Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics [...]

Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Hospital medicine is a maturing field that increasingly focuses on providing high value patient care. A key question in the value equation is how different patient census sizes impact care. Our recent research showed that higher patient censuses were associated with longer hospital length of stay and costs. This study follows up on this [...]

Background: Handoff miscommunications are a leading source of medical errors. Medical error and adverse event rates decreased following implementation of the I-PASS handoff program (a bundled intervention using a structured mnemonic, I-PASS, and other initiatives to sustain implementation) in a pediatric research trial. Whether I-PASS can be implemented in settings outside academic pediatric institutions is [...]

Background: Hospital-acquired delirium is serious, leading to increased falls, pressure ulcers, length of stay, cost, patient institutionalization, and patient and caregiver distress. In addition, it is associated with mortality rates as high as 35-40% within one year in older patients who develop delirium. Programs targeted at delirium prevention and treatment may affect these outcomes. We [...]

Background: Hospital-associated venous thromboembolism (HA-VTE) is a serious condition with controversy regarding ideal risk assessment and VTE prophylaxis (VTEP), especially in medical patients. We conducted a collaborative VTE quality improvement project, supported by a charitable grant from the Gordon and Betty Moore Foundation, in 35 hospitals across three states and assessed the impact on HA-VTE [...]

Background: Audit and feedback is a commonly used strategy to improve performance among providers. Most prior studies on its efficacy were done in the outpatient setting and showed a modest benefit. Certain factors, such as clear targets and repeated frequency of feedback may increase the likelihood of improved performance; however, there is still no consensus [...]

Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]

Background: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

Background: Racism is a public health crisis impacting patients and healthcare workers. Antiracist education is not typical in undergraduate or graduate medical education curriculum. Discriminatory practices in health care result in worse patient outcomes in Black, Indigenous, & People of Color (BIPOC). Committing to antiracist work is the first step in addressing racism and must [...]