Background: Mental illness is common among hospitalized patients and is associated with increased length of stay, higher costs, and worse clinical outcomes. Inpatient psychiatry consultations have traditionally held a reactive model, in which primary teams obtain consultation for patients that have developed active psychiatric symptoms. The reactive model has frequently led to missed opportunities to [...]

Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients [...]

Background: The hospitalist service at this large Academic tertiary center has a length of stay index that is longer than expected. Despite improvements in multi-disciplinary rounds and co-locating patients on a geographical units, improvements in length of stay slowed. Interviews of hospitalist physicians indicate that there are frequent delays in procedures, imaging and consult recommendations. [...]

Background: Hospitalists are key stakeholders in patient flow throughout the hospital and are pivotal in creating efficient patient movement. Throughput metrics are a large focus for all hospitals, and it takes collaborative effort from many disciplines to effectively shift patient flow toward efficiency. Purpose: To reduce decision to admit to bed minutes in a collaborative [...]

Background: Our institution’s rate of hospital acquired Clostridioides difficile (C. diff) infection (CDI) is higher than expected based on documented severity of illness of our patients. The C. diff testing algorithm at our institution utilizes a multi-step approach. It begins with two tests (antigen EIA and toxin A/B EIA). If the results of these two [...]

Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple [...]

Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order [...]

Background: One of the challenges in hospital medicine is the care of patients overnight, when the primary team is unavailable, and care is being provided by those who are not as familiar with the patient. This is compounded by the high volume of pages at night. At UNC Rex Hospital, these factors resulted in delays [...]

Background: Discharge summaries assist in the transition from inpatient to outpatient care by communicating key diagnoses, medication changes, and follow-up instructions. Despite use of standard formats for discharge summaries through electronic medical records (EMR), primary care physicians (PCPs) report dissatisfaction with locating important information in discharge summaries. Purpose: The aim of our project was to [...]

Background: Digital bedside information displays can alert clinicians about patient safety hazards, but the unintended consequences of these interventions are not well understood. Introducing new digital interventions may have implications for clinician satisfaction with the electronic environment, clinical team communication, and patient-centered care. Toward greater understanding of these unintended consequences, we described the content, form, [...]