Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Community acquired severity scores are well known and used routinely in predicting mortality and risk of inpatient and ICU admission in suspected bacterial pneumonia patients. However such scores have not been studied in patients with influenza infection and influenza pneumonia. We attempted to validate one such score, CURB65 and and identify other scores that [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of hospital readmissions in America. Over one-third of patients admitted for COPD exacerbations are readmitted within 90 days, with readmissions costing $15 billion. Medicare instituted financial penalties for excessive readmissions after COPD hospitalizations, incentivizing the creation of readmission prediction tools. Two such tools, the [...]

Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is the third leading cause of readmissions and is now included in the Medicare Hospital Readmissions Reduction Program (HRRP). Our institution developed an inter-professional program aimed at reducing all-cause 30-day readmissions for patients admitted with AECOPD. Methods: We iteratively developed and piloted our inter-professional COPD HRRP [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) Multi-site Quality Improvement Collaborative aims to improve discharge transitions by testing a patient-centered transition bundle. Teach-back is a core component. This is a well-established method of confirming understanding. However, limited evidence exists about the effect of using teach-back for pediatric discharge education on parental knowledge/understanding of essential [...]

Background: The Center for Medicare and Medicaid Services (CMS) instituted the Readmissions Reduction Program to incentivize improvements in care transitions for patients with several common and serious illnesses, including heart failure, acute myocardial infarction, pneumonia, and more recently COPD exacerbations. The HOSPITAL score has been shown to accurately identify medical patients at high-risk for 30-day [...]

Background: Diagnostic errors have been cited as a potential contributor to hospital readmissions, particularly early readmissions (e.g. within 7 days), but little is known about their frequency and characteristics. We performed structured chart review of all medical patients readmitted within 7 days of discharge from a single academic medical center to describe the prevalence of [...]

Background: Remote patient monitoring (RPM) is a promising new tool to monitor patients who have historically required observation visits in a hospital, or would have remained hospitalized longer if initiated at hospital discharge, and was widely used in the COVID-19 pandemic. We report the outcomes of hospital admission and urgent/emergent care service utilization in a [...]