Background: Hospital‐based tobacco cessation counseling is critical, especially among African Americans, who suffer a disproportionate burden of tobacco‐related disease. Recently updated cessation guidelines are available, and quality measures for counseling are tied to physician reimbursement. Yet previous research showed only 10% of patients with tobacco‐related disease quit smoking postdischarge. This study aimed to understand barriers [...]

Background: Similar to national trends, the emergency department (ED) at our 960‐bed institution faced increasing volume and overcrowding, resulting in delays in treatment, lower patient satisfaction, and concerns about quality. Between January 2009 and June 2009, the number of patients treated in the ED rose by 24.5% compared with 2008, causing an increase in internal [...]

Background: Venous thromboembolism (VTE) is a common preventable cause of inpatient mortality. Pharmacologic methods are the preferred mode of prophylaxis according to guidelines. Various risk‐assessment tools are available to assist physicians in identifying patients who should receive VTE prophylaxis when hospitalized. The objective of this study was to determine the level of agreement between 3 [...]

Background: A unit‐localized hospitalist physician is often utilized to improve the overall efficiency of patient care. The effect of this type of system specifically on discharge time of day and length of stay (LOS) in patients with varying discharge needs is unknown. Methods: We examined electronic data on all discharges from a hospitalist service in [...]

Background: Studies show that hospitalized patients do not understand their postdischarge care plan. Increased patient involvement in care has been found to improve outcomes; understanding the care plan is the first step in engaging patients. Several groups, including the Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality, provide resources such as [...]

Background: Localization of medical teams to a hospital unit has been shown to improve nurse–provider communication, but its affect on patient outcomes is unknown. Methods: Between April 1, 2010, and July 10, 2010, we conducted a trial of localizing patients assigned to 2 hospitalist–physician assistant (HPA) teams to 1 nursing unit. We concurrently compared their [...]

Background: Localization of medical teams to a hospital unit is an attractive way to organize hospitalist services but its operational impact on work flow has not been examined. Methods: Between April 1, 2010, and July 10, 2010, we localized patients assigned to 2 hospitalist–physician assistant (HPA) teams on 1 nursing unit. We concurrently compared the [...]

Background: Propofol is widely used to sedate children for radiological procedures. Because propofol is an anesthetic, its use in the past was restricted to anesthesiologists. The hospitalist group at St. Louis Children's Hospital (SLCH) successfully performed more than 1600 propofol sedations between 2005 and 2009. A chart review of patients sedated with propofol over that [...]

Background: Ongoing evaluation of sedation programs and individual physician performance are important elements in a successful sedation program. In our institution, quality improvement (QI) forms are used to track adverse events occurring during procedural sedation. Despite widespread use of similar forms, there are little available data to support the accuracy of such systems in reflecting [...]

Background: Hospital‐acquired venous thromboembolism (HA‐VTE) is a predictable complication that increases morbidity and mortality. Despite overwhelming evidence supporting the effectiveness of VTE prophylaxis, safe, effective, and cost‐efficient methods to prevent VTE remain underutilized. In the high‐risk patient population of a surgical intensive care unit (ICU), we examined the effect on HA‐VTE when a unit‐based multidisciplinary [...]