Background: Deep vein thrombosis (DVT) is typically diagnosed from ultrasound (US) Doppler evaluation and anticoagulation therapy is the standard treatment to prevent life threatening pulmonary embolism (PE). In our hospital, the treating provider is alerted to the positive test result by phone and/or text in the imaging result. There is an absence of clinical decision [...]

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: Discharge to post-acute care settings (PACs), such as skilled nursing facilities (SNFs), requires significant, complex discharge planning which often needs to be started early during hospitalization to be complete by time of discharge. This study sought to identify and model factors which predict a given patient’s likelihood of requiring PAC after discharge, using routinely [...]

Case Presentation: After suffering a left-sided middle cerebral artery stroke and subsequent right sided weakness, an 85-year-old female fell and sustained a fracture of her right intertrochanteric femur. She initially had an ORIF at an outside hospital, but this subsequently failed and the patient had continued pain. She had repeat x-ray imaging of her femur [...]

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 [...]