Background: Overnight vital sign assessment can disrupt sleep in the hospital and may be unnecessary in clinically stable patients. However, providers may not feel comfortable determining which patients can safely forego overnight vitals. We studied the effect of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) that automatically identified clinically […]

Background: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications […]

Background: Sepsis, severe sepsis, and septic shock remain important contributors to hospital utilization, morbidity and mortality in the United States. Timely interventions including blood cultures, intravenous crystalloid infusions, and antibiotics make up the 3-hour sepsis bundle which represents current standard of practice, and the target of hospital quality reporting. Many aspects of sepsis care are […]

Background: Sepsis, severe sepsis, and septic shock remain important contributors to hospital utilization, morbidity and mortality in the United States. Timely interventions including blood cultures, intravenous crystalloid infusions, and antibiotics make up the 3-hour sepsis bundle which represents current standard of practice, and the target of hospital quality reporting. Many aspects of sepsis care are […]

Background: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to […]

Case Presentation: An 82‐year‐old woman came to the emergency department with pleuritic chest pain, cough, and fever. On arrival, she was found to have aphasia and right‐sided hemiparesis. Her family noted that she was normal just hours before. CT scan and MRI of her brain demonstrated only chronic ischemic changes consistent with her previous lacunar […]

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: The patient was a 24‐year‐old white woman with a history of rheumatoid arthritis diagnosed 1 year ago. She presented with symptoms of diffuse postprandial abdominal pain, nausea, and generalized fatigue for a few months. Her symptoms acutely worsened over the course of 3 days, with radiation of sharp abdominal pain to the chest, […]

Background: Observation status was designed to reduce health care costs for patients in need of short hospital stays. CMS suggests that observation care should typically require less than 24 hours, and only rarely last more than 48 hours. However, studies suggest that length of stay for observation patients is often longer than CMS guidance.[1,2] An […]