Background: In 2023, UVA Health’s Catheter-Associated Urinary Tract Infection (CAUTI) Coalition identified diagnostic stewardship as a contributing factor in 57% of all CAUTI events. An independent review of all CAUTIs involving hospitalist physicians from 2022-2023 found that diagnostic stewardship was a key driver. Inappropriate urine testing can lead to treating asymptomatic bacteriuria with antibiotics, which [...]

Background: Patients hospitalized for vaso-occlusive crisis (VOC) frequently report dissatisfaction with pain management, which is exacerbated by variability in treatment approaches across healthcare providers. Negative provider perceptions, stigmatized language in the electronic medical record, and misperceptions of appropriate pain management are associated with undertreatment of pain, prolonged hospitalizations, and worse disease-specific outcomes. Effective management of [...]

Background: Tracheostomies are commonly performed on critically ill patients requiring prolonged respiratory support. Managing them in intermediate care units (IMCU) presents challenges, as complications such as tube displacement, infection, and airway obstruction can pose significant risks. Structured safety protocols like checklists have been successfully used in other high-risk healthcare settings to mitigate these risks. Thomassen [...]

Background: Ultrasound guided peripheral IV (USGPIV) placement is a critical skill that currently requires placement by providers or critical care nurses at Yale-New Haven Hospital. In particular, our Liver and Kidney Transplant unit requires frequent support for IV access placement from our Hospitalist Procedure Team (HPT) and critical care nursing intervention (SWAT team). There are [...]

Background: Physician/Bedside Nurse (RN) communication is at the center of care delivery and patient experience for patients admitted to any Hospital Medicine service. While efficient communication within the healthcare team is the hallmark of high quality care, it is highly variable in terms of timing and quality. Inadequate communication between physicians and nurses, as perceived [...]

Background: Efficiently identifying clinically appropriate patients is integral to the operation and growth of a hospital at home program. Given the nuances of a home-based care delivery model, this task typically relies on a specifically trained small group of experienced providers, significantly limiting the number of patients able to be screened. The Hospital at Home [...]

Background: Providing patient centered care is a core value of all healthcare systems in our nation. However, having a code status discussion with patients and their families continues to be a challenging endeavor due to multiple factors such as competing priorities and time constraints, especially in the hospital setting. To improve code status discussion and [...]

Background: Medicine procedure services (MPS) have been shown to increase procedure volume, procedure completion rate, adherence to best practice safety measures, resident involvement, and resident satisfaction within Internal Medicine (IM). Despite these benefits, widespread deployment of MPSs has proved challenging, partly because the impact of MPSs on non-IM services is unknown, including MPSs’ impact on [...]

Background: The delay or failure to follow-up test results pending at discharge (TRPAD) is a well-documented safety concern occurring in 20-61% of inpatients. Driving factors include ambiguity in the physician responsible and variable handoff practices between the inpatient and outpatient provider. Test result management encompasses many contextual factors such as clinical workflow, user behaviors, and [...]

Background: Inpatient telemetry monitoring is a limited resource. The value of telemetry monitoring in hospitalized patients with high risk for cardiac arrhythmia is high. However, telemetry monitoring is often ordered for inpatients at low risk for cardiac arrhythmia. The SHM’s Choosing Wisely campaign recommended avoiding continuous telemetry monitoring in non-ICU patients without a protocol. Ordering [...]