Background: The American Academy of Pediatrics (AAP) publishes core pediatric clinical practice guidelines advising pediatricians on evidence-based management of common diagnoses. However, multiple studies demonstrate poor guideline compliance by pediatricians. There is no published curriculum on how to teach these guidelines, and on a national survey we conducted of pediatric residency training programs, only two [...]

Background: The “10 commandments of consultation” were published in 1983 and revised in 2007. Since then, academic medical centers have grown significantly, expanding the number of non-teaching teams. This rapid growth risks straining the current subspecialty consultation services’ teaching and educational models. Overuse of consultations and lack of clarity in the consulting question may increase [...]

Background: In hospitalized patients with anemia, the AABB recommends that transfusion of red blood cells occur when a patient’s hemoglobin (Hb) drops below a restrictive transfusion threshold, either at 7 or 8g/dL1. These transfusion guidelines are the result of a growing body of clinical trial evidence showing that transfusion at lower or restrictive Hb thresholds [...]

Background: Addressing the needs of the geriatric population is critical, as “baby boomers” comprise a larger proportion of hospitalized patients. Hospitalists increasingly care for these complex geriatric patients. The “BEERS Criteria” are evidence-based guidelines that encourage medication safety by describing potentially inappropriate and harmful medications (PIMS) among geriatric patients. BEERS guidelines recommend that with a [...]

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: Choice of agent for venous thromboembolism prophylaxis (VTEP) after joint arthroplasty is a complex decision, the difficulty of which has been compounded by divergent guidelines. Specifically, the adequacy of aspirin monotherapy (ASA) for VTEP has long been debated between the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). [...]

Background: Neutropenic Fever (NF) is a common complication for patients on myelosuppressive chemotherapy. Despite guidelines by the Infectious Diseases Society of America (IDSA), however, there is variability in physician compliance. There are limited prior studies assessing compliance in this realm and those studies do not fully assess drivers of poor compliance. Poor compliance can result in increased [...]

Background: Email represents an administrative burden which contributes to overall burnout. While general strategies to mitigate burnout related to email have been published (Armstrong 2017), formal clinical workplace guidelines and specifically their impact have not been described in the literature. The University of Michigan (UM) Division of Hospital Medicine (HM) developed and distributed email management [...]

Background: Clinical practice guidelines (CPG) are a constructive response to the clinical situations providing systematically developed statements that include recommendations intended to optimize patient care. Despite their value, inadequate dissemination and implementation of the CPGs derail quality improvements in patient care. Traditionally, static documents (PDF, HTML pages) have been used to deliver CPGs incorporated into [...]

Background: Strategies to reverse the effect of warfarin, a vitamin K antagonist (VKA), may be necessary for patients who are actively bleeding, asymptomatic with markedly elevated INR values, or requiring urgent invasive procedures. The purpose of this quality improvement activity (QIA) was to evaluate adherence to the 2012 CHEST guidelines for use of vitamin K [...]