Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: Community acquired pneumonia (CAP) is commonly treated in hospitals and frequently results in antibiotic overuse. Important areas of overuse for CAP include excess treatment duration and unnecessary fluoroquinolone use. Smaller hospitals, including critical access hospitals (CAHs), often have limited resources for antibiotic stewardship compared to larger institutions which impedes stewardship efforts. After 2 years [...]

Background: Dichotomous outcomes—such as mortality—rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether [...]

Background: Urgency of and time to antibiotic administration has often been highlighted to prevent complications of community acquired pneumonia (CAP). Adult literature is mixed on whether administration of antibiotics within four hours of diagnosis of CAP reduces morbidity and mortality, however this has not been studied in pediatric patients. We evaluated whether time to antibiotics [...]

Background: Community acquired pneumonia (CAP) is a leading cause of hospitalization, economic burden and excess antibiotic use in the United States.1,2 Previously, a multidisciplinary group at University of Utah Health launched a clinical decision support triggered CAP pathway in 2017 that was associated with cost savings and decreased duration of antibiotics.3 Based on review of [...]

Background: Hospital antibiotic stewardship programs (ASPs) play a critical role in minimizing unnecessary antibiotic use and combating antimicrobial resistance. Although various antibiotic stewardship interventions have been described, the feasibility and sustainability of these approaches remain uncertain. Furthermore, some interventions may be challenging for smaller hospitals to implement due to informatics resource limitations. Thus, we aimed [...]

Background: Carotid artery Doppler ultrasound is a valuable diagnostic tool for patients with neurological symptoms suggestive of cerebrovascular disease, such as transient ischemic attack (TIA), stroke, or focal neurological deficits. However, its diagnostic utility is limited in patients presenting with non-specific symptoms such as syncope, dizziness, or headache. Unnecessary Doppler orders in these cases can [...]

Background: Nearly one-third of laboratory tests in hospitalized patients and up to 60% of routine, repeat lab tests are unnecessary. Unnecessary testing results in excess venipuncture, iatrogenic anemia, patient discomfort, excess costs, wasted lab resources, and a potential cascade of additional tests and interventions. Few academic medical centers, including our institution, have systematic lab stewardship [...]

Case Presentation: A 26-year-old male with HbSS sickle cell disease and a history of recurrent hospitalizations for vaso-occlusive crises, requiring a right chest port for pain management and IV fluids, presented with sepsis and an acute vaso-occlusive crisis. Initial infectious workup, including chest X-ray, CT of the chest, abdomen, and pelvis, and urinalysis, was unremarkable. [...]