Background: The culture of academic medicine lends itself to compulsory laboratory testing and the overutilization of tests. Physicians in training constitute the primary cohort of testers, and a certain tolerance is afforded their ordering behaviors in the name of education. More than 50,000 magnesium and phosphorus assays are ordered by our inpatient teams every year. [...]

Background: The Agency for Healthcare Research and Quality (AHRQ) has adopted iatrogenic pneumothorax (IAP) as a zpatient safety indicator. From 2006 to 2007 our institution was ranked within the lowest United Healthcare Consortium performance quartile for IAP. In response, we established a multidisciplinary team to reduce our rate of IAP. Purpose: A quality improvement (Ql) [...]

Background: Hospitals still have no readily transferable strategy to deliver optimal care consistently. Moreover, the regular data flow necessary to track and drive better performance is typically not available. Pilot work from our hospital medicine program suggests that daily relay of potential quality outliers enables frontline staff to address oversights as they occur. Timely, actionable [...]

Background: High‐quality discharge summaries are a key component of a safe transition in care from the inpatient to the outpatient setting. However, the best ways to incorporate resident training in discharge summary creation into clinical practice in academic medical centers is unknown. Purpose: To determine the effects of a “discharge time‐out” on the quality of [...]

Background: Although surgical comanagement is a rapidly expanding role for hospitalists, the growing challenge is to create a clinical experience that is rewarding to hospitalists long term particularly in academic medical centers. Purpose: To implement a hospitalist comanagement teaching service for orthopedic surgery residents focused on the medical care of orthopedic patients. Description: During 6 [...]

Background: The advancement of academic hospital medicine requires that academic hospitalists receive training that allows them to become leaders in research, education, quality improvement, and other scholarly aspects of academic medicine. However there are few dedicated programs to provide advanced training for graduating residents pursuing careers in academic hospital medicine. The need for nonteaching clinical [...]

Background: Our institution's rapid response team (RRT) data regarding interventions during RRT visits indicated a trend for increased Narcan administration for patients on our orthopedic surgery unit. Purpose: To identify the root cause of increased need for Narcan administration in this patient population and to implement strategies to resolve the problem. Description: During an ongoing [...]

Case Presentation: The patient is a 45‐year‐old Mexican‐American from South Texas. He is a construction worker who fell from a ladder lacerating his left ankle on a jagged brick. He was initially treated at home with ibuprofen, topical ointments, and some dressings applied by a relative. The next day he presented to the ED with [...]

Case Presentation: A 50‐year‐old Chinese woman with a medical history of hepatitis B was brought to the emergency department by her family for a 6‐week history of hypersomnolence, irritability, and confusion. Other presenting symptoms included decreased oral intake, gait instability, and a phobia of stairs. She was afebrile on admission with stable vital signs. On [...]

Case Presentation: A 56‐year‐old man presented with 2 days of severe diffuse abdominal pain and diarrhea. CT scan of the abdomen and pelvis revealed diffuse colitis in the transverse, descending, and sigmoid colon. Admission labs were WBC 28.6, Hgb 13.9, HCT 41.0, platelets 129 K, and PTT > 120 seconds. Stool cultures, Clostridium difficile toxin, and disseminated [...]