Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: An estimated 20-30% of inpatient standing labs are medically unnecessary1, contributing to iatrogenic anemia2, sleep disruption3, and increased healthcare costs. The Society of Hospital Medicine identified routine repetitive complete blood count (CBC) and chemistry (BMP) as a common wasteful inpatient practice4. At our institution, repetitive inpatient CBC, BMP, magnesium, and phosphorus account for 500,000 [...]

Background: High-value care (HVC) is an increasingly important component of medical education. This study aimed to assess differences in medical students’ perceptions and behaviors towards HVC during surgical versus non-surgical rotations and to evaluate the impact of an educational first-year HVC course on these outcomes. Methods: A cross-sectional, annual survey was administered from 2021-2024 to [...]

Background: High-value care (HVC) education is crucial for developing cost- and quality-conscious physicians. This study assesses the impact of a first-year HVC course on experiences in longitudinal ambulatory clerkship (LAC), examining changes with time and gender. Methods: This prospective study lasting from 2021-2024 included first and second-year medical students (n=265) in LAC. Students were divided [...]

Background: Compared with health care systems globally, the U.S. health care system expends more resources yet achieves worse patient outcomes. Growing recognition that such low-value care is a system-level problem has spurred efforts to optimize system-level processes. Low-value hospital admissions are a major contributor to overall low-value care, but limited descriptions of specific processes for [...]

Background: Delirium is an acute, fluctuating confusional state that commonly develops in older and acutely ill hospitalized patients. This condition contributes to patient morbidity and mortality and substantial financial burden to the healthcare system through prolonged hospitalization and increased resource utilization. Clinical decision support within the electronic medical record (EMR) has shown potential to improve [...]

Background: High hospital readmission rates have both clinical and financial consequences which are associated with worse healthcare outcomes for our patients and costly financial penalties for the hospital. The average cost of a readmission estimated to be at $15,200 and adds burden on hospital systems, resources, and cause further harm to our patients, leading to [...]

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: 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 [...]