Background: We identified a number of quality, patient satisfaction, and staff satisfaction issues that all seemed to be linked to throughput challenges. We had trouble getting patients out of the hospital on discharge day, which set off a number of downstream effects including backups in the Intensive Care Unit (ICU) and Emergency Department (ED). These [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value, advances in relevant technologies, and the ongoing global pandemic have driven renewed attention to HaH models, by way of policy-based and academic pilot programs – and even commercialization attempts. Where studied, these models have [...]

Background: Tissue pathology plays an integral role in the diagnosis of various conditions, especially malignancy. Traditionally biopsy procedures, including core needle biopsy (CNB), have been performed by specialists under imaging guidance. They are traditionally done in special procedure rooms/suites–which come with an added cost of nursing staff, transportation and equipment. Meanwhile hospitalists are increasingly becoming [...]

Background: Panel-based Nucleic acid amplification tests (NAATs) are laboratory tools that are used to detect small quantities of RNA or DNA to rapidly identify a multitude of infectious organisms. A systematic review and meta-analysis looking at the diagnostic accuracy of the BioFire® FilmArray® meningitis-encephalitis (ME) panel which is used at our institution showed that it [...]

Background: The American Board of Internal Medicine Choosing Wisely initiative advocates avoiding automatic daily labs as a way to lower hospital costs. The Legacy Health Inpatient Medicine Service (LIMS) aimed to reduce unnecessary and inappropriate lab testing amongst internal medicine inpatients within our five hospital health system. Purpose: To decrease inpatient lab costs in fiscal [...]

Background: Inpatient stewardship has appropriately become a large focus of acute inpatient care. The Vizient™ Clinical Data Base contains hospital discharge data used for benchmarking, and we observed significantly elevated cardiac MRI (cMRI) use at our tertiary hospital, relative to other tertiary academic medical centers, with resource utilization percentile averaging in the top decile (figure [...]

Background: Healthcare expenditures in the US have been increasing at an unsustainable rate, and thus there is a strong interest in resource stewardship of low-value diagnostic tests. At our institution, internal data, as well as The Vizient™ Clinical Data Base, showed high utilization of inpatient daily labs (complete blood count (CBC), basic metabolic panel (BMP) [...]

Background: Currently, patients admitted to the hospital are assigned specific levels of care such as intermediate intensive care or acute care. Differences among care at these levels largely differ through nursing ratio as well as frequency of nursing assessment. Costs per day for patients at different levels of care differ significantly as well. Little is [...]

Background: Updated guidelines recommend testing for inherited or acquired thrombophilias only in rare situations in the acute inpatient care setting, as it has little impact on acute management of thromboembolic events, and in some situations, can be falsely positive leading to inappropriate care. Current data in our academic medical center indicate testing for thrombophilia occurs [...]