Background: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications [...]

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: Evidence suggests that risk of central line-associated bloodstream infection (CLABSI) between patients with traditional central venous catheters (CVC) vs. peripherally inserted central catheters (PICC) is similar. However, how best to predict CLABSI in patients with PICCs is not known.  Methods: We used data from the Michigan Hospital Medicine Safety (HMS) Consortium, a 51-hospital Blue [...]

Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication. In the United States, there are more than 20,000 CLABSI per year, resulting in a cost of about $30,000 per infection. A number of interventions have been employed to decrease the risk of CLABSI. Previous studies have documented the importance of simulation-based training. There is [...]

Background: Sleep is generally poor in hospitalized patients and sleep deprivation has many harmful effects, including delirium, insulin resistance, hypertension, and impaired function of the immune system. In this quality improvement (QI) project, our goal was to delay early morning phlebotomy blood collections to improve sleep for our patients, while not negatively impacting hospitalists’ perception [...]

Background: Patients with cancer require reliable venous access for therapy. Although peripherally inserted central catheters (PICCs) and implanted ports are often used to meet infusion needs, risk of complications between these devices is unknown. We did a systematic review and meta-analysis to compare the risk of deep vein thrombosis (DVT), exit-site complications and central line-associated [...]

Background: Since being introduced in the 1950s, midlines have since gained attention as an intravascular access option—particularly in patients requiring intravenous (IV) therapy for extended time periods. They provide an alternative to frequent venipuncture from peipheral intravenous catheters (PIV) and may reduce cost and increase patient satisfaction. The CDC and MAGIC guidelines currently recommend the [...]

Background: Central line-associated bloodstream infection (CLABSI) is a morbid and potentially lethal complication. National policies related to CLABSI mandate public reporting of this adverse event, with hospitals receiving penalties based on their CLABSI rates. Contemporary data suggest that peripherally inserted central catheters (PICCs) placed outside critical care settings are a large contributor to hospital CLABSI [...]

Background: Unnecessary inpatient laboratory testing is common and negatively impacts patients by causing discomfort and iatrogenic anemia. Such testing also burdens a busy phlebotomy team, particularly when patients decline labs due to recency of previous checks. Audit and feedback interventions are known to reduce low value practices in medical residents, but no published study has [...]