Background: Community acquired pneumonia (CAP) is one of the leading causes of hospitalization in the United States.[1] In an effort to improve the quality of care for this resource-intensive disease, our institution implemented a clinical decision support (CDS) pathway for CAP comprised of three phases: (1) education on best practices, (2) education and a CDS [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Clostroidiodes difficile (CD) is the most prevalent hospital-acquired infection in the United States, accounting for approximately 224,000 infections with 13,000 deaths and over 1 billion dollars spent in 2017, according to the Centers for Disease Control and Prevention (CDC). Clostroidiodes difficile accounts for 10-20% of diarrhea in the setting of recent antibiotics exposure.In St [...]

Case Presentation: A 54-year old female was hospitalized for 3-week history of abdominal pain, chills, nausea and diarrhea. Her past medical history was significant for multiple self-reported antibiotic allergies, Roux-en-Y gastric bypass complicated by gastrojejunostomy leak, and prior perisplenic abscess requiring percutaneous drainage. On admission, blood pressure was 137/79, heart rate of 80, respirations 20, [...]

Background: Dichotomous outcomes—such as mortality—rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether [...]