Background: Clostridioides difficile infection (CDI) is a common, often nosocomial infection associated with substantial morbidity and mortality. Antibiotics are the most important modifiable risk factor, but empiric antibiotics remain appropriate for many patients with severe acute illness. Which antibiotics minimize the risk of CDI remains an important unanswered question. Because protective equipment and isolation were [...]

Background: Early risk stratification scores utilizing data available at the bedside have been used regularly to identify patients at greatest risk of poor outcomes from rapidly evolving conditions like sepsis. Little is known about how point-of-care scores developed for sepsis perform at predicting outcomes in large, heterogeneous cohorts of patients with COVID-19. Our objective was [...]

Background: Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of single interventions. We sought to implement a set of complementary interventions and evaluate the effect on interprofessional teamwork and patient safety. Methods: The REdesigning SystEms to Improve Teamwork and [...]

Background: Patient portal use has been associated with improved patient experience, safety, and health outcomes.1,2 To keep patients better connected to their providers, our institution aimed to expand MyChart utilization. We piloted a standard operating procedure (SOP) to enhance MyChart education and uptake among those admitted to an inpatient general medicine unit. Purpose: Our intervention [...]

Background: Residents are uniquely positioned to learn from and contribute to informatics. As key electronic health record (EHR) users, they offer practical solutions and feedback. Resident informatics engagement promotes EHR proficiency and accelerates implementation of best practices and quality improvement. Understanding how clinical data are structured creates a foundation for future scientific inquiry using clinical [...]

Background: The HCAHPS survey is used nationally by health systems as a standard to measure the patient experience and identify opportunities for improvement. Historically, process improvement initiatives based on the survey are implemented retroactively, attempting to prevent negative experiences for future patients. However, given the increasing complexity of patient care, proactively addressing the identified concerns [...]

Background: There has been ample speculation about potential future applications of natural language processing and related technologies for clinical documentation, and yet the mechanics of clinical documentation have changed very little since the passage of the HITECH Act in 2009. Purpose: While awaiting the integration of more advanced technologies into electronic health records (EHRs), we [...]

Background: Antibiotics are frequently prescribed—and overprescribed—at hospital discharge, leading to adverse-events and patient harm. Antibiotic overuse at discharge varies widely across hospitals, with rates of overuse differing up to 5-fold.(1) Our understanding of what approaches optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework which [...]

Background: Clinicians face an overwhelming volume of communication through various channels, including phone calls, text messages, emails, in-person interruptions, and secure messaging systems. This information overload is increasing[1] and poses significant challenges. Despite the availability of communication tools, failures in communication remain the leading cause of preventable medical errors [2]. Secure messaging systems, while essential, [...]

Background: Work engagement has been an ongoing subject of interest within many organizations as it reflects employee well-being and can affect productivity, work outcomes, emotional health, and physical health (1). Stress levels in the work environment can lead to deterioration of sleep and work engagement and increase burnout (2). Heartfulness meditation is a simple heart-based [...]