Background: Single-center studies have reported low yield of blood culture for skin and soft tissue infections (SSTIs) in children. Blood cultures are commonly obtained in cases of SSTI, though the degree of practice variation is uncertain. Study objectives include: 1) assess the degree of variation in rate of blood culture for SSTIs among children’s hospitals [...]

Background: Infants ≤ 60 days of age with a urinary tract infection (UTI) represent a challenging population without clear guidelines for diagnostic evaluation or antibiotic therapy. UTI represents a significant percentage of serious bacterial infection in this age group and is a common management dilemma for pediatricians. Our study examined patterns of UTI management in [...]

Background: Hip fracture is a common reason for urgent inpatient surgery. In the last few years, several professional societies have identified preoperative echocardiography and stress testing for non-cardiac surgeries as low-value diagnostics. Delaying hip fracture surgery beyond 48 hours leads to worse outcomes. We sought to describe the prevalence of preoperative cardiac testing for inpatient [...]

Background: Clinical practice guidelines (CPG) are a constructive response to the clinical situations providing systematically developed statements that include recommendations intended to optimize patient care. Despite their value, inadequate dissemination and implementation of the CPGs derail quality improvements in patient care. Traditionally, static documents (PDF, HTML pages) have been used to deliver CPGs incorporated into [...]

Background: The use of intraoperative dexamethasone has been on the rise because of its ability to reduce postoperative nausea, vomiting, pain and accelerate post-operative recovery. Use of intraoperative dexamethasone can result in uncontrolled hyperglycemia in the postoperative period especially in patients with a diagnosis of diabetes. The extent and duration of post-operative steroid-induced hyperglycemia is [...]

Background: In 2014, the ACC/AHA released guidelines regarding indications for preoperative transthoracic echocardiogram (pre-op TTE) in patients undergoing noncardiac surgery. Studies indicate that the ordering of pre-op TTE in noncardiac surgery is not consistent with the ACC/AHA guidelines. Some studies suggest the pre-op TTE have a significant impact on management, while others have demonstrated low cardiac [...]

Background: Based on the 2016 State of Hospital Medicine Report, 87% of hospital medicine groups provide surgical comanagement services. Despite its popularity, when studied, the benefits are inconsistent. The vast majority of comanagement research evaluates the process of initiating a program, but there is little to no research on the outcomes of discontinuing a service. [...]

Background: The Obesity Paradox postulates that obesity is a protective factor against mortality in certain chronic conditions such as chronic kidney disease (CKD) and congestive heart failure. Although this paradox is established in CKD, few studies have analyzed the paradox in acute kidney injury (AKI). There are both short and long term ramifications to AKI [...]

Background: The use of opioids postoperatively is becoming common practice to achieve pain relief. The goal of the perioperative period is to relieve suffering, achieve early mobilization after surgery, and reduce length of stay (LOS). Often opioids, are prescribed without trying alternative methods for pain relief. There is a growing concern for overuse of opioids [...]

Background: Perioperative management of anticoagulant in mechanical valve patients is challenging, Current recommendations focus on management in patients undergoing elective surgery, while the data in patients hospitalized for emergency/urgency non-cardiac surgery is limited. We aimed to identify thromboembolic and bleeding events after anticoagulant interruption in patients with mechanical heart valves hospitalized for emergency/urgent non-cardiac surgery. [...]