Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. Furthermore, in-hospital cardiopulmonary resuscitation (CPR) is associated with worse outcomes than intubation. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, [...]

Background: Alarm fatigue is a serious patient safety issue and represents a 2015 National Patient Safety Goal.  False alarms can mask true alarms, and may contribute to suboptimal patient care practices.  Cardiac telemetry monitoring in particular has been a focus in the Choosing Wisely campaign and at our institution. Purpose: A comprehensive, multidisciplinary approach was [...]

Background: Hospital admission presents an important opportunity to engage with patients about goals of care (GOC) and advanced care planning. The significant and sensitive nature of GOC conversations requires that documentation of a patient’s goals be accurate, clear, and easily found in the medical record. This has become increasingly relevant in the setting of frequent [...]

Background:   The overall national patient satisfaction scores have improved since the HCAHPS reporting began. However, it is unknown whether the improvement trends are different between teaching and non-teaching hospitals. Therefore, our objective was to compare long-term changes in patient satisfaction between teaching and non-teaching hospitals. Methods:   We used three datasets; HCAHPS data (2008 [...]

Case Presentation: A 75 year-old man with history of type II diabetes and hypertension presented with progressive dyspnea. Two weeks prior, he had presented with similar symptoms that were attributed to COPD due to a remote history of smoking. He was hypoxic upon presentation requiring bi-level positive pressure ventilation with a FiO2 of 40%. He [...]

Case Presentation: A 65 year-old man with end-stage renal disease was brought to the Emergency Department (ED) when he developed confusion and shortness of breath at a skilled nursing facility (SNF).  He had a recent prolonged hospitalization for pelvic osteomyelitis and was discharged to the SNF 3 days before presentation.  In the ED, the providers [...]