Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

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: 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: Multidisciplinary team-based care is a novel concept in hospital medicine where, healthcare team members representing multiple disciplines collaborate to develop patient care plans. Multiple published studies have shown that team-based care is associated with improved length of stay (LOS) and increased staff satisfaction but the data on patient safety and patient satisfaction is conflicting. [...]

Background: Procalcitonin (PCT) is a precursor peptide to calcitonin produced by the thyroid parafollicular cells, and the intestinal and lung neuroendocrine cells. PCT is a proinflammatoy marker specific to bacterial infections, and was initially used clinically to guide antibiotic therapy in lower respiratory tract infections. PCT has seen its role expanded to aid with initiation, [...]

Background: Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, mortality, and cost with the greatest proportion incurred treating acute exacerbations of COPD (AECOPD). While guidelines recommend oral steroids for the treatment of AECOPD, parental corticosteroids are still used in the inpatient setting; such use is associated with high costs and adverse effects. The [...]

Background: Many hospitals set targets for discharging patients before noon in efforts to optimize patient throughput. However, discharge before noon (DCBN) has been associated with increased length of stay (LOS) in an adult population. The relationship between discharge time of day and LOS in pediatric patients is uncertain. This study aims to evaluate the relationship [...]

Background: The prevalence of delirium among hospitalized patients ranges up to 56% and results in increased hospital mortality and duration of hospitalization. Symptoms of delirium may be subtle in early stages and may present clinically as hyperactive, hypoactive or mixed type. As such delirium often evades early detection. In addition, delirium in the hospital setting [...]