Background: Approximately 5-10% of the US population reports a Penicillin (PCN) allergy. Only 1 in 10 of these patients are found to have a positive reaction to PCN. This label comes at a grave cost, with higher incidences of multidrug-resistant nosocomial infections reported among these patients. With the lack of novel antibiotics and the alarming [...]

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: Approximately 5-10% of the US population reports a Penicillin (PCN) allergy. Only 1 in 10 of these patients are found to have a positive reaction to PCN. This label comes at a grave cost, with higher incidences of multidrug-resistant nosocomial infections reported among these patients. With the lack of novel antibiotics and the alarming [...]

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: Attending evaluations by medical students have many implications including promotion, teaching opportunities, job satisfaction and reputation both for individuals and for groups. In addition to teaching on traditional ward teams with housestaff and students, hospitalists are more commonly teaching in an apprenticeship model, where an attending, often carrying a full census, directly supervises and [...]

Background: With standard diagnostic methods, the etiologic pathogen of community acquired pneumonia (CAP) is detected in ≤ 50% hospitalized CAP patients. In our previous studies using a diagnostic “bundle”, we were able to detect etiologic pathogens in ≥ 70 % of the patients. Our bundle consisted of a nasopharyngeal swab for Biofire film array, that [...]

Background: Uncomplicated Urinary Tract Infections (UTIs) account for more than 100,000 inpatient admissions yearly. IDSA guidelines recommend Nitrofurantoin as first line therapy and recent FDA guidelines recommend against Fluoroquinolone (FQ) use due their side effects and growing resistance; however, Sulfamethoxazole/Trimethoprim (Bactrim) and Ciprofloxacin are still commonly used to treat uncomplicated UTIs. Therefore we hypothesized that [...]

Background: Previous studies demonstrate patient readmissions to the Medical Intensive Care unit (MICU) from the ward are potentially associated with worse outcomes due to breakdowns in communication during ICU-ward transfer. Though previous work highlights the importance of shared mental models (whether clinicians have a mutual understanding) during handoffs, no studies examined the prevalence of a [...]

Background: Intensive Care Unit (ICU) beds are limited, so effective triage is important for resource utilization. However, inappropriate triage of critically ill patients to non ICU settings can lead to poor patient outcomes, as early unexpected ICU transfers are associated with increased mortality. Purpose: We sought to describe the effectiveness of Hospital Medicine (HM), Emergency [...]