Background: The knowledge regarding the association between increased blood pressure variability (BPV) and risk of subsequent clinical outcomes following acute ischemic stroke is not entirely clear. We constructed a cohort of patients hospitalized for new AIS to examine the effect of systolic BPV (SBPV) on the risk of dependency at discharge and 1 year readmission [...]

Background: Among survivors of ischemic stroke (IS), the cumulative long-term burden of readmissions, determinants of readmission, and clinical consequence of hospital readmission remain poorly understood. we aimed to investigate 1) the cumulative incidence of readmission; 2) at-risk patient for readmission, 3) the effect of readmission on subsequent mortality; and 4) whether the days spent in [...]

Background: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital (1-2), the scope of nocturnist practice and the typical workload has not been defined. Methods: In November 2019 a survey was created by a panel of nocturnists made up of members of the SHM Night Medicine Special [...]

Background: Studies indicate that physicians do not clean their stethoscopes regularly, and stethoscope surfaces become contaminated with bacteria. Neither the frequency with which stethoscopes deserve cleaning nor simple, practical cleaning approaches have been well-established for hospitalists or other inpatient clinicians. Our aim was to determine bacterial contamination of stethoscopes directly from a hospital doctor’s white [...]

Background: Over the past three decades, healthcare providers have increasingly recognized point-of-care ultrasound (POCUS) as a valuable tool and have been integrating it into routine practice. Ultrasound machines have the potential to act as fomites. Clinically relevant infectious organisms have been found on ultrasound probes and gels even when they aren’t visibly soiled. Thus, POCUS [...]

Background: The US Bureau of Labor Statistics estimates that healthcare workers experience workplace violence at 4 times the national average and providing care to patients with decompensated psychiatric illnesses disproportionately increases the risk of workplace assault (1). 20-40% of hospitalized medical patients have comorbid, decompensated psychiatric conditions that can impair insight regarding chronic medical conditions, [...]

Background: Delays in treatment of in-hospital cardiac arrest (IHCA) events are associated with lower survival and poor neurologic outcomes (1). For ward patients on centralized telemetry, telemetry technicians notify nursing staff of life-threatening arrhythmias immediately so nursing can verify a patient’s clinical status and determine whether code blue activation is necessary. Delays in this verification [...]

Background: The SARS-CoV-2 outbreak presents an infection control challenge to deliver care in a safe environment for patients and healthcare workers (HCW), further complicated by uncertainty regarding the nature of contagion of SARS-CoV-2 and PPE supply chain. On March 15, 2020, we introduced “medical distancing” rounding guidelines, with the aim of reducing transmission of COVID-19 when [...]

Background: Diagnostic errors (DE) – defined as incorrect, missed, or delayed diagnoses not made within a timeframe consistent with standard clinical practice – are common and can lead to harm, especially in acute care settings. One cause of DEs is suboptimal clinical reasoning in the diagnostic process. Electronic clinical documentation has been suggested to potentially [...]

Background: To date, attempts at estimating diagnostic error (DE), as defined as missed, incorrect, or delayed diagnoses, have focused on the identification of all types of adverse events, not specifically DE. Retrospectively identifying and ascertaining DE for hospitalized patients has been further challenged by (1) variability in operational definitions of DE; (2) use of non-standardized [...]