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: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of hospital readmissions in America. Over one-third of patients admitted for COPD exacerbations are readmitted within 90 days, with readmissions costing $15 billion. Medicare instituted financial penalties for excessive readmissions after COPD hospitalizations, incentivizing the creation of readmission prediction tools. Two such tools, the […]

Background: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. National guidelinesrecommend VTE prophylaxis for all medical patients not at low risk. Several VTE risk prediction models have been developed, but no US models have been validated in a medical population. The ACCP recommends use of the Padua risk assessment model with a […]

Background: The first Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in 5 hospitals. Incorporating lessons learned from MARQUIS1, we implemented a refined version of the toolkit in a larger, more diverse sample of hospitals. Methods: Eighteen sites were selected via […]

Background: Coordination of inpatient and outpatient care is an important challenge in improving population health but evidence examining the effectiveness of existing care coordination programs is mixed. The Comprehensive Care Physician (CCP) Program at the University of Chicago provides patients at increased risk of hospitalization the opportunity to receive inpatient and outpatient care from the […]

Background: Deep vein thrombosis (DVT) is typically diagnosed from ultrasound (US) Doppler evaluation and anticoagulation therapy is the standard treatment to prevent life threatening pulmonary embolism (PE). In our hospital, the treating provider is alerted to the positive test result by phone and/or text in the imaging result. There is an absence of clinical decision […]

Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay, cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Programs targeted at delirium prevention and treatment may affect these outcomes. We […]

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 […]