Background: Hospital associated injury is the third leading cause of death in the United States. Lack of communication about patient safety issues among care team members and with patients is a key source of hospital errors and patient harm, and making errors more visible is a key strategy to reduce negative outcomes. Electronic health record [...]

Background: Bronchiolitis is a clinical diagnosis, with growing research supporting limited use of diagnostic tests and interventions. Hospitals have reduced use of bronchodilators and imaging, but the national average of respiratory viral testing (RVT) in these children continues to be high at 33%. Over the past three years, RCHSD’s rate has persisted at 31-35%, despite [...]

Background: The Society of Hospital Medicine’s Choosing Wisely guidelines recommend regular assessment of inpatients’ need for urinary catheters and telemetry monitoring. Since studies suggest clinicians are not aware which patients have an indwelling catheter or are on telemetry, we aimed to use the electronic patient list to improve cognitive awareness of unnecessary urinary catheters 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:  Transthoracic echocardiography (TTE) is one of the most popular tests in healthcare. Studies of Medicare beneficiaries for example have shown that each year approximately 20% undergo at least one TTE. Repeat TTE defined as TTE done within one year of a prior TTE represent 24-42% of all studies. In the present study we derive [...]