Background: Advanced practice providers (APPs) such as nurse practitioners and physician assistants have become an important addition to the hospital medicine team with the growing demand for physician providers. As APPs experience variable exposure to hospital medicine during training, the Society of Hospital Medicine and other governing bodies such as the American Academy of Physician [...]

Background: Duplicate as-needed (referred to hereafter as “PRN”) orders for common indications such as pain, nausea, insomnia, and constipation are frequent in hospitalized patients. Without explicit instructions for circumstances or order of administration, therapeutic duplication can cause confusion for nurses and violates both Join Commission and the Centers for Medicare & Medicaid Services (CMS) guidelines. [...]

Background: The proportion of high-level bills submitted by our hospital medicine group was lower than national averages as reported by the Clinical Practice Solutions Center (CPSC). This did not seem to align with the complexity of patients at our level 1, safety net hospital in a busy urban location. The purpose of our project was [...]

Background: Obtaining blood work through venipuncture is an important part of the diagnosis and management of hospitalized patients. Through formal and informal patient complaints, we found that patients admitted to the University of Colorado Hospital (UCH) report an excessive number of venipunctures for laboratory blood sampling. This results in overuse of resources, excess patient discomfort, [...]

Background: Regulatory agencies have set a 60-minute window to communicate positive CT PE (computed tomography pulmonary embolism) results to ordering providers. Improving the effectiveness of communication among caregivers for critical results of tests is a national patient safety goal. Our current system of communicating positive results to providers was inconsistent (mean time to verbal report [...]

Background: Multiple safety reports were reviewed for missed doses of critical medications on admission to the inpatient rehabilitation units at a large academic medical center. It was found that providers were inconsistently or incorrectly using the admission medication reconciliation (AdmMedRec) functionality in EHR that could have prevented these errors.Many hospitals struggle with AdmMedRec due to [...]

Background: Many efforts to improve bed availability in hospitals with high occupancy focus on encouraging providers to discharge patients earlier in the day without making substantial changes to workflows or to address barriers to patient care progression. Unfortunately, when this is most needed is often when teams are at their busiest with high census and [...]

Background: Financial incentives motivate hospitals to focus on improving patient experience, quality indicators, and efficiency metrics. Efforts to geographically staff hospitalists have renewed the focus on quality improvement efforts at the inpatient unit level. However, in order to maximize the benefit of geographic staffing, a unit-level leadership structure and quality-improvement support system must be developed. [...]

Background: Medicine is complex with extraneous workload impacting the daily flow of physicians. This may contribute to an increased risk of burnout (BO). Cognitive load from complex systems can decrease performance and increase risk of error. This study aims to evaluate the physician cognitive load (PCL) of a clinical workday in a national sample of [...]

Background: Late afternoon hospital discharges contribute to admission delays, leading to occupancy increase and increased length of stay. However, prominent workplace barriers often exist towards improvement initiatives that target early discharge. Team members cite timing of rounds, absence of early discharge support resources, communication breakdowns, and increased daytime admission volume as barriers to change. Furthermore, [...]