Background: In sepsis, every hour of delay in antibiotic administration after the onset of hypotension is associated with 4-7% increase in mortality, but little is known about the characteristics of patients with treatment delays. Our objective was to determine if septic adults presenting to the Emergency Department (ED) who receive antibiotics more than 60 minutes [...]

Background: “Time is brain” is a trope from the neurologist Camilo Gomez that emphasizes the importance of early treatment to improve the neurological prognosis of ischemic stroke patients. Given the short therapeutic window of evidence-based therapies such as thrombolysis and endovascular treatment, it is important to diagnose ischemic stroke from the numerous possible diagnoses accurately [...]

Background: Endoscopies are commonly performed in the inpatient setting, and successful completion frequently requires close coordination among nurses, hospitalists, gastroenterologists, and anesthesiologists. Given the complexity of this multidisciplinary involvement, as well as variability in patient factors like clinical stability and presentation, endoscopies are prone to delays. These delays may cause frustration amongst care providers and [...]

Background: To date, there are limited reports around the use of well-designed information technology tools to enhance throughput communication during interdisciplinary rounds (IDRs). In collaboration with our technology innovations center, we developed a Microsoft Teams IDR tool known as “NORA.” NORA is an automated process-oriented tool designed to extract patient summary information from electronic health [...]

Background: Japan has the high incidence of tuberculosis with the rapid population aging in developed county. In acute care hospital, delaying in respiratory isolation for tuberculosis can cause serious hospital-acquired infections and subsequent delay in the initiation of treatment, which might be poor prognosis for not only the patient but also the around medical providers. [...]

Background: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. Since 2014, the American Academy of Pediatrics (AAP) has recommended a ‘wait-and-see’ strategy and shorter antibiotic courses for mild or moderate AOM in qualifying patients. While this strategy has been successfully implemented in some pediatric emergency units (EUs), studies have shown that 30-90% of [...]

Background: Ultrasound-guided thoracentesis and paracentesis are frequently performed for both diagnostic and therapeutic indications. While the risk of aspiration is low, our institution has historically required patients to be fasting for 4 hours prior to the procedure. In the hospital setting, unnecessary fasting requirements could contribute to missed patient meals and procedure delays. Here, we [...]

Background: Delays in antibiotic administration in sepsis – particularly after the development of hypotension – are associated with increased mortality. Current guidelines recommend antibiotic initiation within one hour of sepsis recognition. However, it is not known how timing of hypotension relates to the timing of meeting sepsis diagnostic criteria and the initiation of treatment. We [...]

Background: Delays in care may lead to increased length of stay and cost. Identifying and quantifying the reasons for these delays could help target interventions and reduce unnecessary hospital days. Methods: We conducted a cross-sectional observational study at a large tertiary academic medical center, from October 16, 2016 to November 20, 2016. The study participants [...]

Background: There is little data on the relative prevalence of different causes of care delays that contribute to prolonged length of stay. Unnecessary delays in the care of hospitalized patients increase the risk of hospital-related complications and drive up healthcare costs. Prior observational studies have suggested that a reduction in hospital length-of-stay is possible without [...]