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: 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: Excessive laboratory use has been associated with increased hospital costs, increased incidence of anemia, and unnecessary additional testing and procedures. Previous studies have focused on resident interventions within teaching hospitals amongst other residents, but few studies have had residents intervene on non-teaching faculty. A quality improvement initiative was implemented at our institution to reduce [...]

Background: Healthcare expenditures in the US have been increasing at an unsustainable rate, and thus there is a strong interest in resource stewardship of low-value diagnostic tests. At our institution, internal data, as well as The Vizient™ Clinical Data Base, showed high utilization of inpatient daily labs (complete blood count (CBC), basic metabolic panel (BMP) [...]

Background: Direct acting oral anticoagulants (DOACs) have been approved for conditions such as non-valvular atrial fibrillation and venous thromboembolism. High quality randomized controlled trials have demonstrated the safety and efficacy of DOACs as compared to warfarin with exceptions in specific patient populations (such as those with mechanical heart valves). DOACs are more convenient and generally [...]

Background: Healthcare institutions face a narrow operating budget to provide patient care. Centers for Medicare and Medicaid Services (CMS) evaluate healthcare institutions based on efficiency, quality and customer experience–in other words: length of stay, readmission rate and patients’ perception of the care they received. The effectiveness of decreased readmission is based on multiple variables, and [...]

Case Presentation: A 70-year-old woman with morbid obesity and non-alcoholic steatohepatitis cirrhosis was initially treated at an outside hospital for hematemesis. She received aggressive volume resuscitation, a blood transfusion, and was found to have esophageal varices. She was transferred for endovascular management of her varices. During transfer, she had nausea treated with an antiemetic administered [...]