Background: While Medicare data demonstrates that healthcare spending is up to four times higher in yearly decedents than survivors, studies demonstrate that early advance care planning (ACP) leads to improved clinical outcomes and reduces cost without increase in patient anxiety or depression. Nationwide the creation of the Physician Order for Life Sustaining Treatment (POLST), a [...]

Background: With the increasing focus on patient experience over the last decade in American healthcare, it is not surprising that numerous interventions to improve sleep in the hospital setting have arisen. However, measuring sleep in the inpatient setting can be challenging. The majority of inpatient sleep studies have focused in the ICU, primarily using patient-reported [...]

Background: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. There was no standardized protocol for delirium at our hospital prior to 2014. In October 2013, we formed a task force for delirium prevention and early identification across 18 medical-surgical units in our hospital. [...]

Background: Patients evaluated after sexual assault may require non-occupational post-exposure prophylaxis (nPEP) to prevent infection with human immunodeficiency virus (HIV), depending on the assessed risk of HIV transmission in each case1-4. Access to nPEP medications, patient counseling, and follow-up care should be offered in a systematic, comprehensive, and compassionate setting. Unfortunately, multiple barriers may impede [...]

Background: The Veterans Affairs (VA) hospital is a primary site for internal medicine (IM) residents at our program. It provides trainees with exposure to high-yield general medicine cases and an opportunity to care for a unique and vulnerable population. Unfortunately, the admitting structure presents a number of challenges. Factors such as the geographical separation between [...]

Background: The EMR does not provide readily available information that conveys an at-a-glance understanding of discharge progress for a given patient. Healthcare workers have different workflows and need to manage the information in different ways, with a reliance on one-to-one conversations. We believe that optimizing patient length of stay is hindered by lack of: data [...]

Background: The timing and pace of patient discharges are not level-loaded throughout the day at many institutions including our own. At present, only 8% patients are discharged with rooms marked dirty by 11.00 am at our institution. To address this issue, we present the “Discharge when medically ready” model that has been implemented at our [...]

Background: Catheter Associated Urinary Tract Infection (CAUTI) is the most common hospital acquired infection and constitutes upto 40% of all Healthcare Associated infections. Urinary catheter is used in 15% to 25% of hospitalized patients and often utilized for inappropriate indications. Daily risk of Urinary Tract Infection (UTI) is 3 to 7% with the use of [...]

Background: Nosocomial infections are one of the leading causes of mortality and morbidity in the United States. Approximately two million people annually are affected by nosocomial infections in the United States and about 80,000 deaths occur each year. Transmission of healthcare associated infections occurs most often by contaminated hands of health care personnel. Hand hygiene [...]

Background: Updated guidelines recommend testing for inherited or acquired thrombophilias only in rare situations in the acute inpatient care setting, as it has little impact on acute management of thromboembolic events, and in some situations, can be falsely positive leading to inappropriate care. Current data in our academic medical center indicate testing for thrombophilia occurs [...]