Background: At our institution, no current standard exists for teaching rounds’ structure or content, which is largely at the discretion of the attending physician. The purpose of this study was to illustrate the “anatomy” of inpatient rounds as a needs assessment for future process improvement efforts. Methods: We performed a descriptive cross-sectional study of general [...]

Background: Patients are frequently ordered to fast while hospitalized. Though these “nil per os” (NPO) orders are often placed for sound clinical reasons (e.g. small bowel obstruction), they are also frequently placed in preparation for imaging studies or procedures to reduce the theoretical risk of aspiration. There is often a great deal of confusion among [...]

Background: The use of imaging is highly prevalent in hospitalized patients with about two images performed on every hospitalized patient (Levin et al). While imaging is utilized for specific indications, incidental findings are common with 45.0% of chest CTs resulting in incidentalomas (O’Sullivan et al). Lack of appropriate follow up to incidental findings (IFs) leads [...]

Background: There exists no standardized means of assessing hospitalist performance on quality, safety, efficiency and value metrics.Timely, accurate and meaningful feedback on individual performance is imperative to drive improvement. Methods: The components of the MEQI align with the institution’s most important metrics, including readmission rate, hospital acquired conditions and observed to expected length of stay. [...]

Background: Severe alcohol withdrawal and delirium tremens (DTs) are challenging therapeutic dilemmas. To prevent complications and death, management requires close monitoring and intensive treatment, frequently in an ICU. Benzodiazepines are first line therapeutic agents, but optimal use and dosing has been limited, due to a lack of randomized double-blind trials. In lower acuity patients admitted [...]

Background: Regionalization of a provider team’s patients within dedicated nursing units has been shown to allow for improved efficiency and interdisciplinary collaboration. However, the creation of full regionalization is not feasible or appropriate for many medical centers given resource limitations. We hypothesized that we could achieve a significant increase in patient regionalization by modifying admitting [...]

Background: Correctional insulin is frequently used in the hospital to optimize blood glucose levels before meals or even before bedtime. Dosages are not set and are instead scaled to the blood glucose level obtained just prior to administration. Insulin is considered a high-risk medication as dosing errors can potentially lead to serious adverse events such [...]

Background: Resistance in learning (RIL) defines a set of attitudes or behaviors demonstrated by learners in an educational setting that result in decreased learning. Literature describes the etiology as multifactorial, including learning environment, characteristics of the learner, and teaching style. Hospitalists often use quality improvement methodology, such as PDSA cycles to improve the clinical care [...]

Background: Acquired hyponatremia and hypernatremia are common in hospitalized patients and correcting dysnatremia may improve outcomes. Nephrology assistance with dysnatremia may help optimize management, but specialist resources are limited. Targeted Automatic e-Consultation (TACo), a model of selective e-consultation based on automated identification of patients from the electronic health record, has been applied for glycemic management [...]

Background: Hospital readmission rates are heavily scrutinized, and are utilized as a measure of the quality of care provided by hospitals. In the Oklahoma City Veterans Affair Health Care System (VAHCS), there was a significant increase in the number of cardiorespiratory 30-day readmissions in the month of September (8% to 14%). Most patients (76%) were [...]