Case Presentation: A previously healthy 13-year-old Korean-American girl presented with acute altered mental status. She had fatigue, leg and abdominal pain, and was initially diagnosed with “the flu.” Two days later she progressed to worsening pain, emesis, and inability to walk. On admission she was afebrile and had nystagmus, delayed responses, slow speech, weakness, myoclonic [...]

Background: Patient and family experience have become increasingly important to the hospital community, whereby exceptional patient and family experience is the common ground for all six aims of quality care as defined by the Institute of Medicine in Crossing the Quality Chasm — care that is patient centered, safe, effective, timely, efficient, and equitable (1). [...]

Background: Hospitals around the country are facing patient flow issues. Late discharges on the inpatient floors are thought to contribute to overcrowding in the emergency department and increased evening admissions (Wertheimer, 2014). This can lead to decreased quality of care, patient satisfaction, and increased length of stay. Some hospitals have attempted to promote early discharges [...]

Case Presentation: Patient is a 45-year-old female with a history of esophageal reflux and dysmotility, asthma, depression/anxiety, and recent SARS-2-CoV infection (COVID-19) who presented to our hospital 9 months after initial and 3 months after recurrent COVID-19 with headache, dyspnea, and home blood pressures (BP) > 180/100. Patient reported intermittent symptoms for the last 3 [...]

Background: Uncertainty of viral transmission and PPE availability early in the SARS-CoV-2 pandemic created unique infection control challenges for hospitals. Prior to masking recommendations and widespread testing availability, the hospital medicine service at an academic hospital system published “medical distancing” guidelines to reduce the frequency and proximity of physician-patient interactions to minimize transmission. While previous [...]

Background: Hospitalists commonly discuss advance care planning (ACP), which supports patients in understanding and expressing their values for medical care during serious illness. The coronavirus disease of 2019 (COVID-19) pandemic has increased the urgency of these conversations, especially for patients with older age, comorbidities, or an otherwise high risk for complications such as ICU admission, [...]

Background: Increased Emergency Department (ED) boarding has been linked to worse patient outcomes, including delays in treatment (Jiraporn et al 2014), increased length of stay (Singer et al 2011), and increased mortality (Singer et al 2011; Sun et al 2013). Patients who meet time zero (T-0) for diagnosis with severe sepsis while boarding in the [...]

Background: Hospitalists rely on patients’ family members and caregivers to convey medical history, communicate on the patient’s behalf, assist with decision making, participate in care training, partake in discharge planning and provide support. With the rise of COVID-19 infection rates across the country, hospitals promptly enforced strict visitation protocols to prevent transmission, preserve PPE and [...]

Case Presentation: This is a 4-year-old previously healthy girl, fully immunized with the exception of COVID-19 immunizations, who was hospitalized after presenting with fevers and fatigue for one week followed by gross hematuria. At the outset of her fevers, she tested negative for COVID-19 using a home antigen test. 4 days prior to admission, she [...]

Background: COVID-19 (Coronavirus Disease of 2019) is a global pandemic caused by the rapidly spreading SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). The novel coronavirus has stressed the limits of healthcare systems globally, making early identification of risk factors essential to the functioning of our healthcare systems during this ongoing pandemic. Many risk factors are already [...]