Background: Early warning scores are clinical decision support tools that incorporate multiple physiologic variables to detect patient deterioration. Previous studies have highlighted the value of integrating measures of provider intuition into predictive models. (1-3) For example, incorporating the Patient Acuity Rating, a Likert-based measure of nurse worry, into the six-variable Modified Early Warning Score (MEWS) [...]

Background: Bone marrow biopsies (BMB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. BMB are a straightforward procedure with a generally low complication rate. In lieu of using specialists (eg, oncologists) or computed tomography (CT) guidance with radiology, procedure-focused hospitalists can provide an excellent option for doing [...]

Background: Hospital admissions at a tertiary care hospital occurs mostly by two routes: 1) through the Emergency Department (ED), and 2) through Transfer center. Several perceptions exist about transfer patients being more complex, and association with worse outcomes, or similar outcomes as compared to ED admits, and hence need for optimization of transfer decision and [...]

Case Presentation: An 80-year-old gentleman with a past medical history of type 2 diabetes mellitus and stage III chronic kidney disease (baseline creatinine 1.2-1.4 mg/dL) presented to the emergency department with generalized weakness, falls, unintentional weight loss, and constipation. Labs were significant for hypercalcemia (13.2 mg/dL), elevated creatinine (1.96 mg/dL), suppressed intact PTH (10 pg/mL), [...]

Case Presentation: A 79-year-old male with vasculopathy, hypertension, diastolic heart failure, and dialysis-dependent end stage renal disease presented after having hypotensive syncopal episodes during initiation of his last 3 outpatient dialysis sessions. Upon dialysis cessation, he quickly awakened fully oriented with a normal hemodynamics. On arrival, physical exam findings were unrevealing, as were a subsequent [...]

Background: Compassion, considered a cornerstone of quality healthcare by patients, families, clinicians, and policymakers, is believed to have wide-ranging benefits, including improving clinical outcomes, increasing patient satisfaction with services, and enhancing the quality of information gathered from patients. Compassion-filled interactions may also promote clinician wellbeing, decrease burnout, and improve mental health. Compassion is thought to [...]

Background: Medical simulation has been shown to be beneficial to long-term learning (1). A recent systematic review of 21 simulation studies also illuminated its potential role in preventing medical errors (2). Our institution has a robust simulation center with high-fidelity mannequins that all internal medicine residents rotate through on a yearly basis. Each session has [...]

Background: Any given night, an estimated 553,000 individuals experience homelessness in the USA. Many turn to hospitals for healthcare, food, and shelter. These factors and lack of follow-up care upon discharge contribute to high rates of early readmission and frequent ED visits. Due to frequently missed homelessness status by healthcare providers, it is difficult to [...]

Background: Eviction represents a traumatic form of housing instability and is an important social determinant of health. Growing wealth inequality and a housing crisis have resulted in high rates of eviction since 2000, with women renters and those of Black race disproportionately affected. Prior studies demonstrate the negative impact of eviction on self-reported mental and [...]

Background: Timely identification and treatment are integral to sepsis management in emergency department (ED) and inpatient settings. Increasingly, automated alerts embedded in electronic health records (EHRs) are used to expedite sepsis detection but may lead to false alarms and increased alarm fatigue. Additionally, recent data have demonstrated that the EPIC Sepsis Model—a proprietary sepsis alert [...]