Background: Prescription medications are a major driver of the cost of health care. High prescription prices have been associated with medication non-adherence, leading to frequent hospitalizations, readmission and uncontrolled multi-morbidities. At discharge, effort should be taken to provide the greatest value in prescribing for our patients. By utilizing cost comparison applications, physicians and patients can [...]

Background: High value healthcare has been increasingly emphasized during residency training. The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine foundation and the Society of Hospital Medicine recommend against performing repetitive laboratory tests in the setting of clinical and laboratory stability. Unnecessary phlebotomy draws increase healthcare cost, decrease patient satisfaction, and [...]

Background: Hepatic encephalopathy (HE) is a common neurological complication in patients with cirrhosis. In addition to numerous morbidity-related issues, HE is associated with substantial economic burden. Treatment includes lactulose or rifaximin, a nonsystemic antibiotic that is indicated for reducing the risk of overt HE recurrence in adults. Rifaximin has also been shown to reduce the [...]

Background: Hypertensive crisis is classified as either hypertensive emergency or hypertensive urgency, distinguished by presence or absence of end-organ damage, respectively. Guidelines recommend treating hypertensive emergency with intravenous (IV) antihypertensive medications for immediate blood pressure reduction. On the other hand, management of hypertensive urgency involves gradual reduction of blood pressure over hours to days using [...]

Background: The number of hospitalizations related to a primary diagnosis of cirrhosis has been declining since the mid-2000’s. However, the temporal trend of number of hospitalizations and inpatient mortality associated with secondary conditions of cirrhosis remains uncertain. Therefore, we conducted a nationwide population data analysis to show the temporal correlation of hospitalizations and mortality associated [...]

Background: Procalcitonin (PCT) is a biomarker that correlates with the presence of bacterial infection in certain clinical scenarios; it has increasingly accepted indications for antibiotic stewardship. Most sources suggest that antibiotics should be considered for patients with suspected infection and PCT values ≥ 0.25-0.5 ng/ml; conversely, clinicians should consider withholding antibiotics for patients with PCT [...]

Background: Continuous intravenous (IV) infusions aimed at avoiding dehydration are often referred to as “maintenance fluids” (MF). These infusions are common in clinical practice. Though guidelines exist for MF use in other countries (NICE 2017), there are no specific guidelines in the US. A shortage of IV fluid has existed since 2013. In 2017, Hurricane [...]

Background: Patients who have undergone hematopoietic stem cell transplantation (HSCT) are at a higher risk of infection compared to their healthy counterparts. This retrospective chart review aimed to elucidate the incidence and etiology of skin infections in HSCT patients and understand the relationship between these infections and graft-versus host disease (GVHD), neutropenia, and transplant type. [...]

Background: As hospitals are increasingly reimbursed for value-based care, quality improvement projects addressing overutilization of routine “daily labs” have become commonplace. Although there are many published studies of daily labs reduction initiatives, there is little consensus on the actual costs of these routine labs to institutions, with most relying on Centers for Medicare & Medicaid [...]

Background: CT Head imaging for patients with altered mental status is a common procedure that many clinicians utilize to establish a diagnosis. As health care costs rise, practitioners are becoming more conscious about ordering costly imaging studies that are unlikely to change management. The purpose of the study is to determine when obtaining CT imaging [...]