Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics [...]

Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Handoff miscommunications are a leading source of medical errors. Medical error and adverse event rates decreased following implementation of the I-PASS handoff program (a bundled intervention using a structured mnemonic, I-PASS, and other initiatives to sustain implementation) in a pediatric research trial. Whether I-PASS can be implemented in settings outside academic pediatric institutions is [...]

Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]

Background: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

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: Diagnostic errors (DE), defined as missed opportunities to make a correct or timely diagnosis based on the available evidence, are a critical but understudied cause of patient harm. While previous efforts have focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined incidence of [...]

Background: Hospitalizations related to opioid use disorder (OUD) are rising, creating opportunities to initiate medications for opioid use disorder (MOUD) and connect patients with outpatient resources.1,2 Despite evidence that MOUD reduces morbidity and mortality, most patients fail to receive evidence-based treatment during hospitalization.3-6 Addiction consultation services are becoming the standard of care to address this [...]

Background: Overnight vital sign assessment can disrupt sleep in the hospital and may be unnecessary in clinically stable patients. However, providers may not feel comfortable determining which patients can safely forego overnight vitals. We studied the effect of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) that automatically identified clinically [...]

Background: Somatic Symptom and Related Disorders (SSRD) is an umbrella term for a wide variety of disorders commonly encountered in the inpatient pediatric setting, including conversion disorder, amplified pain syndrome, and psychogenic non-epileptiform seizures. These patients can be high utilizers of medical resources. The hospitalist is often charged with ruling out a medical diagnosis and [...]