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: 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: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital (1-2), the scope of nocturnist practice and the typical workload has not been defined. Methods: In November 2019 a survey was created by a panel of nocturnists made up of members of the SHM Night Medicine Special [...]

Background: Studies indicate that physicians do not clean their stethoscopes regularly, and stethoscope surfaces become contaminated with bacteria. Neither the frequency with which stethoscopes deserve cleaning nor simple, practical cleaning approaches have been well-established for hospitalists or other inpatient clinicians. Our aim was to determine bacterial contamination of stethoscopes directly from a hospital doctor’s white [...]

Background: The SARS-CoV-2 outbreak presents an infection control challenge to deliver care in a safe environment for patients and healthcare workers (HCW), further complicated by uncertainty regarding the nature of contagion of SARS-CoV-2 and PPE supply chain. On March 15, 2020, we introduced “medical distancing” rounding guidelines, with the aim of reducing transmission of COVID-19 when [...]

Background: Diagnostic errors (DE) – defined as incorrect, missed, or delayed diagnoses not made within a timeframe consistent with standard clinical practice – are common and can lead to harm, especially in acute care settings. One cause of DEs is suboptimal clinical reasoning in the diagnostic process. Electronic clinical documentation has been suggested to potentially [...]

Background: To date, attempts at estimating diagnostic error (DE), as defined as missed, incorrect, or delayed diagnoses, have focused on the identification of all types of adverse events, not specifically DE. Retrospectively identifying and ascertaining DE for hospitalized patients has been further challenged by (1) variability in operational definitions of DE; (2) use of non-standardized [...]

Background: Coronavirus disease of 2019 (COVID-19) is a novel widespread disease that has a range of manifestation from asymptomatic to fatal. In the United States, there have been approximately 396,000 hospitalizations as of this writing, of which an estimated 25% will require the intensive care unit (ICU)1,2. With the ongoing spread and repeated waves of [...]

Background: Bronchiolitis is one of the most common reasons for hospitalizations in children with > 100,000 admissions each year. High-flow nasal cannula (HFNC) therapy has been widely adopted to treat bronchiolitis with increasing use outside of the pediatric intensive care unit (PICU). The use of oral feeding while on HFNC has been questioned due to [...]

Background: Patient safety assistants (PSAs), or “sitters,” observe patients at bedside considered at “high risk” for in-hospital events [1] such as falls or elopements. While studies suggest PSAs do not impact safety outcomes,[2-4] they are widely utilized without formal guidelines.[2, 5, 6] With increasing healthcare costs and limited resources, efficient care models are sought.[1, 2, [...]