Background: At all academic medical centers, nurses and resident physicians are two prominent front-line contributors to the care of patients. During a patient’s hospital stay, they receive communication regarding their diagnosis, test results, management, and plan of care from both the resident physicians and the nursing staff. Therefore, it is critical to have effective communication [...]

Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: At all academic medical centers, nurses and resident physicians are two prominent front-line contributors to the care of patients. During a patient’s hospital stay, they receive communication regarding their diagnosis, test results, management, and plan of care from both the resident physicians and the nursing staff. Therefore, it is critical to have effective communication [...]

Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: The use of physical restraints (PR) in the hospitals among patients is associated with increased delirium, pressure ulcers, prolonged ventilator use, post traumatic stress disorder and disruption of therapeutic relationship with the healthcare team. The current scientific research suggests their ineffectiveness for patient safety like preventing falls or dislodging medical devices. There has been [...]

Background: Delirium is a neuropsychiatric syndrome that can occur in hospitalized patients. The negative impact that delirium has on the patient and the health system are well described and include increased mortality, risk of falls, length of stay and overall healthcare utilization. Delirium can have a heterogenous presentation including hyperactivity with agitation, restlessness and psychosis [...]

Background: Compared to peripherally inserted central catheters (PICC), midlines have a lower risk of bloodstream infection, but several studies have found increased thrombosis risk for a variety of clots such as deep vein thrombosis, superficial vein thrombosis, and greater daily hazard of thrombosis. Given increased midline use, better safety data is needed for complications such [...]

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: 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: Current surveillance approaches underestimate harmful diagnostic errors (DE) in hospitalized patients. A recent study of 2809 admissions observed that while one or more adverse events (AE) occurred in 23.6% of cases, only 10 AEs (0.1%) were attributable to DEs (1). Studies using the Safer Dx instrument have observed harmful DE rates of 5-7% (2). [...]