Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by […]

Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by […]

Background: Continuous cardiac monitoring (telemetry) is a vital but resource intensive component of patient care, allowing providers to quickly respond to signs of cardiovascular instability. Despite its importance, and existence of American Heart Association (AHA) guidelines, overreliance of telemetry is common. Since telemetry is restricted to specific units, over-use creates a bottleneck in patient flow […]

Background: Medicare Advantage (MA) plans have strong incentives to reduce potentially wasteful healthcare, including costly acute care visits for ambulatory care-sensitive conditions (ACSC) [1-4]. It is unknown, however, whether MA plans lower acute care use relative to Traditional Medicare (TM) or instead shift patients from hospitalizations towards observation stays and emergency department (ED) direct discharges. […]

Background: Equity is an essential domain of healthcare quality [1] but is rarely addressed within quality measurement programs. Quality initiatives, without explicit equity focus, may exacerbate underlying disparities.[2]To address this historic lack of focus on equity, the Centers for Medicare & Medicaid (CMS) now provides confidential reports to hospitals on two disparity metrics for Medicare […]

Background: Unconscious bias within the U.S. health care system has been linked with disparities in the treatment of patients by age, gender, and race (1). While many factors contribute to these disparities, implicit bias may play a significant role. Stigmatizing language often reflects the implicit bias that healthcare providers possess toward patients (2). Recent research […]

Background: Feedback in clinical training is essential to reinforce positive behaviors and to provide areas for improvement. Numeric ratings from student performance evaluations are helpful but are not sufficient to guide the learner about where they may be excelling and where they may need additional development. Narrative written feedback both reinforces verbal feedback and provides […]

Background: Healthcare in the U.S. is increasingly delivered by large health systems that include one or more hospitals and associated outpatient practices. It is unclear what role health systems play in driving or preventing overutilization of healthcare services in the U.S. We sought to learn what characteristics allow certain health systems to avoid low-value care […]

Background: Hospital-associated disability (HAD) is the new loss of ability to complete one or more activities of daily living without assistance after hospital discharge and occurs in 31% of hospitalized patients. HAD and low mobility during hospitalization are associated with higher risk of readmission, permanent disability, new institutionalization, and death. Physical therapy (PT) is invaluable […]

Background: Panel-based Nucleic acid amplification tests (NAATs) are laboratory tools that are used to detect small quantities of RNA or DNA to rapidly identify a multitude of infectious organisms. A systematic review and meta-analysis looking at the diagnostic accuracy of the BioFire® FilmArray® meningitis-encephalitis (ME) panel which is used at our institution showed that it […]