Background: The low published survival rate of pediatric in-hospital cardiopulmonary arrest (25-38%) 1 has led to the development of early warning systems (EWS) to identify patients at risk for deterioration. On our general pediatric unit, we implemented the published validated Children’s Hospital Early Warning System (CHEWS)2 in 04/2021. This composite scoring tool includes caregiver assessment [...]

Background: Communicating to physicians about electronic health record (EHR) software updates is important for maintaining clinical workflow and preserving patient safety. However, reaching providers with mass e-mails is challenging; the optimal strategy for educating providers about EHR updates remains unclear. Purpose: Modify our communication strategy to improve inpatient physicians’ understanding of EHR software updates. Description: [...]

Background: The low published survival rate of pediatric in-hospital cardiopulmonary arrest (25-38%) 1 has led to the development of early warning systems (EWS) to identify patients at risk for deterioration. On our general pediatric unit, we implemented the published validated Children’s Hospital Early Warning System (CHEWS)2 in 04/2021. This composite scoring tool includes caregiver assessment [...]

Background: Decision fatigue describes the erosion of decision making capacity as a consequence of the repeated acts of decision making. The phenomenon has been detected in ambulatory settings with higher rates of inappropriate antimicrobial and opiate prescribing and lower rates of cancer screening associated with appointments that occur later in the day. As hospital medicine [...]

Background: Anemia is a risk factor for cognitive impairment as a result of reduced delivery of oxygen to the brain from low hemoglobin (Hb) levels. In ambulatory patients, mild anemia (Hb 10-12g/dL) has been associated with reductions in patients’ cognitive function [1–3]. In hospitalized patients it is standard of care to maintain Hb levels far [...]

Background: Multiple professional societies recommend red blood cell transfusions for hospitalized patients based on the presence of symptoms of anemia, like fatigue. These recommendations endorse the idea that the severity of anemia symptoms are due to a patient’s nadir or reduced hemoglobin (Hb) concentration, and that correcting the Hb concentration with a transfusion will improve [...]

Background: Alarm fatigue is a serious patient safety issue and represents a 2015 National Patient Safety Goal.  False alarms can mask true alarms, and may contribute to suboptimal patient care practices.  Cardiac telemetry monitoring in particular has been a focus in the Choosing Wisely campaign and at our institution. Purpose: A comprehensive, multidisciplinary approach was [...]

Background: Clinicians rely on physiologic monitor alarms to notify them of their patients’ changing vital signs. Currently, alarms occur very frequently and usually do not warrant clinical intervention. High alarm burden can lead to alarm fatigue, often observed as a slower response or unintentional ignoring of clinically important alarms. For this reason, alarm fatigue has [...]

Background: Fatigability describes how fatigued a patient is at any given level of activity, and is measured as the degree of fatigue a patient experiences after performing a specific amount of activity. The National Institute of Aging has suggested that fatigability is an important measure in patients with conditions where fatigue is a prominent symptom, [...]

Background: Secure text messaging is a primary mode of clinician-to-clinician communication in large acute care hospitals. However, the accessibility and ease of secure messaging, and a lack of best practice recommendations, raise the risk of overuse. Multitasking demands from secure messaging challenge clinicians as they engage in focus-intensive patient care tasks. To address this, we [...]