Background: Overnight vital sign assessment can disrupt sleep in the hospital and may be unnecessary in clinically stable patients. However, providers may not feel comfortable determining which patients can safely forego overnight vitals. We studied the effect of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) that automatically identified clinically […]

Background: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications […]

Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Greater appreciation of complications associated with peripherally inserted central catheters (PICC) and the diffusion of catheter appropriateness criteria has led to expanded use of these devices. However, single center studies comparing […]

Background: Hospital medicine is the fastest growing subspecialty within internal medicine, growing from 10,000 hospitalists in 2002 to over 50,000 in 2016. Despite this growth, there remain relatively few hospitalists who are clinician investigators. We sought to quantify the number of clinician investigators, their dedicated time for research at major United States academic medical centers, […]

Background: Trauma co-management is a growing field within hospital medicine. While improvements in quality metrics have been documented in other co-management services, the impact of co-management of trauma patients is uncertain. This study aimed to determine whether a hospitalist trauma co-management program improves clinical outcomes. Methods: This was a pre- and post-implementation study comparing trauma […]

Background: Prior studies have found racial disparities in how patients are assessed for pain and prescribed opioids from emergency department and surgical settings. However, we do not know whether similar disparities exist among general medicine inpatients. We examined opioid prescriptions at discharge among adults admitted to the general medicine service at our medical center, with […]

Background: Patient experience is increasingly recognized as a measure of healthcare quality and patient-centered care. However, there is insufficient understanding of patient expectations during hospitalization, and of how these are perceived by physicians, nurses, and administrators. The best way to apply the HCAHPS ratings remain elusive due to variability in practice environments, patient and clinician […]

Background: Hospitalists increasingly confront patient care and policy dilemmas due to financial incentives created by bundled payments, single payments that “bundle” acute and post-acute care for specific diagnoses. The most common and most successful bundled payment has been for total joint replacement, where cost savings have been achieved through discharging patients to home rather than […]

Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered […]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they […]