Background: Pulmonary nodules are among the most frequent and medically relevant incidental findings, but are easily overlooked – especially when discovered incidentally during hospitalization. While CT imaging has become an invaluable tool for expedited medical evaluation, its use has been associated with an increasing number of incidental findings, the handling of which creates both medical […]

Background: Christiana Care’s medicine service line previously implemented Interdisciplinary Admission (IDA) and Inter Disciplinary Rounding (IDR) to enhance team-based care of our patients. IDA included an admissions team comprised of attending physician, nurse, pharmacist, case manager and social worker. IDR included the bedside nurse, pharmacist, case manager and social worker. More recently, units have started […]

Background: Peripherally inserted central catheters (PICCs) are commonly inserted/ordered by hospitalists for venous access, long‐term therapies, and infusion of total parenteral nutrition, Despite these salient roles, little is known about PICC use in hospitalized patients. To understand hospitalist practice related to PICC, a Web‐based survey of a convenience sample of hospitalists in 4 health care […]

Background: The Choosing Wisely campaign discourages CT imaging in low-risk patients with suspected pulmonary embolism (PE) (e.g., low clinical probability and negative d-dimer). Few studies have investigated patient, provider, or operational characteristics associated with overuse of CT imaging. One possible approach to this research question is to examine variability in diagnostic yield (i.e., the percentage […]

Background: Pulmonary arterial hypertension (PAH) is a progressively debilitating disorder characterized by sustained increases in pulmonary vascular resistance and pulmonary arterial pressure, which eventually leads to right-sided heart failure. Current therapies for PAH work predominately as vasodilators to target symptoms, rather than focusing on the initial signals that promote disease progression. These therapies have proved […]

Background: With recent duty‐hour restrictions for internal medicine residencies, hospitals are increasingly hiring hospitalists to meet the demand of higher patient volumes not on the teaching services. This creates an interesting dilemma about how newly admitted patients will be distributed between the nonresident hospitalist services and the resident teams. Both services often have unique rules […]

Background: Physical and occupational therapy (PT/OT) services are a limited resource in the inpatient setting. PT/OT consults ordered by resident physicians on patients who do not need them take time and resources away from patients more deserving of skilled rehab services. Purpose: Our objective was to understand utilization of PT/OT services on our medical floors, […]

Background: Pulmonary embolism (PE), refers to obstruction of the pulmonary artery or one of its branches by material (thrombus, tumor, air or fat) that originated elsewhere in the body.Wells criteria must be part of the clinical assessment for PE. With these criteria, we can classify patients as high probability (>6 pts), moderate (2 to 6 […]

Case Presentation: A 57‐year‐old woman who had undergone an elective total knee replacement 9 days earlier presented to the ED with 1 day of progressive, diffuse abdominal pain, nausea, and fevers. Her postoperative course had been notable only for a supratherapeutic INR of 6.2 in the setting of routine DVT prophylaxis with warfarin, for which […]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT […]