Background: Inadequate assessment and recognition of barriers to discharge at time of admission leads to delays in the discharge process and prolongation of hospital admissions. These delays are associated with multiple negative outcomes such as increased length of stay, decreased patient satisfaction, strain on hospital bed capacity, and higher readmission rates. Prior studies have shown [...]

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:  Transthoracic echocardiography (TTE) is one of the most popular tests in healthcare. Studies of Medicare beneficiaries for example have shown that each year approximately 20% undergo at least one TTE. Repeat TTE defined as TTE done within one year of a prior TTE represent 24-42% of all studies. In the present study we derive [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is a rare (0.1-1% of heparinized medical patients) but devastating (up to 10% mortality) side-effect of heparin administration[1].  In thrombocytopenic patients, the pre-test probability of HIT is estimated by the validated “4Ts Score”, which is used to risk-stratify patients into Low (0-3 points), Intermediate (4-5 points), and High (6-8 points) likelihoods [...]

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: The period following hospital discharge is a vulnerable time for patients when increased self-care requirements are common. Low levels of health literacy and social support are thought to contribute to poor post-discharge outcomes. However, little research has specifically examined the role of health literacy alone or in combination with social support in predicting readmission [...]

Background: Coaching and mentorship programs for new hospitalists can help support early career development. However, new faculty may need additional real-time support as they attend on service for the first time. This may be particularly useful on the teaching service given the unique challenges new faculty may face, such as developing teaching points, providing feedback [...]

Background: Design thinking is a framework for creative problem solving. When the design thinking process (often leveraged in fields outside of healthcare delivery) is applied, it leads to a human-centered path to innovation. The infusion of deep empathy, holistic examination, inclusive collaboration, and effective iteration fosters sustainable solutions for complex human concerns. In traditional problem-solving, [...]

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 [...]