Background: The estimated total annual cost of syncope-related hospitalizations in the year 2005 was about $2.4 billion with a mean cost of $5,400 per hospitalization. Syncope of cardiac etiology has 18-33% mortality in comparison to 0-12% with non-cardiac etiology. We sought to evaluate the role cardiac biomarkers in patients presenting with syncope to evaluate their [...]

Background: The 2014 ACC/AHA Perioperative Guidelines suggest using the Revised Cardiac Risk Index (RCRI), myocardial infarction or cardiac arrest (MICA), or American College of Surgeons (ACS)-NSQIP calculators for combined patient-surgical risk assessment. However, there is no published data comparing their performance. Methods: We retrospectively reviewed records of 663 patients seen in our preop clinic who [...]

Background: About 209,000 adults experience an in-hospital cardio-pulmonary arrest (IHCA) every year in the US. Known early warning scoring systems (e.g., MEWS, eCART) have shown low efficiency in predicting a patient’s risk of deterioration. We assessed the possibility of using the Rothman Index (RI) as such a tool. Methods: We conducted a retrospective case-control study with 248 adult inpatients at Yale-New [...]

Background: Cardiac telemetry was originally designed to help detect and provide early intervention in arrhythmic complications of myocardial infarction. Today, however, telemetry use continues to expand beyond the critical and coronary care units, despite adequate research displaying questionable benefit. Our study seeks to assess the utility of telemetry in identifying decompensation in patients with documented [...]

Background: Cardiac monitoring (CM) is often overused, hindering patient mobility, triggering unnecessary cardiac testing, delaying appropriate discharge, and expending resources.  Purpose: To reduce the days that medical and surgical ward patients spend on CM without an indication specified in the 2004 American Heart Association (AHA) guidelines for CM.  Description: At Cedars-Sinai, only 59% of patients [...]

Background: Telemetry is overused in hospitals and continues to be a source of health system waste. Although there have been studies on the cause as well as efforts to reduce telemetry overuse, the extent to which physicians are aware that their patients are on telemetry has not been studied. Unawareness of telemetry status has both [...]

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: Increasing the value of health care, typically regarded as maximizing quality of care while minimizing unnecessary costs, has been an increasing focus of hospitals nationwide.  Ways of reliably measuring unnecessary utilization, however, have not been well-studied. Hospital Compare is a consumer-oriented CMS.gov website that provides information on how well hospitals provide evidence-based care. It [...]

Case Presentation:   A 29-year-old African-American female presented with two weeks of left neck swelling and fever. Over four months, she had noted fatigue, cough, night sweats, and an unintentional 12-pound weight loss. Two empiric courses of antibiotics effected no clinical change. She had no toxic habits and was sexually active with one male partner. [...]

Case Presentation: A 64-year-old man with a past medical history of coronary artery disease, type 2 diabetes, hyperlipidemia, and hypertension presented to the Emergency Department with severe, sharp, crampy abdominal pain. The pain was associated with nausea and vomiting and had progressively worsened over the last 7 days. He denied any chest pain or shortness [...]