Background: A substantial proportion of peripherally inserted central catheters (PICCs) are placed for inappropriate indications. We performed a multi-hospital intervention to improve the appropriateness of PICC use. Methods: We conducted a collaborative cohort study of hospitals participating in the Hospital Medicine Safety Consortium. An evidence-based intervention centered on the Michigan Appropriateness Guide for Intravenous Catheters [...]

Background: Recently coined the “fifth pillar to the bedside physical exam” in a 2018 JAMA article, a growing number of physicians have started incorporating point-of-care ultrasound (POCUS) into their clinical assessments. Many medical schools have already started to integrate POCUS into their educational curriculum. With the emergence of more affordable handheld solutions, practicing physicians and [...]

Background: Aggressive EOL treatments in advanced cancer patients are associated with low-value care and frequently lead to unnecessary hospitalizations. Since 2012, the National Quality Forum (NQF), American Society of Clinical Oncology (ASCO), and Centers for Medicare and Medicaid Services (CMS) have adopted EOL quality measures to reduce aggressive care. Using these measures, we conducted a [...]

Background: Heart failure (HF) and atrial fibrillation (AF) share several risk factors including coronary artery disease, hypertension, smoking, obesity, diabetes, and renal disease, as well as common pathophysiologic pathway involving activation of the renin–angiotensin–aldosterone system, maladaptive atrial remodeling and subsequent impaired conduction system. Some studies have supported the role of angiotensin converting enzyme inhibitors (ACEIs) [...]

Background: Though the advent of highly active anti-retroviral medications has improved survival in HIV infection, mortality from non-infectious complications such as pulmonary arterial hypertension (PAH) has increased. Also, studies have shown that PAH is the leading cause of hospitalization and death in patients with HIV associated PAH (HIV-PAH). However, not much is known about the [...]

Background: Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure. While it is currently recommended for patients with severe aortic stenosis with high or intermediate surgical risk, it is currently being studied in lower risk patients. If approved for expanded use, it stands to become even more commonplace in hospitals around the country. We [...]

Background: Hypertension is a significant risk factor for cardiovascular disease. According to the Centers for Disease Control and Prevention (CDC) half of all United States citizens with hypertension (HTN) do not have their blood pressure under control. As such, HTN remains a large public health challenge, especially in patients with other comorbidities such as diabetes [...]

Background: Unnecessary laboratory orders are a well-known contributor to healthcare cost. Our residents identified “fear of attending” as a barrier to more mindful lab ordering. This project focused on educating attending physicians on high-value care and promoting resident-attending discussions. Purpose: Data was collected via anonymous pre and post-intervention survey (designed by the study team). Participants [...]

Background: In-hospital cardiac arrest (IHCA) is an unpredictable, catastrophic event affecting approximately 200,000 US adults annually. Best outcomes during IHCA result from focused training and credentialing by AHA (ACLS, BLS). Although hospitalists supervise IHCA, best practices for resuscitation skills, preparedness, plus overall approach remain undefined. Methods: We developed an online survey of IHCA resuscitation responsibilities [...]

Background: End of shift sign out is a major part of inpatient care and occurs multiple times for each patient on a Hospital Medicine service. Sign out guidelines recommend specific elements of the written sign out process to ensure patient safety. Use of these standardized written sign outs has been shown to improve care when [...]