Background: Medically acute patient patients are cared for by housestaff and advance practice provider (APPs) overnight. The severity of illness in these patients can vary during their hospital stay. Decompensation in this population is under recognized and can lead to adverse outcomes. Even when correctly identifying decompensation, unclear lines of escalation, and poor documentation practices [...]

Background: When used optimally, technology should serve as a tool for clinicians, not an obstacle. Yet according to a recent study by the Mayo Clinic, Electronic Health Records (EHR) score in the bottom nineth percentile of technologies when evaluated for usability. This lack of usability can lead to increased documenting times, workflow bottlenecks, and physician [...]

Background: Data dashboards are used in many industries to track performance, however their development and efficacy in hospital medicine has not been well described. Data availability, provider attribution, feedback timeliness, and data accuracy have been cited as barriers to developing and implementing an effective performance dashboard. Purpose: We developed a hospital medicine clinical data dashboard [...]

Background: Uncontrolled asthma leading to emergency department (ED) visits and hospitalization causes suffering, disproportionately among underserved patients, and are costly to healthcare systems. Timely treatment and adherence to clinical guidelines via serial monitoring of patients’ reported symptoms, offers the opportunity to improve health outcomes that are important to patients, clinicians, and accountable care organizations (ACO). [...]

Background: Clinical reasoning is a core component of medical training yet learners receive very little formative feedback on their clinical reasoning documentation. We hypothesize that this is related to the lack of a shared assessment rubric and faculty time constraints. Purpose: Here we describe the process of developing a machine learning algorithm for feedback on [...]

Background: Point-of-care ultrasound (POCUS) has expanded in popularity and practice amongst hospitalists, critical care physicians, and is a standard part of the emergency medicine curriculum for a multitude of reasons: increased diagnostic accuracy and speed, cost reduction, and reduced radiation exposure. Internal medicine (IM) residents are exposed to the practice of using POCUS at all [...]

Background: Patients with complex medical problems are at high risk of readmission when transitioning from the hospital to home, especially when they reside in rural areas (as is the case within our VA Health Care System (HCS)). Innovative solutions are needed to improve access to post hospitalization follow up within our facility. We hypothesized that [...]

Background: Patients with advanced cancer have high readmission rates, up to 27% in some studies, and represent unique challenges related to transitions of care, complex disease management, and care coordination. Recent efforts have focused on better identification of potentially avoidable readmissions (PARs). One study found that primary reasons for PARs in cancer patients included pre-mature [...]

Background: Communication between home health care agencies and referring facilities is important for comprehensive care for patients. Yet, both home health care providers and hospitalists feel that this communication is frequently lacking. Purpose: To implement weekly teleconferences to discuss patients recently discharged from the Rocky Mountain Regional VA Medical Center (RMR VAMC) who are initiating [...]

Background: Hospital readmissions within 30 days of discharge have gained national attention and account for more than $17 billion in avoidable U.S. Medicare expenditures each year. (1) In 2011 alone, there were approximately 3.3 million adult 30-day all-cause hospital readmissions, costing the US $41.3 billion.(2) As such, efforts have been made to create algorithms to [...]