Background: The proportion of high-level bills submitted by our hospital medicine group was lower than national averages as reported by the Clinical Practice Solutions Center (CPSC). This did not seem to align with the complexity of patients at our level 1, safety net hospital in a busy urban location. The purpose of our project was [...]

Background: Tissue pathology plays an integral role in the diagnosis of various conditions, especially malignancy. Traditionally biopsy procedures, including core needle biopsy (CNB), have been performed by specialists under imaging guidance. They are traditionally done in special procedure rooms/suites–which come with an added cost of nursing staff, transportation and equipment. Meanwhile hospitalists are increasingly becoming [...]

Background: Malnutrition, defined as deficiencies or excesses in nutrient intake, is associated with worse short and long-term outcomes compared to similar people without the diagnosis. The ASPEN or GLIM criteria are used to diagnose malnutrition, but these criteria are somewhat vague and measurement standards are typically not objective. The Inpatient Prospective Payment System considers severe [...]

Background: The hospitalist role is gaining increasing presence for inpatient care, with the opportunity to care for a variety of higher acuity patient across a breadth of specialties in the hospital setting. Further examination into the types and amount of MS-DRG categories seen by hospitalists and their ordering volumes can provide a better picture of [...]

Background: Despite recent advancements in the medical management of acute and chronic Heart Failure (HF), smooth transitions of care for patients hospitalized with HF remain elusive for most health care systems. Use of home health services and other ancillary services have been promoted in recent years as a means of reducing readmission rates among HF [...]

Background: Patients with cirrhosis complicated by ascites are often admitted to the hospital and require abdominal paracentesis for diagnostic evaluation and symptom relief. When large volumes are removed there is a risk for acute kidney injury (AKI) which can contribute to morbidity and mortality. There are no clear guidelines for what constitutes a safe volume [...]

Background: Many pediatric hospitalist programs in community hospitals around the country function with a 24-hour shift model for 24/7 coverage. This creates significant discontinuity and daily inefficiencies in patient care. Furthermore, there is a robust amount of adult literature that points to the benefits of both inpatient and outpatient continuity of care. When our community [...]

Background: Specialty wards (e.g., cardiology or oncology wards) group clinically similar hospitalized patients in efforts to improve outcomes and costs. When these wards exceed capacity, subsequent patients overflow to “geographically dispersed” alternate wards. Geographic dispersion has been associated with care inefficiency and worse outcomes on specialty wards, but has not been studied in a large, [...]

Background: Hospitalized patients may require central venous access devices (CVADs) for inadequate intravenous (IV) access. CVADs have known complications, including peri-procedural trauma and central line associated bloodstream infections (CLABSI). CLABSI is of concern for patients and hospital systems, as it is largely preventable and used as a quality measure. A CVAD alternative is a short [...]

Background: Medicine procedure services (MPS) increasingly perform bedside procedures such as lumbar puncture (LP). While rates of major complications are low, success rates in the literature are widely variable and dependent on patient body habitus, patient positioning, operator experience, and use of ultrasound guidance.1 Many trainees report discomfort with their skill in performing and supervising [...]