Background: Community acquired pneumonia (CAP) is one of the leading causes of hospitalization in the United States.[1] In an effort to improve the quality of care for this resource-intensive disease, our institution implemented a clinical decision support (CDS) pathway for CAP comprised of three phases: (1) education on best practices, (2) education and a CDS [...]

Background: Accurate medication reconciliation during transitions of care can decrease medication related adverse drug events. The Joint Commission has prioritized medication reconciliation as one of the national patient safety goals. Effective pharmacist-physician-patient collaboration can improve the medication reconciliation process and thus medication safety for hospitalized patients Purpose: 1. Develop a standardized provider-pharmacist discharge medication reconciliation [...]

Background: Failure to follow-up results of laboratory tests pending at discharge (TPADs) can lead to patient harm. Numerous interventions have been proposed to improve follow-up. The Laboratory Medicine Best Practices (LMBP™) workgroup, sponsored by the Centers for Disease Control, commissioned a systematic review to address the impact of various interventions on TPAD documentation, communication, and [...]

Background: Advances in technology and life-sustaining interventions afford patients access to a wider network of subspecialized care through inter-facility transfers. Implicit in these transfers are multiple complex steps that leave patients vulnerable to adverse events. The few guidelines that exist regarding the inter-facility transfer process focus on critically-ill or surgical patients, and emphasize pre-transfer communication [...]

Background: Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-center quality improvement collaborative aiming to improve hospital to home transitions. As part of this project, providers attempt to schedule follow-up visits prior to discharge and conduct post-discharge phone calls. Objective: 1.Determine relationship between scheduling post-discharge follow-up visits and 30-day reutilization rates 2. Characterize patients [...]

Background: Transition from the inpatient to outpatient setting presents a safety risk to pediatric patients. Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-site quality improvement collaborative developed to improve the hospital to home transition for pediatric patients using a transition bundle. One bundle element is the use of teach-back (TB) to confirm caregiver [...]

Background: To address safety risks with transitions from hospital to home, the IMPACT collaborative designed, tested and implemented the Pediatric Patient Centered Care Transition (PACT) Bundle. The bundle element “perfect” handoff (timely and complete) aimed to improve hospitalist handoff to outpatient providers at hospital discharge.Our objective was to  assess outpatient medical provider’s perceptions of hospitalists’ handoff [...]

Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. [...]

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, [...]

Background: Failure to follow-up on lab tests and radiology results can lead to major patient safety concerns due to missed or delayed diagnoses and can be a cause for litigation for health care practitioners. With increasing patient loads, the volume of follow-up testing and clarifications to documentation needed for billing can be a significant burden [...]