Background: Inpatient stewardship has appropriately become a large focus of acute inpatient care. The Vizient™ Clinical Data Base contains hospital discharge data used for benchmarking, and we observed significantly elevated cardiac MRI (cMRI) use at our tertiary hospital, relative to other tertiary academic medical centers, with resource utilization percentile averaging in the top decile (figure [...]

Background: The Warren Clinic Hospitalist Department oversees adult inpatient admissions for the Saint Francis Health System in Oklahoma, comprising over 140 clinical FTE’s. The department handles approximately 40,000 discharges annually across several acute facilities. The health system has seen unprecedented challenges recently due to COVID-19, staffing shortages, and an increasingly older population. These challenges increased [...]

Background: Prolonged immobility during hospitalization is associated with development of hospital-associated disability (HAD) and physical deconditioning. Physical therapy (PT) is important for HAD treatment and prevention but is a constrained resource in most hospital settings and planned sessions can be difficult to complete. Missing planned PT sessions, known as “PT non-treatment”, may compromise patient’s functional [...]

Background: Healthcare system high utilizers create a financial burden raising healthcare costs and quality improvement measures should be assessed to create a positive change. We aimed to characterize the high-utilizer patients in our system to create tailored interventions to address their specific needs and ultimately reduce recurrent admissions. Methods: A quality improvement project was implemented [...]

Background: Blood transfusions are one of the most common hospital procedures in the United States, often associated with adverse events, high costs, and limited availability [1-3]. Prior literature has shown that non-transfusion medicine physicians have poor to intermediate transfusion medicine knowledge (TMK) [4-7]. While physicians often use hemoglobin (Hgb) levels to determine when transfusion is [...]

Background: Proper clinical documentation is essential for effective medical service provision. Inaccurate documentation results in poor communication, ineffective patient care, and reduced compensation for the hospital. [1] A previous study analyzed documentation errors between 06/2021-07/2022 within the internal medicine residency inpatient service at an academic rural teaching hospital. [2] Their findings estimated a financial loss [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Medical procedure services (MPS) are increasingly implemented in Hospital Medicine programs to promote resident learning, support provider workloads, and expedite performance of common bedside medical procedures, including thoracentesis, paracentesis, and lumbar puncture (LP) [. Prior work has demonstrated safety and positive educational experience with MPS but little data exists on the impact of MPS [...]

Background: Consistent with national reports, post-pandemic burnout rates for the >100 hospitalist faculty at our institution were noted to be disproportionally high relative to the department1. Hospitalists engage in a wide range of non-clinical work including QI projects and committees embedded in the structure of efficient and high-quality inpatient care2. Building off literature in which [...]

Background: Unnecessary inpatient laboratory testing is common and negatively impacts patients by causing discomfort and iatrogenic anemia. Such testing also burdens a busy phlebotomy team, particularly when patients decline labs due to recency of previous checks. Audit and feedback interventions are known to reduce low value practices in medical residents, but no published study has [...]