Background: High value care is a key priority in healthcare, but strategies are needed to empower frontline clinicians to work with organizational leadership to reduce healthcare costs and improve care.   Purpose: Caring Wisely (CW) is a program we developed that is designed to engage frontline clinicians and staff, connect them with implementation experts, and [...]

Background:  Successful inpatient glycemic control programs achieve both improved glycemic control and low rates of hypoglycemia.  Using results from the analysis of performance in glycemic control and hypoglycemia, we identified top performers and those demonstrating the most improvement.   We sought to describe their key characteristics.  Methods :  Participating hospitals (84 for ICU, 94 for non-ICUs) [...]

Background: A variety of risk prediction scores have been devised to identify patients at increased risk for VTE in different patient populations and settings. Guideline recommendations for VTE risk assessment vary greatly. We performed a systematic review to identify and synthesize evidence on clinical risk prediction scores for VTE in medical and surgical hospitalized patients. [...]

Background: Caring for patients involves multitudes of moving parts – from teams of physicians, nurses and radiologists to tests, medications and an array of electronic health record (EHR) systems. However, as medical care has evolved, instead of these components working together seamlessly, they often work in silos – both at the provider and patient data [...]

Background: Emergency department (ED) crowding is a widespread national issue which has been shown to negatively impact patient experience and the quality and safety of care delivery.  A community hospital within our academic health system was experiencing significant ED crowding with long ED length of stay (LOS) and high left without being seen (LWBS) rates. [...]

Background:  Per the 2014 State of Hospital Medicine Survey, 94% of adult hospital medicine groups (HMGs) reported financial shortfalls, with a mean of $169,886 in financial support per full time equivalent physician. In addition, many groups face recruitment challenges which lead to workforce shortage and physician burnout. To offset these problems, some groups employ increasing [...]

Background:   Observation care has evolved significantly since its original inception by the Centers for Medicare and Medicaid Services (CMS).  Originally intended to span less than 48 hours in the majority of cases, the Office of Inspector General (OIG) reported that 11% of all observation stays lasted three or more nights in 2012.[1]Having a higher length [...]

Background: Hospital medicine is a maturing field that increasingly focuses on providing high value patient care. A key question in the value equation is how different patient census sizes impact care. Our recent research showed that higher patient censuses were associated with longer hospital length of stay and costs. This study follows up on this [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: In an effort to improve pediatric inpatient asthma care, the Joint Commission developed standards for hospital management in 2003. Despite this initiative, inpatient management of asthma exacerbations and adherence to these guidelines varies by institution.  Such differences have an impact on hospital cost, length of stay, and readmission rates.  Based on data from the [...]