Background: Peripherally inserted central catheter (PICC) lines are placed in inpatients often without weighing the risk of complications such as infection, thrombosis and vein damage. It is reported that there is a nationwide problem of inappropriate PICCs being placed in patients for antibiotics that can be given via alternative routes like oral or intramuscularly. In [...]

Background: Cardiac telemetry use has expanded in the last 30 years. Inappropriate telemetry use leads to prolonged hospital stays, patient discomfort, and increased healthcare costs. As part of SHM’s choosing wisely campaign, we designed and implemented a revised telemetry electronic health record (EHR) ordering system in an attempt to increase appropriate telemetry use in non-intensive [...]

Background: Repetitive morning laboratory orders are a well-known contributor to healthcare cost. Initial data collected in a related project on high-value care showed that 35% of our Internal Medicine residents identified “fear of attendings” as a reason to order morning labs on the inpatient Medicine service. This observation led us to design a project on [...]

Background: Healthcare costs are a challenge; for the greatest impact, high-value care education should begin early in residency training. Routine lab ordering for hospitalized patients is a well-known cause of high costs. This study utilized multiple interventions to decrease the number of BMPs, CMPs and CBCs ordered by residents on the inpatient medicine service. The [...]

Background: Telemetry is an often overused and expensive medical monitoring device designed to measure cardiac disease, arrhythmias or suspected heart abnormalities. In an effort to describe appropriate electrocardiographic monitoring in the hospital setting, the American Heart Association (AHA) put forth guidelines for appropriate telemetry usage. Despite these well-defined recommendations, many patients are monitored on telemetry [...]

Background: Choosing Wisely recommends against testing for amylase in the diagnosis and management of acute pancreatitis; however, national CMS data shows over $19 million in charges for amylase laboratory testing per year. Our hospital spent over $341,000 on roughly 38,000 amylase orders in the past year. Purpose: We developed a quality improvement project to reduce [...]

Background: Palliative care (PC) has been shown to be cost-effective and improve the quality of life for patients facing incurable and life-threatening illness. However, identifying patients benefiting from PC consultation remains a challenge in the inpatient setting. As part of a quality improvement initiative, we created a PC screening tool by adapting elements from existing outpatient [...]

Background: Patients are frequently unable to identify their primary hospitalist in the complex hospital environment. Patients may have multiple primary inpatient physicians due to handoffs, may be seen by multiple specialists, and may see housestaff when on a teaching service. This complexity may hinder their ability to identify and engage with their primary attending, and [...]

Background: Insufficient communication, particularly at transitions in patient care, is a common and accepted cause of negative outcomes. Handoffs between hospitalists and primary care physicians (PCPs) are infrequent, occurring in 3-20% of cases (2). Many institutions are using discharge summaries as automated methods of handing off the patient to the PCP, however it has been [...]

Background: The Joint Commission (TJC) included medication reconciliation (MedRec) as a 2005 National Patient Safety Goal to reduce errors related to medication omissions, duplications and interactions. Medication errors and harms continue to be one of the most widely reported healthcare problems. TJC’s sentinel event database includes > 350 medication errors resulting in death or major [...]