Background: The rate of burnout among health care providers is unacceptably high and recent scholarship has advocated for organization-facing interventions to tackle this problem. To that end, our large academic hospital medicine group has developed a multi-modal strategy to identify high-yield interventions for provider well-being. A part of this initiative involved piloting a digital survey [...]

Background: Preventable hospital readmissions are a common problem for medical centers in the United States. Recent studies have focused on what patients perceive as causes for their return to the hospital. One factor driving readmissions is patients’ difficulty anticipating what to expect after they leave the hospital despite discharge instructions, especially anticipating and surmounting challenges [...]

Background: Patients admitted to our hospital with chest pain concerning for Acute Coronary Syndrome (ACS) have a length of stay exceeding the community average. We postulated that unnecessary stress test orders in some cases may be contributing to this increased length of stay. We hypothesized that implementation of a clinical decision support tool (CDST) would [...]

Background: The hospital discharge is one of the most important aspects of a patient’s hospitalization, yet in residency training, this process often goes overlooked. Most residents are never properly taught how to effectively discharge a hospitalized patient. As a sequelae, patients often lack understanding about their hospitalization, treatment(s), and follow up plans. This uncertainty can [...]

Background: The venous thromboembolism (VTE) rate in patients with current or recent hospitalization is 330/100,000 person-year vs. 8/100,000 in outpatients. Hence, hospitalists often assess risk and pursue a diagnosis of VTE in their patients. Lower extremity (LE) DVT risk prediction tools such as the Wells score perform poorly on inpatients and hospitalist specific guidelines for [...]

Background: Mortality is the first quality metric reported by CMS, and historically a key measure for evidence based medicine since the 1800’s. THINK:  John Snow removing the handle from the Broad street well pump to reduce cholera deaths  Ignaz Semmelweis demonstrating washing hands reduced puerperal fever and death. Mortality rates are risk adjusted [...]

Background: Since the advent of Electronic Health Record(EHR) and subsequent workload of clinical documentation, Hospital Medicine physicians are finding themselves spending more time in front of the computer and less with their patients. The implementation of EHR was intended to help physicians improve productivity and quality, however, data shows we are spending up to 25% [...]

Background: Mortality review committees are charged with identifying areas of potential improvement, with the goal of decreasing preventable death. This laudable aim is accompanied by secondary goals of interest to the organization like improving diagnostic error, fostering teamwork, optimizing information technology, or supporting other quality improvement efforts. At our institution, we developed an interdisciplinary mortality [...]

Background: Opioids are the most commonly used analgesics for pain management in hospitalized patients. Approximately 40% to 81% of patient on opioid analgesics experience opioid induced constipation (OIC) which is associated with significant patient discomfort. Prophylactic scheduled laxative therapy is recommended to prevent OIC. The purpose of this study was to improve appropriate use of [...]

Background: Our goal was to evaluate the group of patients that are admitted to the Medicine service under the care of our hospitalist team and then transferred to the medical intensive care unit (MICU) within 12 hours of admission, to see if this was a result of incorrect triage or progression of the underlying disease [...]