Background:  Children and Young Adults with Special Healthcare Needs (CSCHN), especially those with multiple organ systems involvement, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach and coordination among multi-disciplinary team members. Previous studies have demonstrated that homecare is a cost-effective measure [...]

Background: Regulatory agencies have set a 60-minute window to communicate positive CT PE (computed tomography pulmonary embolism) results to ordering providers. Improving the effectiveness of communication among caregivers for critical results of tests is a national patient safety goal. Our current system of communicating positive results to providers was inconsistent (mean time to verbal report [...]

Background: Capacity constraints are a common problem at many academic institutions.  At Duke University Hospital (DUH) , capacity constraints continue to result in critical bed shortages.  Our affiliated hospital, Duke Regional Hospital (DRH) which is less than 5 miles away, has the capacity and capability to provide care to these general medicine patients. Shifting general [...]

Background: Frequent readmissions pose a challenge to hospitals across the country. They are associated with increasing healthcare costs and display a failure to effectively care for certain groups of patients. The Centers for Medicare and Medicaid Services (CMS) apply a penalty towards hospitals with higher than expected 30-days readmission rates. In response, hospitals have implemented [...]

Background: Hospital discharge handover is a primary metric for measuring healthcare quality and patient safety. Effective post-discharge follow-up (FUPD) reduces costly readmissions, adverse medical events, and preventable deaths. Despite the importance of hospital discharge follow up, the process of scheduling discharge appointments and the effectiveness of the process is often unclear to the medicine team [...]

Background: The Society of Hospital Medicine and the ABIM Foundation‘s Choosing Wisely Campaign have made tackling overutilization of routine labs part of their mission.  Based on the literature, 30-50% of routine labs ordered for hospitalized patients every morning may be unnecessary.  Aside from pain, discomfort and sleep disturbance, these daily labs predispose patients to iatrogenic [...]

Background: Prognostication of survival in advanced cancer patients has been challenging and contributes to poor illness understanding.  Prognostic disagreement occurs even amongst providers and is a less studied phenomenon.  We introduced the Surprise Question (SQ), “Would I be surprised if this patient died in the next 1 year, 6 months, and 1 month?”, at multidisciplinary [...]

Background: Post-hospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on aspects of hospitalization that contribute to this decline, but until an in-depth analysis is completed we cannot be certain. Therefore the aims of this project were to identify aspects of hospitalization [...]

Background: In the past 20 years, the “10/30” rule for blood transfusions has been replaced with conservative guidelines which have demonstrated improved patient outcomes and reduced overall healthcare costs. Hospitals across the country have enlisted transfusion subcommittees to review the appropriateness of blood transfusions. Within medical training, resident physicians rotate with different attendings who have [...]

Background: Approximately 75% of patients with hepatitis C virus (HCV) are born in the years 1945 to 1965. The CDC recommends a one-time screen for patients within that age range, regardless of risk factors. The societal and economic burden of HCV is expected to grow significantly over the next decades. An increase in appropriate screening [...]