Background: Diagnostic errors are common in medicine. The identification of diagnostic errors is often delayed, typically occurring only after a patient has experienced harm. Care transitions are inherent to the practice of hospital medicine and although care transitions have long been recognized as an area of vulnerability for hospitalized patients, they also represent opportunities for [...]

Background: Hospital medicine groups endeavor to avoid excessive workloads which can contribute to burnout. 1,2,3,4Groups vary in how new patients are distributed, but larger groups often assign a single hospitalist to carry an admitting pager and distribute new patients among several colleagues. This “admitting pager” role combines high volume with frequent interruptions and multitasking as [...]

Background: Hospitalists, rather than primary oncologists, are increasingly caring for hospitalized patients with cancer. High medical acuity, complex psycho-social issues, rapidly evolving cancer treatments, advanced care planning, and end-of-life care make management of this patient population especially challenging. The impact of the oncology hospitalist model of care delivery on clinical quality and oncologists’ work satisfaction [...]

Background: Spontaneous bacterial peritonitis (SBP) is a commonly encountered complication of end stage liver disease that carries a high morbidity and mortality. Risk factors for SBP are defined by the American Association for the Study of Liver Diseases (AASLD) as a prior history of SBP, active gastrointestinal bleeding, and low ascites total protein (< 1.5 [...]

Background: With increasing evidence on the impact of hyperglycemia on patient outcomes, hospitals are beginning to move towards using inpatient glucose control as metrics of performance (1-3). However, efforts to improve inpatient glycemic control should assure validity and reliability of laboratory values (4) as these measurements can potentially affect these metrics and how the metrics [...]

Background: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to [...]

Background: The opiate epidemic remains a major national public health crisis with approximately 50,000 overdose deaths reported annually [1]. This epidemic stems in part from the over prescription of opiates and is therefore inexorably linked to physician prescribing habits. In recent years, non-physician providers such as physician assistants and nurse practitioners have become increasingly vital [...]

Background: Agency of Healthcare Research and Quality reported an increase in Opioid-related hospitalizations from 2005 to 2014. Previous studies in patients undergoing surgery have shown an increased risk of readmission with opioid dependence. This study was intended to identify the all-cause 7 and 30-day readmission rates of hospitalizations with opioid-related disorders, and potential predictors of [...]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT [...]

Background: Recent literature supports risk stratifying patients presenting to the Emergency Department (ED) with undifferentiated chest pain based upon the HEART score. Our institution utilizes the HEART score in a chest pain pathway. Patients with scores of 0 to 3 are typically discharged home after two negative troponins while those with intermediate scores of 4 [...]