Background: Accurate and timely discharge summaries are critical to safe transitions of hospitalized patients to the outpatient setting and reduce readmissions1–6. However, composing the hospital course (HC) section of the discharge summary is laborious and time consuming, contributing to increased documentation burden7,8, work outside of work9, and clinician burnout10,11. Recent retrospective studies demonstrated that large [...]

Background: Inter-hospital transfer (IHT, patient transfers between acute care hospitals) is common among hospitalized medical patients (1). However, few data describe which patients may be exposed to the risks of discontinuity of care from IHT without clear benefit (i.e., undergo potentially inappropriate IHT). Methods: The POINT Study, “Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers” [...]

Background: Inter-hospital transfer (IHT, patient transfers between acute care hospitals) is common among hospitalized medical patients (1). However, few data describe which patients may be exposed to the risks of discontinuity of care from IHT without clear benefit (i.e., undergo potentially inappropriate IHT). Methods: The POINT Study, “Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers” [...]

Background: Physical function (PF) impairment is a key determinant of hospital discharge disposition, yet real-time PF assessments remain underutilized in inpatient care. The Patient-Reported Outcomes Measurement Information System Physical Function 5-item tool (PROMIS PF5, or PF5) was embedded into the electronic health record (EHR) across 21 Kaiser Permanente Northern California (KPNC) hospitals to standardize PF [...]

Background: Physical function (PF) impairment is a key determinant of hospital discharge disposition, yet real-time PF assessments remain underutilized in inpatient care. The Patient-Reported Outcomes Measurement Information System Physical Function 5-item tool (PROMIS PF5, or PF5) was embedded into the electronic health record (EHR) across 21 Kaiser Permanente Northern California (KPNC) hospitals to standardize PF [...]

Background: Rich sources of data are available in hospitals, but are often housed in different systems. These include electronic health records (EHRs), physician scheduling software, and existing tools that can be used to electronically contact clinicians. Developing a streamlined way to integrate and connect disparate data has enormous potential for clinical care, operations, and research. [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Clinical decision support tools based on predictive analytics can provide actionable information and improve clinical outcomes for patients at risk of developing sepsis. Scoring systems such as Systemic Inflammatory Response Syndrome (SIRS) and National Early Warning Score (NEWS) that were not specifically trained to detect sepsis tend to have high false alarm rates, leading [...]

Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics [...]

Background: The first Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in 5 hospitals. Incorporating lessons learned from MARQUIS1, we implemented a refined version of the toolkit in a larger, more diverse sample of hospitals. Methods: Eighteen sites were selected via [...]