Background: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications […]

Background: Trauma co-management is a growing field within hospital medicine. While improvements in quality metrics have been documented in other co-management services, the impact of co-management of trauma patients is uncertain. This study aimed to determine whether a hospitalist trauma co-management program improves clinical outcomes. Methods: This was a pre- and post-implementation study comparing trauma […]

Background: Prior studies have found racial disparities in how patients are assessed for pain and prescribed opioids from emergency department and surgical settings. However, we do not know whether similar disparities exist among general medicine inpatients. We examined opioid prescriptions at discharge among adults admitted to the general medicine service at our medical center, with […]

Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered […]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they […]

Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care […]

Background: Sepsis, severe sepsis, and septic shock remain important contributors to hospital utilization, morbidity and mortality in the United States. Timely interventions including blood cultures, intravenous crystalloid infusions, and antibiotics make up the 3-hour sepsis bundle which represents current standard of practice, and the target of hospital quality reporting. Many aspects of sepsis care are […]

Background: Depression is considered an independent risk factor for coronary artery disease. Post-myocardial infarction (PMI) depression, is an increasingly recognized clinical entity with a prevalence of 10%. Compared with other ethnic groups, African Americans (AA) are more likely to be depressed and have higher coronary artery disease (CAD) burden. Few studies have evaluated the implications of […]

Background: Antipsychotics are frequently used in the hospital setting for managing both acute and chronic neuropsychiatric disorders. However, antipsychotics have been associated with higher rates of adverse events, including mortality, due to their association with QT prolongation, which can lead to fatal cardiac arrhythmias such as torsade de pointes, earning a black box warning for use in dementia related psychosis. Yet, […]

Background: Patients admitted with heart failure (HF) have a 12 to 27%, 30-day readmission rate, resulting in decreased quality of life and increased cost of care. 2017 Heart Failure guidelines have recommended a pre-discharge pro-Brain Natriuretic Peptide (pro-BNP) to establish post-discharge prognosis in patients with HF decompensation. We designed a study to evaluate the role […]