Background: Despite years of intense focus, inpatient and observation readmission rates remain high and largely unchanged. Little robust evidence exists to guide hospitals in the selection of interventions effective at reducing 30 day readmissions in real-world settings. Our local healthcare system incorporated the most recent recommendations for preventing readmissions into a comprehensive program called Transition [...]

Background: Bedside rounds (BR) have been proposed as an ideal method to promote patient-centered hospital care. However, their effect on patient-centered outcomes is unclear. Our objective was to determine whether BR, when compared to other forms of hospital ward rounds, improve patient-centered outcomes. To accomplish this aim, we conducted a systematic review and meta-analysis of [...]

Background: Higher rates of 30-day readmissions are associated with lower quality hospital care, and readmissions may put patients at risk for worse health outcomes including death. Historically, 20% of hospitalized Medicare beneficiaries were readmitted within 30 days, and many readmissions appeared avoidable. Accordingly, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmissions [...]

Background: The 2014 ACC/AHA Perioperative Guidelines suggest using the Revised Cardiac Risk Index (RCRI), myocardial infarction or cardiac arrest (MICA), or American College of Surgeons (ACS)-NSQIP calculators for combined patient-surgical risk assessment. Alrezk and colleagues recently published a new geriatric-sensitive cardiac risk index (GS-CRI) to predict MI or cardiac arrest in the geriatric population. We [...]

Background: Emergency room (ER) crowding remains a widespread problem. Hospitalist led transfers for stable patients may be one intervention to improve patient flow and ER overcrowding. There are no prior studies assessing the impact of hospitalist-directed transfers from one ER to an inpatient ward at a different, affiliated hospital on patient flow. Methods: We performed [...]

Background: On the 2016 ACGME survey, our Internal Medicine residents indicated that our service vs. education rating was at 47% compared to the national average of 69%. Purpose: To decrease resident physician workload to improve our education on inpatient wards, decrease the amount of non-physician level tasks to improve efficiency and to improve patient communication. [...]

Background: Many end stage renal disease (ESRD) patients present with complaints related to missed or incomplete hemodialysis (HD). Inpatient HD units often are not credentialed for outpatient use which results in extra cost and consumes additional resources for a standard outpatient procedure. Delays in patient throughput in emergency departments (ED) can cause boarding in the [...]

Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay (LOS), cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Because hospital-acquired delirium is often under-recognized and prevention and treatment involves [...]

Background: Skin and soft tissue infection (SSTI) is a common pediatric diagnosis with substantial economic cost. SSTIs vary in severity and clinical presentation. Providers often fear missing serious systemic infection, causing potential overtesting. However, recent studies suggest that blood cultures (BCx) are not useful in management of simple cellulitis or abscess (uncomplicated SSTIs [uSSTI]), and [...]