Background: Hospital discharge is a critical transition in care, yet recent data show much room for improvement: 1 in 5 patients experiences an adverse event or readmission within 30 days of discharge. Presently, metrics for the quality of discharge care are limited, and little is known about factors affecting the quality of hospital discharge from […]

Background: Practiced teamwork with good communication is a necessary component of safe, quality health care. Communication failures are the leading root cause of harm in hospitalized patients; poor teamwork is associated with worse health care outcomes. The Institute of Medicine and the Joint Commission have made communication and interdisciplinary team training national patient safety goals. […]

Background: Cardiac monitoring has become increasingly available in noncritical beds. Most clinicians assume that this practice enhances patient care and improves outcomes, but such benefits have not been systematically proven. In 2004, the American Heart Association (AHA) published practice standards that included expert opinions regarding indications for electrocardiographic monitoring in hospital settings. However, there is […]

Background: Chronic kidney disease (CKD) affects 13% of adults in the United States, and acute renal failure (ARF) is present in up to 7% of hospitalized patients. Individuals with CKD are at an elevated risk for cardiovascular complications and anemia and have increased mortality. Mortality in ARF can be as high as 50%. Appropriate dosing […]

Background: Urinary tract infection (UTI) is the second most common bacterial infection leading to hospitalization, accounting for 40% of nosocomial infections. Despite the high prevalence of UTI, variability in diagnostic testing and treatment of UTI among hospitalized patients is common and can lead to inappropriate antibiotic use and subsequent antibiotic resistance. We therefore sought to […]

Background: Approximately three quarters of all invasive methicillin‐resistant Staphylococcus aureus (MRSA) infections in the United States are bloodstream infections (BSIs). Many patients with MRSA BSIs are not treated with effective definitive therapy even when antibiotic susceptibility results are known. Inappropriate antibiotic selection for MRSA BSIs results in poor clinical outcomes. Methods: We performed a retrospective […]

Background: Blood cultures are frequently obtained by providers in the emergency department (ED) to evaluate pediatric patients presenting with fever. In pediatrics, nurses and laboratory personnel often obtain blood cultures at the time of placement of an intravenous catheter. Because of this collection technique, blood culture contaminants present myriad scenarios leading to unnecessary and costly […]

Background: Physician interaction with the pharmaceutical industry begins early in medical education. Several studies demonstrate that exposure to the pharmaceutical industry occurs throughout the medical training process, from the first years of medical school on through residency. Practicing physicians’ interactions with pharmaceutical industry representatives have been shown to have effects on physician prescribing behavior and […]

Background: The Institute for Healthcare Improvement recommends that unplanned readmissions within 30 days of discharge prompt a formal case review to identify systematic flaws in discharge processes. As frontline providers, residents may have insights that can help assess readmission preventability and identify underlying system flaws that lead to readmissions. We therefore developed a readmission case […]

Background: Transitions of care occur any time a patient moves from 1 care setting to another or from 1 provider to another. A higher frequency of errors has been described during these vulnerable periods, and a Society of Hospital Medicine Task Force has issued recommendations for best practices in handovers among hospital‐based physicians. We describe […]