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 [...]

Case Presentation: A previously healthy 21-year-old man presented to the emergency department with a three-day history of rash, fever, and fatigue. The rash first appeared on his trunk and spread to his arms and hands on the first day of illness. Over the next two days, he developed worsening fevers and fatigue, and was sleeping [...]

Case Presentation: A 43-year-old male with roux-en-y gastric bypass fourteen years ago with complications and multiple adhesions, hiatal hernia associated with nausea and vomiting, and subsequent small bowel resection last year, started to experience cognitive changes and short-term memory loss. He has also experienced problems with balance, generalized weakness, and unintentional 60-pound weight loss. His [...]

Case Presentation: A 37-year-old-male with no significant past medical history who presents to the hospital with 2 months of progressive exertional dyspnea, palpitations and scrotal pain. He has also noticed some leg swelling and has a nonproductive cough. For the past 6 months, he has had ongoing diarrhea and unintentional weight loss of about 20 [...]

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, [...]