Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days.  However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and device-characteristics associated with short-term PICC use. Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan [...]

Background: Prophylactic anticoagulation is effective at reducing the risk of venous thromboembolism (VTE), but can also increase the risk of bleeding. Whether anticoagulant prophylaxis should be modified for underweight patients to minimize bleeding complications is unknown.  We sought to determine whether being underweight is associated with the risk of major bleeding in hospitalized medical patients [...]

Background: While use of technologies such as ultrasound and electrocardiographic (EKG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the setting, experience or practice of providers that use these tools. Methods: Using data from the PICC1 survey of vascular access specialists, we identified technology-users from non-users. We defined [...]

Background: Delirium is associated with increased duration of mechanical ventilation, longer intensive care unit (ICU) length of stay, increased mortality and cognitive impairment after discharge. Quetiapine has been associated with faster resolution but long-term use is associated with adverse effects. Patients are often discharged from the ICU and subsequently from the hospital on quetiapine without [...]

Background: Adverse drug events (ADEs) are common during transitions from the hospital to the ambulatory setting, with approximately 20% of patients experiencing an ADE within 30 days of discharge. ADEs are often due to patient misunderstanding of the prescribed medication regimen or non-adherence to the regimen.  New approaches are needed to address this problem. Purpose: [...]

Background: Drug-induced prolonged QT syndrome significantly increases the risk of fatal arrhythmias such as torsades de pointes.  Patients with baseline QTc prolongation are particularly vulnerable.  Limiting administration of QT-prolonging medications to high-risk individuals is important for patient safety. Methods: Patients with a baseline QTc > 500 ms were defined as having a high risk for [...]

Background: Hospital-associated infections are a significant cause of morbidity and mortality, and are frequently preventable with careful attention to appropriate hand hygiene (HH).  Unfortunately, HH rates among healthcare providers are often unacceptably low. Driving complex behavior change requires influencing attitudes and culture, which can be challenging. Purpose: To improve safety culture by encouraging all staff [...]

Background: While studies in the ambulatory care setting have found that patients with high level of psychological well-being have high satisfaction with their physicians, no study has evaluated the relationship between psychological well-being and satisfaction with physicians in hospitalized patients. Therefore, we examined the relationship between a patient’s psychological well-being and patient’s satisfaction with physicians [...]

Background: Given the widespread adoption of electronic health record systems, the majority of patient orders are now enacted through electronic orders. We aimed to describe the average number of electronic orders entered for medicine patients hospitalized at different levels of care and determine if electronic ordering patterns reflected patient acuity and severity of illness. Methods: [...]

Background: The systematization of the teaching and training of internal medicine residents should be done with the standardization of techniques, simulations, use of manikins and theoretical lessons. A procedure team was created in a tertiary teaching hospital at south Brazil with the objective of minimizing risks to the patient at the same time optimizing the [...]