Background: The HCAHPS survey is used nationally by health systems as a standard to measure the patient experience and identify opportunities for improvement. Historically, process improvement initiatives based on the survey are implemented retroactively, attempting to prevent negative experiences for future patients. However, given the increasing complexity of patient care, proactively addressing the identified concerns […]

Background: Antibiotics are frequently prescribed—and overprescribed—at hospital discharge, leading to adverse-events and patient harm. Antibiotic overuse at discharge varies widely across hospitals, with rates of overuse differing up to 5-fold.(1) Our understanding of what approaches optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework which […]

Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary […]

Background: Failure to thrive and malnutrition continues to be a common diagnosis in pediatrics contributing to a significant number of hospital admissions (1-5). There is no national practice guideline or consensus recommendation for diagnosis and treatment for patients hospitalized with failure to thrive, contributing to significant clinical practice variation. Unnecessary variability in practice has been […]

Background: Patients with limited English proficiency (LEP) experience inferior health outcomes. The end-of-life period represents a particularly vulnerable time for LEP patients who may not receive optimal symptom management due to language barriers and other factors. There is limited data on disparities in provider practices around opioid administration based on patient LEP status, particularly at […]

Background: Physical therapy (PT) is an invaluable tool to prevent and treat the functional decline that hospitalized patients experience. Although it is a constrained resource in most inpatient settings, PT is often requested for patients with high mobility and independence who may not require skilled therapy. This can waste hundreds of PT hours and decrease […]

Background: Collaborative, interdisciplinary teams—including pharmacists—are critical to optimizing inpatient care. One interdisciplinary role played by clinical pharmacists is antibiotic stewardship. While it’s known that acceptance of stewardship recommendations depends on multiple sociobehavioral factors (e.g., hospital culture, hierarchy, professional autonomy), it’s not known what role gender plays in acceptance of antibiotic stewardship recommendations. Thus, to determine […]

Background: Clinical documentation is challenging when patients are admitted with many diagnoses of varying severity. Documentation of chronic or low-acuity conditions on the History and Physical (H&P) note can feel less salient than primary admission diagnoses. This can lead to under-documentation of comorbid conditions and an underrepresentation of the complexity of care. Capturing this overlooked […]

Background: The advent of internal medicine procedure services within academic medical centers has had a profoundly positive impact on patient care, patient safety, and resident training (1-4). In general, these teams focus on performing invasive bedside procedures, including paracenteses, lumbar punctures, central venous catheter placements, thoracenteses, and ultrasound-guided peripheral intravenous catheter placements. Recently, the procedure service at […]

Background: Error reporting is an integral component in the safety program of hospitals. Residents in training programs are encouraged and expected to participate in error reporting as part of the clinical learning environment. Previous studies identified barriers to resident reporting including knowledge of how to submit reports and understanding how reports affect institutional safety culture. […]