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: 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: The United States sees over 35 million hospital discharges a year with a 20% readmission rate. Unplanned readmissions amount to 20 billion dollars annually. Efforts to prevent readmissions impact patient’s overall morbidity/mortality and alleviate the financial burden on health care systems. To that effect, the United States health care reform, under the Affordable Care [...]

Background: Initial management of acute upper gastrointestinal bleeding (UGIB) aims towards aggressive fluid resuscitation to maintain hemodynamic stability. Existing evidence regarding benefit of early endoscopy is unclear with some studies suggesting mortality benefits and some suggesting otherwise. The purpose of this study is to evaluate if there is any mortality benefit of doing early endoscopy [...]

Background: Historically, patients transferred from one hospital to another are admitted through the emergency department and then placed on the desired unit at the accepting hospital. This practice creates delays for critically ill patients in need of continuous ICU care. A strategy known as the direct admission addresses this issue. With this strategy, transfer patients [...]

Background: Advancements in technology have expanded accessibility to telemetry via remote monitoring and resulted in increased application in hospitalized patients. The American Heart Association (AHA) telemetry guidelines restrict use to patients with sepsis, severe electrolyte disturbances or primary cardiac conditions. Respiratory infections have emerged as a common source of hospitalization and telemetry is frequently applied [...]

Background: Adequate documentation of patient diagnoses is essential for hospitals to capture the extent of services provided, to submit bills, and ultimately receive payment. These diagnoses are used to calculate hospital performance as part of the Hospital Readmission Reduction Program. Diagnoses taken from medical record documentation are also used to place patients in diagnosis-related groups [...]

Background: Serum levels of pro-B-type natriuretic peptide (BNP) and N-terminal (NT) proBNP are measured at admission to assess likelihood of acutely decompensated heart failure (ADHF). Pro-BNP, released by myocardium due to cardiac wall distention, is cleaved into the active BNP and inactive NT-proBNP forms. Elevated NT-proBNP levels on initial presentation are a reliable marker of [...]

Background: Since the implementation of the Hospital Readmission Reduction Program, 30-day readmissions have decreased across the U.S. regardless of hospital teaching intensity. The effect of financial penalties on long term readmission rates has not been studied. Teaching hospitals serve as leaders in medical education, research, innovation, and patient care. Therefore, we examined whether long-term readmission [...]

Background: There is a significant impact of influenza on the individuals, families, and societies, both economically and clinically, in terms of hospital admissions, medication expenses and side effects, secondary bacterial infections and more days off from work or other forms of reduced productivity for the patients or their caretakers. Our objective is to present the [...]