Background: Chemoprophylaxis with subcutaneous heparin or low-molecular weight heparin is recommended for venous thromboembolism (VTE) prevention in appropriate medical patients.  However, all doses are not always administered and the consequences are unclear.  We sought to determine if there is a relationship between missed and/or refused doses and development of in-hospital VTEs. Methods: The study is [...]

Background: According to CDC estimates, Hospital-Acquired Infections (HAI) account for an estimated 1.7 million infections and 99,000 deaths each year. Studies have shown that using alcohol-based or chlorhexidine-based hand hygiene (HH) is associated with decreased rates of HAIs (1, 2). Nudge theory, a concept in behavioral science, uses positive reinforcement and indirect suggestions to achieve [...]

Background: Proper hand hygiene is a cornerstone of infection control [1,2]. Despite this, compliance remains a challenge, averaging only 50% across healthcare systems nationwide [1].Several interventions have been trialed to improve compliance, including audit and feedback [3]. Traditionally, hand hygiene audits have occurred through direct observation. Unfortunately, this approach can capture fewer than 1-3% of [...]

Background: Neutropenic Fever (NF) is a common complication for patients on myelosuppressive chemotherapy. Despite guidelines by the Infectious Diseases Society of America (IDSA), however, there is variability in physician compliance. There are limited prior studies assessing compliance in this realm and those studies do not fully assess drivers of poor compliance. Poor compliance can result in increased [...]

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:  Recent Center for Medicare and Medicaid Services (CMS) rules require hospitals to have their physicians submit inpatient admission orders and certification prior to a patient’s discharge in order to justify hospitalization reimbursement; however, CMS does not specify how hospitals are to achieve this regulation. Use of Health Information Technology (HIT) tools has significantly expanded, [...]

Background: End of life discussion is very important for preventing undesired cardiopulmonary resuscitation (CPR). It is reportedly associated with less aggressive medical care near death and better quality of life. Its importance has been gradually recognized worldwide. However, the compliance of a Do-not-Resuscitate (DNR) order has not been well studied. We reported the incidence rate [...]

Background: Inappropriate telemetry use has been associated with increased health care cost and unnecessary diagnostic procedures. For these reasons, the Society of Hospital Medicine’s Choosing Wisely campaign promoted use of both American Heart Association (AHA) telemetry guidelines and protocol-driven discontinuation of telemetry. Despite these measures, an estimated 59% of patients are placed on telemetry due [...]

Background: Nosocomial infections are one of the leading causes of mortality and morbidity in the United States. Approximately two million people annually are affected by nosocomial infections in the United States and about 80,000 deaths occur each year. Transmission of healthcare associated infections occurs most often by contaminated hands of health care personnel. Hand hygiene [...]

Case Presentation: A 55-year-old male with a history of coronary artery disease, left ventricular (LV) mural thrombus, tobacco use, and recent thalamic, splenic, and renal artery infarcts, presented with two weeks of worsening pain and cyanosis of his left third and fourth toes, associated with claudication. He denied numbness or loss of strength. He denied [...]