Background: The hospitalist service at this large Academic tertiary center has a length of stay index that is longer than expected. Despite improvements in multi-disciplinary rounds and co-locating patients on a geographical units, improvements in length of stay slowed. Interviews of hospitalist physicians indicate that there are frequent delays in procedures, imaging and consult recommendations. […]

Background: The hospitalist service at this large Academic tertiary center has a length of stay index that is longer than expected. Despite improvements in multi-disciplinary rounds and co-locating patients on a geographical units, improvements in length of stay slowed. Interviews of hospitalist physicians indicate that there are frequent delays in procedures, imaging and consult recommendations. […]

Case Presentation: A 61‐year‐old visiting Trinidadian woman with squamous‐cell rectal cancer and hypertension who had received multiple courses of chemotherapy and radiation therapy beginning in May 2012 and was hospitalized in July 2012 at a New York hospital for suspected chemotherapy‐induced anemia. During this hospitalization she received 3 units of packed red blood cells (pRBCs). […]

Background: Family-centered rounds on our pediatric hospital medicine teaching service, which cares for patients in multiple units throughout the hospital, are often prolonged with unpredictable progression. This contributes to inconsistent nursing participation, inefficiencies in patient care, and variable end times. Through the implementation of scheduled-based rounding, our aims were to: 1) start 90% of rounds […]

Case Presentation: A 73‐year‐old obese white man with a medical history of hypertension, asthma, and diverticulosis was brought to the emergency department for sudden‐onset severe left lower quadrant abdominal pain, nausea, vomiting, and diaphoresis. The patient had had similar milder abdominal pain a few days prior to presentation. He was hypotensive and tachycardic. The signs […]

Background: Hospital medicine groups endeavor to avoid excessive workloads which can contribute to burnout. 1,2,3,4Groups vary in how new patients are distributed, but larger groups often assign a single hospitalist to carry an admitting pager and distribute new patients among several colleagues. This “admitting pager” role combines high volume with frequent interruptions and multitasking as […]

Case Presentation: An 80‐year‐old white man with a medical history of stroke without residual deficit in 2006 and coronary artery disease presented with complaints of gradual loss of voice over a 6‐month period. It started with mild hoarseness and progressed to being able to utter only a few incomprehensible sounds. In the previous few weeks […]

Background: Understanding a hospitalist’s efficiency is important to identify opportunities to provide support and prevent burnout (1). This is key when onboarding new hospitalists, as early intervention can lead to rapid improvement and a long-term sustainable career. The evaluation of hospitalist efficiency can be difficult and is often thought to require close clinical shadowing or […]

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. […]

Case Presentation: A 31‐year‐old woman with history of type 1 diabetes mellitus who was 35 weeks' pregnant came to the ER with chief complaints of nausea, vomiting, and severe retrosternal burning sensation for 3 days. Symptoms started after she missed a few doses of her twice daily NPH insulin. Physical exam revealed mild epigastric tenderness. […]