Background: Delays in the discharge process of hospitalized patients impact patient flow and lead to increased costs and slower progression of care. As hospitalist work becomes increasingly shift based, there are concerns for proper patient handoffs and hesitancy with clinical progression of care overnight. This leads to daytime patient flow congestion and is a significant [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care. In this study, we aim to better understand which patients may (or may not) benefit from IHT by evaluating the impact of IHT on clinically important patient outcomes among a variety of patient diagnoses. Methods: We performed [...]

Background: Today, Medicare patients account for approximately 50% of hospital days, costing $1 trillion annually. Despite this staggering financial burden, hospitalization often results in poor outcomes for older adults. The objective of the study was to test the feasibility and impact of using Assessing Care of Vulnerable Elders (ACOVE) Quality Indicators (QIs) as a therapeutic [...]

Background: Deep vein thrombosis (DVT) is typically diagnosed from ultrasound (US) Doppler evaluation and anticoagulation therapy is the standard treatment to prevent life threatening pulmonary embolism (PE). In our hospital, the treating provider is alerted to the positive test result by phone and/or text in the imaging result. There is an absence of clinical decision [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) Multi-site Quality Improvement Collaborative aims to improve discharge transitions by testing a patient-centered transition bundle. Teach-back is a core component. This is a well-established method of confirming understanding. However, limited evidence exists about the effect of using teach-back for pediatric discharge education on parental knowledge/understanding of essential [...]

Background: Alcohol use disorders (AUDs) are common among hospitalized patients. Naltrexone has been proved to assist patients with AUDs in maintenance of sobriety. The initiation of naltrexone has been studied in outpatient and inpatient settings. Our hospitalist program lacked a process for initiation of naltrexone for maintenance of sobriety among inpatients with AUDs. Methods: We [...]

Background: Peripherally inserted central catheters (PICCs) have been associated with venous thromboembolism (VTE) and are a major cause of upper extremity deep vein thrombosis (DVT).  However, mechanisms to identify patients at greatest risk of PICC-associated VTE are limited. Methods:  Using data from the Michigan Hospital Medicine Safety consortium, patients with PICCs that experienced symptomatic, image-confirmed [...]

Background: Over the last several years we have seen the rapid growth of the specialty of hospital medicine across the country. One of the unintended consequences of this expansion has been the decrease in direct teaching responsibilities of the medical subspecialists on the inpatient medical teaching services. As these responsibilities have been subsumed by our [...]

Background: Pain is commonly reported by hospitalized patients and may be managed with opioids, which are associated with benefits and harms.  Clinicians’ perceptions of the benefit to harm ratio may differ across countries, which may lead to variability in prescribing practices.  We sought to determine whether there was an association between willingness to prescribe opioids [...]