Background: Hospital discharge is a vulnerable moment in healthcare delivery that impacts patient safety and experience. Improving this care transition necessitates a focus on the most error-prone and potentially hazardous parts of the process, including discharge logistics (e.g., transportation), medication safety, follow-up plans, and contingency planning. Many interventions have been investigated to improve discharge processes; [...]

Background: In the quest to improve patient satisfaction scores, providers and health systems alike are frustrated with the inability to obtain real-time satisfaction data. Indeed, HCAHPS data lags by six months, and makes it exceedingly difficult to provide real-time feedback to physicians on their communication with patients. As a result, we developed a patient-centered audit [...]

Background: There are no guidelines for designing or evaluating fixed-content signs or electronic displays used to communicate patient-related information in hospital rooms. Accordingly, there is the potential for the displayed information to be ignored, misinterpreted, or distracting in the complex hospital room environment where patients, nurses, and physicians change frequently. Purpose: To address this shortcoming, [...]

Background: Like many institutions nationwide, our health system, an urban tertiary care academic medical center, has experienced challenges due strained hospital capacity. Hospitalists frequently face feedback to place discharge orders as early as possible in the day, for reasons as diverse as assisting patients with obtaining a ride home to expediting bed turnover for the [...]

Background: Physical (PT) and Occupational therapy (OT) are valuable entities, but are overused in hospitals. There is limited published literature on the appropriate utilization of PT and OT evaluations in hospitals. Analysis of all PT/OT referrals for 2018 at NewYork Presbyterian Weill Cornell showed that PT/OT orders were part of the admit order set. These [...]

Background: Given the shift-based nature of modern hospital medicine, block schedules where physicians are on clinical service for a defined period of time are common place. As such, end-of-service handoffs are a routine element of hospital medicine practice. Like handoffs to an overnight cross-covering physician, end-of-service handoffs pose a risk to patients if critical information [...]

Background: One of the Society of Hospital Medicine (SHM) core competencies (listed as Principle 7) is that Hospitalists provide effective clinical resource utilization. Examples: cost effective care, high-value care, and designing processes that address cost per stay and readmissions. Optimized inpatient throughput has been shown as a strategy to improve overall hospital flow, including streamlined [...]

Background: Discharge planning and transition of care (TOC) is a crucial process for inpatient teams hoping to optimize patient experience and outcomes. Feedback from patients prior to leaving the hospital identifies several areas for improvement, as there are often misunderstandings about hospital courses and treatment plans. Such confusion leads to poor TOC. The Hospital Consumer [...]

Case Presentation: A 28-year-old woman with sickle cell disease and chronic pain who required inpatient care several times yearly presented with worsening nausea, emesis and uncontrolled pain to the emergency department (ED). Symptoms were typical of prior pain crises. The patient followed regularly with a hematologist undergoing monthly red blood cell exchange transfusions. In the [...]

Case Presentation: A 48-year-old male from North Carolina with a history of rheumatoid arthritis presented to the ED with complaints of black tarry melena, nausea, vomiting, and nose bleeds. The patient was found to have stomatitis and severe pancytopenia. He eventually admitted to not understanding his methotrexate dose and stated he accidentally took three times [...]