Background: Clostridium difficile infection (CDI) is a growing epidemic in U.S. hospitals. Much of the rapid rise in severe cases of CDI over the past 10 years is thought to be from the fluoroquinolone (FQ)–resistant strain of bacteria BI/NAP1/027. Reducing patient exposure to FQ is a key strategy in reducing CDI. It is unclear which [...]

Background: To increase the use of venous thromboembolism (VTE) prophylaxis, a multidisciplinary team at an academic medical center developed a VTE prophylaxis protocol that was added into medicine admission and surgical postoperative order sets. In this protocol, the physician was given several options for VTE prophylaxis. The options included low‐molecular‐weight heparin (LMWH), unfractionated heparin (UFH), [...]

Background: Patients with very long lengths of stay (LOS) comprising the tail of a normal distribution contributed significantly in raising the overall LOS in our academic teaching hospital. This finding held, even when cases were severity adjusted and compared to expected rates as determined by the University Health Consortium, an alliance of 104 academic medical [...]

Background: In April 2009, a large academic medical center switched the low‐molecular‐weight heparin (LMWH] on its formulary from enoxaparin to dalteparin. This formulary change was studied to determine how venous thromboembolism (VTE) prophylaxis rates and events were affected. Because unfractionated heparin (UFH) remained a prophylaxis option before and after the LMWH change, the process measure [...]

Background: The hospital setting is an ideal environment to counsel patients on smoking cessation. The effectiveness of hospital‐based care for smoking is unclear, specifically among African Americans, who face a disproportionate burden of tobacco‐related disease. This study assessed Ihe quality and efficacy of usual care on chemically verified quit rates 4 weeks postdischarge. Methods: Current [...]

Background: Despite the removal of most internal medicine (IM) residency procedure requirements, residents at all levels continue to perform bedside procedures. Hospitalists may find themselves responsible for oversight of inpatient procedures performed by their residents. Little is known about hospitalist experience and maintenance of procedure skills in this role. Our goal was to determine academic [...]

Background: Approximately 500,000 patients are discharged from U.S. hospitals against medical advice (AMA) each year. The clinical implications of discharge AMA are not known. We hypothesized that discharge AMA would be associated with a strong and significantly increased risk for mortality and readmission in a general medical inpatient population. Methods: We used a propensity‐score‐matched retrospective [...]

Background: Since the prospective payment system began in 1962, hospitals have been incentivized to shorten inpatient length of stay (LOS). Though average LOS has since become shorter, few studies have examined the impact of shorter LOS on patient outcomes. Such studies are particularly difficult because of the need to eliminate confounding. We used a unique [...]

Background: In the United States the elderly make up a disproportionately large percentage of acute hospitalizations. In 2003 persons older than 65 years old made up 12% of the U.S. population but accounted for 33% of all hospitalizations. The number of hospitalized elderly will only rise over the next 40 years as the number of [...]

Background: There is increasing use of propofol by nonanesthesiologists to sedate children for ambulatory diagnostic imaging studies. There is little published data on the safety profile and frequency of adverse events when propofol is used by pediatricians without subspedalty training. Methods: Sedation‐trained pediatric hospitalists have performed more than 1500 propofol sedations from January 2005 to [...]