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 Centers for Medicare & Medicaid Services (CMS) have sought to reduce readmissions through penalties applied to hospitals with readmission rates that are higher than expected, as calculated from models that use patient-level administrative data to account for case mix. Similar approaches are used to determine expected morality rates. Currently, CMS disseminates hospital-level adjusted [...]

Background: Though previous studies have demonstrated that hypoglycemia is a risk factor for inpatient mortality among hospitalized patients, many clinicians may not be aware of the seriousness of this finding. The purpose of this study was to describe the most common comorbidities and outcomes of patients admitted with hypoglycemia (

Background: Accurate and timely documentation is essential for patient care, as well as the appropriate reflection of patient complexity and severity of illness. Most hospitals utilize a traditional retrospective or contemporaneous physician-query strategy to ensure documentation accurately impacts performance data, reputation/ranking, and reimbursement.  Purpose: Here, we highlight three unique, hospitalist-driven interventions to support accurate documentation [...]

Background:  Transitions of care, whether between or within institutions, are an important source of errors, inefficiency, and unnecessary costs.  Inter-hospital transfers are complicated by incongruent information systems, indirect and asynchronous communication, and geographical distance all in settings of high patient complexity and acuity.  We developed a large database of patients transferred between hospitals to identify [...]

Background: It has been unclear about prevalence and in-hospital mortality of severe hypophosphatemia among hospitalized medical patients. Predictors for in-hospital mortality have not yet been determined in terms those may include serum nadir phosphate level, hemolytic complication from hypophosphatemia, or baseline disease as a cause of hypophosphatemia . Methods: A retrospective cohort study was conducted [...]

Background: Spontaneous Bacterial Peritonitis (SBP) is associated with high mortality.  A recent article[1] showed that, in the setting of SBP, delayed paracentesis was associated with increased mortality.  Because of the clinical ramifications of this association, we attempted to recreate this finding using our local patient population. Methods: Similar to the study that prompted this inquiry, [...]

Background:   The Institute of Medicine estimates that there are 44,000-98,000 preventable deaths per year.  However, there is a paucity of literature regarding preventable death rates, despite its importance as a quality measure.  Methods:   All deaths in the general medicine service from 2010-2012 at an academic hospital underwent an independent retrospective chart review by [...]

Background: Since the 1999 IOM report To Err is Humanhighlighted that up to 98,000 preventable deaths occur annually in U.S. hospitals, efforts have intensified to understand and eliminate preventable mortality. At our institution, we developed an in-person, near real-time, multidisciplinary mortality review to capture the insight of frontline providers and improve care. In the analysis presented [...]

Background:  As electronic health records (EHR) become ubiquitous, the impact on patient outcomes remains largely unknown.  One major communication barrier during patient transfers is the lack of interoperability between EHR systems.  Inter-hospital transfers involve transitioning high acuity patients between hospital systems that may not be able to directly communicate with one another, creating the ideal [...]