Background: In 2016, ACGME’s first Clinical Learning Environment Review (CLER) report found that trainees had limited knowledge of Quality Improvement (QI) and patient safety (PS) concepts.. Purpose: We have designed a free, interactive, web-based game named SafetyQuest (http://safetyquest.stanford.edu) to teach QI and PS concepts. Objectives include: 1) Increasing knowledge regarding actions to promote safety such [...]

Background: Traditional inpatient procedural fasting practices lead to excessive periods of patient fasting. Patients are unnecessarily ordered to be nil per os (NPO) at midnight, independent of current recommendations and evidence specific to the type of procedure being performed or expected time for the procedure to occur. This approach is based largely on the assumption [...]

Background: Recent widespread adoption of electronic health records (EHRs) has dramatically increased the amount of information quickly accessible to clinicians. Given recent pushes for interoperability and consumer generated data in EHRs, the volume of information will continue to grow. The result is clinicians who experience information overload and lack the time and ability to comprehensively [...]

Background: Approximately 5-10% of the US population reports a Penicillin (PCN) allergy. Only 1 in 10 of these patients are found to have a positive reaction to PCN. This label comes at a grave cost, with higher incidences of multidrug-resistant nosocomial infections reported among these patients. With the lack of novel antibiotics and the alarming [...]

Background: Some healthcare organizations struggle to improve quality. Identifying characteristics associated with underperformance may help inform approaches to improvement. Therefore, we sought to: (a) Identify organizational factors associated with low-performing healthcare organizations and (b) propose a conceptual framework with actionable domains, which we present as AMP (The Model to Amplify the Missing Potential), to inform [...]

Background: Hospitalization in older adults with cognitive impairment is a seminal event that often leads to iatrogenic complications and exacerbation of behavioral disturbances that require a higher level of observation to ensure the patient’s safety. Our study aimed to determine whether an innovative model, using Patient Engagement Specialists (PES) improves care for hospitalized older adults [...]

Background: Inpatient antibiotic stewardship programs often use pre-prescription approval (PPA) or prospective audit and feedback (PAF) to reduce fluoroquinolone prescribing. Whether these stewardship strategies targeting inpatient fluoroquinolone use also influence prescribing at discharge is unknown. Therefore, we aimed to evaluate the effect of fluoroquinolone stewardship on discharge fluoroquinolone use in patients with pneumonia or a [...]

Background: In the dawning era of precision medicine, increasingly sophisticated tools are becoming available to diagnose and investigate rare and unexplained diseases. The application of these tools to clinical practice will require new models of collaboration between clinicians, tool developers, and laboratory investigators. Many structural barriers to such collaboration exist in our current healthcare delivery [...]

Background: Community acquired severity scores are well known and used routinely in predicting mortality and risk of inpatient and ICU admission in suspected bacterial pneumonia patients. However such scores have not been studied in patients with influenza infection and influenza pneumonia. We attempted to validate one such score, CURB65 and and identify other scores that [...]

Background: Clinical decision support tools based on predictive analytics can provide actionable information and improve clinical outcomes for patients at risk of developing sepsis. Scoring systems such as Systemic Inflammatory Response Syndrome (SIRS) and National Early Warning Score (NEWS) that were not specifically trained to detect sepsis tend to have high false alarm rates, leading [...]