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: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. National guidelinesrecommend VTE prophylaxis for all medical patients not at low risk. Several VTE risk prediction models have been developed, but no US models have been validated in a medical population. The ACCP recommends use of the Padua risk assessment model with a [...]

Background: Clinically stable inpatients may receive potentially unnecessary care, such as overnight vital sign assessment. Nighttime vital signs can disrupt sleep and adversely affect patient satisfaction and contribute to delirium. However, it may be difficult for individual clinicians to determine which patients could safely forego overnight vital signs. Purpose: We developed a predictive algorithm designed [...]

Background: Mortality prediction models are increasingly being adopted in the clinical setting, both to retrospectively assess quality of care and to prospectively inform clinical practice. An open question is whether a particular hospital should employ a model trained using a diverse nationwide dataset or use a model developed primarily from local data. The Veterans Affairs [...]

Background: Diagnostic errors (DEs) represent ongoing threats to patient safety in the hospital. Little is known about the factors present on admission that can predict DE during the hospital encounter. Such knowledge is essential for prospective identification of hospitalized patients at risk for DE who can be targeted for early intervention. The purpose of this [...]

Background: Clostridioides difficile infection (CDI) is a common, often nosocomial infection associated with substantial morbidity and mortality. Antibiotics are the most important modifiable risk factor, but empiric antibiotics remain appropriate for many patients with severe acute illness. Which antibiotics minimize the risk of CDI remains an important unanswered question. Because protective equipment and isolation were [...]

Background: The HCAHPS survey is used nationally by health systems as a standard to measure the patient experience and identify opportunities for improvement. Historically, process improvement initiatives based on the survey are implemented retroactively, attempting to prevent negative experiences for future patients. However, given the increasing complexity of patient care, proactively addressing the identified concerns [...]

Background: Diagnostic errors (DEs), or the failure to accurately identify or provide timely explanations of a patient’s health problem, are a significant source of patient harm. DEs occur in up to 23% of adult inpatients who transfer to intensive care units (ICU) or die. Few studies have examined how clinician team composition impacts DE risk. [...]

Background: Frailty is linked to poor outcomes in older patients, especially those with multiple conditions. The electronic frailty index (eFI) is a validated tool based on the cumulative deficit model used to screen hospitalized patients at risk for poor outcomes1. The eFI relies on 35 ICD-10 codes associated with encounters across four domains (morbidity, sensory, [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value has driven renewed attention to HaH, including from the Centers for Medicare and Medicaid Services. The COVID-19 pandemic has only magnified consideration of alternative sites of care. Where studied, HaH models have had desirable [...]