Background: Discharge delays are associated with excessive costs to healthcare systems and poor patient outcomes. We sought to identify perceived barriers to timely discharge within and outside the control of hospitalists from the multidisciplinary team pivotal to the discharge process, and if different professionals noted different barriers. Methods: In June 2024, we surveyed hospitalist physicians/advanced [...]

Background: Pulmonary embolism (PE) is the third most common cause of death from cardiovascular disease despite significant improvements in diagnosis and management in recent years. PE patients are risk-stratified to guide treatment, and multidisciplinary PE response teams (PERTs) have been established to optimize patient care. This study aims to compare PE patient outcomes over a [...]

Background: Acute heart failure exacerbations are a leading cause of morbidity and mortality and are associated with high rates of hospital admissions and healthcare expenditure. As part of a broader effort to improve heart failure care at our hospital, this project aims to characterize heart failure type prevalence, mortality, and readmission rates to benchmark against [...]

Background: Length of stay is an important marker for quality of care in the hospital. Increased length of stay can affect patient flow through the hospital and can lead to overcrowding, increased boarding in the emergency department, delays in inter-hospital transfer, and cancellation of elective procedures due to bed availability (1). In addition, longer hospitalizations [...]

Background: Self-directed discharges, also referred to as discharge “against medical advice” (AMA), refer to when patients leave the hospital prior to medical readiness. These discharges lead to worse health outcomes for patients, ethical dilemmas for clinicians, and increased readmission rates affecting healthcare systems. Research on self-directed discharges has emphasized patient characteristics affecting discharge, with less [...]

Background: Compared with health care systems globally, the U.S. health care system expends more resources yet achieves worse patient outcomes. Growing recognition that such low-value care is a system-level problem has spurred efforts to optimize system-level processes. Low-value hospital admissions are a major contributor to overall low-value care, but limited descriptions of specific processes for [...]

Background: Delirium is a reversible condition that is common in hospitalized patients. Antipsychotics are often used to manage acute behavioral disturbances associated with hyperactive delirium. During transitions of care, plans to taper or discontinue these newly initiated antipsychotics can be unclear. As a result, these medications may be continued long-term, even as the acute episode [...]

Background: Central line-associated blood stream infections (CLABSIs) are a substantial source of morbidity and mortality. A previous meta-analysis of 1,976 CLABSI cases showed an odds ratio for in-hospital death of 2.75 (CI 1.86-4.07).[1] CLABSIs have also been associated with higher hospital costs and longer length of stay (LOS).[2] Methods: Data was collected from all CLABSI [...]

Background: The American Society of Hematology (ASH) advises against routine thrombophilia testing in hospitalized patients with new venous thromboembolism (VTE) due to the potential for inaccurate results during the acute phase of the disease. Thrombophilia testing is generally reserved for outpatient follow-up, once the acute event has resolved. However, testing may be appropriate in specific [...]

Background: The Center for Medicare and Medicaid Services (CMS) enables Medicare-certified hospitals to provide inpatient-level care at home through their Acute Hospital Care at Home (AHCAH) initiative. A CMS report on 9/30/24 revealed demographic differences between AHCAH patients and traditional inpatients from the same hospitals. AHCAH patients were more likely to be white, live in [...]