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: 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: Balancing attending supervision with resident autonomy is intended to ensure patient safety while allowing trainees to gain graduated competency and independence upon completion of residency. ACGME work-hour restrictions have increased attending supervision, but its effect on resident education and autonomy is unclear. In order to better understand the underlying tensions and contributing factors to […]

Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. […]

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, […]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the […]

Background: Antibiotics prescribed at hospital discharge account for over half of antibiotic exposure related to hospitalization and contribute to antibiotic-related harm. We hypothesized that an antibiotic timeout to reconsider antibiotic necessity, selection, and duration prior to discharge could reduce antibiotic overuse. Thus, we conducted a 6 month prospective, controlled pilot study to determine feasibility and […]

Background: In an effort to combat the national opioid crisis, our state legislation passed House Bill 451 effective July 1, 2019. It addresses medication overprescribing to decrease morbidity and mortality from opioid misuse, abuse, and overdose. The law has several requirements including discussion of non-opioid treatment alternatives, review of the Prescription Monitoring Drug Program (PDMP) […]

Background: As the acuity of hospitalized patients increases, there have been an increasing number of patients requiring mechanical ventilation on the general medical units (GMU). Ventilated patients in intensive care units (ICUs) have a standardized approach to minimize the risks for complications such as ventilator associated events (VAE), GI bleeding and VTE. When patients requiring […]

Background: In light of increasing healthcare costs, diagnostic stewardship is an important component of providing high-value healthcare. Order sets, a collection of orders aggregated in a single location for a given diagnosis, condition, or treatment, are designed to promote adherence to evidence-based practices and reduce variability in care—both known drivers of high-value care (Atlas SJ […]