Background: Admissions from the Emergency Department (ED) to the inpatient floor units are often inefficient; this translates to increased expense via increased length of stay (LOS), fewer available patient rooms via “patient boarding”, and an overall less positive experience for patients and their families. Reducing admission times effectively increases the capacity of the ED and [...]

Background: Most large academic medical centers across the United States have been facing hospital-capacity strain and hospital census fluctuations for years, though these fluctuations of inpatient census have significantly increased with the COVID-19 pandemic. Hospitalists and hospital leaders are uniquely capable of identifying innovations to improve patient flow. Prior research has been insufficient to consistently [...]

Background: Maintenance intravenous fluids (IVFs) are a critical treatment utilized frequently in pediatric medicine to support children with impaired enteral intake suffering from a wide variety of illnesses. Traditional pediatric practice of utilizing hypotonic fluids is thought to derive from Holiday and Seger’s mathematical calculations on IVFs that concluded that the use of hypotonic fluids [...]

Background: The social determinants of health (SDOH) have been shown to be independent predictors for higher rates of heart failure hospital admissions, lower outpatient follow-up, and poorer health outcomes.1-3 One strategy for addressing the SDOH that has demonstrated promising results in decreasing hospitalization rates and average lengths of stay for patients with chronic illnesses is [...]

Background: Catheter-associated DVT (deep vein thrombosis) is a known complication of PICC (peripherally inserted central catheter) placement. In an attempt to reduce our institution’s rate of catheter-associated DVT we devised an intervention to reduce the use of multi-lumen PICCs and use a smaller diameter of PICCs. Methods: A two-part intervention was conducted with 1) educational [...]

Background: Clinical decision making pathways (pathways) embedded within electronic medical record (EMR) systems are an innovative tool intended to assist providers in diagnosing and managing patient conditions. Pathways provide clinical decision trees with the ability access online risk score calculators and select orders for lab and imaging tests, medications, and consultations. Studies have shown that [...]

Background: Community acquired pneumonia (CAP) is one of the leading causes of hospitalization in the United States.[1] In an effort to improve the quality of care for this resource-intensive disease, our institution implemented a clinical decision support (CDS) pathway for CAP comprised of three phases: (1) education on best practices, (2) education and a CDS [...]

Background: COVID-19 has placed an unprecedented strain on healthcare systems worldwide, increasing demand for critical care beds1. To address shortage of critical care beds, innovative methods to increase capacity are needed. At our large, urban academic safety-net hospital, patients with diabetic ketoacidosis (DKA) are admitted to critical care units for intravenous (IV) insulin administration and [...]

Background: The COVID19 pandemic has increased mask demand over 100 fold. The resultant shortage led to the rationing of resources worldwide. We conducted a cross-sectional study seeking to interrogate masking practices among residents through a structured questionnaire. Methods: A confidential survey link (powered via Survey Monkey online platform) was sent via email to 242 residents [...]

Background: Accurate clinical documentation is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. However, since coding rules and terminology differ from common clinical language, there is a risk that the clinical reality will get lost in translation. This is where clinical documentation improvement (CDI) programs come [...]