Background: A LEAN principle is that front line staff provide value as defined by the customer (the patient). Within a LEAN framework, an A3 is both a way to understand your problem and a tool to organize multiple PDSA cycles into one cohesive and visible structure. While the literature cites many examples of PDSA cycles [...]

Background: During 2016, the total billed cost of cardiac monitoring neared 4 million dollars at our institution and many patients were observed on the monitor without approved indication as published by the American Heart Association’s (AHA) guidelines published in 2014. The overutilization of cardiac monitoring constitutes a misappropriation of resources which results in undue health [...]

Background: Readmission rate at UMASS Memorial Hospital medicine division is high at 15.5%. Majority of patients are admitted to Hospitalist service. Given the challenges in obtaining real time readmission data, physician engagement is poor. Etiology of most of the readmissions gets attributed to system related issues. To improve physician engagement, the concept of weekly Idea [...]

Background: Montefiore Health System (MHS) rapidly expanded from three hospitals in close proximity to eleven hospitals across hundreds of miles. The structure of the new health system follows a hub and spoke model with the concentration of specialty care located at the hub which is the Moses campus in Bronx, NY. In order to best [...]

Background: Our 165-bed community hospital is in a phase of rapid growth due to demographic changes and expansion of services offered within the hospital. While offering unprecedented level of healthcare access to the community, improvement with emergency department (ED) throughput has emerged as one of our challenges from a patient safety perspective. Unnecessarily prolonged ED [...]

Background: A robust QI curriculum provides residents with the knowledge of QI methodologies and allows them to participate in a longitudinal QI initiative, demonstrating the skills required to implement, analyze, and present a full PDSA cycle. Limitations to having all residents in a training program be meaningful participants in ambitious QI projects are in large [...]

Background: Blood gas analysis should be performed within 30 minutes of collection to ensure accurate results. Venous blood gas (VBG) data can help evaluate critically ill patients, but it has little role in routine use in non-critically ill hospitalized patients. Nonetheless, we noted that at our urban safety-net hospital, many general medicine patients had VBGs [...]