Background: Alcohol use disorders (AUDs) are common among hospitalized patients. Naltrexone has been proved to assist patients with AUDs in maintenance of sobriety. The initiation of naltrexone has been studied in outpatient and inpatient settings. Our hospitalist program lacked a process for initiation of naltrexone for maintenance of sobriety among inpatients with AUDs. Methods: We […]

Background: Peripherally inserted central catheters (PICCs) have been associated with venous thromboembolism (VTE) and are a major cause of upper extremity deep vein thrombosis (DVT).  However, mechanisms to identify patients at greatest risk of PICC-associated VTE are limited. Methods:  Using data from the Michigan Hospital Medicine Safety consortium, patients with PICCs that experienced symptomatic, image-confirmed […]

Background: Pain is commonly reported by hospitalized patients and may be managed with opioids, which are associated with benefits and harms.  Clinicians’ perceptions of the benefit to harm ratio may differ across countries, which may lead to variability in prescribing practices.  We sought to determine whether there was an association between willingness to prescribe opioids […]

Background: Hospital-acquired C. difficile colitis is associated with increased length of stay (LOS) and significant morbidity and mortality. During hospitalization, patients visit many procedural, diagnostic, and treatment areas throughout the hospital, presenting opportunities for spore contamination of surfaces and nosocomial disease transmission. We developed a novel methodology using electronic health record (EHR) data to map […]

Background: It is often assumed resident physicians at academic medical centers order more tests for inpatients due to different aspects of the clinical learning environment.  Despite this prevailing notion, there is very little evidence to support this claim. We sought to quantify differences in ordering practices between teaching hospitals and non-teaching hospitals for two common […]

Background: Structured mortality review can help identify care issues and focus quality efforts, but existing methods have limitations. In the Department of Medicine at UCLA, we developed a novel in-person, near real-time, interdisciplinary rapid mortality review (RMR) process to capture the insight of frontline providers and improve care. In this study, we compare the yield […]

Background: Advance care planning can be challenging for both patients and providers.  Barriers to understanding patients’ goals of care include patient and provider discomfort with the topic, as well as family and cultural dynamics.  The Stanford Letter Advance Directive (LAD) is a simple tool written at a fifth grade reading level in eight different languages […]

Background: Although point-of-care ultrasound can improve patient care and reduce unnecessary downstream costs, few economic models exist on hospitalist use and whether remuneration for imaging could offset equipment costs.  As the heart and lungs are commonly examined during admission, we observed the frequency of use and projected fiscal outcomes of point-of-care cardiac ultrasound by an […]

Background: Pneumonia is the fourth most common cause of hospital admissions in the United States and the eighth most expensive condition, accounting for over $9.5 billion annually in inpatient costs alone. Multiple clinical trials have shown that shorter durations of antibiotic treatment (5 to 7 days) are as safe and effective as longer courses, findings […]

Background: Rich sources of data are available in hospitals, but are often housed in different systems. These include electronic health records (EHRs), physician scheduling software, and existing tools that can be used to electronically contact clinicians. Developing a streamlined way to integrate and connect disparate data has enormous potential for clinical care, operations, and research. […]