Background: The use of early warning systems (EWS) to augment clinical care is of increasing interest with recent publications showing EWS algorithm alerts coupled with clinical response actions to have significant morbidity and mortality benefit.1 At Stanford Hospital we are developing an alert and response EWS using a machine learning (ML) model predicting clinical deterioration [...]

Background: Pay-for-performance incentives allow for engagement and motivation of participating physicians. Hospitalist compensation structure commonly combines base salary with performance and/or productivity-based incentives. Frequently used quality measures are value based purchasing metrics, patient satisfaction scores, adherence to guidelines and quality of medical documentation. Selection of metrics is strongly influenced by what is measurable and available. [...]

Background: The importance of accurate patient care records for effective communication and medical education is well documented. However, medical documentation as a tool for financial compensation is not emphasized in graduate medical education. We performed a review and analysis of resident charting errors during inpatient rotations to determine the potential revenue loss and economic impact. [...]

Background: Point-of-care ultrasound (POCUS) is increasingly recognized as an important adjunctive diagnostic tool in hospital medicine (HM). The incorporation of POCUS into clinical decision-making has been shown to increase the speed and accuracy of initial diagnosis, decrease procedural complications, and even increase patient satisfaction compared to usual care. It has already been widely adopted in [...]

Background: The United States healthcare system has witnessed an overwhelming trend towards mergers of hospitals and acquisitions, with the proportion of primary care physicians working in hospital – or healthcare system-owned organizations increasing from 28% to 44% from 2010 to 2016. Existing evidence suggests this consolidation has driven higher costs but has had mixed effects [...]

Background: Procedures, both inpatient and outpatient, are an essential part of the training for family medicine residents. Several residency programs struggle to provide the minimum number of procedures for residents to develop competency and comfort with the said procedures. Hospitalists do offer increased experience with procedures, although more recently, hospitalists are also referring most procedures [...]

Background: In-hospital cardiac arrest (IHCA) is an unpredictable, catastrophic event affecting approximately 200,000 US adults annually. Best outcomes during IHCA result from focused training and credentialing by AHA (ACLS, BLS). Although hospitalists supervise IHCA, best practices for resuscitation skills, preparedness, plus overall approach remain undefined. Methods: We developed an online survey of IHCA resuscitation responsibilities [...]

Case Presentation: A 51-year-old Hispanic male with Type 2 diabetes mellitus and dyslipidemia was admitted from the ED for evaluation of recurrent fevers, multiple joint pains, and tachycardia. Physical exam findings included cachectic appearance and right inguinal lymphadenopathy. Initial laboratory testing was significant for a WBC of 23,300 (80.2% neutrophils, 13.3% lymphocytes), Hb of 11.1, [...]

Case Presentation: 61-year-old male with a known history of alcohol and tobacco abuse was admitted with 3 months history of headache, confusion, unsteady balance and unintentional weight loss. Laboratory tests included normal chemistry panel, complete blood count and negative hepatitis and HIV serology. Brain imaging showed 3 lesions in the right cerebral convexity with surrounding [...]

Case Presentation: A 33 year-old female without significant medical history was admitted as a transfer from an outside hospital for daily fevers and generalized weakness for the preceding two weeks associated with neck pain. Had undergone an extensive infectious disease workup prior to arrival with Computed Tomography (CT) of head, chest, abdomen, and pelvis, blood [...]