Background: Sleep disturbance has negative impact on physical coordination, metabolism, cognitive performance, immune function, coagulation cascade, cardiac risk and is associated with an increased risk of falls in hospitalized patients. The number of adverse events related to falls is startling and it poses a major health risk for patients in acute care facilities. As the [...]

Background: Growing antimicrobial resistance, C. difficile infection and cost have triggered a greater reliance on antimicrobial stewardship. Most stewardship models rely upon a central team, often led by ID specialists, to oversee prescribing in an institution. However, there are limitations to this paradigm. Purpose: We believe opportunities exist for hospitalists to drive stewardship by integrating [...]

Background: Proton pump inhibitors (PPI) are the mainstay of treatment and symptomatic remission in GERD. Recently, PPI over-utilization has been a major concern due to associated increased risk of adverse events and unnecessary healthcare cost. Internal Medicine residents treat patients with GERD and prescribe a significant amount of PPI. However, very few studies have assessed [...]

Background: Heart failure (HF) is one of the most common discharge diagnoses for Medicare beneficiaries. As part of the Affordable Care Act, the Center for Medicare and Medicaid Services initiated the Hospital Readmission Reduction Program which reduced payments to hospitals for excess readmissions for HF and other diseases. This quality improvement project focused not only [...]

Background: Atrial fibrillation (AFIB) is the most common recognized arrhythmia in the United States. Currently affecting more than 6 million people, this number is expected to double by 2050. Along with increased costs ($26 billion/year), it is associated with a 5-fold risk for stroke and 2-fold risk for all-cause mortality, independent of comorbid conditions. In [...]

Background: There are 400,000 cases and 30,000 deaths from Clostridium difficile (C. diff) infections in the United States annually. Efforts to reduce the transmission of C. diff have focused on patients with diarrhea, however, many patients with C. diff are carriers who do not have symptoms. Because they are not isolated, carriers serve as a [...]

Background: Timely Clostridium difficile Infection (CDI) testing is challenging but is important for faster and appropriate isolation and treatment of patients. Few studies have specifically addressed effective methods to hasten CDI testing without relying on PCR. We sought to use Quality Improvement methodologies including the Plan-Do-Study-Act (PDSA) Cycle and Control Charts to reduce CDI testing [...]

Background: Increased hospital utilization and admission can lead to increased provider stress and decreased hospital throughput. Hospital rounding and admitting service design may not appreciably change to accommodate for increased utilization. We hypothesized that a data-driven approach with targeting of hospitalist staffing during peak admission hours can alleviate provider stress and improve throughput during the [...]

Background: Discharge from an in-patient hospital stay is a critical opportunity to teach patients about their medications. Communication about medications and appropriate transition of care are two domains of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey via which patients evaluate hospitals. Communication about new medications and side effects is one of [...]

Background: Nebraska Medicine is dedicated to the continuous, goal-directed improvement of: 1. Central venous catheter (CVC) duration 2. Indwelling urinary catheter (IUC) duration 3. Telemetry duration 4. VTE prophylaxis 5. Non-violent restraint order renewal Clinical decision support (CDS) is a cornerstone of quality improvement efforts despite historically sub-optimal response rates. After 2 years of improvements [...]