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: 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 […]

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 […]

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 […]

Background: Procalcitonin (PCT) testing has been shown in randomized trials to decrease antibiotic exposure and be a reliable predictor of clinical response to antibiotics in lower respiratory tract infection (LRTI) and sepsis. Although studied to guide antibiotic discontinuation in LRTI and sepsis, optimal strategies for introducing PCT into “real-world” clinical use are unknown. Our study […]

Background: Acute Kidney Injury (AKI) is a common hospital problem which may lead to increased mortality, hospital costs, and increased length of stay (1). A leading cause of renal dysfunction in the inpatient population is drug nephrotoxicity. Several studies show that physician prescribers often do not take renal function into account with new or existing […]