Background: Availability of acute medical services (e.g., emergency department, intensive care unit) has been associated with adverse clinical outcomes. The association between acute psychiatric inpatient beds and suicide has not been well described. In the Veterans Health Administration (VHA), suicide rates among veterans have increased despite mental health care investments. Our objective was to examine [...]

Background: With the advancement of technology and medical care, more critically ill patients are surviving the medical intensive care unit (ICU) and are transferred to the general wards, where they spend the majority of their hospitalization. While there are guidelines that address common complications in the ICU (delirium and functional decline), once patients are transferred [...]

Background: Diagnostic errors in hospitalized patients are difficult to identify and quantify: error rates range from 4.8 to 49.8%. Though chart review tools, like the Safer Dx instrument, have been developed to assess the presence of diagnostic error in ambulatory settings, they have yet to be validated for acute care. A key issue is identifying [...]

Background: Hospital discharges due to psychotropics poisoning whether intentional, unintentional, prescription errors or related side effects have been increasing nationally. Hospital costs are also increasing subsequently. We compared the annual rate of hospital discharges in 4 regions of United States (West, Midwest, South, and Northeast) while incorporating the number of the mental health providers in [...]

Background: Peripherally inserted central catheters (PICCs) are associated with an increased risk of central line-associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). Catheters that are coated or impregnated with antimicrobial and/or antithrombotic agents have been developed to prevent these complications. However, their effectiveness in preventing CLABSI and VTE is unclear. Using data from a large [...]

Background: Despite the introduction of Early Warning Scores (EWSs), clinical deterioration (CD) remains an actual problem on the general ward. A next step to counter CD would be to intensify measurement from intermittent 8 hours to continuous measurements. This leads to big data sets of patient monitoring data with great potential. Use of advanced predictive [...]

Background: Patient education was emphasized in the updated Centers for Disease Control and Prevention’s educational core element for hospital antibiotic stewardship. Despite this, it is not known what education patients receive prior to discharge or if they are being effectively engaged in antibiotic stewardship efforts. Patients’ perceptions and beliefs about antibiotic use and resistance may [...]

Background: Syncope is usually an isolated occurrence in younger patients whereas it is multi factorial with many predisposing factors in the elderly. Medication use, co-morbidities and functional decline further complicate syncope evaluation in the elderly. Hence, elderly patients presenting with syncope must be risk stratified uniquely. San Francisco Syncope Rule (SFSR) and Evaluation of Guidelines [...]

Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. [...]

Background: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their engagement influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium on PICCs placed in hospitalized medical patients [...]