Background: Lab testing is critical for clinical decision-making and used throughout healthcare systems. Overuse of lab testing is known to be commonplace and contributes to shortages in lab testing materials. While practices exist at medical institutions that aim to limit lab test overuse, it is unclear which interventions are effective. Methods: We aimed to reduce [...]

Background: Venous thromboembolism (VTE) is a prevalent and costly medical condition in hospitalized patients. Risk assessment tools like the Padua Predictive Score aim to differentiate low-risk and high-risk patients for targeted pharmaceutical prophylaxis (pPPX) administration. However, widespread adoption of risk assessment remains suboptimal. This study investigates HA VTE prophylaxis use in medicine inpatients within a [...]

Background: In order to reduce overuse, many hospitals have conducted studies and implemented protocols with the goal of reducing non-indicated telemetry monitoring. A common tool that institutions utilize for these changes are the clinical decision support systems (CDSS). In this report, we will present the telemetry protocol utilized by our hospital and review its effects [...]

Background: Thromboprophylaxis of hospitalized COVID-19 patients – including extended, post-discharge thromboprophylaxis in high-risk patients – has been evaluated in multiple randomized trials and incorporated into antithrombotic guidelines. Yet, provider adoption of best practices remains sub-optimal. Our aim was to assess whether an electronic health record (EHR)-agnostic clinical decision support (CDS) tool incorporating the validated IMPROVE-DD [...]

Background: Observation status was designed to reduce health care costs for patients in need of short hospital stays. CMS suggests that observation care should typically require less than 24 hours, and only rarely last more than 48 hours. However, studies suggest that length of stay for observation patients is often longer than CMS guidance.[1,2] An [...]

Background: Over the past fifty years, remote cardiac monitoring (“telemetry”) has become routine for many patients admitted to the hospital. Telemetry has many clinical benefits and is recommended by the American Heart Association for a limited set of indications, but is often inappropriately used. Overutilization of telemetry can lead to unnecessary tests and procedures, may [...]

Background: Procalcitonin (PCT) testing has been shown in randomized trials to decrease antibiotic exposure and be a reliable predictor of clinical response to antibiotics in lower respiratory tract infection (LRTI) and sepsis. Although studied to guide antibiotic discontinuation in LRTI and sepsis, optimal strategies for introducing PCT into “real-world” clinical use are unknown. Our study [...]

Background: Peripherally inserted central catheters (PICCs) are an increasingly popular choice in the acute care setting for intravenous therapy. However, compared to other catheters, PICCs are associated with a higher risk for venous thromboembolism and blood stream infection, with multi-lumen PICCs having higher complication rates than single lumen. Midline catheters are associated with a much [...]

Background: In-hospital patient deterioration, often unpredictable and multifaceted, presents a significant challenge in hospital medicine. Despite existing measures like illness severity scoring systems and rapid response teams (RRT), patient outcomes remain suboptimal. Delays in recognizing and treating worsening conditions lead to adverse effects and increased healthcare costs. Purpose: In our large healthcare system, covering two [...]

Background: Medical error is now the third leading cause of death in the United States. Approximately 4% of hospitalized patients experience an adverse event with 20% of these adverse events being medication-related, three-fourths of which are prescribing and administration errors. Vancomycin has been reported to account for one-fourth of the medication errors. Prescribing vancomycin is [...]