Background: Communication between Hospital Medicine physician teams and interdisciplinary care providers (e.g. nurses, physical and occupational therapists, case managers) regarding disposition planning is often inconsistent, potentially delaying care and resulting in poor patient and provider experience. Prior studies demonstrate that sharing the estimated discharge date (EDD) early in a patient’s hospitalization can improve communication and [...]

Background: Problem Definition: Inadequate Advance Care Planning conversations and documentation remain a persistent gap in healthcare delivery. Admitting patients to the inpatient service without explicitly exploring the ‘goals of care’ and ‘code status’ results in stressful moments for the patients, their families, and providers if the condition deteriorates and may result in providing care that [...]

Background: Routine patient care including vital signs checks, lab draws, medication administration, during the night contributes to the already disturbed sleep of inpatients. This study aimed to assess the performance of automated risk scores to stratify the risk of an overnight deterioration to better inform letting low-risk patients sleep and more intensively monitoring and/or intervening [...]

Background: There is a population of patients who visit Emergency Department (ED) frequently and this has become a challenge for the health-care system. A small proportion, four percent of ED patients, could constitute up to 20% of ED visits (1-3).Interdisciplinary approach of care management is the most widely evaluated and single-point-of contact (4).We conducted a [...]

Background: In May 2022, Kaiser Permanente introduced “Enhanced Recovery Medical” (ERM). Modeled after “Enhanced Recovery After Surgery,” (ERAS), ERM aims to reduce hospital-acquired debility. Predefined ordersets and modified workflows help healthcare teams optimize elements key to recovery: nutrition, mobility, tethers, pain, sleep, and delirium. This ongoing quality improvement (QI) project examines how a resident-led initiative impacted co-resident [...]

Background: Our single academic medical center implemented a standardized Outside Hospital (OSH) communication process, encouraging physician completion of a dedicated templated patient transfer note for admission to any Department of Medicine (DOM) specialty. Prior outcomes analysis revealed that documentation with any transfer note, templated or non-templated, is significantly associated with improved outcomes of death within [...]

Background: Asking patients “what matters” to them is one of the 4 evidence-based elements of care developed by the Age-Friendly Health Systems initiative to improve the care of older adults, and the question “what matters most” has been extended to other settings. We conducted a study to assess the frequency and categories of responses to [...]

Background: Hospital medicine patients with complex behavioral and psychiatric needs benefit from specific resources and training. Inability to provide intensive, longitudinal, and specialized support for patients with psychiatric needs contributes to dissatisfaction in clinical work for hospitalists, and may increase the risk for workplace violence from patients. Little is known about the prevalence of psychiatric [...]

Background: The primary driver of hospital acquisitions is desire to increase market share. While financial impacts of hospital mergers are well demonstrated and include cost savings and economies of scale, quality impacts are less clear. A systematic review conducted through January 2020 reported inconsistent findings and few statistically significant results of hospital mergers on healthcare [...]

Background: An observation unit is a short-stay, strictly protocolized, low-acuity unit created by and managed by emergency physicians. This traditional model is evolving given the increase in complexity of comorbidities and socioeconomic challenges of patients. Although patients may present with low acuity issues, they do not always meet the inclusion/exclusion criteria for the Emergency Department [...]