Background: In the US, thyroid stimulating hormone (TSH) is the 4th most commonly ordered laboratory test with thyroxine measurement being the 10th commonest. In 2016, Medicare alone spent $482 million on 21.5 million performed TSH tests and $12.28 million on 7.1 million performed thyroxine measurement tests. The objectives of this study were to analyze (a) [...]

Background: Obesity as a disease is increasing in incidence and prevalence across all demographics, socioeconomic status. Our objective was to determine the current trend and possible modifiable factors that can be intervened for a possible halt or negative propensity in the current upward trend. Methods: NHANES data from 1999 thru 2016 were analyzed. Minors (age [...]

Background: Obesity medicine is an upcoming subspecialty in the field of medicine. We are actively learning about the epidemic of rising trend of this disease, as healthcare professionals we must determine our role to make it possible to intervene obesity effectively at every door-step to halt the rising trend Methods: NHANES data from 1999 thru [...]

Background: Academic Medical Centers (AMC) have utilized teams comprised of an attending, resident, interns and medical students to care for hospitalized patients. ACGME work restrictions have reduced the capacity of teaching services. Consequently, most AMCs now rely on direct care Hospital Medicine Services (HMS). Non-clinical tasks (making appointments, faxing for records), traditionally performed by teaching [...]

Background: The burden of acute care among cancer patients, estimated to exceed $70B by 2020, represents ~50% of all costs of advanced cancer care and accounts for 70% of nationwide regional variation in these costs. The Centers for Medicare and Medicaid Services proposed value-driven Rule OP-35 includes a mandate to reduce acute care use among [...]

Background: Increasing number of palliative care patients are cared for by hospitalists, but the value of hospitalist on end-of-life (EOL) care is scarcely reported. The study aims to evaluate the effect of hospitalist care on the intensive care utilization and medical expenditure for end-of-life hospitalizations. Methods: A three-year retrospective observational study was conducted at a [...]

Background: Syncope is a common presentation encountered by hospitals worldwide. While well-established guidelines exist, there is significant variation in practice regarding the investigation and management of these patients. Practitioners tend to over-investigate, which may lead to unnecessary hospitalizations, length of stay and cost. In this study, we analyzed the utilization of healthcare resources for patients [...]

Background: As hospital reimbursement models and publicly available CMS ratings place a stronger emphasis on improved patient throughput, safety, and satisfaction, it has become increasingly important for hospitals to develop cohesive care teams aligned with these goals. At our 800-bed quaternary care hospital located in suburban New York, care had historically been quite heterogeneous, with [...]

Background: Some patients lack the functional capability or social support to perform their own colonoscopy bowel preparation. These patients may be admitted to Inpatient units for support with the bowel preparation, but this process can be costly, lead to long lengths of stay, and decrease the admitting capacity of the hospital. An observation unit may [...]

Background: The use of maintenance fluids (MF, continuous intravenous fluid (IVF)) to prevent dehydration is common, yet highly variable in practice. Unnecessary MF can cause patient harm including fluid overload, sleep disruption (associated alarms), and increase falls risks. In 2017, Hurricane Maria destroyed Puerto Rican facilities that were critical in producing IVF, exacerbating an existing [...]