Background: Consultation in hospital is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consult utilization on hospital outcomes and resource utilization of acute CHF is unknown.   Methods: Discharge data was obtained for patients discharged with a principal diagnosis of acute CHF over 3 [...]

Background: After Libby Zion died tragically in a teaching hospital, much attention from the medical community, public and government, was directed at resident training and the number of hours worked consecutively. This marked a new era heralded by close scrutiny of the time residents spent in the hospital. Two dramatic reductions were mandated nationally by [...]

Background:   Congestive heart failure (CHF) and pneumonia are amongst the leading causes of hospitalization in the United States.  Although a growing number of hospitals use both teaching and nonteaching hospitalist services for patient care, the differences in clinical outcomes and efficiency between these two services is not clearly known. The aim of this study [...]

Background: Results from the recent SPRINT trial demonstrate lower rates of fatal and non-fatal major cardiovascular events and all-cause mortality in non-diabetics at high cardiovascular risk with intensive versus standard treatment, i.e., less than 120 versus less than 140 mmHg systolic, respectively. However, the long-term outcomes remain unknown.Methods: A validated state-transition model with multivariate risk [...]

Background: Mechanically ventilated patients are often administered analgesic medications such as dexmedetomidine (DEX) and lorazepam (LZP) to reduce pain and anxiety. Studies have suggested that benzodiazepines may increase the risk of developing acute brain dysfunction, mechanical ventilation time, and length of stay (LOS) (Pandharipande PP, et al. JAMA 2007). Although Clinical Practice Guidelines recommend use [...]

Background: The Center for Disease Control and Prevention estimates that 1.7 million patients per year develop hospital-associated infections (HAI), of whom 99,000 die. HAIs financially impact the United States healthcare system with an estimated cost of $6 billion per year. At Platte Valley Medical Center (PVMC) in 2013, the urinary catheter utilization ratio and rates [...]

Background: In Canada, as in the US, hospital medicine has become an increasingly important staffing model innovation. Canadian hospitalists are typically Family Physicians and General Internists. In an attempt to advance its hospitalist staffing model into a care model innovation as well,  the Regina Qu’Appelle Health Region (RQHR) implemented Canada’s first Accountable Care Unit (ACU) [...]

Background: The convergence of rising post-acute health care costs with incomparable outcomes havemade reform a priority resulting in the development of new models of care that often extend the scope of practice andjob duties among health professionals. In these new models, aimed to improve clinical and cost effectiveness of care,advance practice “transitionists” diagnose, triage, conservatively [...]

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: Transfers to academic tertiary care centers often involve complicated patients requiring subspecialty consultation and coordination of care.   Therefore appropriate handoff and communication from sending to receiving institution is needed to streamline care and minimize redundancies. At our institution, we received approximately 1200 transfer requests annually.  Process improvement carries the potential to impact many patients [...]