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: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care. In this study, we aim to better understand which patients may (or may not) benefit from IHT by evaluating the impact of IHT on clinically important patient outcomes among a variety of patient diagnoses. Methods: We performed [...]

Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary [...]

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: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care. In this study, we aim to better understand which patients may (or may not) benefit from IHT by evaluating the impact of IHT on clinically important patient outcomes among a variety of patient diagnoses. Methods: We performed [...]

Background: Sub-optimal communication during care transitions contributes to poor patient outcomes. Patients who undergo interhospital transfer (IHT, the transfer of patients between hospitals) are at especially high risk given their level of illness severity. In examination of the IHT process at Brigham and Women’s Hospital (BWH), a 740-bed tertiary care referral hospital, we previously found [...]

Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care [...]

Background: The Institute for Healthcare Improvement tells us that successful discharge planning starts at admission; however, when that admission occurs to a closed Intensive Care Unit (ICU), traditional discharge planning can be delayed until the patient transfers to a general floor. This delay can be exacerbated as a hospital’s adult medical-surgical bed occupancy rises, increasing [...]

Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care, such as errors in communication and gaps in information transfer. In this study, we aim to quantify clinician-reported medical errors attributable to incomplete communication/information transfer during IHT to a tertiary referral hospital. Methods: We included all patients [...]

Background: Inter-hospital transfer (IHT, the transfer of patients between hospitals) exposes patients to risks of discontinuity of care. To identify aspects of the transfer process that increase risk, we examined the impact of select transfer process factors on clinical outcomes among patients undergoing IHT. Methods: We performed a retrospective analysis of patients ≥ age 18 [...]