Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Fracture Liaison Services (FLS) are traditionally outpatient-based and led by orthopedists or endocrinologists. In the United States, over 1 million patients are hospitalized yearly with osteoporotic fractures and internal medicine hospitalists are frequently involved in their co-management. Purpose: Internal medicine hospitalists have an integral role in the prompt recognition and early treatment of patients [...]

Background: Antibiotics targeted against C. difficile bacteria are necessary, but insufficient, to achieve a durable clinical response because they have no effect on C. difficile spores that germinate within a disrupted microbiome. ECOSPOR-III evaluated SER-109, an investigational, biologically-derived microbiome therapeutic of purified Firmicute spores for treatment of recurrent CDI. Methods: Adults ≥18 years with recurrent [...]

Background: Community acquired severity scores are well known and used routinely in predicting mortality and risk of inpatient and ICU admission in suspected bacterial pneumonia patients. However such scores have not been studied in patients with influenza infection and influenza pneumonia. We attempted to validate one such score, CURB65 and and identify other scores that [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of hospital readmissions in America. Over one-third of patients admitted for COPD exacerbations are readmitted within 90 days, with readmissions costing $15 billion. Medicare instituted financial penalties for excessive readmissions after COPD hospitalizations, incentivizing the creation of readmission prediction tools. Two such tools, the [...]

Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is the third leading cause of readmissions and is now included in the Medicare Hospital Readmissions Reduction Program (HRRP). Our institution developed an inter-professional program aimed at reducing all-cause 30-day readmissions for patients admitted with AECOPD. Methods: We iteratively developed and piloted our inter-professional COPD HRRP [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) Multi-site Quality Improvement Collaborative aims to improve discharge transitions by testing a patient-centered transition bundle. Teach-back is a core component. This is a well-established method of confirming understanding. However, limited evidence exists about the effect of using teach-back for pediatric discharge education on parental knowledge/understanding of essential [...]

Background: Ensuring hospital-based Patient and Family Advisory Councils (PFACs) include members from diverse, vulnerable and underrepresented communities is important to ensure that all voices are represented and heard when providing input into hospital quality improvement and research efforts. However, ensuring diverse membership of PFACs remains a challenge. This study aims to describe strategies to recruit [...]