leads to less than optimal outcomes in the majority of hospitalized patients. Purpose: To limit hyperglycemia, reduce the incidence of hypoglycemic events, and minimize or eliminate medication errors with insulin administration, a multidisciplinary […]

Background: Communication problems between medical providers contribute to sentinel events among hospitalized children. Effective communication is particularly important when consultants are involved. Improving communication effectiveness among caregivers is a JCAHO 2006 National Patient Safety Goal. Consultants may not be notified in a timely fashion or may not know how rapidly they need to evaluate the […]

Background: Traditionally internal medicine residents provide consultation service to surgical patients but their formal teaching in perioperative medicine is limited. Purpose: Teaching, evaluation and documentation of residents' competency in Perioperative use of beta‐blockers Material and Methods: We designed specific curriculum in perioperative medicine for internal medicine residents rotating through hospital medicine consult service. We developed […]

Background: Infants less than 23 months of age with influenza ‐ particularly those discharged from the NICU ‐ demonstrate significant morbidity. TIV is indicated for all parents and household caretakers of these infants. However, vaccination rates for influenza in this population is estimated at 30%; with access and convenience of immunization cited as major obstacles […]

Background: Delayed discharges from the hospital can negatively impact hospital throughput by preventing new patients from accessing beds. At Stanford Hospital & Clinics (SHC), the median discharge order time was 13:16 and median discharge time was 15:40 in Q4 2004 on the inpatient medicine service. Barriers to early discharge include culture shift, difficulty predicting discharge […]

Background: Hospitalists perform pre‐operative risk assessment daily. With 30 million non‐cardiac surgeries performed annually, implications for morbidity, mortality, length of stay and cost are enormous. We propose a pocket PC program (PROPCON) to help Hospitalists achieve this goal. Method: We modified Relative Cardiac Risk Index (RCRI) by adding critical aortic stenosis, uncontrolled hypertension, carotid stenosis, […]

Background: National organizations have called for medical school and residency training in patient safety. Although several groups have developed patient safety curricula, techniques for adapting these curricula for medical house officers are not well worked out. Purpose: We adapted a patient safety curriculum developed by our malpractice insurance carrier and designed teaching modules for academic […]

Background: Hospitalized patients deserve medical care that is based on the latest scientific evidence. Numerous sources reveal a very different reality with unexplained variation in practice and widespread problems of quality and safety. Standard order sets for common hospital diagnoses are useful tools for the application of evidence‐based care that can reduce medical errors and […]

Case Presentation: A 58‐year‐old Caucasian woman presented to the emergency department with mental status change since eight weeks. The changes included episodes of confusion, slurred speech, unsteady gait, short call memory impairment, and visual and auditory hallucinations. She had visited a local hospital for her complaints, where she had been diagnosed with anion gap metabolic […]