Background: The most acute patients presenting to the Emergency Department (ED) requirean admission to the inpatient setting. A timely triage and admission process can improve the outcomes of these critically ill patients. Forty-six percent of admissions through our ED are admitted across multiple medicine services. We originally utilized a rotating Medical Admitting Resident (MAR) to [...]

Background: Hospital bed capacity is limited across the nation due to increased demand and staffing shortages. Capacity shortages result in hospital diversion and therefore impact Emergency Department (ED) length of stay and ED medical boarding. A large tertiary hospital typically serves as the referral hub for many smaller hospitals in the region, and optimizing bed [...]

Background: A hospitalist “triagist” physician assesses patients for admission and supports the transition of patients from the outpatient to inpatient setting [1]. Active bed management and triaging by hospitalists have been reported to improve emergency room (ER) patient flow and ER to ICU throughput, while hospitalist-directed transfer and admission of stable ER patients may shorten [...]

Background: Hospital disaster response has historically been the purview of emergency medicine and surgery, without significant involvement of hospitalists themselves or consideration of how mass casualty incidents impact the hospital as a whole. However, many disaster modalities, e.g. pandemic infectious disease or bioterrorism, are outside of the surgical scope of practice and require involvement of [...]

Case Presentation: A 65 year old male with no significant medical history presented to an outside facility complaining of fatigue, weakness, nausea and vomiting. He had moderate alcohol history and significant weight loss over the past 6 months. Initial lab workup was notable for elevated liver transaminases with a hepatocellular pattern, Maddrey score of 53.6 [...]

Background: The management of patients with COVID-19 is challenging for front-line healthcare providers given limited validated, evidence-based clinical decision support. Determining patient mortality risk is critical for effective triage, management, and discharge decision making. Numerous COVID-19 risk prediction models have been created, though the robustness of these models varies. The 4C Mortality Score, created by [...]

Background: Non-beneficial treatment can be defined as medical interventions that are ineffective in achieving a patient’s desired goals or subject patients to discomfort without significant clinical benefit. At times, critically-ill patients are declined Intensive Care Unit (ICU) admission due to perceived lack of benefit but continue to be medically managed on the general medical floor. [...]

Background: Non-beneficial treatment can be defined as medical interventions that are ineffective in achieving the desired goals or are “a disservice to patients who are subjected to ongoing and likely uncomfortable conditions with no benefit”. At times, critically ill patients are declined Intensive Care Unit (ICU) admission due to perceived lack of benefit from medical [...]

Background: In Hospital Medicine, triaging a patient is the process of evaluating an admitted patient and assigning the patient to an appropriate service. Triaging patients is a manual and challenging process which burdens Hospitalists. As with any manual process, there is an inherent risk of missed steps, and in the case of patient triage, the [...]

Case Presentation: A 58-year-old woman presented with abdominal pain, nausea, and oral intolerance. Her vitals were stable on admission, but physical exam revealed a distended abdomen with tenderness to palpation in the left lower quadrant and an absence of bowel sounds. Her laboratory results were remarkable only for a hemoglobin of 8.1, which appeared chronic. [...]