Background: Multidisciplinary rounds (MDRs) or discharge huddles in the hospital were developed to enhance safety and streamline discharge by improving communication between members of the patient care team. Despite efforts to coordinate care around a single brief daily meeting, multiple aspects of the patient’s care can change throughout the day. Keeping all members of the [...]

Background: Our institution’s rate of hospital acquired Clostridioides difficile (C. diff) infection (CDI) is higher than expected based on documented severity of illness of our patients. The C. diff testing algorithm at our institution utilizes a multi-step approach. It begins with two tests (antigen EIA and toxin A/B EIA). If the results of these two [...]

Background: Physician handoffs between inpatient shifts influence safety and care quality. Handoffs are also at risk for communication failures. Poor care coordination and miscommunication cause 80% of sentinel events nationwide. The rise of the electronic medical record (EMR) presented an opportunity to standardize communication during handoffs. Unfortunately, this potential has thus far gone largely unrealized, [...]

Background: With the advent of the Electronic Medical Record (EMR), documentation occupies up to 50% of doctors’ time1 and prior work has revealed that internal medicine residents spend more than four hours daily on documentation2. Secure messaging (SM) has been recently integrated into the inpatient EMR system, allowing healthcare team members to directly message physicians; [...]

Background: The University of Colorado Hospital (UCH) fails to meet the National Healthcare Safety Network (NHSN) benchmarks for central line utilization rates and central line-associated bloodstream infections (CLABSI). Peripherally inserted central catheters (PICCs) are central lines that are overused and misused at UCH. Overuse of PICC lines increases the risks of CLABSI and PICC-associated deep [...]

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: 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: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to [...]

Background: Lab testing is critical for clinical decision-making and used throughout healthcare systems. Overuse of lab testing is known to be commonplace and contributes to shortages in lab testing materials. While practices exist at medical institutions that aim to limit lab test overuse, it is unclear which interventions are effective. Methods: We aimed to reduce [...]

Background: Healthcare expenditures in the US have been increasing at an unsustainable rate, and thus there is a strong interest in resource stewardship of low-value diagnostic tests. At our institution, internal data, as well as The Vizient™ Clinical Data Base, showed high utilization of inpatient daily labs (complete blood count (CBC), basic metabolic panel (BMP) [...]