Background: In the dawning era of precision medicine, increasingly sophisticated tools are becoming available to diagnose and investigate rare and unexplained diseases. The application of these tools to clinical practice will require new models of collaboration between clinicians, tool developers, and laboratory investigators. Many structural barriers to such collaboration exist in our current healthcare delivery [...]

Background: Pneumonia is often treated for longer than necessary, yet factors associated with excess duration of treatment are unknown. We sought to: (a) develop an algorithm to determine appropriate antibiotic duration in non-intensive care unit (ICU) patients hospitalized with pneumonia and (b) apply this algorithm to an ongoing prospective study to determine patient-, provider-, and [...]

Background: In 2015, medical students in their clinical clerkships (traditionally known as third year medical students) began rotating directly with hospitalist attendings. As we began crafting the rotation, we sought to provide value that was not leveraged elsewhere in their clerkships. Different organizations, including the Liaison Committee on Medical Education and Association of American Medical [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: Physician shortage and healthcare access is a serious issue in rural America with reports estimating a shortage of more than 45,000 physicians by 2025. The rural and the underserved communities are predominantly served by International Medical Graduates (IMGs). Majority of the IMG physicians work are on a J1 waiver, National Interest Waiver (NIW) program [...]

Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: It is often assumed resident physicians at academic medical centers order more tests for inpatients due to different aspects of the clinical learning environment.  Despite this prevailing notion, there is very little evidence to support this claim. We sought to quantify differences in ordering practices between teaching hospitals and non-teaching hospitals for two common [...]

Background: Since 2010, 130 rural hospitals have closed, leaving only 2,250 rural hospitals remaining in the United States. Of the remaining facilities, outmigration and/or the bypassing of the local hospitals to a larger facility remains problematic and impacts a community’s access to healthcare while affecting the long-term business viability of the city. In December of [...]

Background: Administrative harm (AH), defined as negative consequences arising from administrative processes and decisions within healthcare, is pervasive in medicine, yet poorly understood and described. Methods: We sought to explore common AHs experienced by hospitalist clinicians, administrative leaders, researchers, and patient and family advisory council members that were part of two national consortiums for hospitalists [...]

Background: At all academic medical centers, nurses and resident physicians are two prominent front-line contributors to the care of patients. During a patient’s hospital stay, they receive communication regarding their diagnosis, test results, management, and plan of care from both the resident physicians and the nursing staff. Therefore, it is critical to have effective communication [...]