Background: The use of advanced practice providers (APPs) is increasingly prevalent throughout all levels of healthcare. However, there is no standard of practice regarding onboarding these providers to their new positions. This is in part due to the vast range of roles and responsibilities that APPs can contribute to the workforce. Although methods for initiating [...]

Background: There are mounting evidence that the clinical outcomes of conservative blood utilization strategy are equal or superior to liberal blood utilization in patients with anemia in the absence of severe acute hemorrhage, hemodynamic instability, or acute ischemia. However, practice variations among clinicians continue to create a challenge to effective blood utilization stewardship. Hospital Medicine [...]

Background: Carotid artery Doppler ultrasound is a valuable diagnostic tool for patients with neurological symptoms suggestive of cerebrovascular disease, such as transient ischemic attack (TIA), stroke, or focal neurological deficits. However, its diagnostic utility is limited in patients presenting with non-specific symptoms such as syncope, dizziness, or headache. Unnecessary Doppler orders in these cases can [...]

Background: As a strategy to address its ongoing capacity crisis, our hospital has focused on reducing length of stay and improving throughput. Our hospitalists care for patients on >20 nursing units across four buildings, which creates inefficiencies that may prolong length of stay. Although other institutions have demonstrated improved patient flow by geographically cohorting patients [...]

Background: Violence towards healthcare workers represents a critical threat to safe and effective care delivery. United States Bureau of Labor statistics demonstrate disproportionately higher rates of violence towards healthcare staff than workers in other industries, with healthcare accounting for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018 (1). The [...]

Background: Nearly one-third of laboratory tests in hospitalized patients and up to 60% of routine, repeat lab tests are unnecessary. Unnecessary testing results in excess venipuncture, iatrogenic anemia, patient discomfort, excess costs, wasted lab resources, and a potential cascade of additional tests and interventions. Few academic medical centers, including our institution, have systematic lab stewardship [...]

Background: Vanderbilt University Hospital continues to experience a capacity crisis, leading to a focus on strategies to improve patient flow and length of stay. Other institutions have demonstrated improved throughput by geographically cohorting patients and their respective care teams. Purpose: To reduce hospital length of stay and increase early discharges through the implementation of a [...]

Background: Insurance companies are issuing more denials and causing financial instability for hospitals. On average, hospitals are paid $6,000 less for a patient in outpatient observation status as compared to inpatient status. According to Kaiser Family Foundation Health, the average expense in 2022 for a hospital per inpatient day was $3,025 and is only increasing. [...]