Background: Inpatient diabetes guidelines recommend insulin therapy for persistent hyperglycemia, defined as ≥ 2 glucose values ≥ 180 mg/dL, with a target glucose range of 140–180 mg/dL (1). However, there is no guidance on point of care glucose (POC-G) testing frequency for patients receiving routine four-times-daily tests without meeting persistent hyperglycemia criteria. Our prior study [...]

Background: Under the Hospital Readmissions Reduction Program (HRRP), a value-based quality initiative by the Centers for Medicare and Medicaid Services (CMS), the 30-day readmission rate is a critical metric for determining financial penalties for hospitals. However, this metric only accounts for patients readmitted to inpatient units, excluding those who return for observation unit stays or [...]

Background: Improving hospital throughput is critical to optimizing patient flow and capacity, particularly during periods of high census and ED boarding which can adversely impact patient experience and have downstream safety implications. Prolonged length of stay may result from inadequate alignment among care team members on patients expected to discharge, insufficient communication of discharge barriers, [...]

Background: Routine transfusion of platelets and Fresh Frozen Plasma (FFP) prior to paracentesis is among the “things we do for no reason”, as recommended against by the American Association of Liver Disease and American Gastroenterology Association in patients with platelets over 20,000. We hypothesize that a Medicine Procedure Service (MPS), which has adopted this recommendation [...]

Background: Iron deficiency is the most common cause of anemia and a common comorbidity in hospitalized patients. Iron deficiency is present in up to 50% of patients with heart failure and intravenous (IV) iron can improve symptoms, functional capacity, and quality of life1. Inflammatory bowel disease has a prevalence of iron deficiency in 25% of [...]

Background: Improving hospital throughput and capacity is a challenge that many health systems face. Specifically, emergency room overcrowding leads to delayed access to treatment and increased mortality, thereby negatively impacting patient safety (Franklin, et al., 2023). Health systems strive to employ multiple strategies to tackle the issues around patient flow. One such strategy includes the [...]

Background: The use of advanced practice providers (APPs) is increasingly prevalent throughout all levels of healthcare. However, there is no standard of practice regarding onboarding these providers to their new positions. This is in part due to the vast range of roles and responsibilities that APPs can contribute to the workforce. Although methods for initiating [...]

Background: There are mounting evidence that the clinical outcomes of conservative blood utilization strategy are equal or superior to liberal blood utilization in patients with anemia in the absence of severe acute hemorrhage, hemodynamic instability, or acute ischemia. However, practice variations among clinicians continue to create a challenge to effective blood utilization stewardship. Hospital Medicine [...]

Background: Carotid artery Doppler ultrasound is a valuable diagnostic tool for patients with neurological symptoms suggestive of cerebrovascular disease, such as transient ischemic attack (TIA), stroke, or focal neurological deficits. However, its diagnostic utility is limited in patients presenting with non-specific symptoms such as syncope, dizziness, or headache. Unnecessary Doppler orders in these cases can [...]

Background: As a strategy to address its ongoing capacity crisis, our hospital has focused on reducing length of stay and improving throughput. Our hospitalists care for patients on >20 nursing units across four buildings, which creates inefficiencies that may prolong length of stay. Although other institutions have demonstrated improved patient flow by geographically cohorting patients [...]