Background: Hospital throughput and length of stay (LOS) are important drivers of success in an increasingly competitive healthcare landscape where revenues are down and demand can exceed hospital capacity. More specifically, longer LOS and hospital throughput bottlenecks impact access to timely care, the quality and safety of care delivery, patient and family satisfaction, and provider […]

Background: The transition between hospital discharge and primary care follow-up is a vulnerable period for patients that can result in adverse health outcomes and preventable hospital readmissions. The COVID-19 pandemic has exacerbated this transitional period, as many patients have forgone their routine healthcare visits, lost touch with their primary care providers (PCPs), and lacked a […]

Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care, such as errors in communication and gaps in information transfer. In our prior work evaluating IHT to general medical (GMS), cardiology, oncology and ICU services at an 800-bed tertiary care referral hospital, we found that in 37% […]

Background: Treatment of complicated urinary tract infections (cUTI), including acute pyelonephritis (AP) due to multi-drug resistant (MDR) Gram-negative uropathogens (e.g., extended-spectrum ß-lactamase (ESBL)-producing and fluoroquinolone-resistant strains) is associated with poor outcomes and increase costs of care. In the setting of limited alternative oral options, patients with cUTI/AP are commonly hospitalized to receive intravenous (IV) antibiotic […]

Background: The period immediately following discharge from a hospital admission is a vulnerable time for patients. Preventable adverse outcomes occur here for various reasons: discontinuity between hospitalists and primary care physicians, changes to medication regimens, and complex discharge instructions [1]. Many of these precipitating factors can be avoided by effective exchange of health information and […]

Background: Hospital clinicians may identify the presence of a patient’s comorbid conditions, overall severity of illness, and clinical status at discharge as risk factors for readmission after COVID-19 hospitalization. Objective data are lacking to support reliance on these factors for discharge decision-making. Objectives included examination of risk factors for readmission to hospital after COVID-19 hospitalization […]

Background: Communication related to medications is an important metric on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure patient experience after discharge from the hospital. There are many factors which can lead to poor communication about medications (Figure 1). Over 20% of readmissions can be related to medications, and of […]

Background: Up to 45% of Americans do not fill prescriptions because of cost. Medication non-adherence annually leads to $100-$300B in excess morbidity and mortality. To better inform medication cost effects on a potentially vulnerable patient population, our primary aim was to measure annual patient out-of-pocket outpatient medication cost for patients without prescription drug insurance coverage […]

Background: Emergency room overcrowding is a national crisis largely attributed to high volumes of admitted patients awaiting beds in the Emergency Department (1). Studies have shown that ED overcrowding delays care for all patients, increases length of stay, and reduces overall quality of care (2). Contributing to this are potentially unnecessary floor admissions. With the […]

Background: Tertiary hospitals and academic medical centers often operate near full capacity while smaller community hospitals have difficulty filling open beds. At our institution, a program was set up to transfer lower acuity patients needing admission from the emergency department of an academic medical center to a community partner hospital for direct admission. This and […]