Background: Croup is a common cause of respiratory distress in young children secondary to viral infection. Oral dexamethasone has been shown to improve the symptoms of respiratory distress caused by croup. The frequency of repeat dexamethasone dosing during admission or on discharge is not well understood, and the effect of re-dosing on re-admission or recurrence [...]

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 [...]

Background: Multiple educational modalities have been utilized to teach high value care to trainees, including lectures, facilitated group discussion, and behavioral nudges and prompts (1–3). However, little has been done to compare different educational strategies delivered via the same modality. The goal of this study was to explore whether different educational prompts encouraging thoughtful lab [...]

Background: The American Board of Internal Medicine and the Society of Hospital Medicine have identified routine laboratory testing of stable inpatients as one source of low-value care.1,2 As it is estimated that upwards of 21% of all lab tests represent inappropriate overutilization,3 reducing unnecessary testing could have a significant impact on cost saving, limiting waste, [...]

Background: Inadequate assessment and recognition of barriers to discharge at time of admission leads to delays in the discharge process and prolongation of hospital admissions. These delays are associated with multiple negative outcomes such as increased length of stay, decreased patient satisfaction, strain on hospital bed capacity, and higher readmission rates. Prior studies have shown [...]

Background: Cardiac arrhythmias pose a significant risk to hospitalized patients, with the potential for increased morbidity and mortality. Rapid recognition of clinically significant arrhythmias is crucial for timely intervention. Cardiac telemetry monitoring offers a means of remote heart rhythm surveillance in the hospital setting. However, limited availability of telemetry beds in many hospitals and the [...]

Background: Urine culture testing should primarily be reserved for patients with clinical symptoms or other limited indications. Unfortunately, many admitted patients undergo unnecessary urine culture testing, leading to overdiagnosis and overtreatment of asymptomatic bacteriuria (ASB). Unnecessary antibiotic treatment for ASB does not improve outcomes and exposes patients to side effects. The negative implications may include [...]

Background: Increasing mobility in the hospital leads to better patient outcomes. However, published efforts to improve inpatient mobility report resulted increases in unnecessary physical/occupational therapy (PT/OT) consults. In our hospital we noted that physicians were ordering PT/OT on all patients in an effort to increase mobility. This meant very functional patients who did not need [...]

Background: Observations units commonly serve as an intermediate stage between the emergency department and inpatient hospitalization where patients of appropriate acuity are managed, however many observation units exist serving diverse patient populations ranging from peripartum or post-op surgical. Patients in observation units typically have lower-acuity health concerns and have an average length of stay of [...]