Background: Adverse drug events (ADEs) are responsible for up to 770,000 inpatient injuries and deaths annually in the United States, most of which are from prescribing errors. Electronic order sets are designed to improve quality by reducing care variability and increasing efficiency of order entry, but may also facilitate prescribing errors via automation bias. There [...]

Background: There is no consensus on the management of asymptomatic inpatient hypertension. This is alarming as the prevalence of inpatient hypertension may be as high as 72%. Hypertension treatment guidelines focus on chronic hypertension in the outpatient setting and evidence for inpatient management is lacking. Aggressive treatment of asymptomatic inpatient hypertension with intravenous antihypertensives is [...]

Background: Role of physician assistants (PA) is well established in United States healthcare system. Hospitalist teams are utilizing PA services in various roles and in many different capacities. Demand of hospitalists is constantly increasing and there are not enough hospitalists to meet the demand. In academic medical centers resident’s duty hour restrictions and regulations have [...]

Background: Peripherally inserted central catheters (PICCs) are associated with central vein stenosis and failure to establish a functioning arteriovenous fistula. Thus, guidelines recommend avoiding PICC placement when patients with chronic kidney disease (CKD) are likely to require hemodialysis. We sought to describe the current practice of PICC placement in hospitalized patients with an estimated glomerular [...]

Background: Venous access is commonly required in hospitalized patients for the administration of intravenous fluids and medications and blood products. Peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) are required for the administration of vasopressors, chemotherapy, or total parenteral nutrition but often they are placed due to difficulty obtaining a peripheral venous catheter [...]

Background: The hands of hospitalists are often the source for transmitting multidrug resistant organisms (MDROs), and as such are the target of numerous hand hygiene interventions. Despite this focus, the prevalence of various MDROs on healthcare personnel (HCP) hands during routine patient care has not been well established. Therefore, we conducted a systematic review to: [...]

Background: Warfarin is commonly used in long-term anticoagulation and has a narrow therapeutic index. Dosing is dependent on intrinsic patient variables including cytochrome P450 2C9 (CYP2C9) and VKORC1 polymorphisms. High protein binding and CYP-dependent clearance mechanisms of NSAIDs also affect warfarin serum levels. This study investigates the observed pharmacologic interaction of concurrent NSAID and warfarin [...]

Background: Advances in technology and life-sustaining interventions afford patients access to a wider network of subspecialized care through inter-facility transfers. Implicit in these transfers are multiple complex steps that leave patients vulnerable to adverse events. The few guidelines that exist regarding the inter-facility transfer process focus on critically-ill or surgical patients, and emphasize pre-transfer communication [...]

Background: Transition from the inpatient to outpatient setting presents a safety risk to pediatric patients. Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-site quality improvement collaborative developed to improve the hospital to home transition for pediatric patients using a transition bundle. One bundle element is the use of teach-back (TB) to confirm caregiver [...]

Background: Inconsistent transitions of care from the inpatient to outpatient setting may lead to preventable readmissions. Critical processes completed at discharge shown to reduce readmissions at our institution include admission and discharge medication reconciliation, clinically appropriate follow-up scheduled prior to discharge, and timely completion of a discharge summary within 48 hours of discharge (the “Core [...]