Background: Clinical decision support tools based on predictive analytics can provide actionable information and improve clinical outcomes for patients at risk of developing sepsis. Scoring systems such as Systemic Inflammatory Response Syndrome (SIRS) and National Early Warning Score (NEWS) that were not specifically trained to detect sepsis tend to have high false alarm rates, leading [...]

Background: Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of single interventions. We sought to implement a set of complementary interventions and evaluate the effect on interprofessional teamwork and patient safety. Methods: The REdesigning SystEms to Improve Teamwork and [...]

Background: Clinical decision support tools based on predictive analytics can provide actionable information and improve clinical outcomes for patients at risk of developing sepsis. Scoring systems such as Systemic Inflammatory Response Syndrome (SIRS) and National Early Warning Score (NEWS) that were not specifically trained to detect sepsis tend to have high false alarm rates, leading [...]

Background:  The Society of Hospital Medicine considers stroke care a core competency in hospital medicine.  It also challenges hospitalists to lead, coordinate, and participate in multidisciplinary efforts to improve stroke care within their organizations.  Hospitalist trainees will be better positioned to accomplish this if they have a broad exposure to the continuum of stroke care [...]

Background: Systems-based practice (SBP) is critical to physicians’ work and is gaining emphasis in medical school curricula. Purpose: In this hospitalist-led pilot curriculum for first-year medical students, we developed a novel didactic and experiential approach to teaching SBP skills, seeking to help students apply newly-acquired SBP concepts to inpatient improvement projects to add value to the clinical environment. Description: For the 12 [...]

Background: Teamwork is essential to providing safe, effective, patient-centered care. Prior research documented discrepancies in perceptions of teamwork and collaboration among nurses and physicians. However, prior studies have been limited to single sites and academic medical centers. Methods: We conducted surveys of healthcare professionals in 4 hospitals participating in the REdesigning SystEms to Improve Teamwork [...]

Background: Physician advocacy and knowledge of healthcare policy are vital elements of medical education and included within the ACGME Core Competency of Systems-Based Practice. The ability to advocate effectively has potential to impact healthcare regulations for both inpatient and outpatient practice. However, many GME programs do not incorporate these topics into their trainee education. To [...]

Background: Health care policy is currently under scrutiny due to health care reform, yet in our experience the majority of house staff have insufficient opportunity to learn about the environment they will soon be practicing medicine in. The ACGME attempts to address this through the Systems-based practice competency, but further guidance is lacking. Purpose: Our [...]

Background: The ACGME has developed competencies for systems-based practice and problem-based learning and improvement to encourage trainees to integrate quality and safety into their everyday practice. Furthermore, the AAMC has a call to action for US Medical schools and teaching hospitals to successfully align clinical and education missions in order to have quality improvement and [...]

Background: Healthcare in the U.S. is increasingly delivered by large health systems that include one or more hospitals and associated outpatient practices. It is unclear what role health systems play in driving or preventing overutilization of healthcare services in the U.S. We sought to learn what characteristics allow certain health systems to avoid low-value care [...]