Background: The Palo Alto VA Hospital has an interdisciplinary Clinical Command Center (C3) that includes “Flow” nurse practitioners (NPs) who work closely with case management, social work and primary medical teams to identify and address barriers to care and assist in discharge planning and coordination. We have created a novel collaboration between a C3 Flow […]

Background: Transforming hospital operations to optimize patient experience begins with a collaborative care team. The geographic re-location of physicians into one unit with an entire care team, in addition to the implementation of Structured Interdisciplinary Bedside Rounds (SIBR), have been linked to multiple outcomes related to effective care team communication and collaboration, including patient safety […]

Background: Pain is assessed by nurses through either reported or observed intensity. Self-reported assessments, specifically a numeric score, are the gold standard and preferred to behavioral assessments. Disparities in the assessment and management of pain across race, ethnicity, and language status are prevalent, but we do not know how actual numeric pain scores vary and […]

Background: The division of the hospital medicine at the University of Florida has 52 attending hospitalist physicians with an average daily census of 200 patients. On any given day, one physician carries 16 patients and practices direct care services. This includes chart review, placing orders, answering pages, coordinating with case managers, requesting consultations, rounding on […]

Background: Managing the complex environment of a general medicine ward requires high performing interdisciplinary teams.(1) In 2016, an Accountable Care Unit (ACU) was implemented on a 35-bed medicine ward at a community based teaching hospital to develop high performing interdisciplinary teams. One of the four features of an ACU is Structured Interdisciplinary Bedside Rounds (SIBR)(2), […]

Background: Clostroidiodes difficile (CD) is the most prevalent hospital-acquired infection in the United States, accounting for approximately 224,000 infections with 13,000 deaths and over 1 billion dollars spent in 2017, according to the Centers for Disease Control and Prevention (CDC). Clostroidiodes difficile accounts for 10-20% of diarrhea in the setting of recent antibiotics exposure.In St […]

Background: Many studies have demonstrated the negative effects of emergency department (ED) crowding on outcomes, including increased length of stay, inpatient mortality, and risk of readmission. Early evidence suggests effective and timely triage of patients with hospitalist input can mitigate some of the detrimental effects of ED crowding. In contrast to prior studies focused on […]

Background: Hospital overcrowding and extended Emergency Department (ED) wait times are challenges facing most urban hospitals today. There is growing evidence to show that overcrowding in the ED is associated with increased morbidity, mortality and patient dissatisfaction. To improve overcrowding, hospitals have focused on discharge before noon (DBN) as an impactful and sustainable remedy. While […]

Background: 22% of the hospitals overall STAR rating is based on readmission reduction for the following disease specific groups: pneumonia, chronic obstructive pulmonary disease, acute myocardial infarction and congestive heart failure. Creating strategies surrounding prevention of readmissions that create workload balance leads to improved ability to manage these patients. The hospitalist medicine, emergency medicine, pulmonary, […]

Background: Early discharge from the hospital improves hospital throughput as well as patient and staff satisfaction. At times, our emergency room tends to board many admitted patients for more than 24 hours, which further distresses our patients and staff. We noticed that the total number of patients leaving the hospital earlier in the day decreased […]