Background: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

Background: Although hospitals should be a place of healing and restoration, multiple studies demonstrate that hospitalized patients face acute sleep deprivation due to potentially modifiable disruptions (vitals, medications, tests). Acute inpatient sleep deprivation is also associated with worse health outcomes both in-hospital and post-discharge. While staff-directed sleep interventions show benefits, no study has tested whether [...]

Background: Delays in the discharge of the hospital ward patients cause a backlog for new admissions from the Emergency Department, and transfers from the Intensive Care Units and telemetry units. This bottleneck unnecessarily increases overall resource utilization and also negatively impacts patient care and satisfaction. Therefore, our Internal Medicine Residency Program aimed through this quality [...]

Background: Nurse-physician teamwork is a critical determinant of outcomes among hospitalized patients. Although improvement interventions have been designed for specific settings (eg, intensive care units and operating rooms), less attention has been given to nurse-physician teamwork in hospital medicine. Therefore, our goal was to assess the quality and effectiveness of interventions for improving nurse-physician teamwork [...]

Background: For patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI), antithrombotic therapy including oral anticoagulants (OAC) and antiplatelets are indicated. The optimal combination is not known. We investigated the efficacy and safety of different antithrombotic strategies in patients with AF undergoing PCI. Methods: PUBMED and EMBASE were searched through September 2019 for [...]

Background: Continuous multiparameter, physiologic monitoring may improve patient outcomes in the medical-surgical wards by identifying patients who need clinical evaluation and or intervention. Alarms may be actionable or non-actionable dependent on whether the alarm is technical in nature or represents a substantive change in patient condition. Alarms will enhance patient care when followed by provider [...]

Background: Diagnostic errors (DEs) are common and can lead to preventable harm in hospitalized patients.[1] To address this problem as part of our AHRQ-funded Patient Safety Learning Laboratory, we characterized diagnostic process failures that contribute to DEs.[2,3] Next, we refined three interventions (Figure 1) that addressed common process failures and were embedded into our electronic [...]

Background: The placement of peripherally inserted central catheters (PICCs) is increasingly performed primarily by vascular access nurses (VAN) in United States hospitals1. Despite the increased use of these specially trained clinicians, little is known about the patient and device characteristics of the PICCs they placed compared to those placed by interventional radiology (IR) providers. While [...]

Background: Thrombophilia testing is frequently ordered in the inpatient setting. However, testing is costly and can be misleading in the setting of acute thromboembolism or concurrent anticoagulation use. Furthermore, hereditary thrombophilias do not predict a clinically significant increase in VTE recurrence. Methods: We conducted an educational intervention with a randomized cross-over design for Internal Medicine [...]

Background: Minority and low-income populations are more likely to be hospitalized and/or re-hospitalized for acute asthma, a key indicator of poorly controlled disease. While hospitals have attempted to improve asthma care by implementing individual-level care interventions, inequities persist during inpatient stays and in intervention delivery. Little is known about the impact of “bundled” systems-level interventions [...]