Background: Through collaborative neurosurgical comanagement services, hospital medicine has had an increasing role in the hospital-based care of the neurosurgical patient.  This care model has evolved with the change in demographics of traumatic brain injury (TBI), in which patients are increasingly likely to be medically complex older individuals sustaining their injury after ground-level fall.  Compared [...]

Background: Previous research has explored the impact of delayed ICU transfer on patient outcomes, but the subjective nature in defining onset of critical illness in many of these studies has made it difficult to accurately quantify this association.  We sought to investigate this impact using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously [...]

Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The success of efforts to improve transitional care likely depends in part on local attitudes, culture, workload, and training. Prior to implementation of a multi-faceted transitions intervention, we strove to better understand these contextual factors among providers involved in care transitions [...]

Background: Point-of-care ultrasound (POCUS) has been rapidly adopted by emergency medicine (EM) as a tool for clinical care. There is growing evidence that POCUS may improve care outside of EM, and POCUS has recently seen increased application in other specialties including internal medicine (IM). Nevertheless, no formal training recommendations exist for IM, and there is [...]

Background: Routine preoperative coagulation tests continue to be ordered despite the lack of evidence supporting their use or ability to predict bleeding complications. This may delay surgery, cause unnecessary concern if “abnormal”, and increase cost. It is also unclear whether prophylactic fresh frozen plasma (FFP) decreases bleeding risk. The hospitalists at our university preoperative assessment [...]

Background: Pediatric obesity is a major public health and economic burden in the US. Recent reports suggest a possible crest in the pediatric obesity epidemic. Many researchers have focused on childhood obesity epidemic and comorbidities associated with it. To identify the growing problem of pediatric obesity, we used national data to look at the number [...]

Background: Patient safety relies in part on timely review of laboratory and other results by appropriate providers. At our quaternary care, free-standing children’s hospital, providers were directly notified only of “critical” results (<1% of all lab results). While inpatient labs resulted prior to discharge are actively reviewed in the electronic medical record (EMR) by inpatient [...]

Background: Acute upper GI bleed (UGIB) is a major cause of hospital admissions, with peptic ulcers being the most common cause.  In addition to pre-endoscopic PPI and urgent endoscopic intervention, current consensus guidelines recommend intensive continuous PPI infusion for 72hrs to decrease the risk of re-bleeding in patients with high risk features. However, a recent [...]

Background: As a requirement of the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS) established the Hospital Readmissions Reduction Program (HRRP) and started reduced payments to hospitals with excess 30-day readmissions on October 1, 2012. Over the past three years, the maximum penalty has steadily increased from 1% to 3%; however, the [...]

Background: Anemia is the most commonly encountered hematologic abnormality in preoperative evaluations and has been associated with major adverse outcomes in surgical procedures but often ignored during preoperative evaluation.  The purpose of this study is to examine the prevalence of preoperative anemia and its relationship to postoperative transfusion requirements in patients undergoing elective joint replacement [...]