Background: Hospital medicine has significantly grown over the last two decades with increasing focus on providing improved quality of care while also reducing cost.  A recent focus has been on transitions of care and handoffs, which have been identified by The Joint Commission as a potential pitfall for miscommunication and area of increased risk for [...]

Background: It has long been recognized that a comprehensive bundled and coordinated care affects sepsis mortality.   The Center for Medicare and Medicaid Service’s (CMS) has mandated reporting of severe sepsis/septic shock management with emphasis on adherence to the bundles.  However, bundles may not be appropriate for all patients.  The current 3-hr bundle includes blood cultures, [...]

Background : As part of the Choosing Wisely campaign, the Society of Hospital Medicine recommends against performing “repetitive complete blood count [CBC] and chemistry testing in the face of clinical and lab stability.” This recommendation stems from a body of research that shows that frequent or excessive phlebotomy can have negative consequences, including iatrogenic anemia, increased [...]

Background: A “safe” hospitalist workload – that is, the point at which caring for too many patients leads to poorer outcomes for each individual patient – has not been defined.  We sought to understand whether the workload of a resident-run inpatient team, measured by number of orders entered into the electronic medical record, was associated [...]

Background: A widely used test for glucose control is the hemoglobin A1c, which correlates with the patient’s mean blood glucose levels over the previous 2-3 months.  To evaluate long-term glycemic control during an inpatient hospitalization, all insulin order sets in the electronic medical record (EMR) have a defaulted hemoglobin A1c order.  However, this raised concerns [...]

Background: Incidental pulmonary nodules are prevalent in hospital medicine, and many require follow-up imaging to exclude lung cancer. The Fleischner Society Guidelines were developed to guide practitioners in their management of these nodules. The purpose of this study was to understand the practices of hospitalist physicians nationally regarding the management of incidental pulmonary nodules, including [...]

Background: As hospitals continue to see increasing costs, quality improvement interventions are essential to maintaining a high level of quality care in the inpatient setting. Multiple studies have shown that a systems based approach offers a clean and simple method for targeted interventions. However, educational interventions, when maintained over time, have an increased long term [...]

Background: Increased Emergency Department (ED) boarding times have been linked to increased patient length of stay, increased mortality and lower patient satisfaction scores. Discharging hospitalized patients earlier in the day has been proposed as one way to reduce ED boarding times and improve hospital patient flow.  To our knowledge, barriers preventing earlier discharge have not [...]

Background: Patients, physicians and health technology developers are increasingly interested in mobile health applications. However, there are few examples of partnerships between hospitalists and the private companies to test novel health technologies in the inpatient setting.   Purpose: To test the feasibility and uptake of a Hospital-Medicine based program for prescribing mobile health applications to hospitalized [...]

Background: Risk stratifying patients for potential development of hospital-related venous thromboembolism (VTE) is an important aspect of inpatient safety and is recommended by current guidelines.  Many risk stratification tools are cumbersome and require significant time to complete.  Developments have been made to partially or fully automate risk stratification tools, however there are restrictions within the [...]