Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Clinically stable inpatients may receive potentially unnecessary care, such as overnight vital sign assessment. Nighttime vital signs can disrupt sleep and adversely affect patient satisfaction and contribute to delirium. However, it may be difficult for individual clinicians to determine which patients could safely forego overnight vital signs. Purpose: We developed a predictive algorithm designed [...]

Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Clinically stable inpatients may receive potentially unnecessary care, such as overnight vital sign assessment. Nighttime vital signs can disrupt sleep and adversely affect patient satisfaction and contribute to delirium. However, it may be difficult for individual clinicians to determine which patients could safely forego overnight vital signs. Purpose: We developed a predictive algorithm designed [...]

Background: Centers for Medicare and Medicaid Service (CMS) publicly report patient experience star ratings for hospitals generated from their performance on the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey. The objective was to make the information more understandable for patients. However, the ratings may not be intuitive or help consumer choice. For [...]

Background: Rising inpatient census, limited physical space and unpredictable admission rates introduce communication inefficiencies among doctors, nurses and patients. Purpose: At UC San Diego Health System, we aimed to streamline communication among physicians, patients and other care team members. Description: Two operational changes were made: 1) establishment of team-based geographic cohorting and 2) segregation of [...]

Background: Patient and family experience of care is a keystone of high-value care and the Centers for Medicare and Medicaid Services’ value-based purchasing incentives for hospitals. As a result, most hospitals and health systems nationally have invested in improving patient experience. While hospitalists can greatly influence patient experience priorities, there is little is known about [...]

Background: Patient & Family Advisory Councils (PFACs) are groups of patients and caregivers who share their overall experiences of care and perspectives on specific topics with hospital leaders at regular meetings. PFACs provide a crucial supplemental layer of feedback to hospitals outside of HCAHPS survey data and post-discharge phone calls. Hospital Medicine specific PFACs are [...]

Background: Patient experience is one of the key foundations of quality care. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is the standard measurement of patient experience, and higher scores have been linked to improved clinical outcomes and reduced readmissions. Few published interventions have improved HCAHPS scores in inpatient settings. Interventions utilizing [...]

Background: Although the intended purpose of the hospital gown is not to cause harm, it reinforces the role of being subordinate to the physician. Gowns put patients in a vulnerable position because they can be readily exposed all day. The identical, interchangeable patient gown reinforces the role of the lowly patient in the hospital hierarchy, [...]