Background: In 2004, the American Heart Association (AHA) published recommendations on the use of cardiac monitoring in the hospital setting. It provided a rating system for its indications (Class I-III), which stratify the likelihood of benefit. In June 2013, The Joint Commission approved NPSG.06.01.01, a patient safety goal on clinical alarm use in the hospital [...]

Background: On October 1, 2007, Medicare changed their payment structure from Diagnosis Related Group (DRG) to Medicare Severity-Diagnosis Related Group (MS-DRG) based reimbursement. This led institutions to prioritize clinical documentation improvement (CDI) programs in an attempt to align healthcare resources with patient complexity. Complete documentation has other benefits to a healthcare system as well. These [...]

Background: As health systems focus on providing high–value, cost–conscious care, efforts to optimize laboratory testing are increasing.  In order to improve safe and effective utilization of the laboratory, it is informative to understand the prevalence of overuse and its contributing factors. Methods: The Value Improves Quality (VIQ) curriculum was implemented at our institution in 2014 [...]

Background: Sickle cell crisis is a acute medical emergency, which may require management in the ICU. Sickle cell anemias are remarkable in their clinical heterogeneity. Some people remain asymptomatic in their adult life, whereas others suffer repeated crisis; requiring multiple hospitalizations. In this study, we determine the demographic factors associated with a high readmission rate [...]

Background: As chronic illnesses are claiming majority of deaths in United States, it is very important that we identify patients with chronic illnesses who have shortened life expectancy and prioritize their needs for palliative care. The different death trajectories of chronic illnesses make it difficult to prognosticate such patients. Available prognostication tools, both disease specific [...]

Background: Patients who are admitted through the emergency department with a primary diagnosis of bleeding represent a group with significant morbidity and mortality. Of those patients admitted with a primary bleeding diagnosis, those on anticoagulants represent the greatest risk for adverse outcomes and cost. Better identification of the types of patients who present with bleeding [...]

Background:   Five percent of Medicare’s patients account for almost 50 percent of its cost. The same 5:50 rule holds true for other insurances. The ongoing changes in health care like Affordable Care Act, Meaningful Use, ICD 10 transition, and Value Based Purchasing has placed acute care hospitals like ours at risk for significant financial [...]

Background: As part of the Choosing Wisely campaign, the Society of Hospital Medicine highlights use of telemetry monitoring as one of the top interventions that physicians and patients should use judiciously.  While telemetry is invaluable when used appropriately, unnecessary telemetry utilization has several drawbacks, including cost as well as potentially reducing patient mobility and ability [...]

Background: The United States is responsible for 43% of lab expenditures worldwide, and up to 30% of lab tests may be unnecessary.  Purpose: This project aims to determine if a human “best practice alert (BPA)” could decrease the number of unnecessary labs ordered by residents at a major academic medical center.  Description: Three internal medicine [...]

Background: Cardiac biomarkers, such as myoglobin and B-type natriuretic peptide (BNP), are frequently ordered in the emergency room and inpatient settings. Newer studies and guidelines have called into question the value of these tests in diagnosis and management. Myoglobin is commonly used for early diagnosis of acute coronary syndrome (ACS) in patients who present with [...]