Background: A small number of patients account for a disproportionate number of hospital readmissions. The Complex High Admission Management Program (CHAMP) is designed to improve care and reduce hospitalizations for frequently readmitted patients. Non-randomized studies of CHAMP found reductions in readmission but may be subject to regression to the mean. We conducted a randomized trial [...]

Background: Frequently hospitalized patients represent a vulnerable population due to discontinuity between episodes of inpatient, outpatient, and specialty care. This discontinuity puts patients at risk for unnecessary over-treatment, dangerous under-treatment, medication errors, and loss of trust due to conflicting messages from healthcare providers. Providers face rising clinical volumes, decreasing familiarity between providers, and ever more [...]

Background: Optimal patient care requires excellent patient communication skills. These skills are associated with improved patient satisfaction and adherence and may positively impact overall patient care and reduction in readmissions. Standardized patients (SPs) are commonly used in Undergraduate and Graduate Medical Education; however, their use for faculty education is uncommon, despite being considered an effective [...]

Background: Frequently hospitalized patients face unique challenges in navigating health care systems. Although practice-, hospital-, and accountable care organization-level programs to address the needs of these patients exist, interventions have had mixed results, with only some demonstrating reduction in hospitalizations or costs. To best serve frequently hospitalized patients and improve future interventions, clinicians, leaders, and [...]

Background: Hospital admissions at a tertiary care hospital occurs mostly by two routes: 1) through the Emergency Department (ED), and 2) through Transfer center. Several perceptions exist about transfer patients being more complex, and association with worse outcomes, or similar outcomes as compared to ED admits, and hence need for optimization of transfer decision and [...]

Background: It has been recently shown that patients admitted at night and during the weekend have worse mortality outcomes. The impact of those variables on other important outcomes such as length of stay (LOS) and readmission is less clear. We sought to analyze this relationship in a large cohort of inpatients. Methods: We performed a [...]

Background: Over the last few years, the USA has seen a sharp increase in the incidence and prevalence of substance use disorder (SUD) and related acute illnesses. The clinical course of many hospitalized patients is impacted by their diagnosis of SUD. At our institution, we put in place an inpatient addiction service where a physician [...]

Background: Falls are associated with significant morbidity and increased healthcare expenses for hospitalized patients. There are hundreds of thousands of inpatient falls every year. There are multiple validated scores to guide the need of imaging for patients presenting to ED after, but no such score exists for hospitalized patients who suffer a fall event. This [...]

Background: Emergency Department (ED) boarding, which occurs when admitted patients do not have an available bed in the hospital, has been associated with adverse patient outcomes. In 2014, 13,109 patients waited greater than 2 hours for a medicine inpatient bed at our large urban academic center. In July 2016, we deployed a 24-hour hospital medicine [...]

Background: Poor sleep is common in hospitalized patients due to multiple factors, including disruption of the circadian rhythm. Greater exposure to natural light for hospitalized patients has been associated with improved outcomes, including increased survival in acute myocardial infarction. Few studies have examined programmable artificial lighting systems in hospital patient rooms, and few have achieved [...]