Background: Providing patient centered care is a core value of all healthcare systems in our nation. However, having a code status discussion with patients and their families continues to be a challenging endeavor due to multiple factors such as competing priorities and time constraints, especially in the hospital setting. To improve code status discussion and [...]

Background: Safety-net hospitals are disproportionately affected by the national intensivist shortage. The Society of Critical Care Medicine estimates the U.S. needs over 48,000 intensivists, but fewer than half are available. This shortage is pronounced in rural and underserved urban areas, leaving hospitalists in resource-limited settings to manage critically ill patients with minimal or no intensivist [...]

Background: Traditional methods to elicit feedback on clinical decision support (CDS) tools lack specificity and actionable insights necessary to optimize hospitalist workflows and patient care (1,2). Alert fatigue—a significant issue among hospitalists—reduces provider satisfaction and jeopardizes patient safety by prompting clinicians to dismiss critical alerts (3). Purpose: This initiative aimed to implement and evaluate a [...]

Background: Risk adjustment indices are frequently used for hospital billing and reimbursements in the United States. Severity of illness (SOI) and risk of mortality (ROM) are two risk adjustment indices used in determining the APR-DRG, a classification system commonly used by insurers to determine hospital reimbursements. Recently, many health systems implemented AI-powered clinical documentation assistants [...]

Background: Studies have shown geographically co-locating patients of the same physician (also known as regionalization) have improved provider satisfaction and increased team efficiency and collaboration. At most institutions, including ours, assigning physicians to patients and units is done manually. Furthermore, interventions to regionalize hospitals in the literature focus on grouping conditions, specialties, or teams (i.e., [...]

Background: Secure text messaging platforms are increasingly replacing traditional paging systems for in-hospital communication1,2. At our institution, the number of secure texts per month nearly doubled from 4.4 million in September 2020 to 8.1 million in September 2023. This growing burden of automated notifications from secure texts without a framework to triage message urgency contributes [...]

Background: Physicians often document patients’ anticipated discharge dates and care progression needs; however, this documentation can be challenging to locate in clinical notes and may be overlooked during care progression. At our institution, physicians are unable to consistently attend multidisciplinary rounds (MDRs), relying heavily on documentation to communicate plans of care and anticipated discharge dates. [...]

Background: A key factor contributing to physician burnout is what is known as “pajama time”—the time spent on clinical tasks outside of regular working hours. For inpatient physicians, responding to after hours texting may contribute significantly to pajama time. Purpose: At our large, urban academic medical center, 163 medicine residents rotate through the general medicine [...]

Background: As surgical and anesthetic practices have advanced, an increasing population of older adults with increased medical complexity are undergoing surgery. A significant portion of these patients may present to the hospital requiring urgent surgical intervention and there is an evolving and expanding role for hospitalists in preoperative risk assessment. However, there remains variable exposure [...]

Background: Advance care planning (ACP) conversations are essential for aligning care with patients’ values, particularly for high-risk hospitalized patients. However, there are limited tools in hospital medicine to identify and prompt clinicians to engage in ACP conversations effectively. Best Practice Alerts (BPAs) are commonly used in electronic medical records (EMRs) to streamline clinical workflows but [...]