Background: The Coronavirus disease 2019 (COVID-19) pandemic caused a staggering 200 million cases with over 4 million deaths globally as of August 2021. COVID-19 is associated with lung inflammation and pulmonary fibrosis. Inhaled corticosteroids (ICS) are used to improve lung function by reducing inflammation, edema, mucus secretion, and inhibiting various cytokine activities. However, there is […]

Background: Emergency Department (ED) overcrowding and lack of hospital bed capacity are pervasive problems made worse by the Covid-19 pandemic. Bed capacity is a significant concern at Academic Medical Centers (AMCs), as patients depend upon AMCs for specialized in-hospital care not available at other regional hospitals. Bed capacity shortage is acutely felt at rural AMCs, […]

Background: Cirrhosis was the fifteenth leading cause of death in the United States in 2019, with ascites being the most common major complication leading to hospital admission. Patients with ascites have recurrent hospital admissions with disproportionate use of hospital resources. Large volume abdominal paracentesis can be done safely by trained providers and is associated with […]

Background: Point-of-care ultrasound (POCUS) is being adopted by hospitalists and internal medicine (IM) residencies due to its impact on procedural safety, diagnostic accuracy and efficiency, provider and patient satisfaction, and its role as a teaching adjunct in medical education. Studies demonstrating impact on system efficiency and cost are few and mostly limited to the emergency […]

Background: In utero opioid exposure can result in neonatal abstinence syndrome (NAS). NAS is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system and gastrointestinal tract dysfunction. Newborns with NAS may require pharmacological management, have increased hospital costs, and have a prolonged hospital length of stay (LOS). NAS incidence has increased […]

Background: Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in the hospital setting. While respiratory symptoms are the fundamental feature of COVID-19 infection, VTE is a known sequelae given the hypercoagulable state of the disease. Therefore, it is common for hospitalists to prescribe prophylactic anticoagulation in the inpatient setting for patients with […]

Background: The SARS-CoV-2 pandemic has required healthcare systems around the world to rapidly innovate and adapt to unprecedented operational and clinical strain. Anticipated limitations in healthcare resource allocation is coupled by the strife caused by the variable clinical course of COVID-19 and the isolation of families inevitable with an inpatient admission. Many healthcare systems have […]

Background: Up to 45% of Americans do not fill prescriptions because of cost. Medication non-adherence annually leads to $100-$300B in excess morbidity and mortality. To better inform medication cost effects on a potentially vulnerable patient population, our primary aim was to measure annual patient out-of-pocket outpatient medication cost for patients without prescription drug insurance coverage […]

Background: Multiple studies support the association between systematic implementation of Patient Blood Management (PBM) programs and improved patient outcomes, reduced RBC utilization, and decreased healthcare costs. In 2019, Sentara Healthcare launched a system-wide PBM program aimed at decreasing avoidable transfusions by 24% over 3 yrs. Several care collaboratives, including the Society of Hospital Medicine (SHM), […]

Case Presentation: A 37-year-old female with Systemic Sclerosis (SSc) presented with new-onset elevated blood pressure. She was on medium to high dose Corticosteroids (CS) a month prior to admission. Her significant vitals on admission included a heart rate of 103 and blood pressure of 193/97. Labs showed hemoglobin 9.6, sodium 130, BUN 63, creatinine (Cr) […]