Background: At its 2014 peak, the opioid overdose crisis claimed nearly 30,000 lives, but many hospitals and health systems have small opioid-related initiatives working in disjointed fashion rather than a cohesive response.  Purpose: We created a hospital-wide initiative called the “Brigham Comprehensive Opioid Response and Education” (B-CORE) program to reduce opioid-related morbidity and mortality in [...]

Background: Unexpected overnight adverse events are known to correlate with worse outcomes in inpatients.  Unfortunately, the exact occurrence and etiologies of such events have been less known.    Purpose: The aim of our study was to clarify the occurrence, etiologies of unexpected overnight adverse events and also propose the algorithm so that the catastrophic events [...]

Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication. In the United States, there are more than 20,000 CLABSI per year, resulting in a cost of about $30,000 per infection. A number of interventions have been employed to decrease the risk of CLABSI. Previous studies have documented the importance of simulation-based training. There is [...]

Background: As of December 2015, 49 states initiated the CMS mandated legislation on “Prescription Drug Monitoring Programs.” Yet opiates continue to be commonly prescribed in older adults, despite their well-known risks. This study aims to determine patterns of opiate prescribing, specifically in hospitalized older adults and their impact on outcomes. Methods: This one year retrospective [...]

Background: Intravenous low-molecular weight iron dextran is indicated for patients with iron deficiency who are unable to take oral iron or experience insufficient efficacy with oral replacement. Adverse effects have been reported, including anaphylaxis and death. The primary purpose of this study was to determine the proportion of patients experiencing adverse reactions in a wide [...]

Background: Hospital associated injury is the third leading cause of death in the United States. Lack of communication about patient safety issues among care team members and with patients is a key source of hospital errors and patient harm, and making errors more visible is a key strategy to reduce negative outcomes. Electronic health record [...]

Background: Determining the quality of medication reconciliation (MR) is a laborious and time-intensive process, often involving chart review and detailed patient interviews. Purpose: To identify meaningful, measurable process measures for high-quality MR obtainable from electronic health records (EHR), and to determine if performance on these measures responded to a campaign focused on improving MR. Description: [...]

Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days.  However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and device-characteristics associated with short-term PICC use. Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan [...]

Background: Prophylactic anticoagulation is effective at reducing the risk of venous thromboembolism (VTE), but can also increase the risk of bleeding. Whether anticoagulant prophylaxis should be modified for underweight patients to minimize bleeding complications is unknown.  We sought to determine whether being underweight is associated with the risk of major bleeding in hospitalized medical patients [...]

Background: While use of technologies such as ultrasound and electrocardiographic (EKG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the setting, experience or practice of providers that use these tools. Methods: Using data from the PICC1 survey of vascular access specialists, we identified technology-users from non-users. We defined [...]