Background: Peripherally inserted peripheral catheter (PICC) use is associated with many complications including line related thromboembolism. Several studies and meta- analyses confirmed the increased risk to develop venous thromboembolism in non-O blood group patients. We wanted to assess the association between PICC line related thromboembolism and the ABO blood group. Methods: Our study sample consisted [...]

Background: Septic patients that require ICU level of care are treated empirically with vancomycin. Although this treatment is effective for MRSA infections, prolonged vancomycin exposure can cause nephrotoxicity and antibiotic resistance. A test to identify patients with a low risk for MRSA infection could facilitate early vancomycin discontinuation. In patients presenting with pneumonia, MRSA swabs [...]

Background: Reducing LOS promotes value, and when aligned with patient preferences, can improve care. Patients referred for palliative care (PC) generally have longer length of stay (LOS) due to their serious illness, multiple complex management issues, and the fact that long LOS is a reason for engaging a specialty PC team. The aim of this [...]

Background: Inappropriate antibiotic use is associated with bacterial resistance, adverse events, and an increased risk of Clostridium difficileinfection. However, providers often prescribe antibiotics for viral respiratory infections and treat infections such as bacterial pneumonia for unnecessarily prolonged durations.  Serum procalcitonin (PCT)-guided treatment is known to safely reduce antibiotic use and duration of treatment in pneumonia. [...]

Background: Previous studies have determined that a small subset (~10%) of the results of tests pending at discharge (TPADs) require action. Challenges for hospitalists in dealing with actionable TPADs include identifying TPADs that are truly actionable and ensuring appropriate follow-up. Little is known about the factors that predict whether a TPAD is actionable. The goal [...]

Background: Unnecessary diagnostic testing contributes to the escalating cost of health care in the US and can cause harm to patients. Daily blood work has become a routine part of care for hospitalized adults though only a fraction of tests change diagnosis or management decisions. At academic medical centers, residents are responsible for ordering most [...]

Background: Earlier discharge time is an important satisfaction metric for patients, maximizes the utilization of hospital beds, and reduces waste and capacity issues in EDs /PACUs. Overall, early discharge represents high-value care and responsible stewardship of a scarce resource. Our healthcare system assessed the discrepancy between bed demand and bed needs, finding 25% of Tuesday [...]

Background: Formal curricula for teaching medical students high value care are lacking, and there is little evidence identifying strategies that can effectively impact students’ knowledge and skills. Research is needed to develop models for student-led HVC implementation in healthcare settings. Purpose: To create a student-led longitudinal curricular experience that leads to improvements in utilization outcomes. [...]

Background: The healthcare system in the United States is often times costly and inefficient. Some estimates suggest that 20-34% of healthcare dollars are spent ineffectively. Despite efforts such as the Choosing Wisely Campaign to limit preoperative testing prior to low risk surgery, preoperative cardiac testing before low risk procedures remains common. This study assesses the [...]

Background: Chest pain accounts for 2-5% of all Emergency Room (ER) visits. Tools like TIMI score and HEART score exist to risk stratify patients, but a low threshold for admission has been traditional because the risk of inadvertent discharge of patients with true ACS. In this study, we evaluate the yield of myocardial perfusion scan [...]