Background: Heart failure (HF) is a major cause of hospital readmissions and healthcare costs. HF patients have the highest rate of unexpected readmission of all diseases tracked by the Centers for Medicare and Medicaid Services (CMS), at 21.2% (1). HF prevalence is also projected to increase 46% from 2012 to 2030, with total costs rising [...]

Background: Interventions to improve inpatient sleep rely on the ability to objectively quantify sleep; however existing methods of measurement (wrist actigraphy and patient survey) are resource intensive and impose a burden on patients. To overcome these barriers, we developed “sleep opportunity” (SLOP), a surrogate metric for sleep derived solely from the electronic health record (EHR). [...]

Background: Nationwide death by suicide burnout continues to rise in physicians (1). The key drivers of burnout are increased emotional exhaustion (EE) and depersonalization (DP) and low levels of personal accomplishment(PA). In a 2014 the Annals of Family Medicine survey revealed that 73% of general internists would not choose the same specialty again, attributing burnout [...]

Background: Identification of pathogens causing community-acquired pneumonia (CAP) in hospitalized patients has improved with the utilization of nasopharyngeal (NP) polymerase chain reaction (PCR). Literature shows that 20-25% of pathogens are identified when using urine antigens, sputum and blood cultures, and can improve up to 70% when adding NP PCR for viruses, Staphylococcus aureus and Streptococcus [...]

Background: Antibiotics prescribed at hospital discharge account for over half of antibiotic exposure related to hospitalization and contribute to antibiotic-related harm. We hypothesized that an antibiotic timeout to reconsider antibiotic necessity, selection, and duration prior to discharge could reduce antibiotic overuse. Thus, we conducted a 6 month prospective, controlled pilot study to determine feasibility and [...]

Background: Hospital Medicine is a young and growing specialty. About 50% of our academic hospital medicine group of nearly 70 physicians are in their first 5 years out of residency. And about 90% of our faculty are millennials (born 1982-2000), the fastest-growing generation in the workforce and the first generation to grow up in a [...]

Background: Penicillin class antibiotics are the most frequently reported drug allergy in the electronic health record (EHR), but recent studies find

Background: Sickle cell disease (SCD) is characterized by lifelong, recurrent episodes of vaso-occlusive pain that often require inpatient hospitalization. Readiness for discharge is dictated by the patient’s pain intensity rated on the Numeric Rating Scale (0-10). Pain is an individualized multidimensional experience and a pain intensity score only measures one facet. Physical function is another [...]

Background: Adults with sickle cell disease (SCD) often present with extremely painful acute vaso-occlusive crises (VOC). VOC guidelines encourage early initiation of opioids, but are lacking in a standardized approach to achieve adequate analgesia and subsequent de-escalation. Various SCD studies comparing continuous basal versus demand bolus patient-controlled analgesia (PCA) show conflicting outcomes. Thus the objective [...]

Background: Hospital readmissions are an important marker of healthcare quality, reflecting worse patient outcomes and resulting in millions of dollars of penalties annually. Medication nonadherence is an important driver of hospital readmissions, with one significant factor being difficulty obtaining medications after discharge. The difficulty could be due to copays, availability, or transportation to a local [...]