Background: Inappropriate telemetry use has been associated with increased health care cost and unnecessary diagnostic procedures. For these reasons, the Society of Hospital Medicine’s Choosing Wisely campaign promoted use of both American Heart Association (AHA) telemetry guidelines and protocol-driven discontinuation of telemetry. Despite these measures, an estimated 59% of patients are placed on telemetry due [...]

Background: Cardiac telemetry is frequently overused in the hospital. Our institution requires telemetry while patients are on the Clinical Institute Withdrawal Assessment (CIWA) protocol, regardless of the presence or severity of alcohol withdrawal (AW).  Telemetry use in this population has not been studied or incorporated into guidelines, however some patients may need monitoring for co-existing indications. [...]

Background: Up to forty-five percent of Americans do not fill prescriptions secondary to cost. Medication non-adherence leads to morbidity and mortality (~$100-300B annually). The majority of physicians cannot price medications within 25% of cost. Our institution alone sees more than 600 prescription-cash-pay patients (under/uninsured or no Part D) each month. Purpose: To empower clinicians to [...]

Background: Inappropriate laboratory utilization in hospitalized patients is a significant contributing factor to health care expenditures, iatrogenic anemia, downstream testing, and poor patient satisfaction. For these reasons, the Society of Hospital Medicine has recommended through the Choosing Wisely Campaign to avoid repetitive complete blood counts (CBC) and chemistry testing in the face of clinical stability. [...]

Background: The Choosing Wisely campaign was launched in 2012 with a goal of “advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.[1] ”  The Society of Hospital Medicine published 5 recommendations for Adult Hospital Medicine in 2013[2] , including one that advised against performing repetitive complete blood count (CBC) and [...]

Background: Venous thromboembolism (VTE) is a common preventable condition in hospitalized medical patients. Chemoprophylaxis with heparin or fondaparinux has been recommended for all hospitalized patients who are not at low risk, and appropriate thromboprophylaxis is a hospital quality measure. However, the specific threshold of VTE risk that warrants prophylaxis has not been defined. We used [...]

Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine electrolyte values obtained by arterial blood gas testing (ABG) and central laboratory testing (VCL) and determine the extent of essentially [...]

Background: Guiding health care delivery towards patient-centered value can be accelerated by reforming physician reimbursement. Recent legislation including the Medicare Access and CHIP Reauthorization Act (MACRA) and the Affordable Care Act have created frameworks for value-based health care payments. By the end of 2018, the United States Department of Health and Human Services aims to have [...]

Background: In response to skyrocketing healthcare costs, providing high value care is an increasing priority for health care systems. Physicians are responsible for translating high value care (HVC) to the bedside, however there is a paucity of instruments designed to measure observable markers of HVC at the beside. This confounds efforts to develop and measure [...]

Background: Interprofessional teamwork in healthcare organizations is crucial to the delivery of quality patient care. Efforts to improve teamwork on hospital medicine units commonly fail due to clinicians and other care team members (case managers and pharmacists) are responsible for patients scattered across numerous floors and units. UK HealthCare developed and implemented the Interprofessional Teamwork [...]