Background: Clinical decision support tools based on predictive analytics can provide actionable information and improve clinical outcomes for patients at risk of developing sepsis. Scoring systems such as Systemic Inflammatory Response Syndrome (SIRS) and National Early Warning Score (NEWS) that were not specifically trained to detect sepsis tend to have high false alarm rates, leading [...]

Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay, cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Programs targeted at delirium prevention and treatment may affect these outcomes. We [...]

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: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Hospitalizations related to opioid use disorder (OUD) are rising, creating opportunities to initiate medications for opioid use disorder (MOUD) and connect patients with outpatient resources.1,2 Despite evidence that MOUD reduces morbidity and mortality, most patients fail to receive evidence-based treatment during hospitalization.3-6 Addiction consultation services are becoming the standard of care to address this [...]

Background: Fracture Liaison Services (FLS) are traditionally outpatient-based and led by orthopedists or endocrinologists. In the United States, over 1 million patients are hospitalized yearly with osteoporotic fractures and internal medicine hospitalists are frequently involved in their co-management. Purpose: Internal medicine hospitalists have an integral role in the prompt recognition and early treatment of patients [...]

Background: Antibiotics targeted against C. difficile bacteria are necessary, but insufficient, to achieve a durable clinical response because they have no effect on C. difficile spores that germinate within a disrupted microbiome. ECOSPOR-III evaluated SER-109, an investigational, biologically-derived microbiome therapeutic of purified Firmicute spores for treatment of recurrent CDI. Methods: Adults ≥18 years with recurrent [...]

Background: Sleep disruptions for routine care, such as vital sign assessments, are common during hospitalization and are associated with negative health outcomes and patient satisfaction. While higher risk patients may benefit from increased monitoring at night, the tradeoff is less obvious for lower risk patients. We hypothesized that assigning overnight vital sign assessment based on [...]

Background: Co-management across service lines has become increasingly common in hospital medicine. While debate continues over clinical outcomes, some co-management arrangements have led to enhanced provider satisfaction, which may have implications for burnout. We have established successful co-management services with orthopedics, urology (GU), otorhinolaryngology (ENT), trauma and neurosurgery (NS). We are a large urban/suburban academic [...]