Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay, cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Programs targeted at delirium prevention and treatment may affect these outcomes. We [...]

Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay, cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Programs targeted at delirium prevention and treatment may affect these outcomes. We [...]

Background: Excessive daily routine laboratory testing for hospitalized patients is a contributor to poor hospital sleep, iatrogenic anemia, and excessive costs. Recommendations from the Choosing Wisely™ campaign specifically state to avoid sleep interruptions for routine care (American Academy of Nursing) and to avoid routine labs for stable patients (Society of Hospital Medicine). The purpose of [...]

Background: Publically reported data is increasingly important to a hospital’s reputation and bottom line. Programs such as CMS Hospital Value Based Purchasing (HVBP) place 2% of a hospital’s base payments at risk, while the CMS Star Rating is frequently used by consumers to select a hospital for elective care. Both programs incorporate claims data to [...]

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: Hospital at Home (HaH) care is an alternative to traditional hospitalization with potential to address issues of cost and hospital capacity, while improving outcomes and patient satisfaction. In 2017, the US Department of Health and Human Services began to consider bundled payments for HaH despite a lack of US-based evidence on patient outcomes, real-world [...]

Background: Sickle cell disease (SCD) and its vasoocclusive sequela are significant causes of morbidity and mortality as well as acute care utilization throughout the United States, with an estimated 92,880 hospital admissions totaling $759 million in aggregate annual costs in 2014. There is a need within health care systems to identify strategies for achieving higher [...]

Background: Single-center studies have reported low yield of blood culture for skin and soft tissue infections (SSTIs) in children. Blood cultures are commonly obtained in cases of SSTI, though the degree of practice variation is uncertain. Study objectives include: 1) assess the degree of variation in rate of blood culture for SSTIs among children’s hospitals [...]

Background: Hip fracture is a common reason for urgent inpatient surgery. In the last few years, several professional societies have identified preoperative echocardiography and stress testing for non-cardiac surgeries as low-value diagnostics. Delaying hip fracture surgery beyond 48 hours leads to worse outcomes. We sought to describe the prevalence of preoperative cardiac testing for inpatient [...]

Background: Antipsychotics can prolong QTc interval and lead to development of the fatal arrhythmia Torsade de Pointes. Accordingly, serial EKG monitoring of QTc in patients newly started on antipsychotics has become common practice in hospitals. By current standards, medical management of antipsychotic therapy is clinically indicated when QTc > 500ms and/or there is an increase [...]