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 […]

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: […]

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 […]

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 […]

Background: On January 1st, 2017, the Joint Commission antibiotic stewardship accreditation standard came into effect, requiring hospital wide antibiotic stewardship programs. In West Virginia, per the CDC, in 2014, less than 28% had a stewardship program that met all 7 of the CDC core elements. In a May 2017 article of Clinical Infectious Diseases, authors […]