Background: The discharge process is often not initiated until late during hospitalization and typically perceived by patients as disorganized. Poor discharge planning is not only a source of dissatisfaction, but may adversely impact safety during transitions. Few efforts have focused on engaging patients in providing real-time input regarding their discharge preparedness prior to leaving the [...]

Background: Sepsis is a leading cause of death among hospitalized patients. Early detection of sepsis has the potential to reduce mortality by facilitating timely evidence-based interventions. Past studies have used electronic health records (EHR) to trigger alerts at the onset of sepsis, or to predict general clinical deterioration. In this study we describe the impact [...]

Background: Sepsis is a leading cause of mortality among hospitalized patients. Early detection and intervention reduces sepsis-related mortality. We implemented a novel early warning system (EWS 2.0) based on a machine-learning algorithm to prospectively identify patients with increased risk of severe sepsis or septic shock. Validation suggested excellent predictive characteristics, including a positive likelihood ratio [...]

Background: Current staffing models cannot deliver the benefits of hospital medicine to the 1300 critical access hospitals (CAHs) located throughout the rural United States.   Staffing each CAH with local hospitalists would require at least 5500 hospitalists (more than 10% of the workforce), to cover less than 2% of the hospitalized population.   A “virtual hospitalist” program [...]

Background: Accurate problem lists linked to the electronic medical record (EMR) can be a source of structured clinical data useful for communication among clinicians for patient care, clinical decision support design, and EMR phenotyping.  Nevertheless, modifying the electronic problem list is disruptive to clinician workflow under traditional charting methods, resulting in incomplete, inaccurate, and outdated [...]

Background: Though the use of point of care ultrasound (POCUS) has increased over the last decade, hospitalists may still find it difficult to gain formal hospital credentialing for POCUS.  National organizations have not yet published recommended guidelines for POCUS credentialing in hospital medicine (HM) We established a protocol for hospitalists at a large tertiary care [...]

Background: The Centers for Disease Control and Prevention (CDC) estimates over 1.2 million Americans are living with HIV (human immunodeficiency virus). Of those, approximately 14% are unaware of their HIV-positive status. In 2014, most hospitals adopted some form of Electronic Health Records (EHR) and one year later, the Centers for Medicare & Medicaid Services extended [...]

Background: Triaging patients from the emergency room, an outside hospital or a service-line within your institution can be a challenging endeavor regardless of the size of your group. The Ohio State University Wexner Medical Center Division of Hospital Medicine (DoHM) faculty are the primary attendings for 21 unique service-lines each day across five hospitals. The [...]

Background: The quality of communication between physicians and nurses plays an important role in patient safety and provider job satisfaction. Efforts to improve the effectiveness of MD-RN communication have traditionally disseminated new programs such as staff training or communication tools, rather than improve established routines such as morning rounds. Having MDs and RNs round together [...]

Background: The original goal of progress notes is to provide a concise, up-to-date reflection of the patient’s condition and the provider’s thought processes.  Electronic health records (EHRs) allow physicians to supplement traditional manual data entry with copied or imported text in these notes. However, this increases the risk of including outdated, inaccurate, or unnecessary information, [...]