Background: Diabetic ketoacidosis (DKA) is a serious, acute complication of diabetes mellitus caused by a state of insulin deficiency requiring exogenous insulin administration.  Significant variation in intensive care unit (ICU) admission rates for DKA exists among hospitals, due to patient- and institution-specific factors, with rates ranging from 16-81%.  Patients with DKA admitted to an ICU [...]

Background: The Choosing Wisely Campaign encourages physicians to avoid over-utilizing routine labs in hospitalized patients with clinical and laboratory stability.  A number of studies have shown adverse effects on hospitalized patients from lab overutilization.  In previous research, we observed that internal medicine physicians at our center often order a daily complete blood count (CBC) and [...]

Background: End of life discussion is very important for preventing undesired cardiopulmonary resuscitation (CPR). It is reportedly associated with less aggressive medical care near death and better quality of life. Its importance has been gradually recognized worldwide. However, the compliance of a Do-not-Resuscitate (DNR) order has not been well studied. We reported the incidence rate [...]

Background: Observation units were initially intended to function as a short stay unit for lower acuity patients with specific diagnoses, however this traditional model is currently evolving.  Rising health care costs and changing health care policy have resulted in an increase utilization of the observation unit and an expansion of diagnostic criteria to include more [...]

Background: Hospital Medicine is a rapidly growing specialty and a higher percentage of patients are under the care of hospitalists across the country.  Like other internal medicine subspecialties, an increasing number of residents have expressed interest in a career in hospital medicine and have requested an elective in the field.  In prior years our Hospitalist [...]

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but deadly thrombotic microangiopathy (TMA) that is caused by ADAMTS13 deficiency. The PLASMIC clinical scoring system was developed and validated to determine the pretest probability of severe ADAMTS13 deficiency in cases of suspected TTP. We studied the role of the PLASMIC score in guiding use of the [...]

Background:  Transthoracic echocardiography (TTE) is one of the most popular tests in healthcare. Studies of Medicare beneficiaries for example have shown that each year approximately 20% undergo at least one TTE. Repeat TTE defined as TTE done within one year of a prior TTE represent 24-42% of all studies. In the present study we derive [...]

Background: Decades-old clinical data and practice guidelines support the use of lipase over amylase in the workup and management of acute pancreatitis. Yet, laboratory testing for amylase continues to cost the Center for Medicare and Medicaid Services more than $19 million in largely avoidable charges each year. Previously hypothesized drivers of overutilization of amylase testing [...]

Background: Misuse of laboratory tests can be difficult to determine unless tests are clearly overused or repeated routinely. However, excessive testing of chronically critically ill patients treated in long-term acute care hospitals (LTACHs) can be potentially harmful. A previously reported quality improvement initiative designed to increase physician awareness of their patterns of lab utilization in [...]

Background: Hospital medicine is the fastest growing specialty in the United States. An interesting aspect of the rapid expansion of hospital medicine is the current expansion of the field beyond North America. While the health care systems, regulations and cultural norms in these nations differ, some of the reasons for the development of hospital medicine [...]