Background: Failure to promptly recognize clinically deteriorating patients in the hospital leads to delays in critical interventions and worse health outcomes. Current standard practice in patient monitoring on most medical-surgical wards involves vital sign assessment at discrete time points, typically every four to eight hours. More frequent or continuous vital sign monitoring has historically been […]

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: 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: One of the challenges in hospital medicine is the care of patients overnight, when the primary team is unavailable, and care is being provided by those who are not as familiar with the patient. This is compounded by the high volume of pages at night. At UNC Rex Hospital, these factors resulted in delays […]

Background: One of the challenges in hospital medicine is the care of patients overnight, when the primary team is unavailable, and care is being provided by those who are not as familiar with the patient. This is compounded by the high volume of pages at night. At UNC Rex Hospital, these factors resulted in delays […]

Case Presentation: The patient was a 24‐year‐old white woman with a history of rheumatoid arthritis diagnosed 1 year ago. She presented with symptoms of diffuse postprandial abdominal pain, nausea, and generalized fatigue for a few months. Her symptoms acutely worsened over the course of 3 days, with radiation of sharp abdominal pain to the chest, […]

Background: Observation status was designed to reduce health care costs for patients in need of short hospital stays. CMS suggests that observation care should typically require less than 24 hours, and only rarely last more than 48 hours. However, studies suggest that length of stay for observation patients is often longer than CMS guidance.[1,2] An […]

Background: There are no guidelines for designing or evaluating fixed-content signs or electronic displays used to communicate patient-related information in hospital rooms. Accordingly, there is the potential for the displayed information to be ignored, misinterpreted, or distracting in the complex hospital room environment where patients, nurses, and physicians change frequently. Purpose: To address this shortcoming, […]

Case Presentation: A 44‐year‐old Vietnamese man with HIV presented with a cavitary pneumonitis after 1 week of subjective fever, nonproductive cough, 3‐ to 4‐pound weight loss, and 2 days of azithromycin therapy from his primary care provider. He denied shortness of breath or dyspnea. His medical history included a diagnosis of tuberculosis 20 years ago […]

Case Presentation: A 28‐year‐old previously healthy Hispanic man presented for evaluation of bleeding gums and rash. Four days prior he noted mild fatigue, cough, headache, and subjective fever consistent with an upper respiratory tract infection. On presentation, vital signs were stable, and physical exam revealed petechial hemorrhages on the soft palate with bleeding gums (wet […]