Background: Peripherally inserted central catheters (PICCs) have been associated with venous thromboembolism (VTE) and are a major cause of upper extremity deep vein thrombosis (DVT).  However, mechanisms to identify patients at greatest risk of PICC-associated VTE are limited. Methods:  Using data from the Michigan Hospital Medicine Safety consortium, patients with PICCs that experienced symptomatic, image-confirmed [...]

Background: Peripherally inserted central catheters (PICCs) have been associated with venous thromboembolism (VTE) and are a major cause of upper extremity deep vein thrombosis (DVT).  However, mechanisms to identify patients at greatest risk of PICC-associated VTE are limited. Methods:  Using data from the Michigan Hospital Medicine Safety consortium, patients with PICCs that experienced symptomatic, image-confirmed [...]

Background: Although the national quality improvement campaigns are implemented to reduce Door-to-Balloon (DTB) time in the U.S.A., the community hospitals in Japan lack human resources and appear to be particularly challenging to implement these strategies such as 24/7 in-house cardiologists. Hospitalist is well positioned to be leaders and perform work improvement. Recently, there is increasing [...]

Background: Cardiac arrest on the wards may be preceded by unmet palliative care needs, including advance care planning and specialty palliative consultation that can seek to align patients’ prognoses and goals for care. Identification of hospitalized patients with limited life expectancy allows for the delivery of appropriate palliative interventions. However, the prognosis on admission of [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: In 2011, sepsis accounted for more than $20 billion (5.2%) of total US hospital costs.  The CDC estimates that hospitalizations for sepsis or septicemia increased from 621,000 to 1,141,000 in 2000 and 2008 respectively.  Severe sepsis has an in-hospital mortality rate of 28.6-37.7%, and those who survive may face a difficult recovery including long-term [...]

Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days.  However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and device-characteristics associated with short-term PICC use. Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan [...]

Background: Multi-lumen (ML) peripherally inserted central catheters (PICCs) are associated with increased risk of central line associated blood stream infection (CLABSI), venous thromboembolism (VTE) and increased cost compared to single lumen (SL) PICCs. Current guidelines recommend minimizing the number of PICC lumens. However, there is a paucity of literature to guide the selection of SL [...]

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 [...]