Background: Delays in care can lead to patient harm. At our large urban academic medical center, we have been struggling with increasing inpatient volumes and delays, particularly to enter our medicine, observation, and cardiology units. With a desire to provide more timely care, we used a model that employed queuing theory to predict expected delays [...]

Background: Hyperglycemia in hospitalized patients is well-known to be associated with adverse outcomes, such as infectious complications, increased length of stay, and increased mortality. To that effect, aggressive treatment of inpatient hyperglycemia has been shown to improve outcomes in both Medicine units and MICU. This study aimed to identify the number of patients experiencing persistent [...]

Background: Financial incentives motivate hospitals to focus on improving patient experience, quality indicators, and efficiency metrics. Efforts to geographically staff hospitalists have renewed the focus on quality improvement efforts at the inpatient unit level. However, in order to maximize the benefit of geographic staffing, a unit-level leadership structure and quality-improvement support system must be developed. [...]

Background: The practice of routinely ordering daily labs not based on clinical indication on patients in the hospital is a wasteful clinical practice. Routine daily labs can also lead to patient harm by causing pain and iatrogenic anemia, and can burden laboratory staff resulting in increased lab reporting times. Raising awareness about unnecessary lab orders [...]

Background: Traditionally, models of healthcare delivery to hospitalized patients have been indirect and inefficient. The typical hospital system has providers spread between multiple units and nurses interacting with multiple provider teams. Several studies focusing on interdisciplinary rounding (IDR) have shown a variety of positive impacts on hospital-associated metrics such as length of stay (LOS), hospital [...]

Background: Using evidence-based clinical pathways has been shown to improve mortality in patients with staphylococcus aureus bacteremia. However, little is known if these pathways can decrease antibiotic use as a means of antibiotic stewardship in patients with suspected contaminated blood cultures. Purpose: We aim to decrease antibiotic use in clinically stable patients with likely gram-positive [...]

Background: Glucose management of hospitalized patients with hyperglycemia has many challenges. One of these challenges is the timing of insulin administration in coordination with meal delivery. The Endocrine Society recommends assessing glucose levels within 60 minutes of prandial insulin administration and that rapid-acting insulin should be administered 15 minutes before or immediately after a meal.1 [...]

Background: Medication errors harm 1.5 million patients yearly, designating medication reconciliation a National Patient Safety Goal. The average hospitalized patient is subject to at least 1 medication error per day (IOM,2007), with 70% of patients experiencing a medication discrepancy at either admission or discharge(Leapfrog,2018). Medication Reconciliation, creating the most accurate list of medications patients take [...]

Background: The number of drug overdose deaths in the United States has never been higher and over 75% of these deaths involved opioids. Hospitalists contribute to opioid initiation for millions of patients a year and, just last year, Internal Medicine (IM) residents at our institution prescribed 479 new opioid prescriptions to patients discharging from the [...]

Background: Up to 17% of all strokes occur in patients hospitalized for another diagnosis or procedure, and in-hospital strokes complicate up to 0.06% of all admissions. In-hospital strokes carry higher mortality, longer length of stay and greater disability than community-onset strokes. Multiple factors contribute to the worse outcomes of in-hospital stroke. Prompt recognition and treatment [...]