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: 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: 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 [...]

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: 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: 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: When patients are transferred between hospitals (interhospital transfer, IHT), incomplete information exchange between electronic health records (EHRs) poses a barrier to continuity of care. As a result, diagnostic tests may be repeated after transfer, exposing patients to additional risk and adding to costs of care. Shared clinical data between EHRs presents a possible solution. [...]

Case Presentation: A 76 year-old male with a history of diverticulitis, T2DM, HTN, persistent atrial fibrillation and compensated alcoholic cirrhosis presented for recurrent gastrointestinal bleeding (GIB). He initially presented to an outside hospital six months prior for shortness of breath and found to be anemic requiring 4 units of packed red blood cells (PRBCs). Since [...]