Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple […]

Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple […]

Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order […]

Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order […]

Background: Commonly used discharge communication workflows hinder timely and efficient discharge. Studies exploring the use of the electronic health record (EHR) for discharge planning have been limited to electronic reports constructed from EHR data elements, including barriers to discharge documented at admission, care management data, and discharge criteria or other targeted interventions such as improving […]

Background: Increased scrutiny of length of stay (LOS) and readmission rates has led to a changing landscape for hospital medicine. Geographic rounding has been studied in academic settings with good results, including a decrease in LOS. Hospitalist groups not associated with teaching programs are trialing geographic rounding with multiple variations, though there is a paucity […]

Background: EHR time motion studies have shown a significant time burden and concern that bedside manner, physical exam skills and physician wellness are at risk. However, nearly all studies to date have only focused on practicing physicians and residency training programs. Nearly all U.S. based medical schools allow medical student access, thus EHR exposure actually […]

Background: Social and environmental factors negatively affect the healthcare of low-income, vulnerable populations. Such determinants of health are often manifested as unmet basic needs that may be remedied through legal mediation, most commonly regarding housing, income, utilities, employment, education, nutrition and family issues. Medical Legal Partnerships (MLPs) provide an interdisciplinary, comprehensive approach to healthcare, utilizing […]

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 […]