Background: Overnight vital sign assessment can disrupt sleep in the hospital and may be unnecessary in clinically stable patients. However, providers may not feel comfortable determining which patients can safely forego overnight vitals. We studied the effect of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) that automatically identified clinically […]

Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care […]

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: 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: The Limited English Proficiency (LEP) population is at higher risk of receiving poorer care and worse health outcomes compared to their English-speaking counterparts. Interpreters should be utilized to help improve these encounters, but physicians are rarely trained on how to work with interpreters effectively. This is reflected in a prior study showing that residents […]

Background: Improving a patient’s experience with the health care system improves outcomes of care. Glickman et al found that higher patient satisfaction is associated with improved adherence and lower inpatient mortality rates. Boulding et al found that higher patient satisfaction was associated with lower 30- day readmission rates for patients with heart failure, acute MI […]

Background: Delirium is a common and costly occurrence in hospitalized patients, particularly elderly patients. Diagnosing delirium can be challenging, particularly given the fluctuating nature of presentation and subtle hypoactive motor subtypes. The Brief Confusion Assessment Method (bCAM) is a delirium screening tool that has been validated for use in the med-surg clinical area. As part […]

Background: Although hip fractures in the elderly are largely due to osteoporosis, rates of treatment for osteoporosis after fragility fracture have been reported as

Background: The 2016 Surviving Sepsis Campaign guidelines recommend antibiotic administration within 1 hour of emergency department (ED) presentation for patients with sepsis. While early antibiotics are associated with reduced mortality, the 1 hr policy has been criticized for its one-size-fits-all approach and risk for over-diagnosis and treatment. Clinicians and quality leaders have called, instead, for […]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the […]