Background: The relation of a patient’s age to survival in cardiac arrest is often discussed at the bedside when clinicians, patients, and families are faced with the question of whether CPR is medically appropriate for elderly individuals. Few studies are available to help guide this conversation. This study sought to evaluate in-hospital cardiac arrest (IHCA) […]

Background: Early intervention has been shown to change outcomes in patients with sepsis. Patients on general medical units often develop and suffer complications from sepsis, but it is unclear if we identify these patients soon enough in order for them to benefit from early intervention. The purpose of this study was to evaluate if a […]

Background: Mitochondrial disease (MD) refers to a group of clinically heterogeneous disorders that result from dysfunctional oxidative phosphorylation and subsequent cellular incapability to meet energy demands. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), myoclonus, epilepsy, ataxia with ragged red fibers (MERRFs), chronic progressive ophthalmoplegia, Kearns–Sayre syndrome, and sensory ataxia neuropathy dysarthria ophthalmoplegia are among […]

Background: As hospitals work to reduce avoidable hospital readmission rates, health care delivery systems more broadly have been working to develop efficient, effective health care delivery models under the rubric of accountable care organizations (ACOs). As the principal providers of inpatient‐based care, hospitalists can build on their quality improvement experience in transitions of care to […]

Case Presentation: A 45‐year‐old man with no medical history presented with a 3‐week history of progressively worsening chest pain. The pain was sharp, exertional, and worsened by lying flat. He denied fever, chills, or recent illness. Vital signs were normal, and the only notable exam finding was muffled heart sounds. Initial EKG showed diffuse, concave […]

Background: Overuse of non-ICU continuous adult cardiac (telemetry) monitoring is a well-documented problem that can lead to increase hospital cost, alarm desensitization, nursing time loss, and patient discomfort 1,2. Previous studies assessing reduction of inappropriate telemetry use have employed a combination of electronic health record (EHR) order, nursing protocol changes, intensive educational, and/or feedback initiatives […]

Case Presentation: Patient 1 is a 22‐year‐old man with no medical history who presented with progressively worsening fevers, severe nausea, and nonbloody severe emesis with a diagnosis of infectious mononucleosis. The patient had fevers to 104°F with chills and a pulse of 100. On physical examination, he was ill appearing and diaphoretic. The patient's CBC […]

Background: In order to reduce overuse, many hospitals have conducted studies and implemented protocols with the goal of reducing non-indicated telemetry monitoring. A common tool that institutions utilize for these changes are the clinical decision support systems (CDSS). In this report, we will present the telemetry protocol utilized by our hospital and review its effects […]

Case Presentation: A 24‐year‐old woman presented to our emergency department with right fifth‐finger metacarpophalangeal (MCP) pain. She had a history of overt hyperthyroidism and had self‐discontinued her methimazole several years prior to admission, and had been lost to medical follow‐up. One week prior to presentation, the patient had noticed mild swelling around the joint and […]

Background: Telemetry over utilization increases wasted spending, increases alarm fatigue, and creates patient safety risks. Despite the presence of American Heart Association (AHA) practice guidelines, patients are often placed on telemetry for inappropriate reasons at the discretion of the medical provider and are monitored for longer than anticipated. The goal of this quality improvement project […]