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 man with a history of exposure to his grandchild diagnosed with erythema infectiosum presented with a 1‐week history of fever, polyarthralgias, and myalgias. Evaluation revealed a platelet count of 68,000 and Hgb 15.7. CT scan showed splenomegaly and intra‐abdominal lymphadenopathy. He presented 2 days later and was hospitalized for generalized urticaria, […]

Background: Improvement of discharge times on house staff run medical floors is particularly complicated. Amato-Vealey et al. describe a domino effect of delayed discharges resulting in inability to transfer patients from intensive care units, advancement towards maximum capacity, and failure to move patients from the ER. This leads to delayed procedures, poor patient satisfaction, and […]

Background: The timing of discharges of admitted patients has a significant impact on hospital efficiency and throughput. Earlier discharges are associated with improved boarding times, admissions arriving to inpatient units earlier in the day, and decreased length of stay. Discharges that occur later in the day creates a bottleneck effect, causing emergency room congestion, overcrowding, […]

Case Presentation: Aortoesophageal fistula is a rare but life‐threatening complication after surgical aortic repair and should be considered in patients with history of aortic graft placement who complains of unexplained gastrointestinal bleeding. The mortality rate of an unrecognized fistula is 100%. A 51‐year‐old African American woman with a history of uncontrolled hypertension, iron deficiency anemia […]