Background: Internal medicine residency contains procedural training, including guidance in paracentesis, thoracentesis, lumbar puncture, arthrocentesis, and central line placement. As a result, most hospitalists are able to perform these bedside procedures. However, national trends confirm that these procedures are increasingly referred to interventional radiology, and these referrals are associated with higher direct hospital costs.1 Enhancing [...]

Background: Endovascular cardiac valve replacement continues to increase in popularity as it becomes more of a standard of care for valve replacements. As the number of ECVR grows each year, complications associated with these procedures may elevate the cost and limit the viability of these procedures in healthcare systems. Hospitalists need to be aware of [...]

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: Telemetry utilization for a long time has been dependent on individual physician experiences, preference as there were no good randomized controlled trails or guidelines from any scientific organization. American Heart Association has released the guidelines for appropriate use of telemetry in Oct 2004. Even more than a decade of these guidelines been available there [...]

Background: Updated guidelines recommend testing for inherited or acquired thrombophilias only in rare situations in the acute inpatient care setting, as it has little impact on acute management of thromboembolic events, and in some situations, can be falsely positive leading to inappropriate care. Current data in our academic medical center indicate testing for thrombophilia occurs [...]

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: 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: 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: [...]

Case Presentation: 57 years old lady with hypertension presented to ER with chest and neck pain for 1 week. Pain was in upper right side of chest and collar bone. Pain character was sharp, 9/10 in intensity, not relieved by acetaminophen, aggravated with movement and without associating factors. On exam, vital signs were normal. She [...]