Background: After discharge from an acute care hospitalization, cancer patients may choose to pursue rehabilitative care in a skilled nursing facility (SNF). Our objective was to examine receipt of anti-cancer therapy, death, readmission, and hospice use of cancer patients who discharge to a SNF compared to those who discharge home or home with home health […]

Background: At this 328‐bed hospital there were 8 hospitalists rounding on up to 9 units per day. This prevented efficient and effective communication with nurses, patients, and families. Physicians spent more than 30 minutes of travel time per day. Length of stay and census per physician were high; patient satisfaction was low. With a deadline […]

Background: Palliative care in seriously ill patients has been shown in some studies to improve satisfaction, symptoms, inpatient mortality rates, healthcare utilization and cost. While inpatient palliative care has been shown to improve symptoms and quality of life measures, the literature on its association with 30-day readmissions have been mixed for heart failure hospitalizations. We […]

Background: Adverse outcomes in surgery account for up to $25 billion expenditure annually. This is despite spending >$30 billion annually on preop testing. Although algorithms and checklists have improved outcomes in a pocketful of areas like infection control and team communication, the same momentum has not been attained in several practice areas including preoperative medical […]

Background: Traumatic brain injuries (TBIs) pose a unique problem because prognosis is difficult to predict; therefore, treatment decisions are complex with uncertain outcomes. According to the American College of Surgeons 2018 Trauma Quality Improvement Project (TQIP), identified patients should receive a palliative care assessment within 24 hours, a family conversation should be held within 72 […]

Case Presentation: A 28‐year‐old woman presented with 3 days of fevers. She also noted headache and dyspnea on exertion. She denied cough, chest pain, vision changes, or neurologic deficits. She had grade III oligoastrocytoma status post resection, adjuvant radiation therapy, and induction chemotherapy with temozolomide. She was taking dexamethasone for cerebral edema prophylaxis. Vital signs […]

Case Presentation: A 67‐year‐old man with long‐standing bipolar disorder presented with acute psychosis. Two weeks after initiation of clozapine, the patient began to experience lethargy, vomiting, diarrhea, low‐grade fevers, and tachycardia. Physical exam revealed a new late‐systolic murmur that was loudest at the left lower sternal border. Labs revealed an elevated white blood cell count […]

Background: Although the vast majority of adult patients in the United States prefer to die at home, most patients die in acute care settings. Barriers include advanced care planning, communication between inpatient and outpatient providers, and delivery of medical equipment. In 2018, our General Medicine Service Line ranked 73rd out of 98 Academic Medical Centers […]

Case Presentation: A 54 year-old man initially presented to an outside hospital with three days of fever, headache and productive cough thought to be upper respiratory viral illness. He received symptomatic treatment but returned with fevers, worsening cough, headache, nausea, and abdominal discomfort. Physical exam was remarkable for fever of 102.8 °F (39.3 °C), bilateral […]

Case Presentation: WF, an 88-year-old man with advanced, wild-type transthyretin-associated (ATTR) cardiac amyloidosis (on tafamidis) complicated by distal conduction disease and heart failure with preserved ejection fraction, presented with syncope and was admitted to the cardiac critical care unit for symptomatic, bradycardic atrial fibrillation. A continuous dopamine infusion was started with resolution of symptoms and […]