Background:   Hyperkalemia (HK; serum K+ ≥5.0mEq/L) is a common electrolyte imbalance, associated with an increase in all-cause mortality and hospitalization.  Moderate to severe HK (K + levels ≥5.5mEq/L) is often managed in the emergency department or hospital, where available treatment options include methods to temporarily lower K+ (e.g., insulin-glucose and beta 2 agonists), use [...]

Background:  The Affordable Care Act (ACA) has recently enabled millions of U.S. adults to acquire healthcare coverage.  The differential shift in payer mix in Medicaid-expansion versus non-expansion states after ACA implementation may be relevant to hospitals beyond reimbursement.  Medicaid has historically been associated with longer hospitalizations and higher mortality in diverse patient populations, more so [...]

Background: The 2015 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the use of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Although prior guidelines did not recommend a dose or route, current guidelines recommend oral (PO) prednisone over intravenous (IV) methylprednisolone for non-ICU AECOPD hospitalizations, given [...]

Background: Factors that impact the length of stay (LOS) in hospitalized patients have not been well characterized. We used a dataset from a large national cohort of hospitalized patients to determine if patient demographics, admission month and weekday, payer type, and other hospital care variables are associated with LOS in hospitalized patients. Methods: We used [...]

Background: Diuretic therapy is the mainstay of treatment for heart failure exacerbations but its optimal dosing strategy remains unclear. In 2011, the DOSE trial exhibited a trend toward improvement in patients’ global symptom assessments when utilizing a high-dose diuretic strategy, which used nearly 80mg intravenous furosemide three times daily in the first 72 hours on [...]

Background: Keeping admitted patients in the emergency room (ER) carries negative operational and clinical consequences. Prolonged stays reduce ER bed turnover, thereby limiting access for other patients. Furthermore prolonged ER length of stay (LOS) has shown to be an independent risk factor for 30 day mortality for admitted patients. For these reasons, Veterans Affairs (VA) [...]

Background: The Joint Commission’s Surgical Care Improvement Project (SCIP)-9 recommended removing indwelling urinary catheters (IUC) before postoperative day 2 to decrease urinary infection (UTI) risk. Our center implemented a best practice alert (BPA) in the electronic health record to enforce SCIP-9 with near-100% compliance.  We sought to study the effect of the BPA on catheter [...]

Background: Hospital medical groups use various staffing models which systematically affect care continuity during the admission process. Our service changed models of care from a “general model”, where hospitalists who perform hospital rounds and discharges also perform admissions on the same service day, to an “admitter-rounder model”, where service work is divided each day between [...]

Background: Many institutions struggle with educational structure in the wake of ACGME duty hour restrictions, and concerns have been raised that there has been a net negative impact on quality of education. Efforts to balance service and education are continuously in flux. At our institution efforts to address this balance have included a redesign of [...]

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 [...]