Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered […]

Background: Training in quality improvement (QI) is an essential part of residency and medical practice. Critical to this is accepting that human infallibility is impossible, and we need to shift the culture of medicine from one that places blame on individuals to one where errors and near misses are seen as critical learning opportunities. The […]

Background: Sepsis is a leading cause of hospital death and readmission (1-2). Prior work has suggested that early, adequate intravenous fluid (IVF) administration during sepsis care is associated with lower mortality, even among those at risk for fluid overload (including patients with chronic kidney disease [CKD] or heart failure [HF]) (3). At the same time, […]

Background: Acute decompensated heart failure exacerbation is the leading cause of hospitalization in the United States. It was associated with total medical costs of more than $30 billion in 2012 with projections estimating around $70 billion in costs by 2030. Currently, six million people in the U.S. have heart failure, with a little over half […]

Background: Chronic obstructive pulmonary disease (COPD) exacerbations occur in a significant proportion of hospitalizations but are often treated with substandard care. This may include inappropriate use of medications during and after hospitalization and failing to receive appropriate referrals for subspecialty care and rehabilitation. After discharge, lack of adequate education can lead to inappropriate medication use. […]

Background: Hospitalist have not previously had a primary role in the setting of eating disorders beyond stabilization in an acute care setting. Following stabilization, patients in need of further treatment are transferred to an eating disorder facility. While in inpatient or residential care for their eating disorder, patient are monitored by physicians or mid-level providers. […]

Case Presentation: A 29‐year‐old man with no medical history presented with increasing shortness of breath and orthopnea for ten days. He denied alcohol and drug abuse. Family history was negative for any cardiac disease. Examination revealed distended neck veins, bibasilar crackles, and S3. EKG showed normal sinus rhythm with QRS duration of 130 ms. An […]

Case Presentation: A 77 year-old Hispanic woman with a past medical history of heart failure with preserved ejection fraction (HFpEF), atrial fibrillation, and chronic kidney disease presented with progressive dyspnea and increased lower extremity swelling for two days. She had been admitted for decompensated heart failure two months earlier, when a cardiac catheterization revealed no […]

Case Presentation: A 62-year-old female with a past medical history of stroke, obesity, hypertension, and hyperlipidemia presented to the emergency department with fever and altered mental status. She was started on empiric meningitis treatment and her mentation improved dramatically with eventual return to baseline. Cerebrospinal fluid (CSF) studies from a lumbar puncture performed later during […]