Background: Although the vast majority of adult patients in the United States prefer to die at home, most patients die in acute care settings. Barriers include advanced care planning, communication between inpatient and outpatient providers, and delivery of medical equipment. In 2018, our General Medicine Service Line ranked 73rd out of 98 Academic Medical Centers [...]

Background: Virtual care is becoming a fully realized modality of providing patient care (1, 2). In hospital medicine, the transition of care from inpatient to outpatient can be challenging to carry out efficiently and effectively while mitigating any preventable harm that may arise prior to a scheduled follow-up appointment with a primary care physician (PCP). [...]

Background: Physical (PT) and Occupational therapy (OT) are valuable entities, but are overused in hospitals. There is limited published literature on the appropriate utilization of PT and OT evaluations in hospitals. Analysis of all PT/OT referrals for 2018 at NewYork Presbyterian Weill Cornell showed that PT/OT orders were part of the admit order set. These [...]

Background: Medically complex patients discharged from hospitals to skilled nursing facilities (SNFs) are at high risk for unintentional errors, re-hospitalization, and mortality. Commonly reported transitional care errors include poor communication of critical information, limited access to medical records, and lack of clarity as to follow-up plans or patients care goals. Telehealth is increasingly used in [...]

Background: Hospitals emphasize early discharge to improve throughput. Interdisciplinary team members often report feeling rushed in the 24 hours before discharge, which may increase the likelihood of discharge errors and burnout for the team. Purpose: To identify obstacles preventing timely completion of discharge activities, improve reliability of the discharge process, improve staff experience, and decrease [...]

Background: Hospitalization provides an opportunity to provide patients who use tobacco with evidence-based treatment for cessation, including nicotine replacement therapy, motivational interviewing, and pharmacotherapy. However, this benefit is often lost without appropriate transitions in care to outpatient cessation resources. We have found that inpatient tobacco cessation interventions at our 600-bed urban academic medical center do [...]

Background: Harborview Medical Center (HMC) is a 413-bed academic safety net hospital in Seattle, WA, and a level one trauma center for five states. Over the past seven years, HMC has observed increasingly long length of stay (LOS) resulting in a critically high patient census and limited capacity. To improve LOS, a Care Management department [...]

Background: Given the shift-based nature of modern hospital medicine, block schedules where physicians are on clinical service for a defined period of time are common place. As such, end-of-service handoffs are a routine element of hospital medicine practice. Like handoffs to an overnight cross-covering physician, end-of-service handoffs pose a risk to patients if critical information [...]

Background: Our experience developing the Comprehensive Care Physician (CCP) program within the Section of Hospital Medicine at the University of Chicago has illustrated the value of relational continuity in the care of patients with complex medical needs. For patients with increased risk of hospitalization and who are willing to find a new primary care physician, [...]

Background: Length of stay (LOS) is an important quality indicator and has significant financial implications and impact on hospital throughput. Geriatric Fracture Center (GFC) is a co-management program between Hospital Medicine and Orthopedic for patients who are age 60 and above with fragility fracture. Delays in skilled nursing facility (SNF) rehabilitation placement are a major [...]