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: 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: Residency training includes learning to be an educator; however, it can be difficult for residents to feel comfortable and empowered to teach. Further, it has been established that the current generation of learners prefers an environment that incorporates a sense of community while providing competitive challenges. Purpose: Our goal was to establish a program [...]

Background: Numerous early warning systems (EWS) exist as potential tools to improve patient safety. Our system recognized higher than peer rates of rapid response (RRT) utilization as well as higher than desired out-of-ICU code blue rates leading to a desire to implement a EWS system. Over a three-year period we reviewed the literature, developed, and [...]

Background: Medical Emergency Teams (METs) are utilized in an inpatient setting to identify patients who exhibit signs of clinical deterioration. Patients, family, or staff activate the team by calling a Code MET when there is a change in clinical status. Patients with End-Stage Renal Disease (ESRD) fare worse than age-, gender-, and race-matched populations. We [...]

Background: Up to 17% of all strokes occur in patients hospitalized for another diagnosis or procedure, and in-hospital strokes complicate up to 0.06% of all admissions. In-hospital strokes carry higher mortality, longer length of stay and greater disability than community-onset strokes. Multiple factors contribute to the worse outcomes of in-hospital stroke. Prompt recognition and treatment [...]

Background: As the concept of a rapid response team continues to evolve nationwide, it is becoming increasingly apparent that the proactive monitoring of patients through surveillance tools is important to prevent adverse events. However, it is notable that the interpretation these surveillance tools require a higher level of clinical expertise and it is more and [...]

Background: Sepsis is a leading cause of death in US hospitals, and is a major contributor to hospital mortality and length of stay. Much has been done in hospitals nationwide to identify and treat sepsis early. Similarly, at Bridgeport Hospital, a clinical redesign was initiated to identify and act on patients with signs of sepsis [...]