Case Presentation: This is a 4-year-old previously healthy girl, fully immunized with the exception of COVID-19 immunizations, who was hospitalized after presenting with fevers and fatigue for one week followed by gross hematuria. At the outset of her fevers, she tested negative for COVID-19 using a home antigen test. 4 days prior to admission, she [...]

Background: The ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (P:F ratio) has known clinical utility. For example, it is a key component of the sequential organ failure assesment (SOFA) score which is a validated mortality predictor and the new operational defintion of sepsis. Yet, its use is limited because [...]

Background: Despite the introduction of Early Warning Scores (EWSs), clinical deterioration (CD) remains an actual problem on the general ward. A next step to counter CD would be to intensify measurement from intermittent 8 hours to continuous measurements. This leads to big data sets of patient monitoring data with great potential. Use of advanced predictive [...]

Background: The development of systems that optimize quality of care, reduce costs, and enhance safety is vital to patient care. The VA healthcare system utilizes 27 quality metrics which allow for institutions to assess their performance in these areas, referred to as Strategic Analytics for Improvement and Learning (SAIL). SAIL data includes performance reports regarding [...]

Background: Telemetry is utilized on high risk cardiac patients for monitoring of arrthymias. Guidelines providing clear monitoring indications have been published by AHA to reduce overuse of this resource, which can lead to increased care costs and false positive alerting. Despite the above evidence, our hospital has a high volume of patients on telemetry causing [...]

Background: Electronic health record (EHR) systems are used by a majority of US hospitals. EHR use has been associated with increased task complexity, clinical data volume and provider documentation demands. Studies of multiple specialties suggest that a significant amount of provider time is spent on indirect patient care activities including turbulent provider workflows and documentation. [...]

Case Presentation: Patient is a 51-year-old man who presented with complaints of progressively worsening dyspnea, productive cough, sore throat and intermittent fevers of about 1 week. He has a past medical history of tobacco use. Initial vitals showed a temperature – 100.5F, heart rate – 118 bpm ,blood pressure – 119mmhg/60mmhg , respiratory rate – [...]

Case Presentation: A 51-year-old African American Female with PMHx of sickle cell trait, vitiligo (developed 5 years ago), T2DM, HTN, unspecified seizure disorder who presented with altered mental status and found to have severe pancytopenia. She presented hemodynamically stable with a physical exam notable for: pale conjunctiva and diffuse skin hypopigmentation consistent with vitiligo. Medications: [...]

Case Presentation: 47 year old female with a past medical history of hypertension presented to the emergency room with two days of right upper quadrant pain and a fever to 102F. For several months prior, she complained of bloating, intermittent diarrhea and diffuse abdominal pain that now localized. Her social history was positive for recent [...]

Background: Clinical handbooks support patient care, with studies demonstrating positive effects in areas such as quality of chart documentation, clinical knowledge, and value of inpatient care. Internal medicine residents rotating through inpatient services are particularly likely to benefit from handbooks, especially when handbooks share local, system-specific, and practical guidance. However, less is known about how [...]