Background: Patients with cancer require reliable venous access for therapy. Although peripherally inserted central catheters (PICCs) and implanted ports are often used to meet infusion needs, risk of complications between these devices is unknown. We did a systematic review and meta-analysis to compare the risk of deep vein thrombosis (DVT), exit-site complications and central line-associated […]

Background: Many problems exist regarding inpatient code status: advance directives are rarely completed in outpatient and inpatient settings, patients' preferences regarding code status are often not elicited, physicians do not provide adequate information to allow patients to make informed decisions about code status, code status discussions are often delayed during an admission until it is […]

Background: Pain management is complex, and multiple variables may affect pain relief for patients. It is estimated that roughly 40% of hospitalized patients experience moderate to severe pain. Because hospitalists now care for an increasing number of inpatients across the United States, developing hospitalist‐based quality improvement for pain is essential, both for improving patient care […]

Background: Central line-associated bloodstream infection (CLABSI) is a morbid and potentially lethal complication. National policies related to CLABSI mandate public reporting of this adverse event, with hospitals receiving penalties based on their CLABSI rates. Contemporary data suggest that peripherally inserted central catheters (PICCs) placed outside critical care settings are a large contributor to hospital CLABSI […]

Case Presentation: A 49‐year‐old woman with a medical history significant for congenital hypofibrinogenemia and platelet dysfunction was admitted to the hospital for observation following percutaneous biliary drain removal. Because of a significant bleeding history, following her procedure, she was admitted for administration of cryoprecipitate and hemoglobin monitoring. During her hospitalization, the patient was prescribed a […]

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: In March 2019, the CEO of our public teaching hospital set a goal for the institution to become a high reliability organization. At that time, the hospital’s rates of catheter associated urinary tract infections (CAUTIs), central line associated blood stream infections (CLABSIs), and hospital acquired pressure injuries (HAPIs) were above the national average. Evaluation […]

Case Presentation: A 14‐month‐old boy was admitted with failure to thrive. He had 10–14 stools daily, occurring within 15 minutes of eating. He had pruritis. There were no recent fevers or vomiting. There was no history of jaundice, icterus, or meconium ileus. Medical history included solitary left kidney with mild hydronephrosis and poor weight gain. […]

Case Presentation: A 20‐year‐old healthy man with no significant medical history presented to the emergency department with multiple episodes of watery, bilious, nonbloody vomiting associated with nausea and poor oral intake for 3 days. He also had an episode of watery diarrhea. The patient denied any fever, chills, abdominal pain, recent respiratory tract infections, ill […]

Background: While multiple organizations have recommended reducing unnecessary and repetitive lab tests in hospitalized patients, this has not resulted in a widespread change in behavior. There is agreement that unwarranted labs increase costs, but data around specific lab costs have not been readily available. At baseline, there were 125,586 labs ordered by the UNC Rex […]