Background: Unit-based medical teams improve cohesiveness and communication among team members and increase time spent with patients. At the University of Iowa Hospitals and Clinics, physician teams had patients in 5-6 different units on an average day.  This geographic dispersion led to wasted physician time and poor coordination with ward-based support staff.  We hypothesized that [...]

Background: Sleep is generally poor in hospitalized patients and sleep deprivation has many harmful effects, including delirium, insulin resistance, hypertension, and impaired function of the immune system. In this quality improvement (QI) project, our goal was to delay early morning phlebotomy blood collections to improve sleep for our patients, while not negatively impacting hospitalists’ perception [...]

Background: With the advent of the electronic health records an increasing amount of data is available for feedback to physicians. However, the impact of regular team-based feedback is unknown particularly physician perceptions of the relevance and utility for their clinical practice. Methods: As part of a previous project resident QI champions with analytic help from [...]

Background: In the inpatient setting, opioids are the most commonly prescribed medication and the 2nd most frequent cause of adverse drug events (ADE).  Identifying patients at high risk for ADEs related to narcotics is essential.  These ADEs include ileus, altered mental status, and respiratory depression. Obstructive sleep apnea, organ impairment, and other medication use (i.e. [...]

Background: Inpatient medication reconciliation errors are common and can lead to serious adverse drug events. Most medication discrepancies are due to errors in taking an accurate medication history. Tools imbedded in the electronic medical record (EMR) are one mechanism by which the accuracy of medication reconciliation can be improved. We constructed an EMR-based admission navigation [...]

Background: The number of hospitals with dedicated observation units has grown in recent years to one-third of all United States hospitals and 80% of academic medical centers, though much is still unknown about how to best deliver care in this setting. At our institution, syncope is among the most common indications for admission to the [...]

Background: Extended stay (> 30 day stay) cases strain hospital resources, psychologically burden staff, increase average length of stay (ALOS) and ultimately are not patient-centric. In 2008, extended stay patients represented 15% of the average daily census on the Medicine service. Methods: In 2008, we convened a proactive interdisciplinary team to engage in addressing barriers to [...]

Background: Patients admitted to the Medicine Service from the Emergency Department (ED) at times when no beds are available pose a particular challenge to workflow, staffing and patient care. Due to the expansion of our clinically integrated network and recruitment of high-volume surgical teams, the hospital daily census surged, causing an increase in the average [...]

Background: CMS and other entities have focused on reduction of readmissions as a national quality improvement goal. The 30-day risk standardized readmission rate is derived from administrative data and requires the accurate coding of a principal diagnosis. We sought to validate the coded principal diagnosis for patients admitted with pneumonia and to determine if local [...]

Background: One year all-cause mortality rates after a fragility fracture are as high as 24%. Treatment of osteoporosis following fracture reduces mortality, recurrent fractures rates, and healthcare costs. Without endocrinology involvement, clinicians often fail to recognize and treat osteoporosis. We aimed to assess the frequency of fragility hip fractures including recurrence rates at our academic [...]