Background:   Academic medical centers are complex healthcare delivery systems that are quickly adopting electronic health records (EHR) nationwide while still using alpha-numeric paging for physicians-in-training raised with cell phones, texting, messaging, and newer technologies.  Understanding workflow processes for these providers of patient care are key to finding solutions to improve healthcare quality and safety.   [...]

Background: Comanagement is a structured collaboration between hospitalists and a surgical service to improve outcomes of surgical patients perioperatively. We identified the potential to improve patient safety and throughput metrics on the Surgical Oncology and Otolaryngology (ENT) services at our institution. We partnered with these two services to create a novel Surgical Oncology Comanagement Service. [...]

Background: Consultative medicine is an important part of Internal Medicine (IM) resident education. According to the Accreditation Council for Graduate Medical Education, residents are expected to “act in a consultative role to other physicians and health professionals.” However, individual programs each have the ability to integrate the consultative experience into training in their own unique [...]

Background: Consultative medicine has been identified as a core part of internal medicine (IM) resident education by providing the opportunity for residents to care for the non-medical patient. In the early 1980s, two separate academic institutions detailed the initiation of their General Medicine Consultation service. They described who consulted them and the reason for consultation. [...]

Background: Care of complex patients are a daily challenge in the hospital setting, with a direct impact on the health care costs. Although there is no standard definition of a “complex” patient, we can argue that they are patients who need more time and resources during their care process. Age and comorbidities are probably important [...]

Background: Co-management across service lines has become increasingly common in hospital medicine. SHM’s Co-Management Task Force has outlined several components of a successful co-management program. Recent studies have shown that cross-disciplinary service arrangements, which are more collaborative, enhance provider satisfaction and may improve patient care. These benefits have encouraged institutions to roll out multiple co-management [...]

Background: Choice of agent for venous thromboembolism prophylaxis (VTEP) after joint arthroplasty is a complex decision, the difficulty of which has been compounded by divergent guidelines. Specifically, the adequacy of aspirin monotherapy (ASA) for VTEP has long been debated between the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). [...]

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: Patient pass-offs represent a known vulnerability in patient care.   The Hospital Medicine Unit at Massachusetts General Hospital has several specialized roles including an admitting hospitalist, a rounding hospitalist, and a nocturnist.  Our on-service time is typically four or five days in a row.  Our hospitalists and nocturnists work in six hour, ten hour and [...]

Background: UGIB is a common cause of inpatient admissions often associated with morbidity and an overall mortality rate approaching 10%. Since therapy is different, it is important to differentiate between variceal and non-variceal GI bleeding. While both will often need volume resuscitation, proton pump inhibitors (PPI), judicious transfusion and early endoscopy, patients with variceal bleeding [...]