Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Hospital capacity constraints remain an immense concern throughout the US and has been recognized as a national crisis for greater than a decade. ER overcrowding is of particular concern due to its downstream effects. It occurs when admitted patients are boarded in the emergency room for greater than 2 hours, while inpatient beds become [...]

Background: In the throughput arena, one of the most challenging groups of hospitalized patients is the long length of stay (LLOS) patients. Although representing a minority of inpatients, this LLOS population contributes to the majority of excess days. At our urban tertiary academic institution, a LLOS is defined as greater than 15 excess days. In [...]

Background: Discharge delays occur because of inconsistent communication among all clinicians and providers. Inefficient utilization of resources also contributes to delays. Effective communication among the patient care team is a foundation of creating an effective discharge planning process. We must standardize the process of communication as well as resource optimization in order to provide our [...]

Background: Multidisciplinary (MDR) team rounds were established at Halifax hospital as daily, dedicated interactions between varying members of the care team on each inpatient floor. Members of the care team include physicians, nurses, physical therapists, pharmacists, and case managers. These multidisciplinary interactions allow for smooth, real-time, and accurate information that facilitate communication and enhance the [...]

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: Length of stay (LOS) outliers are a focus of cost and resource utilization for hospitals in the United States. Limited research has been done to characterize outliers, risk factors, and barriers to discharge. Methods: We conducted a case-control study of inpatient admissions to the general medicine service line between September 2015 and August 2016. [...]

Background: The Obesity Paradox postulates that obesity is a protective factor against mortality in certain chronic conditions such as chronic kidney disease (CKD) and congestive heart failure. Although this paradox is established in CKD, few studies have analyzed the paradox in acute kidney injury (AKI). There are both short and long term ramifications to AKI [...]

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. [...]