Background: With the increasing use of diagnostic imaging modalities, incidental findings (IFs) are a common occurrence in hospitalized patients. They present a unique challenge to hospitalists treating patients admitted for chest pain because of the ever shorter hospital length of stay. Very few studies have focused on describing the characteristics of patient with IFs. A […]

Background: Despite a commitment to high-quality medical education, diagnostic errors continue to be pervasive. Clinical presentations with nonspecific symptoms and diagnoses with wide differentials are prone to diagnostic errors; dizziness may be the epitome of this conundrum. Dizziness is a common symptom, costly to assess, and frequently misdiagnosed. Diagnostic decisions have high stakes, given the […]

Background: Hospitalized patients are at risk for a number of preventable complications. Utilization of indwelling urinary catheters (IUCs) and central venous catheters (CVCs) can increase the risk of infection while provision of venous thromboembolism (VTE) prophylaxis can reduce the risk of VTE. Checklists have been used in a number of clinical situations to standardize practice […]

Background: Diagnostic error is commonly defined as a missed or delayed diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review […]

Background: Diagnostic errors in hospitalized patients are difficult to identify and quantify: error rates range from 4.8 to 49.8%. Though chart review tools, like the Safer Dx instrument, have been developed to assess the presence of diagnostic error in ambulatory settings, they have yet to be validated for acute care. A key issue is identifying […]

Background: Nebulized bronchodilator therapies (“nebs”) are commonly used in the inpatient setting for the treatment of obstructive pulmonary symptoms. Neb administration, however, requires direct respiratory therapist (RT) care, making them a resource‐intensive therapy. Metered dose inhalers (MDIs) have been shown to be equally effective as nebs, but are commonly misused by patients. Therefore, administering unnecessary […]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the […]

Background: Paracentesis and thoracentesis are among the most common procedures performed by hospitalists. Though many hospitalists feel comfortable with these procedures, there are several reasons to use ultrasound for these procedures: (1) the literature supports increased patient safety and operator success; (2) ultrasound has become increasingly accessible due to decreased cost, increased portability, and documented […]

Case Presentation: The patient is a 74‐year‐old Caucasian man who presented for evaluation of double vision and balance problems. Two weeks prior to admission he suffered sudden double vision while driving. It resolved spontaneously after five minutes. Three days later this symptom returned and was accompanied by unsteadiness and a near fall while walking outside […]

Case Presentation: A 66-year-old woman with hypertension presented to the hospital one day after arrival to New York City from Guinea with chronic daily vomiting, unintentional weight loss, progressive shoulder pain, and a subacute pruritic rash. She denied fevers, night sweats, difficulty breathing, chest pain, palpitations, unusual skin exposures, insect bites, trauma to the shoulder, […]