Background: Accurate, high-quality data is critical for work in quality improvement, research, and clinical operations. With an electronic health record (EHR), vast amounts of observational data are collected on patients every day. This data can provide actionable knowledge if an institution can successfully extract and analyze it. At our institution, which adopted the Epic EHR [...]

Background: Venous thromboembolism (VTE) is a common preventable condition in hospitalized medical patients. Chemoprophylaxis with heparin or fondaparinux has been recommended for all hospitalized patients who are not at low risk, and appropriate thromboprophylaxis is a hospital quality measure. However, the specific threshold of VTE risk that warrants prophylaxis has not been defined. We used [...]

Background: The Accreditation Council for Graduate Medical Education’s (ACGME) Clinical Learning Environment Review (CLER) program’s Pathways to Excellence framework includes the expectation that “residents and fellows engage in inter-professional, experiential patient safety event investigations that include analysis” (1, 2). However, as noted by the CLER program national reports, trainee participation in patient safety event analyses [...]

Background: Inpatient experience quality improvement efforts have traditionally been focused on increasing scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients’ open-ended responses about their inpatient experiences may represent a previously unexamined resource for understanding patient motivation behind closed-ended responses. We aimed to describe responses to an HCAHPS open-ended survey [...]

Background: Medical overuse, defined as the provision of services for which harms outweigh benefits, is increasingly recognized as a driver of high cost and poor clinical outcomes in the U.S. health care system. Despite increasing attention to overuse, methods for reducing it are unclear. In contrast, methods of identification, analysis, and prevention of medical errors [...]

Background: Morbidity and Mortality Conference (MMC) has been recognized as a valuable educational resource in training programs to improve patient safety. Traditional MMCs are often poorly defined in terms of format, goals, and outcomes, leading to ineffective reflection, discussion and action. Increasing evidence suggests that a structured and transparent approach to MMCs results in measurable [...]

Background: Health information technology (HIT) systems, though designed to improve clinical workflow efficiency, have ironically contributed to clinician burnout, especially among hospitalists who depend on these systems for patient care and coordination (Adler-Milstein 2020). Addressing these challenges requires a detailed, resource-intensive process to identify workflow inefficiencies. Because this process is difficult, it is often performed [...]

Background: Congestive heart failure (CHF) is a major cause of mortality and morbidity among general population despite recent advancements in goal-directed therapies. The advent of mechanical circulatory devices, the increased availability and improvement in heart transplant techniques have improved some metrics; however, CHF patients continue to have multiple readmissions for acute exacerbations. The frequency of [...]

Background: An increased cardiothoracic ratio (CTR) on chest radiographs (CXR) is considered equivalent to cardiomegaly. However, its diagnostic value to identify left ventricular (LV) dilation is unclear. Methods: We reviewed and included the diagnostic studies that utilized CXR as the index test and TTE as the reference standard to diagnose LV dilation. Two-gate (case-control) diagnostic [...]

Case Presentation: A 43-year-old woman was admitted to the hospital for increasing lower extremity swelling and dyspnea on exertion. Past medical history is pertinent for hypertension, obesity, and stroke. A few months prior, she had a hysterectomy for leiomyomata. Physical examination was within normal limits except for jugular venous distension and irregular heart rate and [...]