Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Background: Developing effective tools which enhance patient-physician communication is crucial to improving the patient experience. Existing research has shown that there are several components which are central to effective communication, including creating a good interpersonal relationship, facilitating exchange of information, and including patients in decision making. Based on our experience at an underserved community hospital [...]

Background: Entrustable Professional Activities (EPAs) are fast becoming the framework to assess medical student preparedness to deliver safe, high quality care. The hospital ward environment leads to highly variable teaching and evaluation of EPAs. Accordingly, we felt that the controlled teaching environment found in simulation (SIM) along with a standardized checklist with trained faculty would [...]

Background: Sickle cell disease (SCD) and its vasoocclusive sequela are significant causes of morbidity and mortality as well as acute care utilization throughout the United States, with an estimated 92,880 hospital admissions totaling $759 million in aggregate annual costs in 2014. There is a need within health care systems to identify strategies for achieving higher [...]

Background: Peripherally inserted central catheter (PICC) use in patients with chronic kidney disease (CKD) is associated with non-functioning arteriovenous fistulae. Existing guidelines recommend avoiding PICC placement in these patients but how often this occurs and how best to implement this recommendation is not known. Methods: Within 42-hospitals participating in the Michigan Hospital Medicine Safety Consortium [...]

Background: Increasing attention has been paid to diagnostic patient safety vulnerabilities, which account for 6 to 17% of hospital adverse events. In 2015, the National Academies of Medicine published a report on diagnostic safety errors, including their causes and evidence to-date on how to intervene to reduce the harm associated with them. In this report, [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) multi-site quality improvement collaborative aims to improve discharge transitions by use of a transition bundle, including use of a discharge checklist (DCL) to ensure completion of important transition tasks. These tasks included identification of a primary care provider, establishing follow up appointments, and ensuring access to medications, [...]

Background: Financial incentives motivate hospitals to focus on improving patient experience, quality indicators, and efficiency metrics. Efforts to geographically staff hospitalists have renewed the focus on quality improvement efforts at the inpatient unit level. However, in order to maximize the benefit of geographic staffing, a unit-level leadership structure and quality-improvement support system must be developed. [...]

Background: Nationally, a minority of patients with complex medical and psychosocial needs consume a disproportionate amount of healthcare. In the U.S. in 2015, the top 1% of the population accounted for 23% of all healthcare expenditures and cost ten times more per year than the average patient. No one disease accounts for a large percentage, [...]