Background: Lack of mobilization of hospitalized non-ICU medical patients has known negative consequences, including worse health and psychological outcomes, functional decline and increased hospital length of stay (1). Known challenges to increasing mobilization amongst inpatients include patient- and institutional-related limitations such as patient symptoms and lack of available assistance (2). At our urban, quaternary care, [...]

Background: Fingerstick blood glucose (FSBG) testing allows inpatient providers to adjust insulin in real time to protect patients from significant hypo- or hyperglycemia. Admitted diabetic patients are often placed on sliding scale insulin with four times per day FSBG testing, regardless of home insulin use. FSBG test materials cost $9 per use (1). We estimate [...]

Background: Continuous intravenous (IV) infusions aimed at avoiding dehydration are often referred to as “maintenance fluids” (MF). These infusions are common in clinical practice. Though guidelines exist for MF use in other countries (NICE 2017), there are no specific guidelines in the US. A shortage of IV fluid has existed since 2013. In 2017, Hurricane [...]

Background: CT Head imaging for patients with altered mental status is a common procedure that many clinicians utilize to establish a diagnosis. As health care costs rise, practitioners are becoming more conscious about ordering costly imaging studies that are unlikely to change management. The purpose of the study is to determine when obtaining CT imaging [...]

Background: Admitted patients with Type II Diabetes Mellitus (T2DM) are often placed on sliding scale insulin with four fingerstick blood glucose (FSBG) tests per day, regardless of home insulin use or baseline glycemic control. FSBG testing in the inpatient setting allows for real-time insulin adjustment to protect patients from significant hypo- or hyperglycemia, but FSBG [...]

Background: Over the last 2 decades there has been increasing adoption of Observation (OBS) units across the healthcare facilities in United States. Health reforms like 2 midnight rule and 30 day readmission penalties, congestion in the ED, poor operational outcomes in OBS population mixed with inpatients (IP) etc. further added to the need for dedicated [...]

Background: The use of maintenance fluids (MF, continuous intravenous fluid (IVF)) to prevent dehydration is common, yet highly variable in practice. Unnecessary MF can cause patient harm including fluid overload, sleep disruption (associated alarms), and increase falls risks. In 2017, Hurricane Maria destroyed Puerto Rican facilities that were critical in producing IVF, exacerbating an existing [...]

Background: There are mounting evidence that the clinical outcomes of conservative blood utilization strategy are equal or superior to liberal blood utilization in patients with anemia in the absence of severe acute hemorrhage, hemodynamic instability, or acute ischemia. However, practice variations among clinicians continue to create a challenge to effective blood utilization stewardship. Hospital Medicine [...]