Background: Effective discharge communication is critical to ensuring safe patient transitions from the hospital and can improve outcomes. We have observed declining HCAHPS communication performance across our Section of Hospital Medicine and the transition out of the hospital was identified as a significant contributor. HCAHPS data was too slow to inform real-time improvement, so we [...]

Background: The transition period from hospital to home is a critical phase in patient care. Inadequate transitions can lead to adverse events, readmissions, delays in care, increased healthcare expenses and increased morbidity and mortality. Individuals with diabetes are particularly susceptible to readmission, facing a significantly higher risk compared to those without the condition. Furthermore, diabetic [...]

Background: Within 3 weeks of hospital discharge, about 19% of patients experience an adverse event, with 66% of these being an adverse drug event. During a patient’s transition from hospital to home, pharmacists have identified and resolved medication discrepancies. Inappropriate continuation or discontinuation of medications post-hospital discharge often stems from medication list complexity, inconsistent or [...]

Background: Outside-hospital (OSH) transfers are crucial to providing patients with a higher level or more specialized care. Despite the intent to improve care, OSH transfers are associated with negative outcomes due to miscommunication, lack of information, and other factors affecting patient care. Currently, there is no widely standardized process for OSH transfers. Studies show that [...]

Background: Transition of care, particularly at the point of discharge, is a pivotal part of the patient’s healthcare journey, carrying substantial risks to safety and quality of care. Whether a patient is discharged to home, an outpatient rehabilitation center, or a skilled nursing facility, each transition introduces opportunities for errors. Errors may include inaccurate medication [...]

Background: Patients are often discharged from the hospital with active medical issues needing outpatient follow-up (AINF) – including recommended labs, imaging, procedures, follow-up appointments, and follow-up of incidental findings – but patients and their outpatient providers often fail to complete these recommended workups [1]. Primary care physicians strongly recommend that discharging providers include a brief [...]

Background: Each year, over 5 million hospital-to-skilled nursing facility (SNF) transitions occur; of these patients, 20% are readmitted within 30 days. SNF transitions can be complex and error-prone, with hospital medicine teams noting unfamiliarity with key handoff information and SNF providers reporting incomplete or inconsistent discharge information. While effective communication between hospital and SNF providers [...]

Background: Since the 1960s, benzodiazepine therapy has been the standard of care for alcohol withdrawal syndrome (AWS) [1]. Recently, phenobarbital-based withdrawal has re-emerged as a potentially safer and more effective option that can decrease admission rates when given in the emergency department (ED) [2-7]. Thus, many academic medical centers (AMCs) have switched to phenobarbital for [...]

Background: Iron deficiency is the most common cause of anemia and a common comorbidity in hospitalized patients. Iron deficiency is present in up to 50% of patients with heart failure and intravenous (IV) iron can improve symptoms, functional capacity, and quality of life1. Inflammatory bowel disease has a prevalence of iron deficiency in 25% of [...]

Background: Improving hospital throughput and capacity is a challenge that many health systems face. Specifically, emergency room overcrowding leads to delayed access to treatment and increased mortality, thereby negatively impacting patient safety (Franklin, et al., 2023). Health systems strive to employ multiple strategies to tackle the issues around patient flow. One such strategy includes the [...]