Background: High value care is a key priority in healthcare, but strategies are needed to empower frontline clinicians to work with organizational leadership to reduce healthcare costs and improve care.   Purpose: Caring Wisely (CW) is a program we developed that is designed to engage frontline clinicians and staff, connect them with implementation experts, and [...]

Background: Hospitalization is costly, associated with the potential for adverse medical events and may have deleterious health effects.  Hospitalist physicians are uniquely positioned to help patients avoid unnecessary hospitalizations.  Our attending-only hospitalist practice in a tertiary academic center admits approximately 350 patients monthly, the majority of which are referred through the emergency department (ED).  Our [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is the third leading cause of readmissions and is now included in the Medicare Hospital Readmissions Reduction Program (HRRP). Our institution developed an inter-professional program aimed at reducing all-cause 30-day readmissions for patients admitted with AECOPD. Methods: We iteratively developed and piloted our inter-professional COPD HRRP [...]

Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Experts identify empathic responses to patient expressions of negative emotion – such as anxiety, sadness, and anger – as a key component of patient-centered communication, yet evidence on the impact of empathy on patient-reported outcomes in the hospital is limited. Methods: Our study objective was to assess the association between hospitalists’ expressions of empathy [...]

Background: Delays in the discharge process of hospitalized patients impact patient flow and lead to increased costs and slower progression of care. As hospitalist work becomes increasingly shift based, there are concerns for proper patient handoffs and hesitancy with clinical progression of care overnight. This leads to daytime patient flow congestion and is a significant [...]

Background: Hospital medicine is a maturing field that increasingly focuses on providing high value patient care. A key question in the value equation is how different patient census sizes impact care. Our recent research showed that higher patient censuses were associated with longer hospital length of stay and costs. This study follows up on this [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) Multi-site Quality Improvement Collaborative aims to improve discharge transitions by testing a patient-centered transition bundle. Teach-back is a core component. This is a well-established method of confirming understanding. However, limited evidence exists about the effect of using teach-back for pediatric discharge education on parental knowledge/understanding of essential [...]

Background: Over the last several years we have seen the rapid growth of the specialty of hospital medicine across the country. One of the unintended consequences of this expansion has been the decrease in direct teaching responsibilities of the medical subspecialists on the inpatient medical teaching services. As these responsibilities have been subsumed by our [...]