Background: Adverse events (AEs) occur in 19-28% of patients after discharge and can lead to unanticipated events, including emergency room visits and readmissions.(1,2) While early indicators include new and worsening symptoms (NWS), monitoring of patient-reported NWS is lacking. The 21st Century Cures Act mandates adoption of application programming interfaces (APIs), offering the potential to engage [...]

Background: Health information technology (HIT) systems, though designed to improve clinical workflow efficiency, have ironically contributed to clinician burnout, especially among hospitalists who depend on these systems for patient care and coordination (Adler-Milstein 2020). Addressing these challenges requires a detailed, resource-intensive process to identify workflow inefficiencies. Because this process is difficult, it is often performed [...]

Background: Rural healthcare in both the US and Brazil faces critical challenges in diagnostic services accessibility and efficiency. The Decentralized Integrated Laboratory System (DILS), an evolved form of Point of Care Testing (POCT) technology, aims to overcome these obstacles by enhancing diagnostic processes and patient care in rural settings of both countries. Building on successful [...]

Background: Transthoracic echocardiography (TTE) is a clinical tool for cardiac evaluation of hospitalized patients but is frequently associated with a greater hospital length of stay.1 At our institution, delays in TTE completion have been attributed to a shortage of sonographers and overutilization by inpatient teams for certain clinical conditions. From January to October 2023, only [...]

Background: The process by which patients are admitted to the inpatient setting after evaluation in the emergency department (ED) is a critical component of their care transition. Striking the proper balance between the speed of the process and the quality of the communication is paramount to optimizing workflows and ensuring patient safety. At our institution, [...]

Background: Goal-concordant care is an ongoing challenge in hospital settings. Failures in communication with patients and caregivers can lead to unwanted usage of hospital resources, including the ICU. This leads to lower quality care for patients and increased burden on the hospital. Goals of care conversations can be utilized to ensure that care aligns with [...]

Background: In 2020 due to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services approved the Acute Hospital Care at Home Waiver allowing hospitals to be reimbursed for hospital-level care for patients in their own home. Almost 300 hospitals across 37 states have been approved to launch their own Hospital at Home (HaH) programs. [...]

Background: On January 1st, 2023, the AMA released updated CPT E&M codes and guidelines. While there were welcome aspects to these changes – including removing need for an extensive physical exam and making it easier to capture prolonged service time – healthcare systems were left grappling with a need to quickly respond to these complex [...]

Background: Prior to Jul 2023, at our academic hospital medicine program, the 6-month clinical schedule was created in commercial scheduling software and released 2-4 weeks before the start of that schedule. The actual schedule creation took 3+ months. This led to physician discontent due to the inability to plan professional and personal obligations. Our schedule [...]

Background: Clinical handbooks support patient care, with studies demonstrating positive effects in areas such as quality of chart documentation, clinical knowledge, and value of inpatient care. Internal medicine residents rotating through inpatient services are particularly likely to benefit from handbooks, especially when handbooks share local, system-specific, and practical guidance. However, less is known about how [...]