Background: Peripherally inserted central catheters (PICCs) are routinely placed in hospitalized patients who are receiving long-term IV antibiotics or who have poor venous access. In our hospital, 1 in 12 patients on the Medicine service receives a PICC line at some point during a hospitalization. 35% of all hospital-acquired venous thromboembolisms (VTEs) on the Medicine [...]

Background: Peripherally inserted central catheters (PICCs) are associated with central vein stenosis and failure to establish a functioning arteriovenous fistula. Thus, guidelines recommend avoiding PICC placement when patients with chronic kidney disease (CKD) are likely to require hemodialysis. We sought to describe the current practice of PICC placement in hospitalized patients with an estimated glomerular [...]

Background: Since being introduced in the 1950s, midlines have since gained attention as an intravascular access option—particularly in patients requiring intravenous (IV) therapy for extended time periods. They provide an alternative to frequent venipuncture from peipheral intravenous catheters (PIV) and may reduce cost and increase patient satisfaction. The CDC and MAGIC guidelines currently recommend the [...]

Background: The placement of peripherally inserted central catheters (PICCs) is increasingly performed primarily by vascular access nurses (VAN) in United States hospitals1. Despite the increased use of these specially trained clinicians, little is known about the patient and device characteristics of the PICCs they placed compared to those placed by interventional radiology (IR) providers. While [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: It has been detailed in the literature that a patient’s socioeconomic status (SES) may play a role in their risk of readmission for specific diseases. For instance, factors such as low income, low educational level, and Medicaid status have all been associated with significantly higher rates of readmission in patients initially admitted for congestive [...]

Background: Peripherally inserted central catheters (PICCs) are essential devices used to provide central venous access. However, they are often placed inappropriately, leading to unnecessary risk of PICC-related complications. Vascular access operators typically place the majority of PICCs, yet little is known about these specialists and their beliefs regarding PICCs. We therefore conducted a national survey [...]

Background: Midline vascular catheters are gaining popularity in clinical practice. However, patterns of use and outcomes related to these devices are not well known. Methods: Trained abstractors collected detailed patient-, device- and outcome data from medical records of hospitalized patients that received midline catheters from 12 hospitals participating in the Michigan Hospital Medicine Safety (HMS) [...]

Background: Palliative care and geriatrics in hospital medicine have an established positive impact on patient experience and outcomes, however, these specialist care services remain underutilized. Recognizing an opportunity to improve the appropriateness of inpatient consultation on a large academic medical hospitalist service, we implemented a multi-disciplinary quality improvement intervention with the goal of increasing appropriate [...]

Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Complications associated with peripherally inserted central catheter (PICC) along with documented overuse has led to emerging interest and increasing use of midlines. However, whether midlines are safer than PICCs is not [...]