Background: Reducing LOS promotes value, and when aligned with patient preferences, can improve care. Patients referred for palliative care (PC) generally have longer length of stay (LOS) due to their serious illness, multiple complex management issues, and the fact that long LOS is a reason for engaging a specialty PC team. The aim of this [...]

Background: Advancement of patient care can necessitate inter-hospital transfers to another facility. The inter-hospital transferring process can pose inherent risks to the patient due to the transition of care, as well as increase overall cost for the healthcare system. Reviewing cases of mortality after inter-hospital transfer can identify opportunities to improve patient safety and efficiency [...]

Background: Patients admitted to the hospital without a documented code status specifying what, if any, heroic measures they would consent to in the event of an emergency are at risk for receiving medical interventions that are not goal concordant with their wishes1. This invites patient harm, patient and family dissatisfaction, and may increase hospital length [...]

Background: Although the vast majority of adult patients in the United States prefer to die at home, most patients die in acute care settings. Barriers include advanced care planning, communication between inpatient and outpatient providers, and delivery of medical equipment. In 2018, our General Medicine Service Line ranked 73rd out of 98 Academic Medical Centers [...]

Case Presentation: A 65 year-old man with end-stage renal disease was brought to the Emergency Department (ED) when he developed confusion and shortness of breath at a skilled nursing facility (SNF).  He had a recent prolonged hospitalization for pelvic osteomyelitis and was discharged to the SNF 3 days before presentation.  In the ED, the providers [...]

Case Presentation: An 84 year old male with past medical history of prostate cancer with metastasis to bone presented with thrombocytopenia. His original diagnosis of prostate cancer was made with a PSA and a transrectal ultrasound-guided needle biopsy of the prostate. The biopsy showed extensive adenocarcinoma in all core samples taken. Bone scan at that [...]

Case Presentation: An 87yo woman with dementia presented with a large right adrenal mass consistent with pheochromocytoma with lymph node metastases based on biochemical testing and MIBG scan. Non-operative management with iobenguane-131 (Azedra) was considered because of her surgical risk. However, given her underlying dementia, comorbid conditions, and frailty, she was appropriately identified as high [...]

Case Presentation: A 72-year-old male with a history of tobacco use (12 pack-years) presented to the hospital with 4 months of a progressive nonproductive cough. He experienced coughing spells lasting minutes with positional changes. The patient additionally endorsed night sweats, unexpected weight loss of 11 pounds, and dyspnea on exertion. In the days prior to [...]

Case Presentation: We present 2 amalgamated, anonymized patient cases, based on 5 ethics consults requested at a single tertiary care hospital over the past 4 years. In the first case, Ms. M, an 89 year old woman with a past history of severe COPD, debilitating chronic back pain, and recent imaging findings suggestive of a [...]

Background: Ensuring that hospitalized patients have a clearly documented Advance Care Plan (ACP) is important to provide them with goal-concordant care. Our institution undertook an inpatient Quality Improvement (QI) initiative to improve accessible ACP documentation. Though this work significantly improved ACP documentation rates, ACP rates for Latinx patients were significantly lower than those of the [...]