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: In 2019, Banner Health innovated by launching Cultivating Happiness in Medicine (CHIM), which was Banner’s commitment to supporting physician and APP well-being and reducing burnout. The CHIM strategy is evidence-based, physician and APP driven, and holistic, supporting clinicians from individual wellness and organizational workplace environment perspectives. The six dimensions of the strategy include the [...]

Background: In the ever-evolving field of healthcare, the need for physicians to understand cost considerations is paramount. Cultivating cost awareness among residents is critical as residents play a pivotal role in shaping the future of medicine. However, the incorporation of cost-consciousness into medical education remains a challenge, often overshadowed by clinical priorities. By examining current [...]

Background: Kidney injury significantly reduces renal clearance, posing unique challenges for patients with type II diabetes, particularly those on insulin. This reduced clearance can lead to elevated insulin levels, increasing the risk of hypoglycemia and subsequent complications, which often extend the patient’s length of stay (LOS). Chronic kidney disease (CKD) itself is an independent risk [...]

Background: Social determinants of health (SDOH) play a critical role in predicting hospital readmission rates across various patient populations. Key SDOH factors, such as neighborhood crime index, income, and household size, are important predictors of unplanned readmissionsi. Importantly, including SDOH in readmission prediction models has been shown to improve accuracyii, highlighting the need for addressing [...]

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: For more than a decade, researchers and institutions have been exploring the phenomenon of “high utilizers” – a small percentage of the population that accounts for a disproportionate amount of healthcare spending, often through frequent and/or lengthy hospitalizations. There is very little information, however, on how this population’s needs affect those who provide care [...]

Background: Discharging complex patients at an academic tertiary care center requires comprehensive evaluation, interprofessional coordination, and meticulous planning to address what is needed to ensure safe and timely discharges. Misalignment across care team members on discharge needs and barriers can lead to a delayed discharge which may result in poor patient satisfaction, increased task burden [...]