Background: Pressure injuries are tissue damage caused by pressure and shear. Susceptible patients are the elderly, acute, critically ill and malnourished. Pressure injuries severely deplete hospital performance measures in the U.S. Currently, over 2.5 million patients develop pressure injuries at a national cost of about $25 billion each year and are implicated in 50,000 deaths. [...]

Background: Best-Practice Alerts (BPAs), utilized to reduce the number of adverse events in medical settings, have limited efficacy partly due to alert fatigue and user desensitization. Alert fatigue often stems from inaccurate alerts firing too often as well as poor physician perception of the efficacy of the alerts, both of which lead to reduced physician [...]

Background: Hyperbilirubinemia is the most common cause of hospitalization among neonates. Severe, untreated hyperbilirubinemia can lead to acute bilirubin encephalopathy and kernicterus. Although rare, these conditions can pose significant risks for morbidity and mortality in neonates.In 2004, the American Academy of Pediatrics (AAP) issued a guideline for management of hyperbilirubinemia in neonates over 35 weeks [...]

Background: The United States is in the midst of a health quality crisis; for this to resolve, we must transform to a high-value, low-cost healthcare culture. To achieve such a culture, trainees must learn high-value care habits. We developed a 95-week longitudinal study to promote mindful laboratory habits in an internal medicine residency program. Purpose: [...]

Background: While Medicare data demonstrates that healthcare spending is up to four times higher in yearly decedents than survivors, studies demonstrate that early advance care planning (ACP) leads to improved clinical outcomes and reduces cost without increase in patient anxiety or depression. Nationwide the creation of the Physician Order for Life Sustaining Treatment (POLST), a [...]

Background: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. There was no standardized protocol for delirium at our hospital prior to 2014. In October 2013, we formed a task force for delirium prevention and early identification across 18 medical-surgical units in our hospital. [...]

Background: Updated guidelines recommend testing for inherited or acquired thrombophilias only in rare situations in the acute inpatient care setting, as it has little impact on acute management of thromboembolic events, and in some situations, can be falsely positive leading to inappropriate care. Current data in our academic medical center indicate testing for thrombophilia occurs [...]

Background: The 7- and 30-day patient readmission rates are tracked by hospitals and are used as a metric to measure physicians’ quality of patient care. Several tools currently predict and prevent early readmission rates based on patient-specific characteristics. However, few studies have demonstrated if physician-specific characteristics play a role. The purpose of this study is [...]

Background: Many hospitalized patients spend most of their time in bed leading to increased complications. For elderly patients, hospitalization results in decreased post-hospital independence up to 1 month after discharge, which can be prevented with inpatient mobility programs. Many patients lament their inability to return home after an admission due to decreased functioning. With increasing [...]

Background: The Society of Hospital Medicine identified questioning the necessity of repeat labs in stable patients as a Choosing Wisely goal to improve overall value of care. Implications of unnecessary blood draws include over-testing, pain, decreased patient experience, and risk for iatrogenic anemia. Interventions to safely reduce provider lab orders have been applied in various [...]