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: 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: 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: 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: Conversations around advance care planning (ACP) allow patients to direct the type and intensity of the medical care that they receive. Known ethnic and racial disparities in ACP exist, with racial and ethnic minorities less likely to have living wills and DNR orders. We aimed to understand the impact of an intervention to improve […]

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 […]