Background: Prioritizing hospital discharges to improve throughput and safety is a common theme in hospital systems. More recently, there has been an increasing importance placed on early discharges. Earlier discharges help to improve flow for admitted patients through the emergency department. In addition, by expediting patient care, patients are able to have their questions answered [...]

Background: Early identification of sepsis is the main driver for patient survival. Roughly 30% of patients diagnosed with severe sepsis do not survive. To drive the desired clinical behavior, it is crucial to identify appropriate sensitivity and specificity of a sepsis early detection system. At our institution, we saw a 515% increase in Sepsis Alerts [...]

Background: As a direct or indirect consequence of the COVID-19 crisis, staff shortages are inevitable. Hospitalists may require quarantine after significant exposure to the virus or due to illness. Census surges are anticipated as well. It is crucial to implement alternate staffing plans to prevent disruptions in patient care. Telemedicine can be leveraged as a [...]

Background: Access to pediatric subspecialty care is often challenging outside of large urban areas, especially in the field of pediatric dermatology. Overall, demand for pediatric dermatologic care outstrips the supply of pediatric dermatologists. As a result, the need for dermatology consultative services to hospitalized children is increasingly unmet. Teledermatology, or the use of telemedicine platforms [...]

Background: Point-of-care ultrasound (POCUS) is being used to support the diagnosis and serially monitor patients with and without COVID-19. There have been concerns about use of personal protective equipment, the ability to receive hands-on supervision and support for interpretations of ultrasound in this era. Efforts to expand POCUS educational initiatives have been hindered by insufficient [...]

Background: Inpatient serum folate testing was recognized as a low-value practice by the Choosing Wisely campaign in 2015. Despite this recognition, clinicians at our hospital system continue to use this test in a standard workup for conditions such as anemia, dementia and altered mental status. Shifting practice patterns away from serum folate testing remains a [...]

Background: Clinical excellence is the mainstay of faculty development and advancement in academic hospital medicine groups (HMGs). Attaining clinical excellence relies heavily on feedback of current clinician skills. However, following completion of medical training, physicians and advanced practice providers (APPs) experience a gap in relevant and real-time feedback. A paucity of literature exists in academic [...]

Background: Geographic decentralization of inpatient teaching teams has been shown to impair physician-nurse communication and efficiency of care. Reliance upon paging or messaging increases probability of miscommunication. Importantly, the inclusion of nurses as integral members of the care team cannot be fully realized in the absence of consistent provider presence on the unit. Purpose: Prior [...]

Background: Hospitalist providers are the backbone of inpatient medicine and are the ideal audience for hospital-driven metrics given their direct and constant care of hospitalized patients. However, these metrics often seem ambiguous, resulting in frustration and dismissal. Guiding hospitalist providers through less commonly understood topics such as utilization review determinations (nuances of observation/inpatient status), high [...]

Background: Medicine procedure services (MPS) have been shown to increase Internal Medicine (IM) procedure volume, procedure completion rates, adherence to best practice safety measures, resident involvement, and resident satisfaction. However, deployment of MPS can be challenging as it requires significant lead time for ensuring skillset consistency, provider scheduling, and developing referral sources. At the same [...]