Background: The Society of Hospital Medicine (SHM) identifies repetitive CBC & chemistry testing as low-value, and they selected this as a Choosing Wisely Recommendation. Overuse of phlebotomy is associated with hospital-acquired anemia, decreased patient satisfaction and increased hospital costs. Process improvement techniques have been utilized to reduce inpatient phlebotomy, but prospectively identifying a cohort of [...]

Background: Utilization of MRI as diagnostic imaging continues to increase in the pediatric population. MRI with sedation accounts for 23% of pediatric MRI studies with 31% of those being inpatient. Barriers to completion of an MRI in pediatric populations includes the frequent use of sedation and poor communication amongst pediatric hospitalist, anesthesia and radiology. With [...]

Background: Proton pump inhibitors (PPI’s) are a commonly used class of medications, whose optimal use is important. Aim: To assess if proactive surveillance in inpatients can reduce PPI use for unapproved indications and their effect over 90 days post-discharge. Methods: Inpatients were approached as part of a QI project at our tertiary-care center for evaluation [...]

Background: The Center for Medicare and Medicaid Services (CMS) uses 30-day readmissions as a measure of quality for a hospital system. However, there is growing literature that 30-day readmissions may not be a good measure of quality since most readmissions towards the end of 30-day window are likely not preventable. Therefore, using a shorter window [...]

Background: The 7- and 30-day patient readmission rates are tracked by hospitals and are used as a metric to measure physicians’ quality of patient care. Several tools currently predict and prevent early readmission rates based on patient-specific characteristics. However, few studies have demonstrated if physician-specific characteristics play a role. The purpose of this study is [...]

Background: Many hospitalized patients spend most of their time in bed leading to increased complications. For elderly patients, hospitalization results in decreased post-hospital independence up to 1 month after discharge, which can be prevented with inpatient mobility programs. Many patients lament their inability to return home after an admission due to decreased functioning. With increasing [...]

Background: In-hospital cardiac arrest (IHCA) is an unpredictable, catastrophic event affecting approximately 200,000 US adults annually. Best outcomes during IHCA result from focused training and credentialing by AHA (ACLS, BLS). Although hospitalists supervise IHCA, best practices for resuscitation skills, preparedness, plus overall approach remain undefined. Methods: We developed an online survey of IHCA resuscitation responsibilities [...]

Background: Patient flow and throughput are challenges that hospitals throughout the country face daily. Delays in throughput lead to prolonged ER times, delays in patient care, increased length of stay, patient dissatisfaction and frustrations for the medical team. Prior studies have shown that discharges before noon does improve hospital throughput. However, hospitals struggle in creating [...]

Background: Multiple studies show that patients with serious illness often do not discuss their goals and preferences with their clinicians leading to low patient and family satisfaction, and costly care that is often unwanted and unnecessary. Even though there is increased awareness on the part of clinicians to have these difficult conversations, the busy schedules [...]

Background: The Society of Hospital Medicine identified questioning the necessity of repeat labs in stable patients as a Choosing Wisely goal to improve overall value of care. Implications of unnecessary blood draws include over-testing, pain, decreased patient experience, and risk for iatrogenic anemia. Interventions to safely reduce provider lab orders have been applied in various [...]