Background: Early planning and successful operationalization of patient discharge has long plagued acute care hospitals as a major element of patient flow inefficiency. Increased census and backed up inpatient acute care services often leads to bed crises and further challenges an already constrained system. In our organization, we assembled a multidisciplinary project team and performed [...]

Background: Discharges against medical advice (AMA) account for 0.8-2.2% of all national discharges and represents an extreme in non-compliance. Patients who elect to leave AMA have increased rates of mortality, morbidity and readmission rates. Literature on this topic, to date, has focused on AMA in the context of specific admitting diagnoses or discharges from certain [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the 4th leading cause of death and a major driver of healthcare utilization worldwide. Established guidelines exist for hospitalized patients with COPD yet adherence to these has been found in multiple studies to be low. Our question is which Quality Improvement system changes best reduce healthcare utilization and [...]

Background: Code status discussions and documentation are a key part of inpatient care for hospital medicine providers as they become more involved in caring for those with advanced illness. Hospitalists are challenged both with efficiently addressing a complicated subject due to time constraints and by a lack of established patient relationships. If it is not [...]

Background: It has been reported that vaccination rates with pneumococcal vaccine are low in elderly persons in Japan. The primary aim of this study was to examine whether introduction of a vaccination status checkbox in electronic medical records increased the vaccination rates. Methods: Subjects were inpatients and outpatients in the Department of General Medicine at [...]

Background: Many hospitalized patients spend most of their admission laying in their hospital beds. This can lead to in-hospital complications such as skeletal muscle atrophy, bedsores, and venous thromboembolism. In-hospital decline in ability to perform ADLs is associated with need for post-acute facility placement and readmission. We aimed to increase the percentage of patients admitted [...]

Background: The insurance authorization process for Inpatient Rehab Facility (IRF) and Skilled Nursing Facility placement is lengthy. It takes several days for insurance companies to make decisions regarding patient disposition. This creates increased length of stay (LOS) for otherwise medically stable patients. Several factors contribute to delays and include the lack of weekend authorization staff [...]

Background: Anywhere from 20-50% of all hospitalized adult patients are impacted by malnourishment on admission. Although malnutrition has a worldwide impact on patient outcomes, it is frequently under documented. This proves detrimental to patient outcomes as the average length of stay is 1.5 times greater than those not affected by malnutrition. This is further exemplified [...]

Background: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection associated with lymphopenic conditions including HIV/AIDS, hematologic malignancy1, organ transplantation2, and lymphocyte-suppressive therapies such as high dose glucocorticoids3,4. PJP prophylaxis, which is highly effective, is indicated when the incidence of PJP exceeds the rate of adverse events due to prophylaxis.4,7 Guidelines from the American Thoracic Society [...]

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), constitute a major health problem in the United States Health System, with a reported high mortality rate and significant economic toll. Despite the prevalence of VTE and associated mortality, clinicians have struggled in prescribing appropriate VTE prophylaxis for the inpatient population, often [...]