Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Greater appreciation of complications associated with peripherally inserted central catheters (PICC) and the diffusion of catheter appropriateness criteria has led to expanded use of these devices. However, single center studies comparing [...]

Background: Skin, soft tissue, and joint infections are common in pediatric patients and can require invasive procedures to drain purulent fluid. Atypical pathogens (fungal and acid-fast bacilli [AFB]) are important but rare causes of these infections with reported case rates as low as 0.6-1.6 cases/100,000 a year. Despite the rarity of these infections, costly atypical [...]

Background: Assessing vitals at regular intervals can be disruptive to a patient’s rest and unnecessary if the patient is clinically stable. These interruptions may lead to impaired sleep, parental fatigue and anxiety, delayed discharge, and increased cost of care. Moreover, alarm fatigue has been described with over-monitoring of patients, as has the overuse of staff [...]

Background: Our hospitalist group has seen a rise in the number of Advanced Practice providers (APP) due to increasing patient workload. The APPs come from varying backgrounds, are within 2 years of graduation and have had little experience in evaluating common emergent and nonemergent presentations on the hospital medicine service. Our current practice is for [...]

Background: Joint leadership- modeled by physician-nurse dyad unit leaders has been a successful leadership structure at our organization for years. Advanced practice providers (APPs) have grown significantly in numbers over the past 10 years and have become critical members of our inpatient healthcare teams. They represent a stable and engaged workforce. In 2016, the nurse-physician [...]

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: 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: Patient-centered communication has been associated with positive patient outcomes such as improved patient understanding and adherence to therapy. Teaching patient-centered care (PCC) and communication throughout a hospital stay, with an emphasis on understanding each patient’s perspective and circumstances, is a focus on one of four general inpatient medicine services at our hospital. We did [...]

Background: Gender disparities in academic medicine are well-documented. In many current academic settings, decisions regarding faculty promotion, teaching time, and pay are influenced by performance evaluations. As a result, it is crucial to understand how evaluations may be impacted by gender bias. There are three aims to this study: 1) assess for differences in the [...]

Background: Introduction : A Medical Orders for Scope of Treatment (MOST) form, adopted by the state of Texas in 2014, is similar to Physician Orders for Life Sustaining Treatment (POLST/MOLST) form in other states. It translates patient preferences for CPR, critical care, assisted nutrition, and transfer between healthcare facilities into a physician order set. Previous [...]