Background: One target for improvement of effective patient centered care on the inpatient medical ward is the mechanism for communication among the multidisciplinary care team (MCT).  The medical service at Stanford Hospital and Clinics recently implemented morning “team care rounds” (TCRs) that provided space for the MCT members, including the physician (MD), nurse (RN), case [...]

Background: Discharge delays occur because of inconsistent communication among all clinicians and providers. Inefficient utilization of resources also contributes to delays. Effective communication among the patient care team is a foundation of creating an effective discharge planning process. We must standardize the process of communication as well as resource optimization in order to provide our [...]

Background: The Center for Disease Control and Prevention estimates that 1.7 million patients per year develop hospital-associated infections (HAI), of whom 99,000 die. HAIs financially impact the United States healthcare system with an estimated cost of $6 billion per year. At Platte Valley Medical Center (PVMC) in 2013, the urinary catheter utilization ratio and rates [...]

Background: Communication between Hospital Medicine physician teams and interdisciplinary care providers (e.g. nurses, physical and occupational therapists, case managers) regarding disposition planning is often inconsistent, potentially delaying care and resulting in poor patient and provider experience. Prior studies demonstrate that sharing the estimated discharge date (EDD) early in a patient’s hospitalization can improve communication and [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is an antibody-mediated pro-thrombotic disorder which occurs after exposure to heparin product. Diagnosis of HIT type II is rather challenging as affected individual often has other causes of thrombocytopenia and a delayed discontinuation of heparin in HIT type II is associated with a mortality rate of 20-30%. 4Ts score is a [...]

Background: Spontaneous bacterial peritonitis (SBP) is a commonly encountered complication of end stage liver disease that carries a high morbidity and mortality. Risk factors for SBP are defined by the American Association for the Study of Liver Diseases (AASLD) as a prior history of SBP, active gastrointestinal bleeding, and low ascites total protein (< 1.5 [...]

Background: The daily progress note is the foundation of inpatient documentation and communication for healthcare providers. With the advent of the electronic medical record, copy-and-pasting, note bloat, inconsistencies, erroneous data, and lack of cognitive processing have become widespread leading to difficult to read and inaccurate progress notes.  Purpose: At Bassett Medical Center, it was determined [...]

Background: Risk stratifying patients for potential development of hospital-related venous thromboembolism (VTE) is an important aspect of inpatient safety and is recommended by current guidelines.  Many risk stratification tools are cumbersome and require significant time to complete.  Developments have been made to partially or fully automate risk stratification tools, however there are restrictions within the [...]

Background: The occurrence of adverse events due to unsafe health care is thought to be one of the 10 leading causes of death and disability in the world. The harm can be caused by a range of adverse events, with nearly 50% of them preventable. Broad adoption of electronic health records (EHR) should ideally harness [...]

Background: Accurate problem lists linked to the electronic medical record (EMR) can be a source of structured clinical data useful for communication among clinicians for patient care, clinical decision support design, and EMR phenotyping.  Nevertheless, modifying the electronic problem list is disruptive to clinician workflow under traditional charting methods, resulting in incomplete, inaccurate, and outdated [...]