Background: Observation status was designed to reduce health care costs for patients in need of short hospital stays. CMS suggests that observation care should typically require less than 24 hours, and only rarely last more than 48 hours. However, studies suggest that length of stay for observation patients is often longer than CMS guidance.[1,2] An [...]

Background: Bed-rest is considered essential to recovery. Functional decline in older patients is an often-overlooked riskfactor during hospitalizations. Older patients have higher 30-day readmission rates, more complications,and longer lengths of stay. Increasing the amount of walking in the hospital has been identified as a potentialsolution, with 900 steps per day identified as a target to [...]

Background: The hospital discharge process is challenging and opportune for human error. Medication discrepancies continue to be a patient-safety problem, exacerbated with the multiple sources of discharge medication documentation. Medication discrepancies may lead to medication errors and may contribute to adverse drug events with potential subsequent healthcare utilization and cost. Discharge medications can be listed [...]

Background: Deep Vein Thrombosis (DVT) is a pathology characterized by the formation of a blood clot inside the venous system. It comprises either distal vein thrombosis, but also proximal vein thrombosis (i.e. Femoral, Popliteal and Iliacal veins), which leads to a significant increase in complications of the disease, such as pulmonary thromboembolism (PE) and even [...]

Background: Physicians increasingly utilize electronic health records (EHR) to deliver healthcare, and the EHR has been identified as leading source of physician burnout and frustration [Shanafelt et al]. Studies report up to 52.6% of hospitalists exhibit symptoms of burnout [Roberts et al]. However, there is no data to inform how hospital medicine physicians spend their [...]

Background: The transitioning from pediatric to adult care has been correlated with worsened outcomes including increased mortality [1]. Improving patient experience (PEX) has been correlated to improved adherence and lower inpatient mortality rates [2] as well as lower 30-day readmission rates for patients with heart failure, acute MI and pneumonia [3]. Young adults transiting from [...]

Background: Hospitalization despite lack of medical acuity (so-called “non-medical” or “social” admission) is relatively common, especially in a safety-net setting. Hospitalists directly involved in triaging admission requests from the Emergency Department (ED) bring unique insight of the process. Here, we use a qualitative approach to explore hospitalist perspectives on disposition decisions for patients thought not [...]

Background: Despite system-level focus on avoidance of potentially preventable hospitalizations, the decision to admit a patient with low medical acuity has been understudied. Our study sought to identify factors associated with admission versus discharge from the Emergency Department (ED) for patients considered unlikely to be medically appropriate for admission. Methods: We conducted a retrospective cross-sectional [...]

Background: Hospitalists have increasingly engaged in admission decision-making for acute care medical patients. The role, duties, and impact of a Hospital Medicine Triage Attending (“triagist”) are emerging yet ill-defined. To our knowledge, no study thus far has catalogued the activities of these physicians in a comprehensive way. Our objectives were to 1) characterize the demands [...]

Background: The first years of transition from pediatric to adult care are associated with an increased mortality in select disease states [1]. While transitioning the outpatient care of children into adult care is well-established [2-4], there is no data on how to best transition young adults in the inpatient setting [5]. The first experience of [...]