Background: As healthcare costs continue to burgeon and grow at an unprecedented rate, cost utilization is an increasingly important field of research. In-hospital costs are one of the most expensive contributors to healthcare costs in the United States. Very little research has been done in the United States regarding length of stay outliers and their [...]

Background: Interdisciplinary rounds (IDR) have become widely implemented in hospital settings in recent years due to proposed positive impact on various outcome measures such as length of stay, frequency of adverse effects, patient and team satisfaction. However, subsequent studies and data are conflicting. A key contributing factor is the high variability of models that are [...]

Background: Currently, patients admitted to the hospital are assigned specific levels of care such as intermediate intensive care or acute care. Differences among care at these levels largely differ through nursing ratio as well as frequency of nursing assessment. Costs per day for patients at different levels of care differ significantly as well. Little is [...]

Background: The use of contact precautions (CP) for patients with colonized or infected (endemic) methicillin-resistant staphylococcus aureus (MRSA) is common in many hospitals, but emerging literature does not support CP over standard precautions in preventing hospital acquired infection. CP use has been associated with delays in admission and discharge, fewer bedside evaluations, preventable adverse events [...]

Background: Health care proxies (HCP), decision-making surrogates and involved family members often struggle with indecision when offered the option of went withdrawal (VW) for a patient who is intubated. A VW is a procedure offered when an intubated patient fails to demonstrate meaningful recovery or the patient is not likely to survive given the extent [...]

Background: Serum B-type natriuretic peptide (BNP) levels, measured on admission and discharge, have been a prudent predictor of outcomes among patients with heart failure. However, daily BNP measurements have no benefits for the management of heart failure and are costly. We investigated the practice pattern in St. Luke’s Hospital, and employed an educational intervention to [...]

Background: Technology within the inpatient setting is an opportunity to improve communication between patients, families, and their care team. Prior studies identified barriers to patient use of existing healthcare portals and patient preferences for functionality within post-production portals. However, to maximize usability, end-user input should be included in the technology design phase and little research [...]

Background: Blood cultures are frequently ordered in hospitalized patients, often to work up undifferentiated fever or leukocytosis. This leads to low rates of positive cultures and high burden of false positive results resulting in avoidable interventions and waste. A recent study in hospital medicine patients identified several predictors of blood stream infection (BSI), but the [...]

Background: Electronic health record (EHR) systems are used by a majority of US hospitals. EHR use has been associated with increased task complexity, clinical data volume and provider documentation demands. Studies of multiple specialties suggest that a significant amount of provider time is spent on indirect patient care activities including turbulent provider workflows and documentation. [...]

Background: Electronic prescribing (eRx) at discharge enhances safety and quality of care transitions. It results in improved medication adherence and a decreased chance of readmission. Stage 3 Meaningful Use goals include discharge eRx rates of greater than 25%. As of September 2017, our large academic medical center had a year-to-date discharge eRx rate of 18.3%, [...]