Background: Hospital-acquired delirium is a common cause of increased morbidity and mortality. In an earlier pilot study, we identified through surveys that adult medicine inpatients slept an average of 4 hours. Also, multiple factors including environmental noise, vital sign checks, and lab draws were recognized as barriers to sleep. Based on this information and prior [...]

Background: AKI occurs in 10% of hospitalized patients and the incidence is rising. Renal Ultrasound (US) is frequently performed but its clinical utility has been questioned. The goal of this study was to evalaute US diagnostic yield in AKI cases and establish indications for inpatient kidney US. Methods: A retrospective analysis of renal US were obtained from January 2016 to March [...]

Background: The Society of Hospital Medicine’s Choosing Wisely guidelines recommend regular assessment of inpatients’ need for urinary catheters and telemetry monitoring. Since studies suggest clinicians are not aware which patients have an indwelling catheter or are on telemetry, we aimed to use the electronic patient list to improve cognitive awareness of unnecessary urinary catheters and [...]

Background: Despite detailed Infectious Disease Society of America (IDSA) skin and soft tissue infection guidelines, patients with cellulitis at our institution consistently receive antibiotics with high local resistance or that are inappropriate based on IDSA guidelines. Our baseline data showed that 55 percent of patients receive antibiotics per IDSA guidelines and only 33 percent of [...]

Background: Ultrasound-guided thoracentesis and paracentesis are frequently performed for both diagnostic and therapeutic indications. While the risk of aspiration is low, our institution has historically required patients to be fasting for 4 hours prior to the procedure. In the hospital setting, unnecessary fasting requirements could contribute to missed patient meals and procedure delays. Here, we [...]

Background: Multi-lumen (ML) peripherally inserted central catheters (PICCs) are associated with increased risk of central line associated blood stream infection (CLABSI), venous thromboembolism (VTE) and increased cost compared to single lumen (SL) PICCs. Current guidelines recommend minimizing the number of PICC lumens. However, there is a paucity of literature to guide the selection of SL [...]

Background: Health care expenditures in the United States have been increasing exponentially while hospital care accounts for one-third of the costs. Approximately 18% of hospitalized Medicare beneficiaries are being readmitted within 30 days following their discharge. As a quality measure, penalties for high readmission rates are inversely affecting the reimbursements.  Currently, research on the factors [...]

Background: Chemoprophylaxis with subcutaneous heparin or low-molecular weight heparin is recommended for venous thromboembolism (VTE) prevention in appropriate medical patients.  However, all doses are not always administered and the consequences are unclear.  We sought to determine if there is a relationship between missed and/or refused doses and development of in-hospital VTEs. Methods: The study is [...]

Background: The American Board of Internal Medicine Choosing Wisely initiative advocates avoiding automatic daily labs as a way to lower hospital costs. The Legacy Health Inpatient Medicine Service (LIMS) aimed to reduce unnecessary and inappropriate lab testing amongst internal medicine inpatients within our five hospital health system. Purpose: To decrease inpatient lab costs in fiscal [...]

Background: Hospital medicine programs have a responsibility to maintain high standards of clinical excellence, patient safety, and efficiency for all hospitalists within their program.  Organizational change, program growth, and faculty turnover make this endeavor challenging.  Developing a thoughtful monitoring, evaluation and feedback process is essential to successfully maintain the highest standards of care. Purpose: Describe [...]