Background: The “weekend effect” is a term to define worse outcomes among patients that present to the hospital on weekends. For upper gastrointestinal bleed (UGIB) some of these outcomes include increased mortality and increased length of stay (LOS). A 2018 meta-analysis suggests that mortality is higher for non-variceal bleed than for variceal bleed for weekend [...]

Background: While checking serum folate levels in hospitalized adults is no longer recommended, and only one hospital meal is needed to replete a low serum folate level, more than 2500 serum folate levels were obtained in 2015-2016 at our urban teaching hospital in New York City. Checking levels is considered wasteful in folate fortified countries. The lack [...]

Background: Chest radiographs (CXRs) aid in the evaluation of clinical status and assess the placement of new lines and tubes in patients in the Medical Intensive Care Unit (MICU). Despite studies documenting the safety of foregoing routine CXRs for stable, intubated patients and guidelines recommending against this practice, it remains standard in many ICUs. Purpose: [...]

Background: Hospital disaster response has historically been the purview of emergency medicine and surgery, without significant involvement of hospitalists themselves or consideration of how mass casualty incidents impact the hospital as a whole. However, many disaster modalities, e.g. pandemic infectious disease or bioterrorism, are outside of the surgical scope of practice and require involvement of [...]

Background: The annual incidence of sepsis is about 1.7 million in the United States and about 270,000 Americans die as a result of sepsis each year. Atrial fibrillation is the most common arrhythmia seen in hospitalized patients and has shown to unfavorably alter the cardiovascular hemodynamics in patients admitted with sepsis. However there are only [...]

Background: Hospitalized patients are complex and often receive concurrent treatment for multiple diseases. Patients presenting with shortness of breath and infiltrates on chest x-ray may be treated for pneumonia, congestive heart failure (CHF) or both. Fluid and blood pressure management may be particularly challenging for these patients. Our goal was to define the impact of [...]

Background: Partnership with Regional Medical Centers is a growth strategy for Virginia Mason as well as a service to our patients in the community. It is important to maintain our capacity to provide care to all patients wanting to come to Virginia Mason. Deflections, when we turn away patients from outside transferring hospitals, are expensive [...]

Background: Providers are often frustrated by the lack of cost transparency in the US healthcare system. Studies aimed at assessing providers’ knowledge of medical costs generally show poor cost awareness. Pilot studies examining the effects of price transparency initiatives on healthcare utilization have explored a wide variety of formats, and have returned mixed results. Methods: [...]

Background: Hospitalization can be overwhelming for patients. Diagnostic uncertainty is common, and patients interact with many professionals who present information that may seem confusing. We bring a design thinking perspective to creating more patient-responsive hospital care, allowing their stories to drive the creation of a human-centered experience. Design thinking is about understanding needs and generating [...]

Background: Regardless of specialty or discipline, healthcare professionals are tasked with addressing high value care (HVC). It is therefore crucial that hospitalists and other members of the interprofessional team have training in addressing HVC, specifically around education and incorporating HVC into clinical practice and health systems improvement activities. Purpose: We developed a longitudinal curriculum at [...]