Background: Preoperative assessment is a common medical practice, with latest guidelines emphasizing use of additional diagnostic testing only in patients to whom it would bring substantial change in management. The objective of our study is to determine the appropriateness of diagnostic tests used in preoperative assessment Methods: This observational study was conducted at a 200 [...]

Background: Thrombophilia testing is frequently ordered in the inpatient setting. However, testing is costly and can be misleading in the setting of acute thromboembolism or concurrent anticoagulation use. Furthermore, hereditary thrombophilias do not predict a clinically significant increase in VTE recurrence. Methods: We conducted an educational intervention with a randomized cross-over design for Internal Medicine [...]

Background: Compared with patients in the community, patients acutely hospitalized are at higher risk of developing venous thromboembolism (VTE), contributing to patient morbidity and mortality and healthcare costs. The need for thromboprophylaxis for post-surgical patients is well-known and the importance of thromboprophylaxis for acutely-ill hospitalized medicine patients has been increasingly accepted. We aimed to analyze [...]

Background: Several studies attest the effectiveness of physician order set, also known as Power Plan (PP) in standardizing patient care and improving outcomes. In general, PP use is suboptimal. We hypothesized that PP use in patients admitted with Chronic Obstructive Pulmonary Disease (COPD) assists in  standardization and appropriateness of inpatient management. Methods: We conducted a [...]

Background: Laboratory testing is an integral part of modern medicine with an estimated 4-5 billion tests performed in the United States each year, and accounts for 3-5% of healthcare spending. At our resident-run clinic in an underserved community, the cost of laboratory tests in 2013 was over $400,000, exceeding the government subsidy. In this study, [...]

Background: Patients often must wait several hours before being seen by an admitting attending physician. Protracted admit wait times are undeniably associated with delays in care, patient and family dissatisfaction, and very likely increased lengths of stay (LOS), morbidity, and mortality. For over 10 years at our tertiary care academic institution, advanced practice providers (APP) were responsible [...]

Background: The development of systems that optimize quality of care, reduce costs, and enhance safety is vital to patient care. The VA healthcare system utilizes 27 quality metrics which allow for institutions to assess their performance in these areas, referred to as Strategic Analytics for Improvement and Learning (SAIL). SAIL data includes performance reports regarding [...]

Background: Administering opiates safely in hospitalized patients with acute on chronic pain is challenging. There is limited data to guide pain management in this population due to high prevalence of opiate tolerance and variance in daily opiate exposure. There is a need to establish a safe and effective pain medicine regimen in the hospital that stratifies opiates based on [...]

Background: Medical patients with comorbid psychiatric illness comprise 20-40% of general medicine inpatient admissions. These patients often have multiple providers involved in their care which can lead to poor communication, longer lengths of stay, and increased resource utilization. Despite substantial need, no standard model of care exists for this patient population. At our academic medical [...]

Background: The advent of the Electronic Health Record (EHR) has changed the face of medical documentation. Illegibility and absence of data have all but disappeared, and EHRs can foster thoughtful assessments by providing a platform to craft differential diagnoses. However, EHRs have also introduced features like “copy and paste” and “blow in” templates that can [...]