Background: In the US, hospitalist system has been introduced with improvement of quality and safety of care, education and value. Japan now face rapidly declining birthrate and aging population. Organ-based subspecialty system has difficulty in managing patients with multiple diseases. Patient-centered general medical care is required for inpatient management. However, in Japan, there are only [...]

Background: Fingerstick blood glucose (FSBG) testing allows inpatient providers to adjust insulin in real time to protect patients from significant hypo- or hyperglycemia. Admitted diabetic patients are often placed on sliding scale insulin with four times per day FSBG testing, regardless of home insulin use. FSBG test materials cost $9 per use (1). We estimate [...]

Background: Patients (pts) with congestive heart failure (CHF) are at an increased risk for community-acquired bacterial pneumonia (CABP) [1]. Moreover, CABP itself and macrolide antibiotics, which current guidelines recommend for CABP treatment [2], are both associated with increased risk of cardiac events, including worsening heart failure [3,4]. Lefamulin (LEF) is a first-in-class systemic pleuromutilin antibiotic [...]

Background: Physical therapy (PT) is a valuable tool to help prevent the functional decline and loss of mobility hospitalized patients experience. Yet, it is a constrained resource in most hospital settings. The AM-PAC score is a validated tool that has been used to predict discharge destination within 48 hours of admission. It has also been [...]

Background: In light of increasing healthcare costs, diagnostic stewardship is an important component of providing high-value healthcare. Order sets, a collection of orders aggregated in a single location for a given diagnosis, condition, or treatment, are designed to promote adherence to evidence-based practices and reduce variability in care—both known drivers of high-value care (Atlas SJ [...]

Background: Older adults commonly lose mobility during hospitalization. This loss of mobility may be preventable if it is identified and addressed early in a patient’s hospital course. However, currently there is no systematic method to identify these patients early, and current practices are guided by physician experience and intuition. To this end, we used machine [...]

Background: Inpatient experience quality improvement efforts have traditionally been focused on increasing scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients’ open-ended responses about their inpatient experiences may represent a previously unexamined resource for understanding patient motivation behind closed-ended responses. We aimed to describe responses to an HCAHPS open-ended survey [...]

Background: Altered mental status (AMS) is prevalent in hospitalized patients, especially the elderly (1). The work up of AMS is based on history, physical exam, pertinent labs and imaging. Common etiologies include fluid and electrolyte disturbances, infections, drug toxicity, drug withdrawal and metabolic derangements. Many routine labs drawn in the evaluation of acute encephalopathy are [...]

Background: Asthma, bronchiolitis, and pneumonia are common pediatric inpatient diagnoses. Viral testing (VT) is not routinely necessary for these diagnoses as it often does not impact management. Our study objectives for each diagnosis are to; 1) describe trends in VT over the last 5 years including seasonal variation (respiratory season- Oct-March versus non-respiratory season- April-Sept), [...]

Background: The utility of procalcitonin (PCT) in pediatrics is debated. Proposed diseases in which PCT elevation is thought to be suggestive of a bacterial process include meningitis, urinary tract infection, pneumonia, neonatal fever, and sepsis of unknown source. However, elevated PCT is non-specific for bacterial infection and the strength of the test is generally felt [...]