Background: Unimpeded patient flow enhances quality, patient experience and access, while reducing costs. Our hospital has an in house discharge pharmacy, which allows us to send patients home with their imperative medications prior to discharge. About 53% of our discharges were delayed due to discharge medications, which equates to 27.8 hours for the ~30 daily [...]

Background: Opening new residency programs in community hospitals is one strategy to address physician shortage. Previous reports showed better outcomes in university based hospitals. However, less is known about teaching community hospitals. Disrupting well- established workflows in community hospitals is feared to cause an increased cost and possibly a slide in quality of care. Our [...]

Background: The use of IV insulin is one of the primary therapeutic options for the treatment of hyperkalemia. Unfortunately the available literature reports that hypoglycemia is a common occurrence as a result of the treatment of hyperkalemia. During our safety event review process, we identified the same issue within our own institution. Due to reports [...]

Background: Hospitals are compelled by a variety of factors to optimize patient satisfaction. Pain management has been identified as an important determinant of overall inpatient satisfaction. However, effective pain management may be more challenging in the current climate of more cautious opioid use. Purpose: The 32-item Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) [...]

Background: Uncomplicated Urinary Tract Infections (UTIs) account for more than 100,000 inpatient admissions yearly. IDSA guidelines recommend Nitrofurantoin as first line therapy and recent FDA guidelines recommend against Fluoroquinolone (FQ) use due their side effects and growing resistance; however, Sulfamethoxazole/Trimethoprim (Bactrim) and Ciprofloxacin are still commonly used to treat uncomplicated UTIs. Therefore we hypothesized that [...]

Background: The benefits of early ambulation for patients admitted to a hospital are well recognized. Our hospital has a “Nurse Driven Progressive Mobility Protocol” which is intended to guide bedside practitioners in implementing individualized progressive mobility for patients and includes several items that nurses are required to document. It categorizes patients into 5 mobility levels; [...]

Background: Opiates, frequently used to provide analgesia, are associated with post-analgesia related tolerance effects such as hyperalgesia and hyperkatifeia, which lead to worsening of the pain experience. Patients can subsequently experience dissatisfaction with their care and seek further opiate use as a solution, worsening their experience further. Due to pharmacologic and healthcare-associated operational factors, the [...]

Background: Hospitalists today are tasked with maintaining quality care while also lowering health care costs. Length of stay and excess day reduction are surrogate markers of the efficiency of a hospitalist group by measuring lower utilization of resources. Despite this metric being attributed to hospitalists, there are many other departments that have key roles in [...]

Background: Abdominal aortic aneurysm (AAA), defined as aortic diameter ≥ 3.0 cm, affects an estimated 1.5% to 1.7% of men aged 65 or older. It was estimated that a ruptured AAA has a mortality rate of 75% – 90%. Screening for AAA with an abdominal ultrasound is relatively cost-effective. It was noted that screening for [...]

Background: Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in hospitalized patients due to convenience and long term viability. PICC lines are known to have complications such as deep venous thromboses and central line associated bloodstream infections (CLABSI). According to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), there are few appropriate [...]