Background: High value care is a key priority in healthcare, but strategies are needed to empower frontline clinicians to work with organizational leadership to reduce healthcare costs and improve care.   Purpose: Caring Wisely (CW) is a program we developed that is designed to engage frontline clinicians and staff, connect them with implementation experts, and [...]

Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable [...]

Background: Patient portal use has been associated with improved patient experience, safety, and health outcomes.1,2 To keep patients better connected to their providers, our institution aimed to expand MyChart utilization. We piloted a standard operating procedure (SOP) to enhance MyChart education and uptake among those admitted to an inpatient general medicine unit. Purpose: Our intervention [...]

Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: The Choosing Wisely Campaign started in 2012 with the aim of promoting high-value care. On its Choosing Wisely List, the Society of Hospital Medicine cited daily basic metabolic panel (BMP) and complete blood count (CBC) testing in the absence of clinical suspicion as unnecessary practice. Since the implementation of Choosing Wisely, there have been [...]

Background: High value care is a key priority in healthcare, but strategies are needed to empower frontline clinicians to work with organizational leadership to reduce healthcare costs and improve care.   Purpose: Caring Wisely (CW) is a program we developed that is designed to engage frontline clinicians and staff, connect them with implementation experts, and [...]

Background: Skin, soft tissue, and joint infections are common in pediatric patients and can require invasive procedures to drain purulent fluid. Atypical pathogens (fungal and acid-fast bacilli [AFB]) are important but rare causes of these infections with reported case rates as low as 0.6-1.6 cases/100,000 a year. Despite the rarity of these infections, costly atypical [...]

Background: Assessing vitals at regular intervals can be disruptive to a patient’s rest and unnecessary if the patient is clinically stable. These interruptions may lead to impaired sleep, parental fatigue and anxiety, delayed discharge, and increased cost of care. Moreover, alarm fatigue has been described with over-monitoring of patients, as has the overuse of staff [...]

Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable [...]

Background: Excessive daily routine laboratory testing for hospitalized patients is a contributor to poor hospital sleep, iatrogenic anemia, and excessive costs. Recommendations from the Choosing Wisely™ campaign specifically state to avoid sleep interruptions for routine care (American Academy of Nursing) and to avoid routine labs for stable patients (Society of Hospital Medicine). The purpose of [...]