Background: Internal medicine residency contains procedural training, including guidance in paracentesis, thoracentesis, lumbar puncture, arthrocentesis, and central line placement. As a result, most hospitalists are able to perform these bedside procedures. However, national trends confirm that these procedures are increasingly referred to interventional radiology, and these referrals are associated with higher direct hospital costs.1 Enhancing [...]

Background: After Libby Zion died tragically in a teaching hospital, much attention from the medical community, public and government, was directed at resident training and the number of hours worked consecutively. This marked a new era heralded by close scrutiny of the time residents spent in the hospital. Two dramatic reductions were mandated nationally by [...]

Background: The prevalence of gout has risen in recent decades despite advancements in therapeutic options due to several reasons, including lack of adherence to treatment guidelines by physicians and patients’ poor perception and adherence to therapy. We aim to assess the beliefs and knowledge of gout management in Internal Medicine residents, to investigate the gaps, [...]

Background: Children with medical complexity (CMC) are a growing pediatric population with disproportionately high health needs and costs often insured by Medicaid. Identification of CMC using complexity classification systems applied to population-level data and establishment of baseline patterns of population-level health care utilization are essential to target patients who may benefit most from complex care [...]

Background: There is a population of patients who visit Emergency Department (ED) frequently and this has become a challenge for the health-care system. A small proportion, four percent of ED patients, could constitute up to 20% of ED visits (1-3).Interdisciplinary approach of care management is the most widely evaluated and single-point-of contact (4).We conducted a [...]

Background: Excessive laboratory use has been associated with increased hospital costs, increased incidence of anemia, and unnecessary additional testing and procedures. Previous studies have focused on resident interventions within teaching hospitals amongst other residents, but few studies have had residents intervene on non-teaching faculty. A quality improvement initiative was implemented at our institution to reduce [...]

Background: Readmissions after hospitalisation are a healthcare quality indicator and carry considerable financial penalties in some healthcare systems. Internationally, readmission rates at 28 – 30 days for medical inpatients range between 10 – 22%. However there is almost no information available around readmissions for medical inpatients in the Middle East region. We conducted a pilot [...]

Background: Misuse of laboratory tests can be difficult to determine unless tests are clearly overused or repeated routinely. However, excessive testing of chronically critically ill patients treated in long-term acute care hospitals (LTACHs) can be potentially harmful. A previously reported quality improvement initiative designed to increase physician awareness of their patterns of lab utilization in [...]

Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine electrolyte values obtained by arterial blood gas testing (ABG) and central laboratory testing (VCL) and determine the extent of essentially [...]

Background: Academic Medical Centers (AMC) have utilized teams comprised of an attending, resident, interns and medical students to care for hospitalized patients. ACGME work restrictions have reduced the capacity of teaching services. Consequently, most AMCs now rely on direct care Hospital Medicine Services (HMS). Non-clinical tasks (making appointments, faxing for records), traditionally performed by teaching [...]