Background: While many Hospital Medicine groups employ overnight providers to exclusively care for previously admitted patients (cross-coverage), little data exists regarding factors contributing to the perceived workload of this role. The NASA-Task Load Index (NASA-TLX) is a validated questionnaire used to quantify perceived workload. Methods: Overnight providers completed the NASA-TLX at the end of each [...]

Background: Providers have a variety of situations arise on shift that challenge or inhibit their ability to provide care to patients, sometimes with advanced notice but often without. Most programs have coverage systems in place for emergent needs, but these are less than ideal for immediate and short-term situations (Table 1). Without a set policy, [...]

Background: Our Hospital (Two Campuses A and B) is a part of Yale New Haven Health System (YNHHS). YNHHS is a nonprofit healthcare system in New Haven, Connecticut. Average length of stay (ALOS) for inpatients at Bridgeport Hospital remains longer than the national average. With the recent acquisition of another campus, inpatient volume at our [...]

Case Presentation: A 55 year old male with past medical history significant for congestive heart failure, severe persistent asthma and eosinophilic pneumonia on chronic prednisone and status post bronchial thermoplasty presented with fever, cough, shortness of breath and chest pain of 2 weeks and hemoptysis of 3 days duration. He also had two recent hospitalizations [...]

Case Presentation: A 55-year-old male with a history of coronary artery disease, left ventricular (LV) mural thrombus, tobacco use, and recent thalamic, splenic, and renal artery infarcts, presented with two weeks of worsening pain and cyanosis of his left third and fourth toes, associated with claudication. He denied numbness or loss of strength. He denied [...]

Case Presentation: A 68-year-old man presented with dizziness, blurry vision, and leg paresthesias for one week, which started after a bout of gastroenteritis. Past medical was notable for an MCA stroke at age 40 with residual left-sided weakness. He was a never-smoker and had no risk for carbon monoxide exposure. On exam, patient had a [...]

Case Presentation: A 62-year-old female with a history of polycythemia vera presented to urgent care with swelling, redness, and pain over her right foot and ankle. She denied any trauma or insect bites. She was diagnosed with cellulitis and treated with intravenous Ceftriaxone for 3 days with minimal improvement. She continued therapy with oral Cefpodoxime, [...]

Case Presentation: A 56-year-old-male with hypertension, diabetes mellitus, chronic kidney disease (CKD) stage 3 presented with a 6-month history of intermittent lower extremity swelling and a 3-week history of scrotal and abdominal swelling. 9 months prior, he was noted to have worsening renal function and nephrotic range proteinuria (13g) prompting two renal biopsies which demonstrated [...]

Case Presentation: An 80-year-old woman with a history of hypertension, pre-diabetes, chronic kidney disease (stage 3b), and remote ischemic stroke without residual deficits presented to the emergency department complaining of several hours of epigastric discomfort and malaise. An EKG revealed >1 mm ST segment elevation in leads V4-6 (Fig. 1). The troponin I was elevated [...]

Case Presentation: A 76 y.o. female with history of chronic diastolic heart failure and poorly controlled polycythemia vera (PV) on 500 mg of hydroxyurea daily presented with 2 days of progressive difficulty breathing, sialorrhea and uncontrolled movements of the face and mouth. Due to general malaise, she stopped taking her furosemide and hydroxyurea 2 days [...]