Case Presentation: A 14-year-old male presented to an emergency department with 6 days of left thigh pain and inability to bear weight following a fall from bed. Associated symptoms included nausea, diaphoresis and weakness. Review of systems revealed pallor, easy bruising and yellow eyes. history was negative except for developmental delay, described as auditory processing [...]

Case Presentation: Almost 3 yo female presented to the ED) with multiple contusions, finger fractures and abrasions. Mother sought care for evaluation of a left occipital swelling that she noticed following the patient’s stay with a respite-care. The worker denied injury. When questioned by the social worker, the mother mentioned that her daughter did not [...]

Background: Transfusion of packed red blood cells in the United States has more than doubled from 1997 to 2011; however, it is thought that greater than 50% of transfusions may be unnecessary. Numerous clinical trials have demonstrated that restrictive transfusion strategies are noninferior or superior to liberal strategies across a variety of clinical scenarios; as [...]

Background: Acute heart failure (AHF) hospitalization is about one million hospital admissions per year and has tripled in the last 30 years in the United States. These illustrate the importance of recognizing early signs of AHF. Therefore, risk stratification can aid physicians in selecting appropriate evidence-based medical therapies. Red blood cell distribution width (RDW) is [...]

Background: Heart failure (HF) is one of the most common discharge diagnoses for Medicare beneficiaries. As part of the Affordable Care Act, the Center for Medicare and Medicaid Services initiated the Hospital Readmission Reduction Program which reduced payments to hospitals for excess readmissions for HF and other diseases. This quality improvement project focused not only [...]

Background: Prolonged intensive care unit (ICU) length of stay (LOS) has been shown to delay patients’ recovery, increase their exposure to the risk of infections, upsurge healthcare costs, and reduce care availability to other critically ill patients. ICU LOS is directly influenced by both medical and institutional factors. The aim of the project is to [...]

Background: The practice of routinely ordering daily labs not based on clinical indication on patients in the hospital is a wasteful clinical practice. Routine daily labs can also lead to patient harm by causing pain and iatrogenic anemia, and can burden laboratory staff resulting in increased lab reporting times. Raising awareness about unnecessary lab orders [...]

Background: Nationally, a minority of patients with complex medical and psychosocial needs consume a disproportionate amount of healthcare. In the U.S. in 2015, the top 1% of the population accounted for 23% of all healthcare expenditures and cost ten times more per year than the average patient. No one disease accounts for a large percentage, [...]

Background: Guidelines recommend in-hospital evaluation with cardiac monitoring and transthoracic echocardiogram (TTE) to assess syncope in patients that are considered high-risk for major adverse cardiovascular events. We sought to identify variables associated with performing TTE in patients presenting with syncope. Methods: We abstracted demographic and clinical data from all patients evaluated for syncope at the [...]

Background: Hepatic encephalopathy (HE) is a common complication in patients with end stage liver disease. Variability in presentation can be a source of clinical uncertainty for medical providers. Ammonia levels have historically been used to aid in the diagnosis of HE despite low positive and negative predictive values. Our primary objective was to determine the [...]