Background: Studies of the impact of provider workload on patient safety and quality of care have primarily focused on nurses and resident physicians, but not hospitalists. We examined the relationship between workload and patient safety and quality via a survey of an online community of hospitalists. Methods: We electronically surveyed 890 self‐identified hospitalists enrolled in [...]

Background: Nearly all hospital‐acquired infections are preventable. There has been at least a twofold increase in hospital‐acquired Clostridium difficile–associated diarrhea (HA‐CDAD) across the country. Hospitalized patients with CDAD can have 3 times the length of stay and 4.5 times the death rate. CDAD is an enteric pathogen often seen in patients shortly after a course [...]

Background: Posthospitalization phone calls have been proposed as a means to reduce postdischarge adverse events, increase patient satisfaction, and reduce costly return visits to the hospital. Some programs have utilized hospital‐based nurses to provide follow‐up calls, but the outcomes of these interventions have not been well described. Methods: After a 3‐month pilot on a single [...]

Background: Perioperative hyperglycemia is a risk factor for increased morbidity and mortality. Improved glycemic control has been demonstrated to reduce surgical site infections and reduce perioperative morbidity and length of stay. However, safe and effective glycemic control in transition from the postanesthesia care unit (PACU) can be limited by expert clinician availability. We implemented and [...]

Background: Guidelines for the use of EKG telemetry monitoring for inpatients with cardiac diagnoses, such as myocar‐dial infarction, are provided by the American Heart Association. However, no guidelines exist for its use specifically in patients with medical diagnoses, such as renal failure or pulmonary embolism. This is in large part due to the paucity of [...]

Background: Lactic acid is a marker of life‐threatening illness, and any delay between recognizing an increased level and initiating treatment may be dangerous. The presence or absence of an anion gap (AG) has classically been used as a screening tool for lactic acidosis. Prior studies of the reliability of AG as a screening tool in [...]

Background: A large majority of emergency cranial computed tomography (CCT) scans performed in the evaluation of nontrauma neurological complaints neither reveal clinically significant abnormalities nor result in emergent interventions. Over‐utilization of imaging modalities results in radiation exposure, undue reliance on imaging, delayed emergency department (ED) throughput, and increased costs. To reduce unwanted imaging, we studied [...]

Background: Defensive medicine is defined as a deviation from sound medical practice induced primarily by a threat of liability and is categorized as assurance or avoidance behaviors. Assurance behaviors include the provision of additional services of minimal value with the goal of reducing adverse outcomes. Avoidance behaviors include efforts to avoid providing services or caring [...]

Background: Optimal conversion to a subcutaneous insulin regimen following an insulin infusion requires knowledge of patients’ current clinical status, medical history, and most recent intravenous (IV) insulin drip requirements. This up‐to‐date information is most available to a bedside nurse. We proposed that implementation of a nurse‐driven transition protocol would result in improved glycemic control when [...]

Background: Hospital readmission within 30 days of discharge is an area of emphasis of health care reform. Recent reports reveal that readmissions are costly and potentially preventable in many cases. Limited research is available on what factors place a patient a risk and if targeted interventions can reduce the observed readmission rate. Our objectives were [...]