Case Presentation: A 14yo girl presented with syncope and 4 days of URI symptoms. She had no past medical or family history. On presentation, she was hypotensive with mildly elevated lactate, troponin, and BNP, and an unremarkable ECG and chest radiograph. Initial echocardiogram showed normal LV function. Cardiac MRI revealed a pericardial effusion and increased [...]

Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Methods: We conducted a pooled cohort study using data from three acute heart failure trials (DOSE, ROSE, and ATHENA-HF). [...]

Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead [...]

Background: Frailty is linked to poor outcomes in older patients, especially those with multiple conditions. The electronic frailty index (eFI) is a validated tool based on the cumulative deficit model used to screen hospitalized patients at risk for poor outcomes1. The eFI relies on 35 ICD-10 codes associated with encounters across four domains (morbidity, sensory, [...]

Background: Hospital discharges can be complex for patients, and ensuring patient comprehension of their clinical records and discharge summaries is critical for improving health-related outcomes. However, studies suggest that 88% of discharge instructions are not readable to the population served. In our prior study we demonstrated that generative AI (AI) has the potential to transform [...]

Background: Failure to thrive and malnutrition continues to be a common diagnosis in pediatrics contributing to a significant number of hospital admissions (1-5). There is no national practice guideline or consensus recommendation for diagnosis and treatment for patients hospitalized with failure to thrive, contributing to significant clinical practice variation. Unnecessary variability in practice has been [...]

Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered [...]