Background: Evidence is equivocal that unit-based interventions improve quality on inpatient medical services, but most studies have reported their effect in isolation. These interventions may be better conceptualized as complementary components of a redesigned clinical microsystem. A clinical microsystem is defined as the small group of people who work together in a defined setting on [...]

Background: Collaboration between multidisciplinary teams during the discharge process can optimize the safety of discharge planning. At our tertiary academic medical center, case managers (CM) and pharmacists have historically been assigned to patients by unit rather than medicine teams. As a result, medicine teams often need to interact with several unit-based CMs and pharmacists due [...]

Background: Control over work hours and schedule flexibility are important predictors of clinicians’ career satisfaction, work-life balance, and burnout, which are in turn linked to quality of patient care, recruitment, and retention.  In our rapidly expanding academic hospital medicine group with over 60 providers, the scheduling process has grown increasingly complex, leading to high levels [...]

Background: Audit and feedback improves clinical care by highlighting the gap between current and ideal practice.  Electronic health record (EHR) data can provide contemporaneous data for quality improvement but has not yet been studied extensively.  We conducted a randomized trial to determine whether audit and feedback leveraging EHR data with modern web-based dashboards could improve [...]

Background: Delays in care may lead to increased length of stay and cost. Identifying and quantifying the reasons for these delays could help target interventions and reduce unnecessary hospital days. Methods: We conducted a cross-sectional observational study at a large tertiary academic medical center, from October 16, 2016 to November 20, 2016. The study participants [...]

Background: Evidence-based medicine is inconsistently used in the evaluation of syncope, leading to misutilization of resources. We studied the effect of a multifaceted intervention on the adherence to evidence based recommendations. Methods: A multidisciplinary group developed an evidence based syncope algorithm that included a risk stratification tool. Educational (ED nursing education on orthostatic vital signs [...]

Background: The measurement of fluid balance (FB) for hospitalized patients has been a standard of nursing practice for many years, but its utility and accuracy is questioned in the literature. There is no gold standard benchmark for accuracy of FB measurement. From a clinician’s standpoint, FB data are essential in guiding treatment decisions.  The inaccuracy [...]

Background: Unnecessary laboratory (lab) testing contributes to excess health care expenditures and patient harm.  Multiple professional societies have recommended avoiding repetitive lab testing in the absence of clinical indications and some institutions have reduced lab utilization with improvement initiatives. However, repetitive lab testing remains a common practice at many hospitals. We conducted an initiative to [...]

Background: Patient complaints reflect their unmet expectations and are a valuable resource to understand key drivers of patient experience. It is unclear, however, how patient complaints can be used to improve service quality and guide improvement work Purpose: Our objective was to identify a strategy to decrease the number of patient complaints and enhance patient [...]

Background: The majority of patients on medicine wards are phlebotomized daily. This is particularly problematic in academic centers where trainees are primarily responsible for patient care. Unnecessary phlebotomy is not only costly, but can lead to iatrogenic anemia, puncture site infection, and increase patient discomfort. The objective of this study was to determine whether an [...]