Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: Maternal chorioamnionitis usually means an otherwise healthy appearing newborn gets cultured and treated for presumptive bacterial infection pending culture results. This is often done in a NICU setting. These babies are overwhelmingly well and are discharged after they ‘rule out’. However, the need for additional treatment and care in a NICU setting as well [...]

Background: Diabetic ketoacidosis (DKA) remains one of the commonest causes of medical and intensive care unit hospitalisations. DKA is a preventable hospital admission which is associated with multiple modifiable risk factors. However, little is known about factors that can predict healthcare resource utilisation in DKA. Previous studies have explored clinical and biochemical factors affecting the [...]

Background: Transfusion of packed red blood cells in the United States has more than doubled from 1997 to 2011; however, it is thought that greater than 50% of transfusions may be unnecessary. Numerous clinical trials have demonstrated that restrictive transfusion strategies are noninferior or superior to liberal strategies across a variety of clinical scenarios; as [...]

Background: Disposition planning is a vital part of clinical care in the hospital setting and requires a collaborative multidisciplinary approach. Physical therapy (PT) assessments are often a key part of this process but due to staffing shortages and high acuity – both of which were exacerbated by the COVID pandemic – therapists at a large [...]

Background: The Choosing Wisely Campaign encourages physicians to avoid over-utilizing routine labs in hospitalized patients with clinical and laboratory stability.  A number of studies have shown adverse effects on hospitalized patients from lab overutilization.  In previous research, we observed that internal medicine physicians at our center often order a daily complete blood count (CBC) and [...]

Background: Guidelines recommend in-hospital evaluation with cardiac monitoring and transthoracic echocardiogram (TTE) to assess syncope in patients that are considered high-risk for major adverse cardiovascular events. We sought to identify variables associated with performing TTE in patients presenting with syncope. Methods: We abstracted demographic and clinical data from all patients evaluated for syncope at the [...]

Background: Syncope is a common presentation encountered by hospitals worldwide. While well-established guidelines exist, there is significant variation in practice regarding the investigation and management of these patients. Practitioners tend to over-investigate, which may lead to unnecessary hospitalizations, length of stay and cost. In this study, we analyzed the utilization of healthcare resources for patients [...]

Background: Physical therapy (PT) in the inpatient setting is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care. Overutilization of inpatient PT services is an increasingly recognized problem. Patients with minimal or no functional limitations frequently receive PT evaluation, diverting resources and delaying care for the patients [...]

Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]