Background: The Centers for Medicare & Medicaid Services (CMS) have sought to reduce readmissions through penalties applied to hospitals with readmission rates that are higher than expected, as calculated from models that use patient-level administrative data to account for case mix. Similar approaches are used to determine expected morality rates. Currently, CMS disseminates hospital-level adjusted [...]

Background: In Canada, as in the US, hospital medicine has become an increasingly important staffing model innovation. Canadian hospitalists are typically Family Physicians and General Internists. In an attempt to advance its hospitalist staffing model into a care model innovation as well,  the Regina Qu’Appelle Health Region (RQHR) implemented Canada’s first Accountable Care Unit (ACU) [...]

Background: CMS and other entities have focused on reduction of readmissions as a national quality improvement goal. The 30-day risk standardized readmission rate is derived from administrative data and requires the accurate coding of a principal diagnosis. We sought to validate the coded principal diagnosis for patients admitted with pneumonia and to determine if local [...]

Background: Do-not-resuscitate (DNR) orders are intended to allow patients to forgo cardiopulmonary resuscitate (CPR) in the event of cardiac arrest. They are applied to cases of cardiac arrest, and they cannot be applied to any situation other than cardiac arrest. However, prior studies have shown that the presence of DNR orders led to changes in treatment [...]

Background: Despite widespread awareness of best practices in the early management of sepsis, sepsis continues to burden our healthcare systems with high mortality, prolonged length of stay and excessive cost.  Early recognition of sepsis and adherence to evidence-based initial resuscitation protocols is known to reduce both mortality and costs associated with care.  In 2013, a [...]

Background: Hospital Medicine is a young and growing specialty. About 50% of our academic hospital medicine group of nearly 70 physicians are in their first 5 years out of residency. And about 90% of our faculty are millennials (born 1982-2000), the fastest-growing generation in the workforce and the first generation to grow up in a [...]

Background: An effective patient safety and quality improvement (QI) curriculum is imperative for graduate medical education (GME) training programs. Yet many health systems are lacking pedagogical training in these methods. Learning often takes the form of group project work, yet projects may not reflect institutional priorities, duplicate ongoing efforts, or remain unfinished after allotted time [...]

Background: Resistance in learning (RIL) defines a set of attitudes or behaviors demonstrated by learners in an educational setting that result in decreased learning. Literature describes the etiology as multifactorial, including learning environment, characteristics of the learner, and teaching style. Hospitalists often use quality improvement methodology, such as PDSA cycles to improve the clinical care [...]

Background: Atrial fibrillation (AFIB) is the most common recognized arrhythmia in the United States. Currently affecting more than 6 million people, this number is expected to double by 2050. Along with increased costs ($26 billion/year), it is associated with a 5-fold risk for stroke and 2-fold risk for all-cause mortality, independent of comorbid conditions. In [...]

Background: Provider-level practice variation is common and may impact clinical outcomes, such as length of stay and imaging ordering. However, it is unclear which provider characteristics lead to variations in practice. Using individual performance data from a provider-level dashboard, we aimed to evaluate variability in clinical performance and predictors of high or low performance. Methods: [...]