Background: Joint leadership- modeled by physician-nurse dyad unit leaders has been a successful leadership structure at our organization for years. Advanced practice providers (APPs) have grown significantly in numbers over the past 10 years and have become critical members of our inpatient healthcare teams. They represent a stable and engaged workforce. In 2016, the nurse-physician […]

Background: Joint leadership- modeled by physician-nurse dyad unit leaders has been a successful leadership structure at our organization for years. Advanced practice providers (APPs) have grown significantly in numbers over the past 10 years and have become critical members of our inpatient healthcare teams. They represent a stable and engaged workforce. In 2016, the nurse-physician […]

Background: Medicare patients account for over 50% of hospital days and over 30% of all hospital discharges in the United States. The number of healthcare providers with specialized geriatric training dedicated to the care of hospitalized vulnerable older adults is currently insufficient. The growth of the hospitalist movement has become the key strategy for providing […]

Background: Communication failures amongst interdisciplinary internal medicine (IM) teams occur often in the inpatient setting, which can inhibit mutual understanding of care plans, increase the potential for medical error, and contribute to patient dissatisfaction. Efforts to enhance interdisciplinary collaborative teamwork within inpatient IM teams highlighted a critical need to address concerns related to communication. Methods: […]

Case Presentation: A 41‐year‐old man with no medical history presented for a second opinion for chest pain, cough, fevers, and an 80‐pound weight loss in 2 months. Previous evaluation revealed peripheral eosinophilia, pericarditis, and pneumonia. On presentation to our facility, his WBC count was 28,000/μL with an eosinophil count of 12,600 cells/μL. A workup was […]

Background: Telemetry beyond 48 hours is indicated for a select patient population and when used inappropriately has risk. This includes increased cost of care, skin irritation, delirium contribution, and more likely to have false positives resulting in errors or extending length of stay.To encourage care that is truly necessary, free of harm, not duplicative, and […]

Background: Late afternoon hospital discharges contribute to admission delays, leading to occupancy increase and increased length of stay. However, prominent workplace barriers often exist towards improvement initiatives that target early discharge. Team members cite timing of rounds, absence of early discharge support resources, communication breakdowns, and increased daytime admission volume as barriers to change. Furthermore, […]

Case Presentation: A previously healthy 41‐year‐old man presented to the emergency department (ED) with right‐sided pleuritic chest pain of 1‐week duration. He was diagnosed with right lower lobe pulmonary embolism (PE) on CTA of the chest, attributed to recent prolonged travel history, and the patient was subsequently discharged home on warfarin. After 2 weeks, patient […]

Case Presentation: A 62‐year‐old woman with a history of stage IIB squamous cell carcinoma of the cervix was treated with total abdominal hysterectomy–bilateral salpingo‐oophorectomy and chemoradiotherapy in 2003. In September 2011 the patient presented to our hospital with mild abdominal pain, jaundice, and weight loss of 3 months' duration. Laboratory results were significant for total […]

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 […]