Background: We identified a number of quality, patient satisfaction, and staff satisfaction issues that all seemed to be linked to throughput challenges. We had trouble getting patients out of the hospital on discharge day, which set off a number of downstream effects including backups in the Intensive Care Unit (ICU) and Emergency Department (ED). These [...]

Background: Improving hospital throughput is a barrier facing medical facilities.  Poor throughput leads to prolonged patient wait times for beds, a cause of patient complaints.  Often these wait times are the result of late discharge times for admitted patients.  One focus of multidisciplinary rounds is early discharge, hoping to get admitted patients to their beds [...]

Background: The Centers for Medicare & Medicaid Services (CMS) started penalizing hospitals with “excess” 30-day readmissions, as determined by observed-to-expected ratio, for patients discharged after treatment for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). An understanding of modifiable determinants of 30-day readmission will likely help in developing interventions to reduce preventable AECOPD readmissions. [...]

Background: Adverse drug events (ADEs) are common during transitions from the hospital to the ambulatory setting, with approximately 20% of patients experiencing an ADE within 30 days of discharge. ADEs are often due to patient misunderstanding of the prescribed medication regimen or non-adherence to the regimen.  New approaches are needed to address this problem. Purpose: [...]

Background: Inpatient hospital care cost $971.8 billion in 2014 and costs are projected to rise by 5.8% per year. Inpatient operational efficiency and waste reduction have become the focus of cost-reduction measures. A recent study found that nearly one in four patients in a pediatric hospital experienced a medically unnecessary prolonged length of stay with [...]

Background:  Children and Young Adults with Special Healthcare Needs (CSCHN), especially those with multiple organ systems involvement, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach and coordination among multi-disciplinary team members. Previous studies have demonstrated that homecare is a cost-effective measure [...]

Background: A “safe” hospitalist workload – that is, the point at which caring for too many patients leads to poorer outcomes for each individual patient – has not been defined.  We sought to understand whether the workload of a resident-run inpatient team, measured by number of orders entered into the electronic medical record, was associated [...]

Background: Patients discharged against medical advice (AMA) have disproportionately high healthcare costs and increased morbidity, mortality, and hospital readmissions. While patient risk factors for discharge AMA are known, there is little data regarding providers’ practice patterns during AMA discharge, including provision of follow-up appointments. Similarly, the frequency of a documented discussion of the risks and [...]

Background: Patients admitted to inpatient hospital services are increasingly cared for by hospitalists rather than their primary care providers. When transitioning from hospital-based to ambulatory care, suboptimal information transfer can lead to serious adverse events and readmissions; therefore, demands for timely preparation of high-quality discharge summaries are increasing. Confronted with these demands, most hospitalists are [...]

Background: Patients diagnosed in-hospital with acute venous thromboembolism (VTE) are at high risk for post-discharge complications and readmission similar to patients with chronic conditions. Patient navigation reduces post-discharge complications and readmissions in patients with chronic diseases, however its role in acute conditions is less clear. Similarly, the use of mobile technology to improve patient engagement [...]