Background: There is minimal automated electronic feedback to hospitalists about their level of service in professional billing. Based on today’s payor requirements for inpatient admission, the medical decision-making involved in the care of inpatients almost always justifies a level of service above level 1. However, encounters may still receive level 1 due to under-documentation (e.g. […]

Background: There is minimal automated electronic feedback to hospitalists about their level of service in professional billing. Based on today’s payor requirements for inpatient admission, the medical decision-making involved in the care of inpatients almost always justifies a level of service above level 1. However, encounters may still receive level 1 due to under-documentation (e.g. […]

Background: Patients feel “uncomfortable, vulnerable, and exposed” in their gowns while providers are distressed at seeing and caring for their fellow human beings clad in sub-human “threadbare,” “ugly” garments. The purpose of this study was to create a patient gown based on design suggestions by patients and providers (physicians and nurses) and to refine the […]

Case Presentation: A 53‐year‐old African American woman presented with 2 weeks of productive cough not responsive to antibiotics and 1 week of fever, headache, night sweats, and lightheadedness. She also reported a 25‐pound weight loss over 2 months, but she denied dyspnea and chest pain. She had a 15‐pack‐year smoking history and was febrile, tachycardic, […]

Case Presentation: This is a 51‐year‐old man with no significant medical history who presented to an outside hospital with a 1‐day complaint of sudden‐onset left‐sided chest pain radiating to the left shoulder, associated with diaphoresis and shortness of breath that developed while working out at home. The initial electrocardiogram showed acute ST‐segment elevations in leads […]

Background: A publicly funded Health Authority embraced a Hospitalist service in 2000 as a quality improvement initiative. This relationship turned contentious over several contract renegotiations. With each successive contract, trust declined and the working environment became adversarial. Failed negotiations lead to a contract termination in 2015, ultimately affecting the stability of this medical service. Purpose: […]

Case Presentation: A 47‐year‐old man with a history of stroke presented after a fall without loss of consciousness. He reported increased thirst and urination as well as headaches without vision changes. Vital signs including orthostatics were normal, and physical exam was unremarkable. Visual fields were intact and there was no thyromegaly or skin abnormalities. Laboratory […]

Background: Patients with advanced cancer have high readmission rates, up to 27% in some studies, and represent unique challenges related to transitions of care, complex disease management, and care coordination. Recent efforts have focused on better identification of potentially avoidable readmissions (PARs). One study found that primary reasons for PARs in cancer patients included pre-mature […]

Case Presentation: A 76‐year‐old white man with a medical history of Hashimoto's thyroiditis, atrial fibrillation, coronary artery disease and hypertension presented to the emergency department with clouding of consciousness for 1 day. His vital signs were stable. Chest and cardiovascular examination was normal. He was admitted for further workup, which revealed CBC and electrolytes to […]

Background: Hospitals emphasize early discharge to improve throughput. Interdisciplinary team members often report feeling rushed in the 24 hours before discharge, which may increase the likelihood of discharge errors and burnout for the team. Purpose: To identify obstacles preventing timely completion of discharge activities, improve reliability of the discharge process, improve staff experience, and decrease […]