Background: Evidence suggests that oxygen supplementation is only beneficial to hypoxic patients (or oxygen saturation (SPO2) < 90%) yet is commonly given to normoxemic patients despite having no clinical indication for its use. Excessive oxygen supplementation with saturations above 96% for long periods of time has also been proven to increase mortality rates when compared […]

Background: One in three heavy drinkers experience acute alcohol-associated hepatitis (AAH). AAH is defined as acute liver injury with elevated bilirubin and AST/ALT ratio >1.5 in the setting of heavy alcohol use. AAH has a high mortality rate and is associated with development of chronic liver disease; thus, it is crucial to correctly identify patients […]

Background: Persistently high hospital volumes, increased patient complexity, and lack of skilled nursing bed availability have led to significant bottlenecks in care and decreased inpatient bed availability. A hospital-wide initiative was created to increase the rate of discharge before noon (DBN). To meet discharge targets on hospital medicine units, we formed a multidisciplinary quality improvement […]

Background: Targeted approaches for early discharge times have been utilized to improve patient flow, but literature shows sparse evidence for hospital-wide efforts and mixed benefits for the length of stay and readmission rates. Furthermore, there is limited data for this approach across a large academic medical center. We set an aim to increase the percentage […]

Background: The REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) study sought to improve teamwork and quality for hospitalized patients by providing mentorship and resources to hospitals as they implemented: (1) Unit-based Physician Teams, (2) Unit Nurse-Physician Co-leadership, (3) Enhanced Interprofessional Rounds, (4) Unit-level Performance Reports, and (5) Patient Engagement Activities. Two […]

Background: Non-beneficial treatment can be defined as medical interventions that are ineffective in achieving the desired goals or are “a disservice to patients who are subjected to ongoing and likely uncomfortable conditions with no benefit”. At times, critically ill patients are declined Intensive Care Unit (ICU) admission due to perceived lack of benefit from medical […]

Background: Evidence-based guidelines/protocols for electrolyte replacement that safely encourage oral (PO) and/or intravenous (IV) dosing attain goal levels more successfully than standard care. PO is generally more comfortable and less dangerous than IV. Between 5/2017-11/2017, our institution dosed ~300,000 doses of potassium (K) and magnesium (Mg), with 30% and 19% of doses being PO, respectively. […]

Background: Overtreatment or low value care, including overutilization of laboratory testing, has an estimated annual cost of waste of $75.7 to 101.2 billion annually. Providing performance feedback to hospitalists has been shown to be an effective way to encourage the practice of quality improvement focused medicine. There remains limited data regarding implementation of performance feedback […]

Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary […]

Background: Failure to thrive and malnutrition continues to be a common diagnosis in pediatrics contributing to a significant number of hospital admissions (1-5). There is no national practice guideline or consensus recommendation for diagnosis and treatment for patients hospitalized with failure to thrive, contributing to significant clinical practice variation. Unnecessary variability in practice has been […]