Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered […]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they […]

Background: Delays in the discharge of the hospital ward patients cause a backlog for new admissions from the Emergency Department, and transfers from the Intensive Care Units and telemetry units. This bottleneck unnecessarily increases overall resource utilization and also negatively impacts patient care and satisfaction. Therefore, our Internal Medicine Residency Program aimed through this quality […]

Background: Delays in the discharge of the hospital ward patients cause a backlog for new admissions from the Emergency Department, and transfers from the Intensive Care Units and telemetry units. This bottleneck unnecessarily increases overall resource utilization and also negatively impacts patient care and satisfaction. Therefore, our Internal Medicine Residency Program aimed through this quality […]

Background: Clinicians have struggled to achieve consistent levels of appropriate hand hygiene (HH) in the inpatient setting. The behavior of influential members of the team is known to affect HH practices of others, but the mechanics of this influence on a teaching service have not been previously described. Methods: Undercover observers recorded HH practices during […]

Background: Chest pain and related symptoms are the number two reason patients visit emergency departments in the United States, often leading to routine hospitalization or observation. Improving utilization management of patients presenting to the emergency department with chest pain is an important goal for hospitals. Use of 5th generation troponins and risk stratifying tools can […]

Background: Painful diagnostic or therapeutic procedures are commonly performed in the emergency department (ED). Previous investigations indicate that practitioners frequently do not provide adequate anesthesia for painful medical procedures. Patients indicate they would like to receive local anesthesia prior to a painful procedure, but often it is not offered. Topical anesthetics have been recommended as […]

Background: Staffing of inpatient medicine services with Advanced Practice Providers (APPs), including physician assistants and nurse practitioners, is becoming increasingly common at academic medical centers across the United States. The various roles filled by APPs have not been well-described in the literature. The purpose of this study is to better characterize how APPs are utilized […]

Background: Renal dysfunction is a complication in patients with decompensated cirrhosis. Due to the potential morbidity and mortality of these disorders in cirrhotic patients, it is important to ensure accurate clinical measurements of renal function. Standard creatinine-based estimated glomerular filtration rate (eGFR) equations have proven to be inaccurate in cirrhotic patients, as these patients have […]

Background: Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is managed by a variety of specialists. Current guidelines differ in their recommendations and may not adequately address management in the acute setting, leading to uncertainty regarding important clinical decisions. We sought to document practice pattern variation among cardiologists, emergency medicine physicians (EMs), […]