Background: Transitions of care, including Inter-Hospital Transfers (IHT), are known to be a period of elevated risk in patient care. Patients who are transferred via the IHT process face a higher inpatient mortality rate than patients who are not admitted via the IHT process1 as well as higher costs, longer length of stay, and lower […]

Background: Transitions of care from one service to another are a precarious time with risk of adverse events, medical errors, and clinician dissatisfaction. Every handoff involves transferring information and responsibility for a patient from one physician to another. The appropriateness of transfer is critical to safe patient care. The transfer process from an intensive care […]

Background: Emergency room crowding has been proven to lead to poor outcomes (e.g., mortality) and has worsened during the COVID-19 pandemic. Novel clinics that work collaboratively with emergency departments (ED) to transfer lower acuity patients to receive care in ambulatory settings rather than the ED have emerged. Our innovative ED Surge program cares for these […]

Background: Early introduction of palliative care for medically complex patients can improve patient-centered outcomes. Yet, little is known about how to address these issues as patients are cared for by multiple teams in multiple care settings between hospital, home health care and primary care. Here we highlight clinician perspectives about introducing palliative care in the […]

Background: Since early 2020, the entire world has been enveloped within the COVID-19 pandemic. As research surrounding healthcare processes during the pandemic has surged, little has been studied regarding the pandemic’s impact on home-healthcare agencies (HHA). Previous research during the 2009 H1N1 pandemic found varied pandemic preparedness among HHAs. Therefore, this study aims to understand […]

Background: While hospitals are primarily designed to provide acute care, a subset of patients have prolonged lengths of stay beyond medical necessity for months on general medicine wards[1]. These cases often occur in vulnerable patient populations, including those with mental health and substance use disorders[2], impaired decision-making capacity[3, 4], and housing insecurity[3]. However, few studies […]

Background: The hospital discharge represents a time-dependent and vulnerable chapter in the patient pathway. Approximately one-fifth of hospital discharges suffer delays due to non-medical reasons with one major factor being inadequate assessment and recognition of barriers to discharge when first admitted. Promising work in the existing literature demonstrates a relationship between a measure of patient’s […]

Background: The recent passage of the 21st Century Cures Act “open notes” mandate underscores the central role of patient portals in the healthcare system. Additionally, the use of patient portals such as MyChart has been associated with greater patient engagement and improved health outcomes[1]. At our institution, we aimed to characterize the patient demographics associated […]

Background: The inter-hospital transfer process is complex even under ideal circumstances, susceptible to logistical errors, inefficiencies, and patient harm. Clinical hospitalists have historically been responsible for triage of all Medicine transfers at Oregon Health and Science University (OHSU), fielding 10-20 calls daily alongside clinical and educational responsibilities. In part due to time constraints during triage, […]

Background: Previous studies have documented discriminatory refusals from post-acute care facilities related to opioid use disorder or opioid agonist therapy, however the impact of inability to secure skilled nursing facility (SNF) placement for patients with any substance use disorder (SUD) has not been fully explored. The objective of this study is to measure the odds […]