Background: As hospital length of stay has shortened from an average of 6.5 days in 2015 to 4.5 days in 2019 (1), there is increased urgency for providers to efficiently address inpatient needs and to shift diagnostic and therapeutic management to outpatient settings. Patients are faced with increased self-care burdens, often tasked to implement complex [...]

Background: Despite significant efforts, sepsis remains a common cause of hospital readmissions nationwide, and patients are often readmitted within two weeks after their index admission. Not only are patients who develop sepsis often chronically debilitated, sepsis can lead to systemic sequelae that includes functional deconditioning, cognitive impairment, sepsis-induced immunosuppression and inflammation, and cardiovascular risks. This [...]

Background: Discharge planning and transition of care (TOC) is a crucial process for inpatient teams hoping to optimize patient experience and outcomes. Feedback from patients prior to leaving the hospital identifies several areas for improvement, as there are often misunderstandings about hospital courses and treatment plans. Such confusion leads to poor TOC. The Hospital Consumer [...]

Background: On January 1st, 2017, the Joint Commission antibiotic stewardship accreditation standard came into effect, requiring hospital wide antibiotic stewardship programs. In West Virginia, per the CDC, in 2014, less than 28% had a stewardship program that met all 7 of the CDC core elements. In a May 2017 article of Clinical Infectious Diseases, authors [...]

Background: At academic institutions and other referral centers the process of accepting transfers from other hospitals has been a challenging and potentially laborious process to coordinate smoothly. It was also one that was not previously reimbursable. However, beginning in 2017 Medicare and other insurance companies began reimbursing Non-Face-to-Face Prolonged services procedural codes. These new codes [...]

Background: While rapid response teams are well established for inpatient emergencies, outpatient emergency response on large medical campuses is much more variable. At our institution, this need for outpatient emergency response is particularly acute. As a tertiary referral center, cancer treatment center, and the largest transplant center in the state, our clinics provide 1.4 million [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Recent demand for healthcare value and advances in relevant technologies have driven renewed attention to HaH models, including from the Center for Medicare and Medicaid Services (CMS), and have spawned several pilots within the U.S. Where studied, these [...]

Background: In many urban hospitals, Emergency Department (ED) crowding and patient boarding is an increasing challenge. Admitted patients often spend prolonged periods of time in the ED while waiting for an inpatient bed. These ED boarded patients can have delayed or inadequate care, increased adverse events and increased mortality. Furthermore, these ED boarded patients place [...]

Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spending most of their clinical time seeing patients, documenting or coordinating care and have minimal time to disrupt workflow to perform common bedside procedures such as paracentesis, lumbar punctures, central lines, arthrocentesis [...]

Background: For academic hospital medicine groups to thrive and be partners with their hospital systems, physicians must document and bill appropriately as a means of demonstrating their clinical value. Yet, many major academic hospital medicine groups may be unaware or receive little training for this very important skill set. Based on data from the Society [...]