Background:  Opiate, alcohol and polysubstance abuse are increasingly recognized for their catastrophic consequences on the health of populations across demographic groups.  Inpatient management of polysubstance use or dependence is often a crucial aspect of appropriate medical care.  Hospitalists are regularly involved in the care of patients with substance abuse. Co-management with Addiction Recovery specialists can […]

Background: Diabetes Mellitus is one of the most common chronic diseases in the United States and worldwide.1-2 Hemoglobin A1C is a surrogate marker for the average blood glucose level over the previous 3 months.3 In 2009 the American Diabetes Association (ADA) recommended using A1C greater than 6.5% to diagnose diabetes.4 Hemoglobin A1C can be measured […]

Background: Prior To March 2016 interdisciplinary rounds were held in the back of the nurses’ stations on two inpatient medial units. Patients satisfaction scores around the discharge process and communication were consistently low. Medical director and nurse manager dyad leadership teams redesigned interdisciplinary rounds to improve communication between the patient and the health care team. […]

Background: Co-management across service lines has become increasingly common in hospital medicine. While debate continues over clinical outcomes, some co-management arrangements have led to enhanced provider satisfaction, which may have implications for burnout. We have established successful co-management services with orthopedics, urology (GU), otorhinolaryngology (ENT), trauma and neurosurgery (NS). We are a large urban/suburban academic […]

Background: A variety of risk prediction scores have been devised to identify patients at increased risk for VTE in different patient populations and settings. Guideline recommendations for VTE risk assessment vary greatly. We performed a systematic review to identify and synthesize evidence on clinical risk prediction scores for VTE in medical and surgical hospitalized patients. […]

Background: National guidelines recommend sampling unilateral pleural effusions to characterize the fluid as either transudative or exudative.  Currently, the only method to characterize pleural fluid is by collecting a sample through an invasive drainage procedure that has risks of complications and is uncomfortable for the patient.  Few noninvasive methods have been studied to differentiate exudative […]

Background: A growing body of evidence supports the use of point of care ultrasound increasingly as augmentation of the physical exam and clinical decision making. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on the training approach and development of competency for hospitalists […]

Background:   Observation care has evolved significantly since its original inception by the Centers for Medicare and Medicaid Services (CMS).  Originally intended to span less than 48 hours in the majority of cases, the Office of Inspector General (OIG) reported that 11% of all observation stays lasted three or more nights in 2012.[1]Having a higher length […]

Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics […]

Background: Pneumonia is often treated for longer than necessary, yet factors associated with excess duration of treatment are unknown. We sought to: (a) develop an algorithm to determine appropriate antibiotic duration in non-intensive care unit (ICU) patients hospitalized with pneumonia and (b) apply this algorithm to an ongoing prospective study to determine patient-, provider-, and […]