Background: Traumatic brain injuries (TBIs) pose a unique problem because prognosis is difficult to predict; therefore, treatment decisions are complex with uncertain outcomes. According to the American College of Surgeons 2018 Trauma Quality Improvement Project (TQIP), identified patients should receive a palliative care assessment within 24 hours, a family conversation should be held within 72 [...]

Background: As the acuity of hospitalized patients increases, there have been an increasing number of patients requiring mechanical ventilation on the general medical units (GMU). Ventilated patients in intensive care units (ICUs) have a standardized approach to minimize the risks for complications such as ventilator associated events (VAE), GI bleeding and VTE. When patients requiring [...]

Background: Clostridium difficile infections (CDI) is the most common cause of healthcare-associated infections in the United States. CDI accounts for 15%- 25% of all cases of nosocomial diarrhea. CDI is associated with significant adverse outcomes such as higher inpatient mortality rate, a longer length of hospital stays and increased hospital costs. The incidence of Hospital-acquired [...]

Background: Early morning patient discharge is increasingly being recognized as a key dimension of quality care. Late discharges are associated with hospital overcrowding, delayed inter-unit patient transfers, lower patient satisfaction and longer emergency room length of stay (1). At our institution there is a significantly lower early discharge rate on teaching hospitalist teams in comparison [...]

Background: Testing of ascitic fluid is recommended in all patients admitted to the hospital and delay in paracentesis has been shown to increase in-hospital mortality. Academic hospitalists in collaboration with internal medicine residency programs are establishing medicine procedure services to address concerns about resident training in procedures and patient safety. Our aim in this study [...]

Background: Early planning and successful operationalization of patient discharge has long plagued acute care hospitals as a major element of patient flow inefficiency. Increased census and backed up inpatient acute care services often leads to bed crises and further challenges an already constrained system. In our organization, we assembled a multidisciplinary project team and performed [...]

Background: Discharges against medical advice (AMA) account for 0.8-2.2% of all national discharges and represents an extreme in non-compliance. Patients who elect to leave AMA have increased rates of mortality, morbidity and readmission rates. Literature on this topic, to date, has focused on AMA in the context of specific admitting diagnoses or discharges from certain [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the 4th leading cause of death and a major driver of healthcare utilization worldwide. Established guidelines exist for hospitalized patients with COPD yet adherence to these has been found in multiple studies to be low. Our question is which Quality Improvement system changes best reduce healthcare utilization and [...]

Background: Code status discussions and documentation are a key part of inpatient care for hospital medicine providers as they become more involved in caring for those with advanced illness. Hospitalists are challenged both with efficiently addressing a complicated subject due to time constraints and by a lack of established patient relationships. If it is not [...]

Background: Current Infectious Diseases Society of America (IDSA) practice guidelines for skin and soft tissue infections (SSTIs) recommend against obtaining blood cultures for typical presentations of cellulitis. The guidelines only recommend cultures for those patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunity, immersion injuries or animal bites. Our institution has no protocol for guiding [...]