Background: Healthcare institutions have chronic bed shortages and a medically and socially complex patient population that makes optimal management of post-discharge care especially important. Effective and timely follow up post-hospitalization can improve clinical outcomes by delivering transitional care when patients are the most vulnerable. We developed a multimodal design that delivers education to patients and [...]

Background: Critical illness requires initiation of several classes of medications to treat or prevent different conditions. These include nebulizers, PPIs, antipsychotics, antibiotics, steroids, anticoagulants, opioids, benzodiazepines, & several others. Continuation of these medications upon transfer from MICU to the floor is a common occurrence with downstream implications including side effects or potential harm to patients, [...]

Background: Hospital systems are increasingly focusing on health equity, including identifying and addressing social drivers of health and healthcare disparities. Conventional quality improvement (QI) approaches have been used to address disparities with varying success. In our health system, using QI to increase use of interpreters has been the primary intervention for improving outcomes in patients [...]

Background: Cardiac arrhythmias pose a significant risk to hospitalized patients, with the potential for increased morbidity and mortality. Rapid recognition of clinically significant arrhythmias is crucial for timely intervention. Cardiac telemetry monitoring offers a means of remote heart rhythm surveillance in the hospital setting. However, limited availability of telemetry beds in many hospitals and the [...]

Background: Communication between team members is fundamental to providing high quality care to hospitalized patients (1). Breakdowns in communication lead to compromised patient safety, delays in care, and poor utilization of resources (2). Our Veterans Affairs (VA) hospital has about 200 inpatient beds, primarily staffed by resident physician teams. Bedside nurses use the admission order [...]

Background: Though the ACGME dictates that Internal medicine residents should be exposed to the domains of quality improvement (QI) and medical education (Med Ed), most residency programs provide limited opportunities to develop these skills. Furthermore, most existing hospital medicine electives which attempt to cover these topics are 4 weeks in length. Purpose: We sought to [...]

Background: Medication reconciliation (MR) is foundational to patient safety during and after a hospital admission. Frequently, MR can be delayed at the time of hospital admission due to incomplete records, patient health literacy, barriers to patient communication such as language or mental status, and unavailability of family or primary care providers. Electronic health records (EHR) [...]

Background: Direct acting oral anticoagulants (DOACs) have been approved for conditions such as non-valvular atrial fibrillation and venous thromboembolism. High quality randomized controlled trials have demonstrated the safety and efficacy of DOACs as compared to warfarin with exceptions in specific patient populations (such as those with mechanical heart valves). DOACs are more convenient and generally [...]

Background: Clinical documentation is essential for adequate representation of patient quality care metrics and accurate diagnosis capture but rarely taught in graduate medical education. Inaccurate capture of diagnoses leads to clinical documentation integrity (CDI) queries, which increase workload on busy providers. Implementation of a standardized note template for our resident physicians previously resulted in an [...]

Background: Approximately 12% of hospitalizations are related to substance use disorder (SUD), an estimated 20% of hospitalized patients may have SUD, and patients with SUDs are nearly twice as likely to be readmitted. Pharmacotherapies for SUD are underutilized in hospitals, especially in Texas, due to lack of training, structures, and organizational cultures to support evidence-based [...]