Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Sub-optimal communication during care transitions contributes to poor patient outcomes. Patients who undergo interhospital transfer (IHT, the transfer of patients between hospitals) are at especially high risk given their level of illness severity. In examination of the IHT process at Brigham and Women’s Hospital (BWH), a 740-bed tertiary care referral hospital, we previously found [...]

Background: Poor communication among providers is a barrier to seamless transitions in patient care. This problem is compounded when patients undergo interhospital transfer (IHT), where complex patients are transferred between providers, settings and healthcare systems. Templated notes have been used in other hospital-based care transitions to improve communication but have not been widely utilized during [...]

Background: Numerous early warning systems (EWS) exist as potential tools to improve patient safety. Our system recognized higher than peer rates of rapid response (RRT) utilization as well as higher than desired out-of-ICU code blue rates leading to a desire to implement a EWS system. Over a three-year period we reviewed the literature, developed, and [...]

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: Advancement of patient care can necessitate inter-hospital transfers to another facility. The inter-hospital transferring process can pose inherent risks to the patient due to the transition of care, as well as increase overall cost for the healthcare system. Reviewing cases of mortality after inter-hospital transfer can identify opportunities to improve patient safety and efficiency [...]

Background: Interhospital transfer is a necessary part of patient care in an increasingly complex healthcare environment. However, it is an ill-defined process that has been associated with increased mortality, cost, and length of stay, even after disease severity adjustment. Purpose: We aim to describe the triage process for interhospital transfer requests at a large, urban [...]

Background: Interhospital transfer is a poorly understood transition of care that is associated with increased length of stay and mortality. The processes and communication between transferring and accepting facilities and providers are not standardized. Purpose: Hospitalist faculty education on triage processes is an area for potential intervention to improve interhospital transfer. New faculty hires are [...]

Background: Racial/ethnocultural inequities have been demonstrated throughout our health care system, though their presence among patients who undergo interhospital transfer (IHT), commonly done to provide patients with more specialized care, is poorly understood. The goals of this study are to evaluate the association between patient race/ethnicity and IHT to identify potential racial disparities in this [...]