Background: Diagnostic errors (DEs), or the failure to accurately identify or provide timely explanations of a patient’s health problem, are a significant source of patient harm. DEs occur in up to 23% of adult inpatients who transfer to intensive care units (ICU) or die. Few studies have examined how clinician team composition impacts DE risk. [...]

Background: Preventive care is a crucial but underutilized component of optimal population health management. Of eligible patients, 69.0% have received pneumococcal vaccine, 24.1% zoster vaccine, and 30.0% hepatitis B vaccine. Cancer screening rates are similarly low, with 12.5% screened for lung cancer and 71.6% for colorectal cancer. Gaps in preventive care are even larger in [...]

Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value has driven renewed attention to HaH, including from the Centers for Medicare and Medicaid Services. The COVID-19 pandemic has only magnified consideration of alternative sites of care. Where studied, HaH models have had desirable [...]

Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Greater appreciation of complications associated with peripherally inserted central catheters (PICC) and the diffusion of catheter appropriateness criteria has led to expanded use of these devices. However, single center studies comparing [...]

Background: The Choosing Wisely Campaign started in 2012 with the aim of promoting high-value care. On its Choosing Wisely List, the Society of Hospital Medicine cited daily basic metabolic panel (BMP) and complete blood count (CBC) testing in the absence of clinical suspicion as unnecessary practice. Since the implementation of Choosing Wisely, there have been [...]

Background: On a daily basis, hospitalists prescribe Venous Thromboembolism (VTE) prophylaxis. While of benefit to certain populations, VTE prophylaxis has not been proven to benefit medical patients at low risk for VTE. Pharmacologic prophylaxis may increase the risk of serious bleeding, mechanical prophylaxis is associated with an increased risk of delirium, and both methods are [...]

Background: Unit-based care teams offer inherent benefits to hospitalist services, including opportunity for improved efficiency, interdisciplinary collaboration, and enhanced patient experience. However, many barriers exist to creation of these care teams such as high occupancy rates and conflicting interests among stakeholders.  Failure to account for such barriers has led to unsuccessful initiatives to achieve regionalization, [...]

Background: Both the ACP through its High Value, Cost-Conscious Care Initiative, and the ABIM through its Choosing Wisely campaign, have called on clinicians to engage in efforts to improve the value of the care we provide Purpose: We sought to develop a curriculum to provide internal medicine residents both a theoretical and a practical exposure [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]