Background: Amanda Guay, outreach coordinator at North Country HealthCare in Flagstaff, Arizona, believes that affordable nutrition based meals are an important issue in the Flagstaff community, especially for underserved populations. Diabetes, obesity, hypertension, and hyperlipidemia are major issues in the area in part due to monetary restrictions and lack of a healthy eating culture. There [...]

Background: Inappropriate antibiotic use is associated with bacterial resistance, adverse events, and an increased risk of Clostridium difficileinfection. However, providers often prescribe antibiotics for viral respiratory infections and treat infections such as bacterial pneumonia for unnecessarily prolonged durations.  Serum procalcitonin (PCT)-guided treatment is known to safely reduce antibiotic use and duration of treatment in pneumonia. [...]

Background: Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-acquired infection nationally, and in the era of publically reporting and reimbursement based on outcomes, represents a preventable hospital-acquired infection that harms patients and institutions. The rate of CAUTI at our institution was higher than state and national averages, and a multidisciplinary team was tasked [...]

Background: Previous studies have determined that a small subset (~10%) of the results of tests pending at discharge (TPADs) require action. Challenges for hospitalists in dealing with actionable TPADs include identifying TPADs that are truly actionable and ensuring appropriate follow-up. Little is known about the factors that predict whether a TPAD is actionable. The goal [...]

Background: Unnecessary diagnostic testing contributes to the escalating cost of health care in the US and can cause harm to patients. Daily blood work has become a routine part of care for hospitalized adults though only a fraction of tests change diagnosis or management decisions. At academic medical centers, residents are responsible for ordering most [...]

Background: Earlier discharge time is an important satisfaction metric for patients, maximizes the utilization of hospital beds, and reduces waste and capacity issues in EDs /PACUs. Overall, early discharge represents high-value care and responsible stewardship of a scarce resource. Our healthcare system assessed the discrepancy between bed demand and bed needs, finding 25% of Tuesday [...]

Background: Formal curricula for teaching medical students high value care are lacking, and there is little evidence identifying strategies that can effectively impact students’ knowledge and skills. Research is needed to develop models for student-led HVC implementation in healthcare settings. Purpose: To create a student-led longitudinal curricular experience that leads to improvements in utilization outcomes. [...]

Background: Reducing denied days, or days of hospitalization that aren’t reimbursed by payers, is critical for hospital financial stability, and to ensure efficient, patient-centered care. In 2015, payers denied payment on ~20% of all hospital days at LAC+USC Medical Center, a 676-bed safety-net hospital with a Level 1 Trauma Center. The Department of Medicine, which [...]

Background: The healthcare system in the United States is often times costly and inefficient. Some estimates suggest that 20-34% of healthcare dollars are spent ineffectively. Despite efforts such as the Choosing Wisely Campaign to limit preoperative testing prior to low risk surgery, preoperative cardiac testing before low risk procedures remains common. This study assesses the [...]

Background: Chest pain accounts for 2-5% of all Emergency Room (ER) visits. Tools like TIMI score and HEART score exist to risk stratify patients, but a low threshold for admission has been traditional because the risk of inadvertent discharge of patients with true ACS. In this study, we evaluate the yield of myocardial perfusion scan [...]