Background: Asthma, bronchiolitis, and pneumonia are common pediatric inpatient diagnoses. Viral testing (VT) is not routinely necessary for these diagnoses as it often does not impact management. Our study objectives for each diagnosis are to; 1) describe trends in VT over the last 5 years including seasonal variation (respiratory season- Oct-March versus non-respiratory season- April-Sept), [...]

Background: The Society of Hospital Medicine (SHM) identifies repetitive CBC & chemistry testing as low-value, and they selected this as a Choosing Wisely Recommendation. Overuse of phlebotomy is associated with hospital-acquired anemia, decreased patient satisfaction and increased hospital costs. Process improvement techniques have been utilized to reduce inpatient phlebotomy, but prospectively identifying a cohort of [...]

Background: Hospital at Home programs originated as pilot initiatives on a national scale, gaining momentum during the COVID-19 pandemic. The need for reevaluating healthcare delivery systems became pronounced during this period. Kent Hospital in Rhode Island collaborated with key stakeholders, including Blue Cross Blue Shield of Rhode Island, United Health Care, and CMS, to bring [...]

Background: As hospitals are increasingly reimbursed for value-based care, quality improvement projects addressing overutilization of routine “daily labs” have become commonplace. Although there are many published studies of daily labs reduction initiatives, there is little consensus on the actual costs of these routine labs to institutions, with most relying on Centers for Medicare & Medicaid [...]

Background: Studies have shown that overutilization of labs is common and can cause adverse health outcomes.  No study to date has compared whether variation in lab ordering tendencies exists between different services within the same hospital.       Methods: This observational study combined a survey of internal medicine residents and hospitalists and a retrospective [...]

Background: In 2004, the American Heart Association (AHA) published recommendations on the use of cardiac monitoring in the hospital setting. It provided a rating system for its indications (Class I-III), which stratify the likelihood of benefit. In June 2013, The Joint Commission approved NPSG.06.01.01, a patient safety goal on clinical alarm use in the hospital [...]

Background: As health systems focus on providing high–value, cost–conscious care, efforts to optimize laboratory testing are increasing.  In order to improve safe and effective utilization of the laboratory, it is informative to understand the prevalence of overuse and its contributing factors. Methods: The Value Improves Quality (VIQ) curriculum was implemented at our institution in 2014 [...]

Background: Cardiac arrhythmias pose a significant risk to hospitalized patients, with the potential for increased morbidity and mortality. Rapid recognition of clinically significant arrhythmias is crucial for timely intervention. Cardiac telemetry monitoring offers a means of remote heart rhythm surveillance in the hospital setting. However, limited availability of telemetry beds in many hospitals and the [...]

Background: Upon hospitalization, patients are assigned to an inpatient or an outpatient status for the hospital stay. Failure of this status to match the requirements of the Centers for Medicare & Medicaid Services may lead to lost revenue or increased risk of audits and penalties. Timely ordering of observation services for patients with an outpatient [...]

Background: Over the past 50 years, observation status patients have been cared for in a variety of settings: in the emergency department, on inpatient floors, and in dedicated observation units. At our medical center, inpatient teams have traditionally cared for observation patients on medical wards. Patients were often unaware of their admission status until they [...]