Background: Growing antimicrobial resistance, C. difficile infection and cost have triggered a greater reliance on antimicrobial stewardship. Most stewardship models rely upon a central team, often led by ID specialists, to oversee prescribing in an institution. However, there are limitations to this paradigm. Purpose: We believe opportunities exist for hospitalists to drive stewardship by integrating [...]

Background: As the acuity of hospitalized patients increases, there have been an increasing number of patients requiring mechanical ventilation on the general medical units (GMU). Ventilated patients in intensive care units (ICUs) have a standardized approach to minimize the risks for complications such as ventilator associated events (VAE), GI bleeding and VTE. When patients requiring [...]

Background: Uncomplicated Urinary Tract Infections (UTIs) account for more than 100,000 inpatient admissions yearly. IDSA guidelines recommend Nitrofurantoin as first line therapy and recent FDA guidelines recommend against Fluoroquinolone (FQ) use due their side effects and growing resistance; however, Sulfamethoxazole/Trimethoprim (Bactrim) and Ciprofloxacin are still commonly used to treat uncomplicated UTIs. Therefore we hypothesized that [...]

Background: Inappropriate antibiotic use is associated with bacterial resistance, adverse events, and an increased risk of Clostridium difficileinfection. However, providers often prescribe antibiotics for viral respiratory infections and treat infections such as bacterial pneumonia for unnecessarily prolonged durations.  Serum procalcitonin (PCT)-guided treatment is known to safely reduce antibiotic use and duration of treatment in pneumonia. [...]

Background: Asymptomatic bacteriuria (ASB), the presence of bacteria in urine without signs or symptoms of a urinary tract infection, is a common finding. The current recommendation by the Infectious Diseases Society of America is against screening for and treating ASB in patients undergoing non-urologic surgeries, due to the lack of demonstrable benefit in reducing the [...]

Background: Geographic decentralization of inpatient teaching teams has been shown to impair physician-nurse communication and efficiency of care. Reliance upon paging or messaging increases probability of miscommunication. Importantly, the inclusion of nurses as integral members of the care team cannot be fully realized in the absence of consistent provider presence on the unit. Purpose: Prior [...]

Background: Previous studies demonstrate patient readmissions to the Medical Intensive Care unit (MICU) from the ward are potentially associated with worse outcomes due to breakdowns in communication during ICU-ward transfer. Though previous work highlights the importance of shared mental models (whether clinicians have a mutual understanding) during handoffs, no studies examined the prevalence of a [...]

Background: Intensive Care Unit (ICU) beds are limited, so effective triage is important for resource utilization. However, inappropriate triage of critically ill patients to non ICU settings can lead to poor patient outcomes, as early unexpected ICU transfers are associated with increased mortality. Purpose: We sought to describe the effectiveness of Hospital Medicine (HM), Emergency [...]

Background: In light of increasing healthcare costs, diagnostic stewardship is an important component of providing high-value healthcare. Order sets, a collection of orders aggregated in a single location for a given diagnosis, condition, or treatment, are designed to promote adherence to evidence-based practices and reduce variability in care—both known drivers of high-value care (Atlas SJ [...]

Background: Proton Pump Inhibitors are widely misused in both the outpatient and inpatient setting. Often, they are initiated and continued for reasons that do not follow best practice guidelines. Purpose: A Proton Pump Inhibitor Stewardship Committee was created to address this problem as part of a Quality Improvement project. The goal was to determine the [...]