Background: Executing safe transitions of care for hospitalized patients is important because of the vulnerability of patients during this time period.  While hospital-based providers frequently schedule appointments on behalf of their patients prior to discharge, cancellations and non-attendance (“no-shows”) for post-discharge follow-up appointments are anecdotally common and diminish the quality  of patient care.  Little is [...]

Background: Co-management across service lines has become increasingly common in hospital medicine. While debate continues over clinical outcomes, some co-management arrangements have led to enhanced provider satisfaction, which may have implications for burnout. We have established successful co-management services with orthopedics, urology (GU), otorhinolaryngology (ENT), trauma and neurosurgery (NS). We are a large urban/suburban academic [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

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: Hospitalization is costly, associated with the potential for adverse medical events and may have deleterious health effects.  Hospitalist physicians are uniquely positioned to help patients avoid unnecessary hospitalizations.  Our attending-only hospitalist practice in a tertiary academic center admits approximately 350 patients monthly, the majority of which are referred through the emergency department (ED).  Our [...]

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. [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Community acquired severity scores are well known and used routinely in predicting mortality and risk of inpatient and ICU admission in suspected bacterial pneumonia patients. However such scores have not been studied in patients with influenza infection and influenza pneumonia. We attempted to validate one such score, CURB65 and and identify other scores that [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of hospital readmissions in America. Over one-third of patients admitted for COPD exacerbations are readmitted within 90 days, with readmissions costing $15 billion. Medicare instituted financial penalties for excessive readmissions after COPD hospitalizations, incentivizing the creation of readmission prediction tools. Two such tools, the [...]

Background: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. National guidelinesrecommend VTE prophylaxis for all medical patients not at low risk. Several VTE risk prediction models have been developed, but no US models have been validated in a medical population. The ACCP recommends use of the Padua risk assessment model with a [...]