Background: Midlines are peripheral vascular devices inserted in the veins of the upper extremity with the tip located at or below the axillary vein. Greater appreciation of complications associated with peripherally inserted central catheters (PICC) and the diffusion of catheter appropriateness criteria has led to expanded use of these devices. However, single center studies comparing [...]

Background: Urinary catheters, vascular catheters, and wounds such as pressure injuries are often hidden from view under gowns and sheets – out of sight, out of mind – contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (e.g., fever, delirium) related to catheters and wounds. We developed and pilot tested a [...]

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: CDC guidelines recommend and promote public awareness for Hepatitis C virus (HCV) screening for baby boomers (1945-1965) and individuals who report risk factors such as IDU. These strict guidelines and targeted educated are hindering positive patients who are non- baby boomers without risk factors from entering care due to the lack of education for [...]

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: High need patients are characterized by medical complexity, high amounts of health acute care utilization and disproportionate costs[1]. Recent studies have characterized worsening of loneliness in the general population, however, it has not been characterized in the high need population. We hypothesized that increases in loneliness would be associated with increasing symptoms of depression; [...]

Background: Lonely adults are prone to a variety of poor health outcomes, including accelerated functional and cognitive decline, depression, and premature mortality. As a result, lonely adults may be prone to higher health-related suffering, triggering increased healthcare utilization and possibly undesired aggressive care, particularly as they approach end of life (EOL). However, little is known [...]

Background: Peripherally inserted central catheters (PICCs) are routinely placed in hospitalized patients who are receiving long-term IV antibiotics or who have poor venous access. In our hospital, 1 in 12 patients on the Medicine service receives a PICC line at some point during a hospitalization. 35% of all hospital-acquired venous thromboembolisms (VTEs) on the Medicine [...]