Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value has driven renewed attention to HaH, including from the Centers for Medicare and Medicaid Services. The COVID-19 pandemic has only magnified consideration of alternative sites of care. Where studied, HaH models have had desirable [...]

Background: A small number of patients account for a disproportionate number of hospital readmissions. The Complex High Admission Management Program (CHAMP) is designed to improve care and reduce hospitalizations for frequently readmitted patients. Non-randomized studies of CHAMP found reductions in readmission but may be subject to regression to the mean. We conducted a randomized trial [...]

Background: Procedural complications are a common source of adverse events in hospitalized patients(1, 2). In academic centers, bedside procedures have traditionally been performed by trainees, often without experienced proceduralist supervision, or referred to interventional radiology or consultant services, often with an associated delay in procedure performance. Many trainees report discomfort with their skill in performing [...]

Background: Patient and family experience have become increasingly important to the hospital community, whereby exceptional patient and family experience is the common ground for all six aims of quality care as defined by the Institute of Medicine in Crossing the Quality Chasm — care that is patient centered, safe, effective, timely, efficient, and equitable (1). [...]

Background: Pulmonary embolism (PE) and atrial fibrillation (AF) may coexist. The association and impact of AF on PE have not been well studied. Methods: We queried the 2018 National Inpatient Sample (NIS) database to identify PE and AF hospitalizations using appropriate ICD-10 codes. PE with AF group was compared to PE without AF. Chi-square test [...]

Background: Patient-physician communication is essential to medical care. Simple physician behaviors, such as sitting at the bedside, may bolster patient-physician communication.1-3 Yet despite the potential benefit of sitting, prior work suggests that inpatient physicians do not sit frequently.1,4 Methods: Trained staff performed in-person surveys of patients admitted to seven general internal medicine teaching services from [...]

Background: Uncertainty of viral transmission and PPE availability early in the SARS-CoV-2 pandemic created unique infection control challenges for hospitals. Prior to masking recommendations and widespread testing availability, the hospital medicine service at an academic hospital system published “medical distancing” guidelines to reduce the frequency and proximity of physician-patient interactions to minimize transmission. While previous [...]

Background: Electronic messages represent a growing proportion of inter-professional team communication in the inpatient setting. Poor communication hinders team collaboration, increases patient readmissions, and may facilitate burnout. Descriptions of inter-provider communications have largely utilized survey data in specialized settings at a single time-point. We sought to characterize in-patient hospital-wide inter-provider communication patterns over a year. [...]

Background: Over the last few decades, medicine has seen increasing specialization and a proliferation of roles, trends which can complicate patient care in the hospital setting. Inpatient care teams are comprised of many types of members, and the boundaries between roles can change and at times be ambiguous, e.g., between hospitalist and subspecialist consultants. In [...]

Background: For 6 months in 2018, a major quaternary-care teaching hospital underwent closure of operating rooms (OR) and cardiac catheterization laboratory (CCL) due to flooding/sterilization issues and planned upgrades. Surgery and interventional cardiology trainees were reassigned to other teaching hospital sites of Yale School of Medicine, with the anticipated impact on Medicine/subspecialties not fully known. [...]