Background: Anemia is an acute and/or chronic condition with a range of underlying etiologies present in an estimated 40-70% of hospitalized patients. While comprehensive diagnostic and treatment algorithms for anemia exist, they are rarely used by hospitalist clinicians in the inpatient setting. This is because these algorithms were derived in ambulatory patients where acute anemia [...]

Background: The use of early warning systems (EWS) to augment clinical care is of increasing interest with recent publications showing EWS algorithm alerts coupled with clinical response actions to have significant morbidity and mortality benefit.1 At Stanford Hospital we are developing an alert and response EWS using a machine learning (ML) model predicting clinical deterioration [...]

Background: Current surveillance approaches underestimate harmful diagnostic errors (DE) in hospitalized patients. A recent study of 2809 admissions observed that while one or more adverse events (AE) occurred in 23.6% of cases, only 10 AEs (0.1%) were attributable to DEs (1). Studies using the Safer Dx instrument have observed harmful DE rates of 5-7% (2). [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is a rare (0.1-1% of heparinized medical patients) but devastating (up to 10% mortality) side-effect of heparin administration[1].  In thrombocytopenic patients, the pre-test probability of HIT is estimated by the validated “4Ts Score”, which is used to risk-stratify patients into Low (0-3 points), Intermediate (4-5 points), and High (6-8 points) likelihoods [...]

Background: Effective discharge planning requires early identification of patients’ post-acute care needs as well as potential barriers to placement. Housestaff receive little formal training on discharge planning and are instead expected to learn “on-the-go”. At the West Los Angeles Veterans Affairs (WLAVA) Medical Center there exists many disposition options that aren’t available to our housestaff [...]

Background: Telemetry beyond 48 hours is indicated for a select patient population and when used inappropriately has risk. This includes increased cost of care, skin irritation, delirium contribution, and more likely to have false positives resulting in errors or extending length of stay.To encourage care that is truly necessary, free of harm, not duplicative, and [...]

Background: Discharge planning plays a critical role in managing hospital length of stay (1). We report on the implementation of a program in a large hospital system where health care providers were requested to estimate and record the Medically Ready for Discharge Date (MRDD) in the electronic health record (EHR) for hospitalized patients to facilitate [...]

Background: Efficiently identifying clinically appropriate patients is integral to the operation and growth of a hospital at home program. Given the nuances of a home-based care delivery model, this task typically relies on a specifically trained small group of experienced providers, significantly limiting the number of patients able to be screened. The Hospital at Home [...]