Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients [...]

Background: Our institution’s rate of hospital acquired Clostridioides difficile (C. diff) infection (CDI) is higher than expected based on documented severity of illness of our patients. The C. diff testing algorithm at our institution utilizes a multi-step approach. It begins with two tests (antigen EIA and toxin A/B EIA). If the results of these two [...]

Background: Discharge planning should begin at the time of admission and involve preparing patients for the transition out of the hospital. Unfortunately, many hospitalized patients disagree with their provider about their discharge plan, including what needs to be accomplished in the hospital or the dismissal’s timing and location. When patients and their providers do not [...]

Background: Residents identify formal didactic teaching (FDT) as a critical component of learning on the medical wards on annual residency surveys. Similarly, faculty express a desire to incorporate FDT into the daily inpatient rotation experience. However, both residents and faculty note multiple barriers to its consistent implementation. We aim to study the impact of various [...]

Background: Balancing attending supervision with resident autonomy is intended to ensure patient safety while allowing trainees to gain graduated competency and independence upon completion of residency. ACGME work-hour restrictions have increased attending supervision, but its effect on resident education and autonomy is unclear. In order to better understand the underlying tensions and contributing factors to [...]

Background: Attending evaluations by medical students have many implications including promotion, teaching opportunities, job satisfaction and reputation both for individuals and for groups. In addition to teaching on traditional ward teams with housestaff and students, hospitalists are more commonly teaching in an apprenticeship model, where an attending, often carrying a full census, directly supervises and [...]

Background: Internal Medicine Teaching Teams (IMTTs) aim to deliver both exceptional clinical education and efficient, high-quality patient care. However, increasing workloads and the fast pace on inpatient wards are challenging this dual objective. Our study sought to understand the tensions between education and clinical practice in IMTTs and how academic leaders are addressing these challenges. [...]

Background: With standard diagnostic methods, the etiologic pathogen of community acquired pneumonia (CAP) is detected in ≤ 50% hospitalized CAP patients. In our previous studies using a diagnostic “bundle”, we were able to detect etiologic pathogens in ≥ 70 % of the patients. Our bundle consisted of a nasopharyngeal swab for Biofire film array, that [...]

Background: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. Since 2014, the American Academy of Pediatrics (AAP) has recommended a ‘wait-and-see’ strategy and shorter antibiotic courses for mild or moderate AOM in qualifying patients. While this strategy has been successfully implemented in some pediatric emergency units (EUs), studies have shown that 30-90% of [...]

Background: Surgical site infections (SSI) can complicate any operative procedure although this risk is mitigated through the use of preoperative antibiotic prophylaxis.  While antibiotic prophylaxis can provide great benefit, inappropriate use can lead to the development of multi-drug resistant organisms causing increased morbidity, mortality, and cost. Although national clinical guidelines for preoperative antibiotics prophylaxis were [...]