Background: Evidence suggests that risk of central line-associated bloodstream infection (CLABSI) between patients with traditional central venous catheters (CVC) vs. peripherally inserted central catheters (PICC) is similar. However, how best to predict CLABSI in patients with PICCs is not known.  Methods: We used data from the Michigan Hospital Medicine Safety (HMS) Consortium, a 51-hospital Blue [...]

Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication. In the United States, there are more than 20,000 CLABSI per year, resulting in a cost of about $30,000 per infection. A number of interventions have been employed to decrease the risk of CLABSI. Previous studies have documented the importance of simulation-based training. There is [...]

Background: Sleep is generally poor in hospitalized patients and sleep deprivation has many harmful effects, including delirium, insulin resistance, hypertension, and impaired function of the immune system. In this quality improvement (QI) project, our goal was to delay early morning phlebotomy blood collections to improve sleep for our patients, while not negatively impacting hospitalists’ perception [...]

Background: The Society of Hospital Medicine and the ABIM Foundation‘s Choosing Wisely Campaign have made tackling overutilization of routine labs part of their mission.  Based on the literature, 30-50% of routine labs ordered for hospitalized patients every morning may be unnecessary.  Aside from pain, discomfort and sleep disturbance, these daily labs predispose patients to iatrogenic [...]

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: 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: Cirrhosis is the permanent fibrosis of the liver and carries a prevalence of 600,000 cases per year. Hospitalizations due to cirrhosis have doubled from 2001 to 2011 with an average hospitalization cost of $15,000. Hospital readmissions for cirrhosis are frequent and have been noted to be up to 3 readmissions per year. Given the [...]