Background: Glucocorticoids are prescribed at high rates in the inpatient setting for various autoimmune and inflammatory conditions. A common complication is steroid-induced hyperglycemia (SIHG), diagnosed when blood glucose levels surpass 140 mg/dL (7.8 mmol/l) in response to steroid exposure. Clinical practice guidelines offer strategies for correction of hyperglycemia among hospitalized patients but lack specific best [...]

Background: Diagnostic errors frequently represent significant adverse events that can occur in any medical setting, particularly in rushed handovers and constrained timing. Cases that result in emergency hospitalization at the time of the initial outpatient visit are more likely to have complex or serious patient conditions and more detrimental diagnostic errors. Our study investigated diagnostic [...]

Background: Transitioning from inpatient to outpatient care is high-risk, often associated with harm from incomplete or ineffective communication of clinical information [1]. In one report, 41% of patients had at least one pending study at the time of discharge, 43% of which were abnormal and 9.4% potentially actionable [2]. The discharge summary is a ubiquitous [...]

Background: In our NIH funded multi-site cluster randomized clinical trial (RCT), we used implementation science methods to develop and implement quality improvement programs consisting of evidenced-based interventions to improve care transitions for patients hospitalized with chronic obstructive pulmonary disease (COPD). Since the hospitals were the ‘subject’ of study, typical patient-level RCT enrollment practices were not [...]

Background: The Mount Sinai at Home (MSaH) program is a continuum of care that includes Hospitalization at Home (HaH), Palliative Care at Home and Subacute Rehab at Home (RaH). With these care delivery models, we can meet a wide and expanding spectrum of patient care needs. At MSaH, hospitalists, nurses, physical and occupational therapists, social [...]

Background: Critical to any health system’s mission is ensuring patients receive timely access to care. Continuity of care has been shown to decrease rates of ED utilization and hospitalizations and to improve patient satisfaction [1]. Providing patients with quick access to care following a hospital stay is a tenet of high-quality health care. A growing [...]

Background: Effective discharge communication is critical to ensuring safe patient transitions from the hospital and can improve outcomes. We have observed declining HCAHPS communication performance across our Section of Hospital Medicine and the transition out of the hospital was identified as a significant contributor. HCAHPS data was too slow to inform real-time improvement, so we [...]

Background: The transition period from hospital to home is a critical phase in patient care. Inadequate transitions can lead to adverse events, readmissions, delays in care, increased healthcare expenses and increased morbidity and mortality. Individuals with diabetes are particularly susceptible to readmission, facing a significantly higher risk compared to those without the condition. Furthermore, diabetic [...]

Background: Within 3 weeks of hospital discharge, about 19% of patients experience an adverse event, with 66% of these being an adverse drug event. During a patient’s transition from hospital to home, pharmacists have identified and resolved medication discrepancies. Inappropriate continuation or discontinuation of medications post-hospital discharge often stems from medication list complexity, inconsistent or [...]

Background: Outside-hospital (OSH) transfers are crucial to providing patients with a higher level or more specialized care. Despite the intent to improve care, OSH transfers are associated with negative outcomes due to miscommunication, lack of information, and other factors affecting patient care. Currently, there is no widely standardized process for OSH transfers. Studies show that [...]