Background: Inappropriate telemetry use has been associated with increased health care cost and unnecessary diagnostic procedures. For these reasons, the Society of Hospital Medicine’s Choosing Wisely campaign promoted use of both American Heart Association (AHA) telemetry guidelines and protocol-driven discontinuation of telemetry. Despite these measures, an estimated 59% of patients are placed on telemetry due [...]

Background: Cardiac telemetry is frequently overused in the hospital. Our institution requires telemetry while patients are on the Clinical Institute Withdrawal Assessment (CIWA) protocol, regardless of the presence or severity of alcohol withdrawal (AW).  Telemetry use in this population has not been studied or incorporated into guidelines, however some patients may need monitoring for co-existing indications. [...]

Background: Up to forty-five percent of Americans do not fill prescriptions secondary to cost. Medication non-adherence leads to morbidity and mortality (~$100-300B annually). The majority of physicians cannot price medications within 25% of cost. Our institution alone sees more than 600 prescription-cash-pay patients (under/uninsured or no Part D) each month. Purpose: To empower clinicians to [...]

Background: Avoiding repeated complete blood count (CBC) testing in the face of clinical and laboratory stability is a Choosing Wisely initiative recommendation endorsed by the Society of Hospital Medicine. We investigated the prevalence and clinical utility of this practice in patients hospitalized with community-acquired pneumonia (CAP). Methods: This was a multicenter study of 61 patients [...]

Background: Inappropriate laboratory utilization in hospitalized patients is a significant contributing factor to health care expenditures, iatrogenic anemia, downstream testing, and poor patient satisfaction. For these reasons, the Society of Hospital Medicine has recommended through the Choosing Wisely Campaign to avoid repetitive complete blood counts (CBC) and chemistry testing in the face of clinical stability. [...]

Background: In an era where the cost of healthcare in the United States is rising at an unsustainable rate, promoting high value care has never been more important. As highlighted by the Society of Hospital Medicine Choosing Wisely Campaign, routine inpatient lab draws, in the setting of clinical stability can lead to adverse health consequences [...]

Background: The Choosing Wisely campaign was launched in 2012 with a goal of “advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.[1] ”  The Society of Hospital Medicine published 5 recommendations for Adult Hospital Medicine in 2013[2] , including one that advised against performing repetitive complete blood count (CBC) and [...]

Background: Venous thromboembolism (VTE) is a common preventable condition in hospitalized medical patients. Chemoprophylaxis with heparin or fondaparinux has been recommended for all hospitalized patients who are not at low risk, and appropriate thromboprophylaxis is a hospital quality measure. However, the specific threshold of VTE risk that warrants prophylaxis has not been defined. We used [...]

Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine electrolyte values obtained by arterial blood gas testing (ABG) and central laboratory testing (VCL) and determine the extent of essentially [...]

Background: Telemetry is a useful tool to detect malignant cardiac arrhythmias but may be associated with increased cost and patient inconvenience. In 2004 the American Heart Association (AHA) established recommendations regarding appropriate telemetry use for non-ICU patients. The degree to which providers understand and apply these recommendations is not well understood.  Purpose: To develop a [...]