Background: Diagnostic errors have been cited as a potential contributor to hospital readmissions, particularly early readmissions (e.g. within 7 days), but little is known about their frequency and characteristics. We performed structured chart review of all medical patients readmitted within 7 days of discharge from a single academic medical center to describe the prevalence of [...]

Background: Diagnostic errors have been cited as a potential contributor to hospital readmissions, particularly early readmissions (e.g. within 7 days), but little is known about their frequency and characteristics. We performed structured chart review of all medical patients readmitted within 7 days of discharge from a single academic medical center to describe the prevalence of [...]

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: Joint Commission has identified “communication” as the third most frequent root cause of sentinel events.1 Alpha-numeric pagers are common for communication among healthcare professionals. Pagers are not HIPAA compliant and communication through pagers often lacks sufficient information for effective communication.2 Because pager communication is one-way, closed loop communication requires a return telephone call, disrupting [...]

Background: Discharging patients is a complicated process that requires planning, coordination and communication between multiple care team members. Ideally this process begins at admission and is updated in real time as the patient care plan evolves and discharge needs become known. Discharge plans are often made using some form of static communication, such as in-person [...]

Background: At the University of Colorado, we developed the ‘Health Innovations Scholars Program’ (HISP), a 5-week intensive training program for pre-clinical medical students who seek to lead innovative transformation of the healthcare system. The program focuses on quality improvement, patient safety, leadership skills, design-thinking, and change management delivered through didactic sessions and applied to an [...]

Background: The ACGME has developed competencies for systems-based practice and problem-based learning and improvement to encourage trainees to integrate quality and safety into their everyday practice. Furthermore, the AAMC has a call to action for US Medical schools and teaching hospitals to successfully align clinical and education missions in order to have quality improvement and [...]

Background: Health information technology (HIT) has the potential to decrease rates of hospital-acquired conditions. The Patient Safety Learning Lab (PSLL) developed a suite of HIT tools to engage patients, families, and providers in identifying, assessing, and reducing patient safety threats. The goal of this current evaluation is to quantify the effects of this intervention on [...]

Background: Adverse events (AEs) are a major concern in the inpatient setting, with many considered preventable. The Patient Safety Learning Lab implemented a Patient Safety Dashboard integrated with our electronic health record as part of a suite of health information technology tools to reduce inpatient AEs. The goals of this evaluation were to understand patterns [...]

Background: Since 1951, medical television dramas have impacted how the public views, understands, and learns about the medical profession. Previous studies have examined how these shows depict topics such as cardiopulmonary resuscitation; other studies have shown that medical television dramas influence viewers’ perceptions of the healthcare profession. Our particular area of interest is that of [...]