Background: Hospitalists increasingly confront patient care and policy dilemmas due to financial incentives created by bundled payments, single payments that “bundle” acute and post-acute care for specific diagnoses. The most common and most successful bundled payment has been for total joint replacement, where cost savings have been achieved through discharging patients to home rather than [...]

Background: Hospitals are incentivized to reduce 30-day readmissions under the Affordable Care Act. Medicare payments can be reduced when inpatient readmissions are excessive. The Centers for Medicare & Medicaid Services (CMS) readmission measure is defined among encounters classified with only an inpatient status. At this time, observation encounters are not included in this measure. This [...]

Background: To address safety risks with transitions from hospital to home, the IMPACT collaborative designed, tested and implemented the Pediatric Patient Centered Care Transition (PACT) Bundle. The bundle element “perfect” handoff (timely and complete) aimed to improve hospitalist handoff to outpatient providers at hospital discharge.Our objective was to  assess outpatient medical provider’s perceptions of hospitalists’ handoff [...]

Background: Alternative payment models have been proposed for lower extremity joint replacement surgeries to deliver well-coordinated and high quality care. It is speculated that while these payment models may lead to more cost effective care, institutions may “cherry pick” less costly and less complex patients to minimize financial risks. In this study, we aim to [...]

Background: Sepsis is the leading cause of death in US hospitals; prompt recognition and treatment are critical. Early sepsis recognition and treatment varies depending on location (ED/floor/ICU) and evaluation time (presentation vs during stay). “Sepsis response teams” (SRT) improve sepsis care. After our hospital system implemented a “best-practice alert” utilizing Epic’s “sepsis score” (SS) to [...]

Background: Sepsis is a systemic host response to infection that may result in significant morbidity with mortality rates from severe sepsis or septic shock reaching over 20% in most studies.  Research on sepsis has focused on use of groups of sepsis specific interventions (termed care bundles) that are given in response to the declaration of [...]

Background: Heart failure (HF) is one of the most common discharge diagnoses for Medicare beneficiaries. As part of the Affordable Care Act, the Center for Medicare and Medicaid Services initiated the Hospital Readmission Reduction Program which reduced payments to hospitals for excess readmissions for HF and other diseases. This quality improvement project focused not only [...]

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: BACKGROUNDSepsis has been recognized as a major cause of mortality and morbidity in the United States. If not recognized and managed promptly, it can lead to septic shock which is one of the leading causes of deaths in the hospital (WHO, 2020). To promote early identification and treatment of severe sepsis and septic shock, [...]

Background: A patient’s hospitalization encounter is a valuable opportunity to align potential social and structural barriers with the healthcare multidisciplinary team’s (MDT) resources for intervention. Teaching learners to assess and address social determinants of health (SDH) is a key objective of medical education and becoming a physician. Few studies describe curricula implementing these skills during [...]