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: 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: Healthcare expenditures in the United States have grown from 5% of the gross domestic product in 1960 to nearly 18% in 2015. Despite spending more for healthcare than any other industrialized country, healthcare outcomes are inferior. There are many factors identified for rising costs without an equivalent improvement in outcomes. This includes an estimated [...]

Background: Previous work suggests that hospitals’ teaching status is correlated with readmission rates, cost of care, and mortality. This research has focused on conditions closely tracked by the Centers for Medicare and Medicaid Services (CMS). The extent to which hospitals’ teaching status impacts care processes for syncope has not been extensively studied. Methods: We merged [...]

Background: Obtaining blood work through venipuncture is an important part of the diagnosis and management of hospitalized patients. Through formal and informal patient complaints, we found that patients admitted to the University of Colorado Hospital (UCH) report an excessive number of venipunctures for laboratory blood sampling. This results in overuse of resources, excess patient discomfort, [...]

Background: Healthcare costs are a challenge; for the greatest impact, high-value care education should begin early in residency training. Routine lab ordering for hospitalized patients is a well-known cause of high costs. This study utilized multiple interventions to decrease the number of BMPs, CMPs and CBCs ordered by residents on the inpatient medicine service. The [...]

Background: The Choosing Wisely campaign aims to engage clinicians and public in addressing overuse in healthcare. Through adoption in 20 countries and 75 organizations, clinician engagement is largely successful. However, patient and public engagement remains a challenge, and there is concern that the impact of Choosing Wisely will be dampened if this is not achieved. [...]

Background: Appropriate use of consultation can improve mortality and decrease cost of care. However, inappropriate consultation may carry risks to patients. Little is known about the variability of inpatient consultation. We aim to describe patient-, admission-, and physician- level factors that influence the variability of inpatient consultation. Methods: We conducted a secondary analysis of 2011-2015 [...]

Background: Constipation accounts for approximately 20,000 hospitalizations in the United States per year and contributes to increased length of stay for patients hospitalized with other diagnoses. Docusate is routinely prescribed for inpatient constipation although extensive studies have shown minimal effectiveness. It contributes to increased pill burden and polypharmacy for patients, and adds to unnecessary use [...]

Background: The American healthcare system is focused on promoting value; providing high quality care while paying close attention to associated costs. Studies have shown that admission to a teaching hospital is associated with better outcomes, reduced mortality, compared to nonteaching hospitals. It is not known whether the value proposition at academic hospitals is worthwhile for [...]