Background: Accurate coding is paramount to hospital revenue generation and is often supported by a clinical documentation integrity (CDI) team made up of registered nurses and non-clinical coding personnel. Physician-led coding initiatives have demonstrated improvement in case-mix index and clinical documentation. We hypothesized that physician integration into CDI would result in a more robust improvement [...]

Background: The role of the clerkship director (CD) in Internal Medicine (IM) has been increasingly recognized and valued as a ‘legitimate pathway towards academic advancement. We hypothesized that salary support for the IM CD has lagged behind the recommended 0.5 full-time equivalent (FTE) put forth by Pangaro and colleagues. Methods: In 2016, Clerkship Directors in [...]

Background: Obesity is associated with overall higher mortality risk in the general population however, some authors have noted patterns to suggest a survival advantage in a certain clinical subpopulation. Obesity paradox is reported for stroke, myocardial infarction, heart failure, renal disease, and diabetes. Clostridium difficile infection (CDI) is the most common nosocomial infection in the [...]

Background: The overall incidence of Clostridium difficile infection (CDI) is higher among patients with inflammatory bowel disease (IBD). The nature of this disease association is unknown but likely involves an altered gut microbiome and impaired host immune responses. Studies on CDI in IBD patients have yielded variable and conflicting results on outcome measures such as [...]

Background: There is no formal curriculum for medical students, residents or advanced practitioner students on appropriate clinical documentation improvement (CDI). As the primary documenters for medical records, several studies have shown benefit in billing, coding and hospital metrics with trainee education [1-2]. Despite this, there remains a scarcity of education on documentation for residents and [...]

Background: Timely Clostridium difficile Infection (CDI) testing is challenging but is important for faster and appropriate isolation and treatment of patients. Few studies have specifically addressed effective methods to hasten CDI testing without relying on PCR. We sought to use Quality Improvement methodologies including the Plan-Do-Study-Act (PDSA) Cycle and Control Charts to reduce CDI testing [...]

Background: Clostridium difficile infections (CDI) is the most common cause of healthcare-associated infections in the United States. CDI accounts for 15%- 25% of all cases of nosocomial diarrhea. CDI is associated with significant adverse outcomes such as higher inpatient mortality rate, a longer length of hospital stays and increased hospital costs. The incidence of Hospital-acquired [...]

Background: The Children’s Hospital Association (CHA) Sepsis Collaborative recognizes pediatric sepsis as a significant cause of mortality and nationwide efforts are being developed to improve sepsis recognition. A critical component to decreasing sepsis mortality is early identification of sepsis so that interventions are initiated quickly. At Johns Hopkins All Children’s Hospital, there is a significant [...]

Case Presentation: A 70 year-old woman with no known history was admitted with symptoms of urinary incontinence and generalized weakness. Workup was notable for a positive urinalysis, positive Influenza swab, and serum sodium of 142mmol/L. She was started on ceftriaxone, oseltamivir and isotonic fluids (normal saline). On hospital day (HD) 2, her sodium was 159mmol/L, [...]

Background: Accurate clinical documentation is essential for capturing patient severity of illness (SOI) and risk of mortality (ROM). These metrics directly influence hospital quality reporting, including rankings like Vizient and metrics such as Observed-to-Expected Mortality (O:E) ratios. Traditional documentation methods rely heavily on manual input, which in busy clinical practices, results in underrepresented patient risk [...]