Background: The primary goal of an acting internship or sub-internship is to prepare a fourth-year medical student for their intern year. At our institution, this has traditionally occurred on inpatient hospital medicine teaching teams which include senior residents, interns, and third-year medical students. Because these teaching teams are crowded with learners, our acting interns report [...]

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. [...]

Background: The COVID-19 RT-PCR test is a real-time reverse transcription polymerase chain reaction (rRT-PCR) test for the qualitative detection of nucleic acid from SARS-CoV-2 virus (8). False negative RT-PCR tests pose a serious challenge as they can lead to diagnosis and treatment delays as well as increased risk of viral transmission in the community (1-10). [...]

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: Studies have shown that early exposure to statins preoperatively have been associated with significant reductions in perioperative mortality and improved post-operative outcomes [1]. Despite guideline recommendations, use of statin therapy remains sub-optimal [2]. A retrospective study at our institution revealed over 40% of patients that presented to our preoperative optimization clinic were not on [...]

Background: Thrombotic disorders, such as venous thromboembolism (VTE) and ischemic stroke are highly prevalent conditions. In many cases, an underlying inciting risk factor is clearly visible that can explain the thrombotic event. When a clear explanation is not found, diagnoses such as “idiopathic VTE” and “cryptogenic stroke” are made. Except when there is a concern [...]

Background: Given its ability to identify obscure bleeding at a rate of 0.1-0.5 mL/min, technetium-labeled red cell scans have long been considered the most sensitive radiographic test for gastrointestinal bleeding. They are routinely compared to computed tomography angiography, which detects bleeding at a minimum rate of 0.5 mL/min or greater. We conducted a clinical quality [...]

Background: The ordering of unnecessary daily labs affects the safety of patients through hospital-acquired anemia, patient discomfort, and unnecessary downstream testing. This results in both additional financial and labor costs burdening the health system. As such, establishing effective interventions is warranted with necessary analysis of site-specific lab-ordering culture. We seek to perform this analysis to [...]

Background: Low-value care in the form of overuse of inpatient diagnostic testing is an important driver of high healthcare costs. Financial incentives are known to impact physician behavior and may be a driver of inpatient diagnostic overuse. However, the association between hospital payer mix (which likely impacts the financial incentives for ordering diagnostic tests) and [...]