Background: Clinically stable inpatients may receive potentially unnecessary care, such as overnight vital sign assessment. Nighttime vital signs can disrupt sleep and adversely affect patient satisfaction and contribute to delirium. However, it may be difficult for individual clinicians to determine which patients could safely forego overnight vital signs. Purpose: We developed a predictive algorithm designed [...]

Background: Advance care planning can be challenging for both patients and providers.  Barriers to understanding patients’ goals of care include patient and provider discomfort with the topic, as well as family and cultural dynamics.  The Stanford Letter Advance Directive (LAD) is a simple tool written at a fifth grade reading level in eight different languages [...]

Background: Although point-of-care ultrasound can improve patient care and reduce unnecessary downstream costs, few economic models exist on hospitalist use and whether remuneration for imaging could offset equipment costs.  As the heart and lungs are commonly examined during admission, we observed the frequency of use and projected fiscal outcomes of point-of-care cardiac ultrasound by an [...]

Background: Remote patient monitoring (RPM) is a promising new tool to monitor patients who have historically required observation visits in a hospital, or would have remained hospitalized longer if initiated at hospital discharge, and was widely used in the COVID-19 pandemic. We report the outcomes of hospital admission and urgent/emergent care service utilization in a [...]

Background: Healthcare disparities have existed for decades, yet it took a global pandemic to put this emergency into the spotlight. The Joint Commission states “health related social needs” (HRSN) are the root cause of many disparities. HRSN encompasses a wide spectrum including inability to pay bills, poor access to transportation, and lack of housing. At [...]

Background: The CDC Core Elements of Antibiotic Stewardship recommend that patients initiated on broad-spectrum antibiotics (BSA) undergo antibiotic de-escalation within 48-72 hours based on available culture data. However, adherence with this recommendation in patients with sepsis has not been well studied. We assessed the incidence of, and characteristics associated with, anti-methicillin resistant staphylococcus aureus (MRSA) [...]

Background: The low published survival rate of pediatric in-hospital cardiopulmonary arrest (25-38%) 1 has led to the development of early warning systems (EWS) to identify patients at risk for deterioration. On our general pediatric unit, we implemented the published validated Children’s Hospital Early Warning System (CHEWS)2 in 04/2021. This composite scoring tool includes caregiver assessment [...]

Background: Facilitating safe transitions of care is a common concern for the discharging hospitalist. Telephone calls are the most common method of contact for post-discharge outreach. These are labor-intensive and therefore limited in scope. To better support patients after hospital discharge, we designed and implemented a 30-day automated texting program. In a pilot study, this [...]

Background: Since 2010, 130 rural hospitals have closed, leaving only 2,250 rural hospitals remaining in the United States. Of the remaining facilities, outmigration and/or the bypassing of the local hospitals to a larger facility remains problematic and impacts a community’s access to healthcare while affecting the long-term business viability of the city. In December of [...]

Background: Hospital readmissions are frequent and can represent low-quality, high-cost care. Timely post-hospital follow-up has been described as an important element of high-quality transitions of care and readmissions prevention (1-3), yet exactly what type of follow-up is most successful is unclear. We sought to understand the relationship between timing, hospital follow-up visit provider specialty and [...]