Background: Blood transfusion is the most common procedure performed in US hospitals.1 The Joint Commission recently determined that transfusion is among the top five overused procedures,2 and now five societies have Choosing Wisely aims to reduce unnecessary transfusions.3Due to the added risks and cost of transfusion overuse, we implemented a health system-wide patient blood management [...]

Background: Proton pump inhibitors (PPIs) are commonly started inpatient for stress ulcer prophylaxis and wrongly continued on discharge. But in addition to polypharmacy and patient cost, there are significant adverse events associated with chronic use including increased risk of Clostridium difficile, community acquired pneumonia, hip and spine fractures, accelerated progression to chronic kidney disease, and [...]

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: Although controversy exists regarding the effectiveness of rapid response teams (RRTs), they are an essential tool in most hospitals to address rapid patient deterioration and ideally optimize patient safety (1-5). The utility of RRTs is dependent on the quality of the response, which in turn depends on multiple individual and institutional factors. Communication gaps and lack [...]

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 [...]