Background: One of the challenges in hospital medicine is the effective and efficient evaluation of patients through the emergency department and admission. When this does not work well we see long wait times in the emergency department, patients leaving without being seen and decreased patient satisfaction. In the extreme case, we see ambulance diversion. This [...]

Background: A vaso-occlusive episode (VOE) is a common complication of sickle cell disease (SCD). The most common presentation of VOE is pain that, if undertreated, can lead to life-threatening complications. Nearly all persons with SCD will have a VOE, however, data show that patients frequently receive inadequate analgesia when being treated for acute pain related [...]

Background: An increased cardiothoracic ratio (CTR) on chest radiographs (CXR) is considered equivalent to cardiomegaly. However, its diagnostic value to identify left ventricular (LV) dilation is unclear. Methods: We reviewed and included the diagnostic studies that utilized CXR as the index test and TTE as the reference standard to diagnose LV dilation. Two-gate (case-control) diagnostic [...]

Background: Tobacco use remains the leading cause of preventable morbidity and mortality in the United States. Hospitalization is known to be an opportune time to initiate cessation interventions, and interventions with sustained postdischarge contact may increase the relative likelihood of cessation by 65% compared to usual care. Additionally, compared to physicians and nursing staff, clinical [...]

Background: Subcutaneous (SC) methylnaltrexone (MNTX) is approved for opioid-induced constipation (OIC) in adults with chronic noncancer pain and OIC in adults with advanced illness or with active cancer who require opioid dosage escalation for palliative care. This post hoc analysis evaluated data pooled from 3 randomized studies of patients with advanced illness and OIC. Methods: [...]

Background: Most patients hospitalized with community-acquired pneumonia (CAP) can be safely treated with 5-days of antibiotic therapy. However, many are not. We aimed to determine whether a hospitalist-focused collaborative could reduce excessive antibiotic use in patients hospitalized with CAP through a combination of collaboration with antibiotic stewardship, data feedback, pay-for-performance, and sharing best practices. Methods: [...]

Background: Background: Advanced Practice Providers (APPs) are being increasingly utilized in hospital medicine groups. However, there is significant variation in how APPs are trained and utilized, resulting in high turnover rates, decreased provider satisfaction, and resistance to adopting a physician-APP practice model. Much of the literature around APP utilization is comparative in nature, describing APP [...]

Background: Over the past 50 years, observation status patients have been cared for in a variety of settings: in the emergency department, on inpatient floors, and in dedicated observation units. At our medical center, inpatient teams have traditionally cared for observation patients on medical wards. Patients were often unaware of their admission status until they [...]

Background: Delivering HVC is a core component of hospitalist practice, and equipping residents with skills and experience to lead HVC initiatives is a priority for training institutions and for society. We describe the design, founding and implementation of the nation’s first Housestaff Council on Value and Innovation (HCVI) as a platform for engaging trainees in [...]

Background: Hemoglobin and hematocrit, routinely measured in hospitalized patients, are likely affected by shifts in plasma volume related to posture. This could have important ramifications on hemoglobin trends overnight, resulting in over diagnosis of anemia and potentially unnecessary anemia work-up and treatment. We hypothesized that hemoglobin measured in early morning (supine) samples, after plasma shifts [...]