Background: Heart failure (HF) is a common, chronic clinical syndrome often accompanied by episodes of acute decompensation driven by volume overload (1). Reversing this overloaded state is the principal goal in treatment of acute decompensated HF, typically achieved using loop diuretics (2). Despite ubiquitous use of loop diuretics, guidance on initial dosing strategies remains limited [...]

Background: Low-value care in the form of overuse of inpatient diagnostic testing is an important driver of high healthcare costs. Financial incentives are known to impact physician behavior and may be a driver of inpatient diagnostic overuse. However, the association between hospital payer mix (which likely impacts the financial incentives for ordering diagnostic tests) and [...]

Background: Sodium Polystyrene Sulfonate (SPS, Kayexalate) has commonly been prescribed for patients with hyperkalemia since 1958. However, reports of severe gastrointestinal side effects, particularly intestinal necrosis, have been persistent since the 1970s, leading some authors to recommend newer costlier alternatives to SPS. A prior systematic review of the literature found 30 separate case reports or [...]

Background: Healthcare costs in the United States continue to increase, largely driven by the high cost of pharmaceuticals. Cost transparency, the act of showing the cost of drugs to providers, has been proposed as a method of reducing healthcare costs, but its effectiveness has not been studied on a large scale. Methods: We tracked the [...]

Background: A growing number of hospitalists are incorporating point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or guide performance of invasive bedside procedures. This study at a 464 bed community hospital investigated hospital medicine department physicians’ choices regarding POCUS as a branch point in clinical decision making. Methods: During shifts covering [...]

Background: Inappropriate utilization of daily labs—complete blood counts (CBC) and serum electrolyte panels (SEP)—is an important cause of increased costs in the hospital setting. The Minnesota Lab Appropriateness (MLAB) criteria were previously developed to facilitate assessment of CBC and SEP appropriateness (1). A combination of clinical judgment and common healthcare data, including recent vital signs [...]

Background: With nearly 60 million cases and 1.4 million deaths globally (1), the COVID-19 pandemic has been deemed a traumatic event that transcends the range of normal human experience (2). History suggests those on the frontline of disasters are at risk of burnout, depression, post- traumatic stress disorder, and in grim cases—suicide. (3) The current [...]

Background: Ferric carboxymaltose (Injectafer) has a higher rate of hypophosphatemia than other iron formulations. The proposed mechanism for this is a transient increase of intact fibroblast growth factor 23 (FGF23) leading to renal phosphate wasting. Prescribing information for ferric carboxymaltose lists the incidence of hypophosphatemia (defined as 60 ml/min was noted in 46% of patients. [...]

Background: Falls are associated with significant morbidity and increased healthcare expenses for hospitalized patients. There are hundreds of thousands of inpatient falls every year. There are multiple validated scores to guide the need of imaging for patients presenting to ED after, but no such score exists for hospitalized patients who suffer a fall event. This [...]

Background: Patient-clinician/clinician-family communication presents multiple challenges in the setting of serious illness. Cross cultural interactions compound these challenges. Amongst the United States’ American Indian (AI) tribes, there is minimal research that has addressed the challenges in clinician-patient communication. Studies in other ethnic minorities reveals an interest by patients and families for more direct information regarding [...]