Background: Research suggests that high workloads in the inpatient setting (often measured through patient encounters/visits) contribute to increased hospital length of stay, increased costs, and delayed discharges. High workloads also negatively impact our quality improvement efforts and result in a mismatch in job demands and job resources leading to clinician burnout. To date, there is [...]

Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]

Background: Inter-hospital transfer (IHT, patient transfers between acute care hospitals) is common among hospitalized medical patients (1). However, few data describe which patients may be exposed to the risks of discontinuity of care from IHT without clear benefit (i.e., undergo potentially inappropriate IHT). Methods: The POINT Study, “Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers” [...]

Background: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

Background: Accurate and timely discharge summaries are critical to safe transitions of hospitalized patients to the outpatient setting and reduce readmissions1–6. However, composing the hospital course (HC) section of the discharge summary is laborious and time consuming, contributing to increased documentation burden7,8, work outside of work9, and clinician burnout10,11. Recent retrospective studies demonstrated that large [...]

Background: Physical function (PF) impairment is a key determinant of hospital discharge disposition, yet real-time PF assessments remain underutilized in inpatient care. The Patient-Reported Outcomes Measurement Information System Physical Function 5-item tool (PROMIS PF5, or PF5) was embedded into the electronic health record (EHR) across 21 Kaiser Permanente Northern California (KPNC) hospitals to standardize PF [...]

Background: New hospitalists can often feel overwhelmed by learning system practices, navigating difficult dispositions, and managing difficult patient and family relationships. This can lead to increased length of stay1, increased burn out, and a feeling of lack of mentorship. Purpose: We hypothesized that weekly meetings between a hospitalist director and a junior faculty hospitalist to [...]

Background: Racism is a public health crisis impacting patients and healthcare workers. Antiracist education is not typical in undergraduate or graduate medical education curriculum. Discriminatory practices in health care result in worse patient outcomes in Black, Indigenous, & People of Color (BIPOC). Committing to antiracist work is the first step in addressing racism and must [...]

Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Diagnostic errors (DE), defined as missed opportunities to make a correct or timely diagnosis based on the available evidence, are a critical but understudied cause of patient harm. While previous efforts have focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined incidence of [...]