Background: Respiratory rate (RR) is a predictor of adverse outcomes and an integral component of many risk prediction scores for hospitalized adults. Despite its clinical value, RRs are often inaccurate and may lead to misclassification of disease severity, potentially jeopardizing patient safety. Purpose: We sought to improve inpatient RR measurement by patient care assistants (PCAs) [...]

Background: Patients with SCD have frequent hospitalizations due to repeated vascular occlusion resulting in multiple organ damage, acute on chronic pain, fatigue, and frequent infections2. Sickle cell pain crisis challenges patients and health professionals in countries like Saudi Arabia where the disease is common and use of narcotic analgesics is strictly controlled3. Sickle cell disease [...]

Background: Insulin is considered a high-alert medication due to frequent prescription or administration errors and severe adverse events. Insulin prescription errors during hospital discharge may lead to increased re-admissions and increased emergency department visits. We analyzed the frequency of patients discharged on insulin pens with and without an associated prescription for pen needles. Methods: Patients [...]

Background: Emergency Department (ED) boarding, which occurs when admitted patients do not have an available bed in the hospital, has been associated with adverse patient outcomes. In 2014, 13,109 patients waited greater than 2 hours for a medicine inpatient bed at our large urban academic center. In July 2016, we deployed a 24-hour hospital medicine [...]

Background: Failure to promptly recognize and intervene upon patient deterioration leads to morbidity and mortality. Numerous “early warning scores” (EWS) intend to identify such patients but their performances lack adequate sensitivity and specificity. “DELTA” was designed to automate the methodical thought-process and trend analysis of a human provider and to distinguish itself by leveraging relative [...]

Background: Telemetry is utilized on high risk cardiac patients for monitoring of arrthymias. Guidelines providing clear monitoring indications have been published by AHA to reduce overuse of this resource, which can lead to increased care costs and false positive alerting. Despite the above evidence, our hospital has a high volume of patients on telemetry causing [...]

Background: Paracentesis is a commonly performed bedside procedure in hospitalized patients. It is often necessary for patients who are taking anticoagulant therapies and/or have disorders of hemostasis. Concerns about bleeding complications often lead to care delays, blood product transfusions, medication changes, and costly labs. Purpose: This study evaluates the safety and clinical outcomes for a [...]

Background: The Intermediate Care Unit was developed in the 1960s and 70s as a level of care between general medicine (GMU) and intensive care units (ICU) [1]. While all IMU patients could be cared for in an ICU, hospitals have too few ICU beds to accommodate patients who are not critically ill, and higher levels [...]

Background: The Intermediate Care Unit (IMU) was developed in the 1960s – 1970s as a level of care between general medicine (GMU) and intensive care units (ICU) [1]. The Society of Critical Care Medicine has established guidelines for admitting patients to an IMU based on severity of illness or need for frequent or complex nursing [...]

Background: Many hospitalized patients do not understand their treatment and care plans [1] and research shows that better physician communication skills improve patient outcomes [2]. Since these communication skills are teachable, many institutions implement a standardized communication tool for physicians and trainees [3, 4, 5, 6]. The evidence-based Acknowledge, Introduce, Duration, Explanation, and Thank (AIDET) [...]