Background: The number of hospitals with dedicated observation units has grown in recent years to one-third of all United States hospitals and 80% of academic medical centers, though much is still unknown about how to best deliver care in this setting. At our institution, syncope is among the most common indications for admission to the [...]

Background: CMS and other entities have focused on reduction of readmissions as a national quality improvement goal. The 30-day risk standardized readmission rate is derived from administrative data and requires the accurate coding of a principal diagnosis. We sought to validate the coded principal diagnosis for patients admitted with pneumonia and to determine if local [...]

Background: One year all-cause mortality rates after a fragility fracture are as high as 24%. Treatment of osteoporosis following fracture reduces mortality, recurrent fractures rates, and healthcare costs. Without endocrinology involvement, clinicians often fail to recognize and treat osteoporosis. We aimed to assess the frequency of fragility hip fractures including recurrence rates at our academic [...]

Background: Many red blood cell transfusions (RBCT) are unnecessary or harmful according to clinical trials and guidelines. These RBCT put patients at risk and waste scarce healthcare resources. Clinical decision support (CDS) using the Epic™ computer provider order entry system has reduced unnecessary transfusion (Goodnough et al, Transfusion 2014) at one center with a post-intervention [...]

Background: Hospitalized patients have significantly reduced ambulation, which leads to decreased muscle strength, coordination, and balance, all which increase the risk of falls. According to the Joint Commission, hundreds of thousands of patients fall in hospitals every year, resulting in injury in 30% to 50% of cases. Serious injuries, such as fractures, subdural hematomas, excessive [...]

Background: Hospitalized patients get fewer than five hours of sleep a night. Poor sleep leads to increased rates of delirium, falls, and hypertension, and decreased patient satisfaction. Purpose: To improve sleep among hospitalized patients through a resident-led project aimed at minimizing nighttime disruptions and changing culture. Description: In a needs assessment survey, hospitalized patients reported [...]

Background: Practical and financial pressures have placed a renewed focus on improving the human experience of healthcare from both the patient and provider perspective. Despite this, aligning patients and interdisciplinary providers around meaningful experience improvement in the inpatient setting remains elusive. We sought to develop an innovative interdisciplinary design process for experience improvement on a [...]

Background: Do-not-resuscitate (DNR) orders are intended to allow patients to forgo cardiopulmonary resuscitate (CPR) in the event of cardiac arrest. They are applied to cases of cardiac arrest, and they cannot be applied to any situation other than cardiac arrest. However, prior studies have shown that the presence of DNR orders led to changes in treatment [...]

Background: Hospitalization of the patient with advanced cancer can be a pivotal moment and opportunity to explore patient goals of care in order to deliver high value, patient-centered care that emphasizes quality of life. Part of this discussion should define patient preferences regarding code status as it is known that prognosis is extremely poor and [...]

Background: Interprofessional rounds have the potential to improve patient safety, quality, and experience.  Although increasingly implemented, significant variation in rounding practice patterns exist and few data are available to evaluate impact on patients’ experiences. We implemented a novel inpatient collaborative care (CC) model, which includes interprofessional rounds, and also purposely integrates patients and families into [...]