Background: Physician shortage and healthcare access is a serious issue in rural America with reports estimating a shortage of more than 45,000 physicians by 2025. The rural and the underserved communities are predominantly served by International Medical Graduates (IMGs). Majority of the IMG physicians work are on a J1 waiver, National Interest Waiver (NIW) program […]

Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or […]

Background: Despite a public health crisis – over 500,000 individuals have died from opioid overdoses since 2000 – and the availability of effective therapies, most patients with Opioid Use Disorder (OUD) are not offered treatment. Medication-Assisted Treatment (MAT), such as with buprenorphine, is associated with significantly higher rates of abstinence and follow-up, lower rates of […]

Background: Diagnostic errors have been cited as a potential contributor to hospital readmissions, particularly early readmissions (e.g. within 7 days), but little is known about their frequency and characteristics. We performed structured chart review of all medical patients readmitted within 7 days of discharge from a single academic medical center to describe the prevalence of […]

Background: Clinically stable inpatients may receive potentially unnecessary care, such as overnight vital sign assessment. Nighttime vital signs can disrupt sleep and adversely affect patient satisfaction and contribute to delirium. However, it may be difficult for individual clinicians to determine which patients could safely forego overnight vital signs. Purpose: We developed a predictive algorithm designed […]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of […]

Background: Adolescent reproductive health education is essential to prevent transmission of sexually transmitted infections (STIs) and teen pregnancy. Half of all new STIs occur among 15-24 year-olds and 1 in 4 adolescent females has had an STI. In the United States, approximately 750,000 teenagers become pregnant per year. Adolescents are known to have poor access […]

Background: Sub-optimal communication during care transitions contributes to poor patient outcomes. Patients who undergo interhospital transfer (IHT, the transfer of patients between hospitals) are at especially high risk given their level of illness severity. In examination of the IHT process at Brigham and Women’s Hospital (BWH), a 740-bed tertiary care referral hospital, we previously found […]

Background: In hospital-based medicine, maintaining an open line of communication between inpatient teams and community pediatricians serves as an essential component of providing comprehensive patient care and ensuring continuity at time of discharge. At St. Louis Children’s Hospital, inpatient resident teams are responsible for providing timely communication with community pediatricians regarding major patient events. Despite […]

Background: Hospitalists on inpatient resident teaching services receive variable training in how to facilitate high-quality education during rounds. Teaching of cognitive skills such as clinical reasoning, acknowledging uncertainty, and non-cognitive behaviors such as eye contact are important techniques of effective educators. To enhance bedside teaching, the Hospital Medicine Division of the University of Michigan and […]