Background: Structured mortality review can help identify care issues and focus quality efforts, but existing methods have limitations. In the Department of Medicine at UCLA, we developed a novel in-person, near real-time, interdisciplinary rapid mortality review (RMR) process to capture the insight of frontline providers and improve care. In this study, we compare the yield [...]

Background: Advance care planning can be challenging for both patients and providers.  Barriers to understanding patients’ goals of care include patient and provider discomfort with the topic, as well as family and cultural dynamics.  The Stanford Letter Advance Directive (LAD) is a simple tool written at a fifth grade reading level in eight different languages [...]

Background: Although point-of-care ultrasound can improve patient care and reduce unnecessary downstream costs, few economic models exist on hospitalist use and whether remuneration for imaging could offset equipment costs.  As the heart and lungs are commonly examined during admission, we observed the frequency of use and projected fiscal outcomes of point-of-care cardiac ultrasound by an [...]

Background: Rich sources of data are available in hospitals, but are often housed in different systems. These include electronic health records (EHRs), physician scheduling software, and existing tools that can be used to electronically contact clinicians. Developing a streamlined way to integrate and connect disparate data has enormous potential for clinical care, operations, and research. [...]

Background: Co-management across service lines has become increasingly common in hospital medicine. While debate continues over clinical outcomes, some co-management arrangements have led to enhanced provider satisfaction, which may have implications for burnout. We have established successful co-management services with orthopedics, urology (GU), otorhinolaryngology (ENT), trauma and neurosurgery (NS). We are a large urban/suburban academic [...]

Background: A variety of risk prediction scores have been devised to identify patients at increased risk for VTE in different patient populations and settings. Guideline recommendations for VTE risk assessment vary greatly. We performed a systematic review to identify and synthesize evidence on clinical risk prediction scores for VTE in medical and surgical hospitalized patients. [...]

Background: National guidelines recommend sampling unilateral pleural effusions to characterize the fluid as either transudative or exudative.  Currently, the only method to characterize pleural fluid is by collecting a sample through an invasive drainage procedure that has risks of complications and is uncomfortable for the patient.  Few noninvasive methods have been studied to differentiate exudative [...]

Background: A growing body of evidence supports the use of point of care ultrasound increasingly as augmentation of the physical exam and clinical decision making. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on the training approach and development of competency for hospitalists [...]

Background:   Observation care has evolved significantly since its original inception by the Centers for Medicare and Medicaid Services (CMS).  Originally intended to span less than 48 hours in the majority of cases, the Office of Inspector General (OIG) reported that 11% of all observation stays lasted three or more nights in 2012.[1]Having a higher length [...]

Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics [...]