Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Hospitalization is costly, associated with the potential for adverse medical events and may have deleterious health effects.  Hospitalist physicians are uniquely positioned to help patients avoid unnecessary hospitalizations.  Our attending-only hospitalist practice in a tertiary academic center admits approximately 350 patients monthly, the majority of which are referred through the emergency department (ED).  Our [...]

Background: Hospitalization is costly, associated with the potential for adverse medical events and may have deleterious health effects.  Hospitalist physicians are uniquely positioned to help patients avoid unnecessary hospitalizations.  Our attending-only hospitalist practice in a tertiary academic center admits approximately 350 patients monthly, the majority of which are referred through the emergency department (ED).  Our [...]

Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: The Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review (CLER) program has placed a much-needed spotlight on the role of resident physicians in patient safety (PS) and quality improvement (QI). Medical school training in PS/QI is highly variable and our residents received very limited formal training in PS/QI prior to the intervention [...]

Background: Emergency Department (ED) overcrowding and delays in ED throughput have several important consequences , such as boarding of admitted patients in the ED, longer hospital stays and delay in effective inpatient discharge planning (1). Longer ED boarding time and delay in inpatient discharge process are parts of a vicious cycle of internal bottleneck contributing [...]

Background: The American Board of Internal Medicine expects all general internists to be competent, at least “with regard to their knowledge and understanding,” in bedside paracentesis, thoracentesis, central venous catheterization, and lumbar puncture, among other less invasive procedures.  Unfortunately, increasing patient loads with a focus on efficiency caused a shift away from our hospitalist group [...]

Background: Sepsis, severe sepsis, and septic shock combined, are estimated to affect between 650,000 and 750,000 Americans annually, and has an associated mortality rate between 20 to 50%.  Early identification of patients with sepsis is critical, as treatment delays are associated with significant increases in mortality. The electronic health record (EHR) contains near-real-time physiologic parameters, [...]

Background: In-hospital mortality attributable to sepsis is higher than overall population mortality (Gaieski DF et al, 2013; Dombrovskiy VY, 2007). Furthermore, the rates of severe sepsis are increasing annually (Dombrovskiy VY,2007). Early detection and early intervention have been shown effective at reducing mortality among in-patients (Dombrovskiy VY, 2007). Internal data suggests that the identification of [...]

Background: Discussion of medical errors in patient care is often not formally taught in most residencies or medical schools.  Yet the skill set needed for addressing patient adverse events when they occur and preventing similar occurrences in the future is instrumental for the practice of medicine. A Morbidity and Mortality Conference (M&M) is one way [...]