Background: On a daily basis, hospitalists prescribe Venous Thromboembolism (VTE) prophylaxis. While of benefit to certain populations, VTE prophylaxis has not been proven to benefit medical patients at low risk for VTE. Pharmacologic prophylaxis may increase the risk of serious bleeding, mechanical prophylaxis is associated with an increased risk of delirium, and both methods are [...]

Background: Unit-based care teams offer inherent benefits to hospitalist services, including opportunity for improved efficiency, interdisciplinary collaboration, and enhanced patient experience. However, many barriers exist to creation of these care teams such as high occupancy rates and conflicting interests among stakeholders.  Failure to account for such barriers has led to unsuccessful initiatives to achieve regionalization, [...]

Background: Both the ACP through its High Value, Cost-Conscious Care Initiative, and the ABIM through its Choosing Wisely campaign, have called on clinicians to engage in efforts to improve the value of the care we provide Purpose: We sought to develop a curriculum to provide internal medicine residents both a theoretical and a practical exposure [...]

Background:  Successful inpatient glycemic control programs achieve both improved glycemic control and low rates of hypoglycemia.  Using results from the analysis of performance in glycemic control and hypoglycemia, we identified top performers and those demonstrating the most improvement.   We sought to describe their key characteristics.  Methods :  Participating hospitals (84 for ICU, 94 for non-ICUs) [...]

Background: Caring for patients involves multitudes of moving parts – from teams of physicians, nurses and radiologists to tests, medications and an array of electronic health record (EHR) systems. However, as medical care has evolved, instead of these components working together seamlessly, they often work in silos – both at the provider and patient data [...]

Background: Emergency department (ED) crowding is a widespread national issue which has been shown to negatively impact patient experience and the quality and safety of care delivery.  A community hospital within our academic health system was experiencing significant ED crowding with long ED length of stay (LOS) and high left without being seen (LWBS) rates. [...]

Background:  Per the 2014 State of Hospital Medicine Survey, 94% of adult hospital medicine groups (HMGs) reported financial shortfalls, with a mean of $169,886 in financial support per full time equivalent physician. In addition, many groups face recruitment challenges which lead to workforce shortage and physician burnout. To offset these problems, some groups employ increasing [...]

Background: In an effort to improve pediatric inpatient asthma care, the Joint Commission developed standards for hospital management in 2003. Despite this initiative, inpatient management of asthma exacerbations and adherence to these guidelines varies by institution.  Such differences have an impact on hospital cost, length of stay, and readmission rates.  Based on data from the [...]

Background: The financial success of a hospital medicine practice is dependent on accurate billing and documentation practices. Academic hospitalists face the additional challenge of educating resident physicians on appropriate documentation. As most patients admitted to a tertiary care center are medically complex, initial inpatient E/M code 99221 often signifies a deficiency in documentation rather than [...]

Background: To maximize its effectiveness, performance feedback must be personalized, accurate, timely, and visually appealing. In the clinical environment, effective feedback must therefore extract accurate data from an electronic health-record system, link patient care activity to care teams, and report on meaningful metrics. This requires a synthesis of EHR data, scheduling data, which is often [...]