Background: Consultation in hospital is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consult utilization on hospital outcomes and resource utilization of acute CHF is unknown.   Methods: Discharge data was obtained for patients discharged with a principal diagnosis of acute CHF over 3 [...]

Outcomes of an ‘Attending-Only’ Hospitalist Bedside Procedure Service Background: Patients admitted to the hospital frequently require bedside procedures including central venous catheter placement, paracentesis, thoracentesis, and lumbar puncture.  Procedure training varies across residency programs resulting in varying levels of competency among practicing physicians.1 In addition, the time consuming nature of these procedures has led to [...]

Background: Healthcare research has traditionally relied upon data collected from clinical trials and data generated from patient registries and insurance claims to drive analyses. As electronic health records (EHR) and computerized physician order entry have proliferated, large quantities of healthcare data is being generated daily through their routine use. A form of “big data,” this [...]

Background: Procedures, both inpatient and outpatient, are an essential part of the training for family medicine residents. Several residency programs struggle to provide the minimum number of procedures for residents to develop competency and comfort with the said procedures. Hospitalists do offer increased experience with procedures, although more recently, hospitalists are also referring most procedures [...]

Background: Inpatient subspecialty consultation is one of the most common physician practices in the care of hospitalized patients. As per a CMS report, approximately 33,000 inpatient consultation occurred per day in 2008 costing Medicare approximately $1.9 billion. Common reasons for requesting a consultation include assistance with treatment, diagnosis, and request for a procedure. Consult quality [...]

Background: Congestive heart failure (CHF) is a major cause of mortality and morbidity among general population despite recent advancements in goal-directed therapies. The advent of mechanical circulatory devices, the increased availability and improvement in heart transplant techniques have improved some metrics; however, CHF patients continue to have multiple readmissions for acute exacerbations. The frequency of [...]

Background: In 2006, the Institute of Medicine issued a report on the state of emergency care, which identified overcrowding and patient boarding as major concerns. Subsequent research has confirmed that boarding in the emergency department (ED) leads to adverse events including medication errors, higher mortality, and lower patient satisfaction. In answer to this, hospitalist groups [...]

Background: Much of medical education relies on effective consultation between primary teams and consultants. Previous work has shown that trainees have difficulty with placing and receiving consults. Resident-driven interventions have been shown to increase the number of teaching interactions during consults. Purpose: Our objective was to evaluate the effect of an educational workshop and the [...]

Background: Clinical ethics consultation can promote ethical delivery of care by helping identify ethical questions, frame clinical decisions in the context of values, clarify policies and address the care team’s moral distress. Though hospitalists routinely grapple with ethical dilemmas, there is a paucity of literature on characteristics and value of ethics consults (ECs) in hospital [...]

Background: Palliative care (PC) is a multidisciplinary consult service aimed at ensuring goal-concordant medical care while optimizing patient/family support. Prior studies have illustrated that palliative care consultation can be associated with a significantly shorter length of stay but without significant change in mortality or disposition. Utilization of standard high-risk descriptive criteria or “triggers” that uniformly [...]