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: Thoughtful laboratory testing is a key component of high-value and cost-effective patient care. Studies estimate that nearly half of laboratory tests may be unnecessary in certain patient populations. The drivers of observed variation in laboratory testing are not clearly established; our study aims to examine whether testing varies by hospitalist years of experience. Methods: [...]

Background: There exists no standardized means of assessing hospitalist performance on quality, safety, efficiency and value metrics.Timely, accurate and meaningful feedback on individual performance is imperative to drive improvement. Methods: The components of the MEQI align with the institution’s most important metrics, including readmission rate, hospital acquired conditions and observed to expected length of stay. [...]

Background: Computed tomography (CT) can provide critical information for diagnosis and is a prevalent and easy-to-use imaging test, but overtesting becomes a big probleｍ. The previous report showed 30-40% of abdominal CT scans were medically unnecessary. Therefore, head CT is a research topic in overtesting, and clinical predictive scores have been developed to avoid overtesting [...]

Background: Telemetry over utilization increases wasted spending, increases alarm fatigue, and creates patient safety risks. Despite the presence of American Heart Association (AHA) practice guidelines, patients are often placed on telemetry for inappropriate reasons at the discretion of the medical provider and are monitored for longer than anticipated. The goal of this quality improvement project [...]

Background: There is a paucity of literature examining length of stay for medical patients requiring discharge to subacute rehabilitation facilities (SAR). At our institution, this subset of patients had an average length of stay (ALOS) of 8.2 days while medical patients being discharged to home had ALOS of 4.2 days during the first half of [...]

Background: In the US, hospitalist system has been introduced with improvement of quality and safety of care, education and value. Japan now face rapidly declining birthrate and aging population. Organ-based subspecialty system has difficulty in managing patients with multiple diseases. Patient-centered general medical care is required for inpatient management. However, in Japan, there are only [...]

Background: Fingerstick blood glucose (FSBG) testing allows inpatient providers to adjust insulin in real time to protect patients from significant hypo- or hyperglycemia. Admitted diabetic patients are often placed on sliding scale insulin with four times per day FSBG testing, regardless of home insulin use. FSBG test materials cost $9 per use (1). We estimate [...]

Background: Physical therapy (PT) is a valuable tool to help prevent the functional decline and loss of mobility hospitalized patients experience. Yet, it is a constrained resource in most hospital settings. The AM-PAC score is a validated tool that has been used to predict discharge destination within 48 hours of admission. It has also been [...]