Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple […]

Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple […]

Background: Introduction : A Medical Orders for Scope of Treatment (MOST) form, adopted by the state of Texas in 2014, is similar to Physician Orders for Life Sustaining Treatment (POLST/MOLST) form in other states. It translates patient preferences for CPR, critical care, assisted nutrition, and transfer between healthcare facilities into a physician order set. Previous […]

Background: Invasive bedside procedures are associated with high complication rates — 15% for central venous lines (CVLs), 20% for thoracenteses, and 6% for paracenteses. The American Board of Internal Medicine, while requiring that “the internist be thoroughly evaluated and credentialed as competent in performing a procedure,” does not provide specific mechanisms by which to document […]

Case Presentation: Five months prior to admission to our hospital, a 71‐year‐old man with end‐stage renal disease who undergoes hemodialysis 3 times per week via an upper‐extremity AV fistula, was diagnosed at his outpatient dialysis center with a bloodstream infection; it was treated for a total of 2 weeks with 6 doses of vancomycin given […]

Background: Conversations around advance care planning (ACP) allow patients to direct the type and intensity of the medical care that they receive. Known ethnic and racial disparities in ACP exist, with racial and ethnic minorities less likely to have living wills and DNR orders. We aimed to understand the impact of an intervention to improve […]

Case Presentation: A 54 year-old man initially presented to an outside hospital with three days of fever, headache and productive cough thought to be upper respiratory viral illness. He received symptomatic treatment but returned with fevers, worsening cough, headache, nausea, and abdominal discomfort. Physical exam was remarkable for fever of 102.8 °F (39.3 °C), bilateral […]

Case Presentation: WF, an 88-year-old man with advanced, wild-type transthyretin-associated (ATTR) cardiac amyloidosis (on tafamidis) complicated by distal conduction disease and heart failure with preserved ejection fraction, presented with syncope and was admitted to the cardiac critical care unit for symptomatic, bradycardic atrial fibrillation. A continuous dopamine infusion was started with resolution of symptoms and […]