Background: Long discharge times (DT), (the time from discharge order to patient leaving room), have detrimental impacts on any hospital. Apart from causing dissatisfaction among patients and their families who are waiting to go home, prolonged DT also increases wait times for patients being admitted from the ED. Delayed admissions pursuant to late discharges, caused [...]

Background: The first Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased unintentional medication discrepancies with potential for harm in five hospitals. Purpose: For MARQUIS2 we utilized lessons learned from MARQUIS1 to implement the toolkit across 18 diverse medical centers. Description: MARQUIS2 is a real-world, mentored [...]

Background: Hospitalists have an increasing role in caring for patients with advanced illness. Due to time constraints, lack of experience and the sensitivity of the topic, it is challenging for Hospitalists to engage in adequate conversations regarding advanced care planning. Moreover, when these conversations do occur, documentation of Advanced Directives and Code Status is frequently [...]

Background: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a serious public health problem causing over 90,000 deaths each year. VTE rates at our institution have been high and costly, with insurer penalties for post-operative VTE exceeding $5.5M in 2014. While prophylaxis for at-risk inpatients can reduce hospital-associated (HA) VTE by up [...]

Background: Ultrasonography has been used for the last decades as a diagnostic tool. In recent years has been used in internal medicine at the bedside as a safe method that can easily detect abnormalities and provides immediate feedback. Purpose: Describe the Point of Care Ultrasound (POCUS) that has been made in an Internal Medicine Department [...]

Background: At our urban, academic hospital, use of outdated protocols and unnecessary variations in the care of DKA patients treated with ICU requiring IV insulin protocols have led to multiple safety events, delays in care with associated increased costs, and overtreatment of hyperglycemia with ketosis frequently resulting in unnecessary ICU utilization. After multi-disciplinary stakeholder development [...]

Background: Geographical rounding can improve provider to nurse communication as well as between other members of healthcare team resulting in improved efficiency of care. Better communication enables improvement in patient safety and decrease adverse events. Moreover in recent years, the Centers for Medicare and Medicaid Services (CMS) has tied part of hospital’s re-imbursement to patients’ [...]

Background: During 2016, the total billed cost of cardiac monitoring neared 4 million dollars at our institution and many patients were observed on the monitor without approved indication as published by the American Heart Association’s (AHA) guidelines published in 2014. The overutilization of cardiac monitoring constitutes a misappropriation of resources which results in undue health [...]

Background: Standardizing inter-shift handoff procedures enhances continuity of care and quality with an associated reduction in preventable medical errors. This is particularly relevant in the inpatient oncology population where patients have a relatively high morbidity/mortality compared to the general inpatient population. With increasing handoffs due to work hour restrictions, and rising utilization of multidisciplinary teams, [...]

Background: Late discharges are associated with hospital overcrowding, delayed inter-unit patient transfers, lower patient satisfaction scores and longer length of stay. At our hospital, there has been a consistent discordance between the teaching and non-teaching hospitalist services in the percentages of patients discharged before 11 am, which was 8.4% (teaching teams) versus 36.4% (non-teaching teams) [...]