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 [...]

Background: The Society of Hospital Medicine (SHM) identifies repetitive CBC & chemistry testing as low-value, and they selected this as a Choosing Wisely Recommendation. Overuse of phlebotomy is associated with hospital-acquired anemia, decreased patient satisfaction and increased hospital costs. Process improvement techniques have been utilized to reduce inpatient phlebotomy, but prospectively identifying a cohort of [...]

Background: Over the past 50 years, observation status patients have been cared for in a variety of settings: in the emergency department, on inpatient floors, and in dedicated observation units. At our medical center, inpatient teams have traditionally cared for observation patients on medical wards. Patients were often unaware of their admission status until they [...]