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: One way academic organizations recognize staff achievements and scholarly activities is through four levels of academic appointments: Instructor, Assistant Professor, Associate Professor and Professor. Nurse Practitioners and Physician Assistants (NPPAs) employed by the Mayo Clinic are highly encouraged to pursue an academic appointment. A 2016 survey at our three main sites showed that only [...]

Background: From 2016 to 2018, advanced practice provider (APP) utilization in academic hospital medicine groups (HMGs) has increased by 23.6%, with 75.7% of academic HMGs now employing APPs. Due to a lack of standardization around APP utilization, and the frequent use of shared billing models, determination of return on investment for APPs is challenging and [...]

Background: Physician handoffs between inpatient shifts influence safety and care quality. Handoffs are also at risk for communication failures. Poor care coordination and miscommunication cause 80% of sentinel events nationwide. The rise of the electronic medical record (EMR) presented an opportunity to standardize communication during handoffs. Unfortunately, this potential has thus far gone largely unrealized, [...]

Background: Third year medical students (MS3s) have not regarded the Pediatrics Clerkship at our institution with as high praise as other clerkships. Students cite a relative lack of teaching on the floors from pediatric residents as a key etiology. Interestingly, said residents endorse a desire to teach more. The most common barriers cited are time, [...]

Background: Anticoagulants are among the highest-risk medications in hospitalized patients. Studies have demonstrated that a majority of in-hospital anticoagulant adverse drug events are not only preventable, but are the result of excessive dosing. This is especially true for warfarin dosing, which is complicated by a lack of consensus among validated initial dosing nomograms. As part [...]

Background: Clinical practice guidelines (CPG) are a constructive response to the clinical situations providing systematically developed statements that include recommendations intended to optimize patient care. Despite their value, inadequate dissemination and implementation of the CPGs derail quality improvements in patient care. Traditionally, static documents (PDF, HTML pages) have been used to deliver CPGs incorporated into [...]

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: Prior to this project, inpatient Advanced Practice Providers (APPs) at UW Health lacked organizational data including volumes, patient experience, hospital acquired conditions, and operational efficiency metrics. In 2016, inpatient APPs collaborated with UW Health’s Analytics and Information Systems team to develop a method for inpatient APP attribution and identification of team-based, APP sensitive metrics [...]

Background: Background: Advanced Practice Providers (APPs) are being increasingly utilized in hospital medicine groups. However, there is significant variation in how APPs are trained and utilized, resulting in high turnover rates, decreased provider satisfaction, and resistance to adopting a physician-APP practice model. Much of the literature around APP utilization is comparative in nature, describing APP [...]