Background: Frailty is linked to poor outcomes in older patients, especially those with multiple conditions. The electronic frailty index (eFI) is a validated tool based on the cumulative deficit model used to screen hospitalized patients at risk for poor outcomes1. The eFI relies on 35 ICD-10 codes associated with encounters across four domains (morbidity, sensory, [...]

Background: While there are now equal numbers of women and men graduating from medical school, disparities in female representation within academic medicine persist. Gender bias has been cited as one of the main drivers of gender disparity in academic medicine and continues to be a significant barrier for women in the workplace. Grand rounds is [...]

Background: Unconscious bias within the U.S. health care system has been linked with disparities in the treatment of patients by age, gender, and race (1). While many factors contribute to these disparities, implicit bias may play a significant role. Stigmatizing language often reflects the implicit bias that healthcare providers possess toward patients (2). Recent research [...]

Background: Patients with limited English proficiency (LEP) comprise 19% of the adult population of California (1). Communication barriers between providers and patients with LEP contribute to health disparities and associate with increased adverse events (2,3). Working with professional interpreters associates with decreased hospital length-of-stay and readmission rates (4). However, few providers receive formal training on [...]

Background: Uncertain language, specifically for the diagnosis of pneumonia in chest radiograph reports has been noted in previous research studies (1, 2, 3). In fact, as many as 1 out of every 4 chest x-rays (CXRs) are not positive or negative for pneumonia but are uncertain (4). Some uncertain reports use language modifiers that precede [...]

Background: Stigmatizing language in clinical notes can negatively impact physician attitudes, propagate bias, affect prescribing behaviors, and exacerbate healthcare disparities, yet remains prevalent even in the Open Notes era. Prior analyses of stigmatizing terms in clinical notes are limited by the lack of context in which terms are used and multiple meanings of certain words [...]

Background: Use of stigmatizing language in clinical note documentation is a recognized problem, but such notes may be viewed disparately and irregularly. Whether such language is also used in highly visible behavioral alerts (BAs), which are presented forcefully through push notifications and viewed repeatedly whenever a chart is opened, is unknown. Further, whether BAs with [...]

Background: Previous studies have identified racial differences in sepsis incidence and sepsis mortality. Some evidence points towards differential treatment and subsequent sepsis outcomes in Black versus White patients. However, it is unclear to what extent racial differences exist in presentation and subsequent interpretation of complaints in the early phase of sepsis. Using History and Physical [...]

Background: In 2015, the United States had 25 million people with limited English proficiency (LEP). Most prior studies on disparities in outcomes in hospitalized patients with LEP compared to those with English proficiency were conducted outside the US and focused on outcomes such as hospital length of stay and mortality. There are also Emergency Department [...]

Background: Patients with Limited English Proficiency (LEP) face multiple barriers to care and are at risk for worse health outcomes compared to similar patients with English Proficiency (EP). In sepsis, a common diagnosis and major cause of mortality in the US, the association of LEP with health outcomes has not been widely explored. We aimed [...]