Background: Alternative payment models have been proposed for lower extremity joint replacement surgeries to deliver well-coordinated and high quality care. It is speculated that while these payment models may lead to more cost effective care, institutions may “cherry pick” less costly and less complex patients to minimize financial risks. In this study, we aim to [...]

Background: Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon, and may contribute to higher mortality. We implemented a unique surgical co-management (SCM) model in July 2014 at our institution where two SCM hospitalists were dedicated to Colorectal surgery year round. Each patient was screened daily by a [...]

Background: Current guidelines for the use pre-operative non-invasive cardiac testing, especially in older patients with multi-morbidity and poor functional capacity are unclear. Our study aimed to evaluate the use of nuclear stress test (NST) and transthoracic echocardiogram (TTE) in older adults admitted to the hospital with acute hip fracture. Methods: A 2-year, multi-center, retrospective study [...]

Background: High risk patients undergoing elective surgery are at increased risk of life-threatening complications. Also, most are under anesthesia, lacking capacity for at least that time. Despite this they often lack advance directives (ADs) or do not have them accessible in their medical records. Methods: We did a retrospective chart review of 231 patients seen [...]

Background: Hip fractures are a major health problem in the geriatric population in the United States, with estimated costs of $18B annually. Hip fractures are highly morbid in the elderly, as deconditioning and acute complications compound chronic comorbidities. To improve care for this high-risk population, hip fracture patients are preferentially admitted to our medicine hospitalist [...]

Background: Severe aortic stenosis (SAS) had been identified as being at elevated risk for non-cardiac surgery. However, two reports demonstrated that SAS did not increase mortality of intermediate to high risk non-cardiac surgery. The European Society of Cardiology guideline states non-cardiac surgery of low to intermediate risk can be safely performed among patients with SAS. [...]

Background: Venous Thromboembolism (VTE) is a potentially life-threatening disorder and in some cases, is related to underlying hypercoagulability which may be congenital or acquired. Guidelines suggest performing extensive work -up for hypercoagulability only in select patients: those with close family history of VTE at young age ( < 45), young age at first VTE (<45), [...]

Background: The diagnostic yield and therapeutic consequences of daily routine chest x-rays are very low. Several studies show discontinuation of daily routine chest x-rays does not affect ICU length of stay, readmission rate, or hospital mortality.We hereby present results of an educational intervention at a tertiary care university medical center to avoid daily routine chest [...]

Background: It has been routine practice to keep patients undergoing cardiac stress testing nil per os (NPO) until the results of the test were reported. The rationale is to enable left heart catheterization the same day if the stress test is positive, thereby reducing time to coronary intervention and length of stay (LOS). Often, NPO [...]

Background: The prevalence of delirium among hospitalized patients ranges up to 56% and results in increased hospital mortality and duration of hospitalization. Symptoms of delirium may be subtle in early stages and may present clinically as hyperactive, hypoactive or mixed type. As such delirium often evades early detection. In addition, delirium in the hospital setting [...]