Background: The Centers for Medicare & Medicaid Services (CMS) started penalizing hospitals with “excess” 30-day readmissions, as determined by observed-to-expected ratio, for patients discharged after treatment for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). An understanding of modifiable determinants of 30-day readmission will likely help in developing interventions to reduce preventable AECOPD readmissions. [...]

Background: Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, mortality, and cost with the greatest proportion incurred treating acute exacerbations of COPD (AECOPD). While guidelines recommend oral steroids for the treatment of AECOPD, parental corticosteroids are still used in the inpatient setting; such use is associated with high costs and adverse effects. The [...]

Background: Increased asthma and obesity prevalence are independently associated with health disparities.  This study sought to examine the relationship between these two conditions, particularly within the pediatric population at a major inner city teaching hospital. Methods: Patients aged 3 to 18 with a diagnosis of bronchial asthma and at least one hospital encounter for an [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic, irreversible airway obstruction that can precipitate into acute exacerbations (AECOPD) of cough, dyspnea and sputum production, often requiring hospitalization. Hospital systems aiming to improve outcomes for patients with AECOPD are testing innovative approaches to care in the acute care setting. To enroll [...]

Background: In the South Bronx, 30% of the population lives with heart failure. CHF readmission andmortality rates surpass the national average in the Bronx. Our hospital serves anethnically diverse population, predominantly Hispanic and African American, many ofwho have a low socioeconomic status. Despite multiple interventions including educating patients about CHF Action Plan, ensuring all eligible [...]

Case Presentation: Type A Lactic acidosis is commonly caused by decreased oxygen delivery and poor peripheral perfusion. Type B lactic acidosis ensues in absence of hypoxia or tissue hypoperfusion, mostly occurring in alcoholism, mitochondrial dysfunction, medications like metformin. We present an unusual case of Type B lactic acidosis induced by nebulized albuterol in the treatment [...]

Case Presentation: A 72-year-old female with rheumatoid arthritis, ILD, hypertension, hypothyroidism, iron deficiency anemia, and monoclonal paraproteinemia presented with 3-day history of progressive dyspnea and productive cough and was admitted for acute hypoxic respiratory failure initially requiring 3 L/minute oxygen via nasal cannula (NC). The remaining vital signs were stable. Exam revealed rales at right [...]

Case Presentation: A 38 year-old female with history of asthma presented to the emergency department (ED) with symptoms of progressive dyspnea, wheezing, and dry cough, consistent with asthma exacerbation. In the ED, she was treated with continuous albuterol nebulizer for nearly 8 hours along with intravenous methylprednisolone.  Her clinical status worsened with increased work of [...]

Background: Acute heart failure exacerbations remain a leading cause of morbidity and mortality and are associated with high rates of hospital admissions and healthcare expenditure. As hospital medicine (HM) primary service footprint expands, further information regarding patient care provided by HM compared to cardiology (CV) is needed. As part of a broader effort to improve [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is among the top three leading causes of hospital readmissions in the United States. Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD) is associated with increased morbidity, mortality, and cost with AECOPD accounting for more than half of the 15.5 billion USD spent on COPD[1,2]. In this project, we aim [...]