Background: Many hospitalist groups recognize the importance of ensuring that the individual preferences, strengths, and practice styles of their providers are taken into account while determining the work schedule for the practice. Rigid schedules with longer scheduled periods per provider can minimize care transitions for patients, whereas flexible schedules allow hospitalists to seek a balance [...]

Background: The number of attending‐only services in traditional teaching hospitals has increased. This trend is largely a result of decreased patient coverage by residents in response to ACGME duty‐hour restrictions, as well as planned growth within institutions. Medical student enrollment has not decreased, leading to medical student participation on attending‐only teams. An attending‐only service can [...]

Background: Central line–associated bloodstream infections (CLABSIs) increase length of stay, add an additional $10,000 in costs per event, and increase mortality. Education, procedure carts, and checklists to improve compliance with evidence‐based, sterile procedures have been shown to decrease CLABSI rates in intensive care units. High‐volume, specialized operators have been shown to improve outcomes for high‐risk [...]

Background: Noncardiac surgery in patients with pulmonary arterial hypertension (PAH) is associated with a morbidity of 42% and a mortality of 7%. The most important pathophysiologic consideration is the effect of increased pulmonary vascular resistance (PVR) on the right ventricular function. PAH has a progressive nature; initially it is caused by a vasoconstrictor process that [...]

Background: Handling deaths is a stressful but unfortunately common event for hospital‐based trainees. This experience is a key component of the practice of palliative care. Training in palliative care is a responsibility and a requirement of postgraduate medical education programs. Systems‐based improvements have the capacity to reinforce learned behaviors. Purpose: (1) To teach trainees key [...]

Background: Clinician‐educators are responsible for more information and sicker patients than in the past. Yet they face greater time pressures. Faculty development programs ought to teach clinician‐educators to handle these conflicting responsibilities while retaining excellence in medical education. Purpose: To improve the inpatient attending experience by teaching skills for leadership, time management, bedside teaching, and [...]

Background: Our program admits approximately 15,000 patients a year. Bed assignment depends on availability and level of care required. Incorrect placement occurs frequently, leading to delays in patient care and causing a drain on nursing, physician, and housekeeping resources. Purpose: In spring 2010, our hospital contacted a consultant group to examine its efficiency and throughput. [...]

Background: In 2001 our residency program developed a quality improvement elective. Our goals were to provide residents with hands‐on experience in peer review root cause analysis (RCA) and performance improvement, which would also satisfy the ACGME systems‐based practice competency. In 2006 the rotation became mandatory for all residents. As residents took on a larger role [...]

Background: Hospitalized patients are frequently readmitted within 30 days of their discharge. It is believed that many patients are readmitted because of a recurrence or worsening of the same condition for which they were originally hospitalized. Such readmissions might be preventable if related to inadequate treatment or poor care transitions. However, the degree to which [...]

Background: Beginning in January 2011, hospitals will report central line‐associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network (NHSN) per Center for Medicare and Medicaid Services (CMS) payment rules. The NHSN definition of CLABSI uses central line‐days as the denominator. Manual collection of line‐days is resource intensive, and NHSN allows for use of electronic [...]