Background: Skin, soft tissue, and joint infections are common in pediatric patients and can require invasive procedures to drain purulent fluid. Atypical pathogens (fungal and acid-fast bacilli [AFB]) are important but rare causes of these infections with reported case rates as low as 0.6-1.6 cases/100,000 a year. Despite the rarity of these infections, costly atypical [...]

Background: Assessing vitals at regular intervals can be disruptive to a patient’s rest and unnecessary if the patient is clinically stable. These interruptions may lead to impaired sleep, parental fatigue and anxiety, delayed discharge, and increased cost of care. Moreover, alarm fatigue has been described with over-monitoring of patients, as has the overuse of staff [...]

Background: Thoughtful laboratory testing is a key component of high-value and cost-effective patient care. Studies estimate that nearly half of laboratory tests may be unnecessary in certain patient populations. The drivers of observed variation in laboratory testing are not clearly established; our study aims to examine whether testing varies by hospitalist years of experience. Methods: [...]

Background: Computed tomography (CT) can provide critical information for diagnosis and is a prevalent and easy-to-use imaging test, but overtesting becomes a big probleｍ. The previous report showed 30-40% of abdominal CT scans were medically unnecessary. Therefore, head CT is a research topic in overtesting, and clinical predictive scores have been developed to avoid overtesting [...]

Background: In the US, hospitalist system has been introduced with improvement of quality and safety of care, education and value. Japan now face rapidly declining birthrate and aging population. Organ-based subspecialty system has difficulty in managing patients with multiple diseases. Patient-centered general medical care is required for inpatient management. However, in Japan, there are only [...]

Background: Fingerstick blood glucose (FSBG) testing allows inpatient providers to adjust insulin in real time to protect patients from significant hypo- or hyperglycemia. Admitted diabetic patients are often placed on sliding scale insulin with four times per day FSBG testing, regardless of home insulin use. FSBG test materials cost $9 per use (1). We estimate [...]

Background: Physical therapy (PT) is a valuable tool to help prevent the functional decline and loss of mobility hospitalized patients experience. Yet, it is a constrained resource in most hospital settings. The AM-PAC score is a validated tool that has been used to predict discharge destination within 48 hours of admission. It has also been [...]

Background: In light of increasing healthcare costs, diagnostic stewardship is an important component of providing high-value healthcare. Order sets, a collection of orders aggregated in a single location for a given diagnosis, condition, or treatment, are designed to promote adherence to evidence-based practices and reduce variability in care—both known drivers of high-value care (Atlas SJ [...]

Background: Altered mental status (AMS) is prevalent in hospitalized patients, especially the elderly (1). The work up of AMS is based on history, physical exam, pertinent labs and imaging. Common etiologies include fluid and electrolyte disturbances, infections, drug toxicity, drug withdrawal and metabolic derangements. Many routine labs drawn in the evaluation of acute encephalopathy are [...]

Background: The utility of procalcitonin (PCT) in pediatrics is debated. Proposed diseases in which PCT elevation is thought to be suggestive of a bacterial process include meningitis, urinary tract infection, pneumonia, neonatal fever, and sepsis of unknown source. However, elevated PCT is non-specific for bacterial infection and the strength of the test is generally felt [...]