Background: The care of surgical patients is becoming more complex as patients with increasing comorbidities require surgical procedures. In adult hospital medicine, co-management of complex medical patients by hospital medicine and surgery has been shown to decrease length of stay and readmission for many procedures. It remains unclear, however, which patients are most likely to [...]

Background: Discharge education is a key component of safe transition from inpatient to outpatient care in the pediatric population. Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-site quality improvement project developed to improve care transitions for pediatric patients using a transition bundle. One bundle element focuses on thorough discharge education (DE) and the [...]

Background: Heart rate (HR) assessment is a vital component in the neonatal resuscitation (NR) algorithm. Research has consistently found auscultation to be an inaccurate means of assessing neonatal HR and may lead to incorrect resuscitation interventions. Current Neonatal Resuscitation Program (NRP) recommendations include auscultation for initial HR determination. Whether HR assessment via auscultation during NR [...]

Background: The Pediatric Hospital Medicine (PHM) service at Medical College of Wisconsin/Children’s Hospital of Wisconsin has historically consisted of patient care teams with an attending pediatric hospitalist, pediatric residents, rotating family medicine residents and medical students. In 2017, the PHM service saw an unexpected increase in patient volumes with a 28% increase in the number [...]

Background: Bronchiolitis is one of the leading causes of hospitalization in patients less than 2 years old. It can be a source of frustration for providers as numerous interventions that have been trialed throughout the years have not been shown to be effective. Albuterol is one such intervention as wheezing is a common clinical finding [...]

Background: Neonatal herpes simplex virus (HSV) infections are one of the most clinically challenging infections of the newborn period because of the often subtle presentation and devastating consequences of a missed diagnosis. The availability of HSV polymerase chain reaction (PCR) testing has led to widespread use of both HSV testing and empiric therapy but guidelines [...]

Background: Recent data suggest that there are mortality benefits from preoperative statin therapy in patients at high risk for atherosclerotic cardiovascular disease (ASCVD). Current guidelines recommend moderate or high intensity statin for all patients with established ASCVD or 10-year risk of > 7.5%. In our preoperative evaluation clinic which is staffed by hospitalists, there were [...]

Background: Controversy still exists regarding the use of angiotensin axis blockade (AAB) with angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs preoperatively. Multiple studies suggest the AAB results in acute kidney injury (AKI) (1,2), while other studies do not (3,4 ). Some studies suggest that the AKI associated with AAB is due [...]

Background: Each year 45 million procedures are performed in the United States. For elective procedures, the preoperative evaluation is an opportunity to identify and manage risk factors that may contribute to post -operative morbidity and mortality. Increasingly thispre-operative visit has come under the purview of hospital medicine. While studies have demonstrated that pre-operative evaluations reduce [...]

Background: Perioperative hyperglycemia is associated with poor surgical outcomes, including infection and mortality, with higher rates of complications in patients without diagnosed diabetes (NDM) than in those with diabetes. Insulin therapy has been found to decrease the risk of infection and other adverse outcomes following surgery. It is unclear, however, whether insulin therapy for hyperglycemia [...]