Background:   Observation care has evolved significantly since its original inception by the Centers for Medicare and Medicaid Services (CMS).  Originally intended to span less than 48 hours in the majority of cases, the Office of Inspector General (OIG) reported that 11% of all observation stays lasted three or more nights in 2012.[1]Having a higher length [...]

Background: Following hospitalization, a reported 20% of all Medicare patients are discharged to skilled nursing facilities (SNFs).  Sepsis was the cause of 25-68% of readmissions from SNFs based on a review of Medicare readmissions from patients at 96 SNFs in southeast Michigan. Sepsis is also the most common all-cause admission diagnosis and represents over $20 [...]

Background: On March 7, New York was declared in “State of Emergency”; all Emergency Room and hospital facilities in NYC were overwhelmed by the rapid and high influx of patients with COVID-19 infection. At least 20% of patients with criteria for hospitalization received mechanical ventilation, and the Mortality reached 80% in a time when the [...]

Background: ARDS incidence in patients with COVID-19 pneumonia varies from 15-42%; between 5-20% of patients with hospitalization criteria received mechanical ventilation (1-3). Prone positioning demonstrated mortality benefits for patients with Severe ARDS (sARDS) with lung injury, but its use in patient COVID-19 is not clear (4-6). ARDS protocol (ARDSp) is recommended by ATS and The [...]

Background: Patient safety assistants (PSAs), or “sitters,” observe patients at bedside considered at “high risk” for in-hospital events [1] such as falls or elopements. While studies suggest PSAs do not impact safety outcomes,[2-4] they are widely utilized without formal guidelines.[2, 5, 6] With increasing healthcare costs and limited resources, efficient care models are sought.[1, 2, [...]

Background: Indwelling urinary catheters (IDUCs) are commonplace in hospital medicine wards, facilitating patient care but introducing risks such as catheter-associated urinary tract infections (CAUTIs). The urgency to minimize these complications has spurred initiatives to refine catheter utilization protocols. This study examines the efficacy of the Foley Removal Countdown Strategy, a novel, proactive approach in the [...]

Background:  Delirium affects 20-60% of the general hospitalized patients, and up to 85% of intensive care unit (ICU) patients. Its occurrence is associated with higher morbidity and mortality, long-term institutionalization, worse long-term cognitive outcomes, and increased hospital length of stay and costs. It is often missed due to lack of standardization in assessment and diagnostic [...]

Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine electrolyte values obtained by arterial blood gas testing (ABG) and central laboratory testing (VCL) and determine the extent of essentially [...]

Background: Catheter associated urinary tract infections (CAUTI) are one of the most common hospital acquired infections and cost on average $13,793 per case according to the AHRQ. Many quality and safety organizations including the Society of Hospital Medicine recommend reducing the prevalence of indwelling urinary catheters (IUC) as a means to reduce the incidence of [...]

Background: Sepsis is a leading cause of morbidity and mortality in the US. Annually, over 250,000 people die from sepsis nationwide. Therefore, in 2013 New York State mandated that hospitals adhere to standardized protocols designed to improve sepsis outcomes. A recent cohort analysis on the rollout of these standards demonstrated that mortality decreased by 6% [...]