Background: We identified a number of quality, patient satisfaction, and staff satisfaction issues that all seemed to be linked to throughput challenges. We had trouble getting patients out of the hospital on discharge day, which set off a number of downstream effects including backups in the Intensive Care Unit (ICU) and Emergency Department (ED). These [...]

Background: The hospitalist service at this large Academic tertiary center has a length of stay index that is longer than expected. Despite improvements in multi-disciplinary rounds and co-locating patients on a geographical units, improvements in length of stay slowed. Interviews of hospitalist physicians indicate that there are frequent delays in procedures, imaging and consult recommendations. [...]

Background: Joint Commission has identified “communication” as the third most frequent root cause of sentinel events.1 Alpha-numeric pagers are common for communication among healthcare professionals. Pagers are not HIPAA compliant and communication through pagers often lacks sufficient information for effective communication.2 Because pager communication is one-way, closed loop communication requires a return telephone call, disrupting [...]

Background: Physician handoffs between inpatient shifts influence safety and care quality. Handoffs are also at risk for communication failures. Poor care coordination and miscommunication cause 80% of sentinel events nationwide. The rise of the electronic medical record (EMR) presented an opportunity to standardize communication during handoffs. Unfortunately, this potential has thus far gone largely unrealized, [...]

Background: Consultation among providers is a foundation of modern health care and a very frequent means of interdisciplinary communication. Classifying consultation requests can facilitate clear communication between providers and across medical specialties, improve workflow, provider satisfaction and ultimately patient care. We previously proposed an organizing framework of 7 specific consultation types: ideal, obligatory, procedural, S.O.S., [...]

Background: Interprofessional collaboration (IPC) is vital for high-quality patient care, and effective IPC among medical professionals, especially trainees, is crucial to supporting positive individual and team outcomes. Measuring IPC and understanding its impact on patient care remains underexplored. Understanding which IPC patterns are associated with better patient and individual outcomes will inform how to best [...]

Background: For the academic hospitalist, rounds are the cornerstone of teaching, learning, and patient care. At our institution, a study found that internal medicine residents on the inpatient wards spent an average of 3.4 hours rounding daily. However, most residents and attendings described rounds as “inefficient” and “low value.” With the importance of ACGME work [...]

Background: Treating alcohol withdrawal in the inpatient medical setting requires timely identification of the severity of alcohol withdrawal so appropriate treatment can be administered. Delayed or missed diagnosis can lead to increased morbidity and mortality, increased cost and length of stay, and ICU admissions. CIWA-Ar is the most commonly used scale, but it is lengthy [...]

Background: Length of stay (LOS) is an important outcome measure in the evaluation of the quality of care for hospitalized patients. LOS in adults with diabetic ketoacidosis (DKA) is reported to be about 3 days, but detailed information about LOS in pediatric patients with DKA is lacking. Knowledge of factors that impact LOS is essential [...]

Background: Family-centered rounds on our pediatric hospital medicine teaching service, which cares for patients in multiple units throughout the hospital, are often prolonged with unpredictable progression. This contributes to inconsistent nursing participation, inefficiencies in patient care, and variable end times. Through the implementation of scheduled-based rounding, our aims were to: 1) start 90% of rounds [...]