Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Clostridioides difficile infection (CDI) is a common, often nosocomial infection associated with substantial morbidity and mortality. Antibiotics are the most important modifiable risk factor, but empiric antibiotics remain appropriate for many patients with severe acute illness. Which antibiotics minimize the risk of CDI remains an important unanswered question. Because protective equipment and isolation were [...]

Background: The HCAHPS survey is used nationally by health systems as a standard to measure the patient experience and identify opportunities for improvement. Historically, process improvement initiatives based on the survey are implemented retroactively, attempting to prevent negative experiences for future patients. However, given the increasing complexity of patient care, proactively addressing the identified concerns [...]

Background: There has been ample speculation about potential future applications of natural language processing and related technologies for clinical documentation, and yet the mechanics of clinical documentation have changed very little since the passage of the HITECH Act in 2009. Purpose: While awaiting the integration of more advanced technologies into electronic health records (EHRs), we [...]

Background: Antibiotics are frequently prescribed—and overprescribed—at hospital discharge, leading to adverse-events and patient harm. Antibiotic overuse at discharge varies widely across hospitals, with rates of overuse differing up to 5-fold.(1) Our understanding of what approaches optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework which [...]

Background: Despite the widespread use of technology across our daily lives, many processes in the hospital remain manual and labor-intensive. As hospital medicine divisions grow, there is an increasing need for automated and scalable solutions. While many hospitals look to external vendors to provide automated solutions, these often lack customizability and gaps remain. Purpose: To [...]

Background: As patient satisfaction surveys become a routine part of physician performance evaluations, it is increasingly important to study the tools that are utilized to evaluate this performance. Little research has been performed to assess the metrics of these tools. Top box percentage is frequently used to report physician performance but the relationship of top [...]

Background: Esophageal varices with bleeding (EVB) are one of the most common causes of deaths in cirrhotic patients in the United States. Over the course of years, studies have reported an increase in the incidence of EVB and is associated with a high risk for morbidity and mortality. Data is lacking with regards to recent [...]

Background: Serious Illness Conversations (SICs) lead to a better understanding of patient values and preferences, improved patient and family satisfaction, and other benefits. Prognostic awareness and early identification of patients who may benefit from an SIC remains a challenge. Epic’s Risk of Unplanned Readmission (Readmission Risk Score), a composite score (0-100) that includes clinical factors [...]

Background: Despite the proven mortality benefit of screening colonoscopy, approximately 27% of hospitalized women are non-adherent with colorectal cancer screening guidelines. Colonoscopy is the most frequently used test for colorectal cancer screening in US. Although Medicare and most insurance plans would cover screening colonoscopy, colorectal cancer screening has not been part of usual hospital care. [...]