Background: Some healthcare organizations struggle to improve quality. Identifying characteristics associated with underperformance may help inform approaches to improvement. Therefore, we sought to: (a) Identify organizational factors associated with low-performing healthcare organizations and (b) propose a conceptual framework with actionable domains, which we present as AMP (The Model to Amplify the Missing Potential), to inform [...]

Background: Hospitalization in older adults with cognitive impairment is a seminal event that often leads to iatrogenic complications and exacerbation of behavioral disturbances that require a higher level of observation to ensure the patient’s safety. Our study aimed to determine whether an innovative model, using Patient Engagement Specialists (PES) improves care for hospitalized older adults [...]

Background: Sleep deprivation has deleterious effects on immune function, wound healing, insulin resistance, pain, and even mortality. Patients in hospitals often suffer from sleep deprivation due to environmental noise and interruptions from staff. The American Academy of Nursing Choosing Wisely guidelines recommend not to “wake the patient for routine care unless the patient’s condition or [...]

Background: Inpatient antibiotic stewardship programs often use pre-prescription approval (PPA) or prospective audit and feedback (PAF) to reduce fluoroquinolone prescribing. Whether these stewardship strategies targeting inpatient fluoroquinolone use also influence prescribing at discharge is unknown. Therefore, we aimed to evaluate the effect of fluoroquinolone stewardship on discharge fluoroquinolone use in patients with pneumonia or a [...]

Background: Multidisciplinary rounds (MDRs) or discharge huddles in the hospital were developed to enhance safety and streamline discharge by improving communication between members of the patient care team. Despite efforts to coordinate care around a single brief daily meeting, multiple aspects of the patient’s care can change throughout the day. Keeping all members of the [...]

Background: While medical school experience could be very rewarding, it is also known to be unusually stressful to many future physicians. Previous cross sectional studies have shown that symptoms of depression and burnout are higher among medical students compared to age matched general population. A meta-analysis reported overall pooled crude prevalence of depression, or depressive [...]

Background: Hospital Medicine groups are often called upon to lead initiatives that require access to high-quality data from their local health system. These include quality and value improvement (QI) efforts as well as health services and outcomes research. Although these efforts can be important for clinical operations as well as academic advancement, clear mechanisms to [...]

Background: Many academic hospital medicine programs have reached a critical transition point as they attempt to sustain and develop growth in their non-clinical, academic missions. To meet increasing clinical needs, the Duke Hospital Medicine Program (DHM) has grown rapidly to over 100 providers dedicated to careers in academic hospital medicine. The majority of this group [...]

Background: The Institute for Healthcare Improvement tells us that successful discharge planning starts at admission; however, when that admission occurs to a closed Intensive Care Unit (ICU), traditional discharge planning can be delayed until the patient transfers to a general floor. This delay can be exacerbated as a hospital’s adult medical-surgical bed occupancy rises, increasing [...]

Background: With over 50% of hospitalists affected by burnout cited in the literature, it is imperative to evaluate tools and techniques to abate the downstream consequences. Recent work on resiliency has focused on how to decrease emotional exhaustion through exercises that can reframe a negative outlook into a positive perspective. Employing the “three good things” [...]