Background: Guidelines on the treatment of Clostridioides (Clostridium) difficile infection (CDI) have historically recommended avoiding antimotility agents (AAs) in patients with active CDI based on theoretical concerns that administration of AAs may precipitate serious adverse events such as toxic megacolon in these patients. These recommendations, however, are based on limited and conflicting data. We previously [...]

Background: There is evidence that physicians consider a variety of “non-medical” factors (e.g. lack of social support, barriers to access) in hospital admission decision-making out of concern for patient safety, and that patients are hospitalized even in the absence of a level of medical acuity warranting admission. The rationale underlying this decision may overvalue the [...]

Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Complications associated with peripherally inserted central catheter (PICC) along with documented overuse has led to emerging interest and increasing use of midlines. However, whether midlines are safer than PICCs is not [...]

Background: It is often challenging to assess pain in patients on chronic opioids either in acute care setting or in outpatient centers. Pain assessment in this group is more challenging especially if they are hospitalized with acute or acute on chronic pain. Opioid uses associated with increased pain perception and increased self-report of pain. Further, [...]

Background: In caring for hospitalized patients, hospitalists frequently perform bedside procedures. Shared decision-making, fluency in the procedure being performed, and consistent use of best practices are imperative for high quality, safe patient care. In review of bedside paracentesis between 8/2017–4/2018 by hospitalist fellows in conjunction with attending physicians and resident physicians, variations in procedure technique, [...]

Background: Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. We found in a 2013 national survey (571 hospitals, 71% response rate) that while infection prevention practices for CDI were common in U.S. hospitals, only 52% had an antibiotic stewardship program (ASP). On 1 January 2017, The Joint Commission required [...]

Background: The “July effect” is a perceived increased risk of medical errors that occurs when US medical graduates begin residencies. There is substantial variability in results across studies of the “July effect” on patients who are admitted for heart attacks. Furthermore, studies that do show statistically significant increase in mortality at the start of residency [...]

Background: Hospitalized children are interrupted at night for many reasons, and these disruptions may inhibit healing and contribute to illness. Through the Choosing Wisely initiative, The American Academy of Nursing advises to only wake patients for routine care overnight if required by their condition. Recent literature questions the necessity of routine vital signs (VS) checks [...]

Background: The 2011 AAP policy statement regarding recommendations for a safe infant sleeping environment included hospitalized infants, but unsafe sleep practices continue to be common in hospitalized infants. Safe sleep position compliance was observed to be low at Baystate Chidlren’s Hospital (BCH), as described in a prior abstract (http://abstract.staging.hospitalmedicine.org/abstract/improving-infant-safe-sleep-practices-in-the-inpatient-setting-using-qi-methodology/). Interventions designed to improve rates of [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) multi-site quality improvement collaborative aims to improve discharge transitions by use of a transition bundle, including use of a discharge checklist (DCL) to ensure completion of important transition tasks. These tasks included identification of a primary care provider, establishing follow up appointments, and ensuring access to medications, [...]