Background: Commonly used discharge communication workflows hinder timely and efficient discharge. Studies exploring the use of the electronic health record (EHR) for discharge planning have been limited to electronic reports constructed from EHR data elements, including barriers to discharge documented at admission, care management data, and discharge criteria or other targeted interventions such as improving [...]

Background: Prior research in the field of academic hospital medicine has described unique challenges to achieving promotion for academic hospitalists.  A consensus conference identified challenges for academic hospitalist success including alignment of hospitalists with clinical priorities that may not be recognized for academic advancement, inadequate infrastructure to promote success, and lack of national funding for [...]

Background: Making the hospital discharge process faster and more predictable may help improve patient flow, reduce delays in admitting new patients, and increase hospital capacity. Some hospitals have implemented initiatives to promote timelier discharges as ways to improve hospital throughput.  We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness [...]

Background: Professional Advancement Models (PAM) have been researched and implemented at large academic institutions as a solution to provide structure and support for career advancement for Advancement Practice Providers (APPs).1,2 Many of these programs fail to appreciate the nuances of inpatient vs outpatient providers. Given the inherent differences of these practice settings, we aim to investigate [...]

Background: Length of stay (LOS) outliers are a focus of cost and resource utilization for hospitals in the United States. Limited research has been done to characterize outliers, risk factors, and barriers to discharge. Methods: We conducted a case-control study of inpatient admissions to the general medicine service line between September 2015 and August 2016. [...]

Background: Prolonged lengths of stay (PLOS) on general internal medicine wards are associated with increased mortality and morbidity for patients and represent a costly source of health care spending [1]. Increasingly, nonmedical barriers to discharge, including the need for guardianship, limited facility options, and lack of home support are recognized as contributors to PLOS in [...]

Background: Preventable hospital readmissions are a common problem for medical centers in the United States. Recent studies have focused on what patients perceive as causes for their return to the hospital. One factor driving readmissions is patients’ difficulty anticipating what to expect after they leave the hospital despite discharge instructions, especially anticipating and surmounting challenges [...]

Background: Misalignment of goals of care at the End-of-Life exposes patients to risk and the health care system to considerable costs. A lack of end of life conversations can lead to unrealistic patient expectations, patient harm, and multiple hospital readmissions. This study aims to identify physician perspectives on the barriers to initiating end of life [...]

Background: Patients are discharged home on medications different than those they were taking before admission.  New and discontinued medications as well as dosage changes contribute to medication-related adverse events.  Purpose: To help address this problem, interns in our program developed a standard process during their quality improvement (QI) curriculum to ensure that at least 95% [...]

Background: Increased hospital capacity causes significant strain on medical institutions. Patients who are clinically ready for discharge but “stuck” awaiting post-acute resources are thought to contribute to this capacity strain. Here, we aim to provide a clinically relevant measurement of the prevalence (proportion of patients) and weight (proportion of days) for patients who have spent [...]