Holiday Discharges Are Associated with Higher 30-Day General Internal Medicine Hospital Readmissions at an Academic Medical Center

Objective: Academic medical centers face unique challenges in educating physician trainees in effective discharge practices to prevent readmissions. Meanwhile, residents must handle high workloads coupled with frequent rotations to different services. This study aimed to determine whether daily service census, service turnover, time of discharge, and day of discharge...

Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina

Objectives: Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit bed capacity) for North Carolina overall and by region and population density. We also assessed daily trends in...

Curing Health Care by Adding Value: How About a Physical Examination?

New diagnostic technologies … telemedicine on your mobile phone … online portals for reviewing test results and scheduling appointments … electronic medical records … paperless physician’s office—these are cornerstones of the modern healthcare experience in the United States today, but are we really getting what we want? To know...

Patients’ Perceptions of the Role of Physicians in Questioning and Educating in Firearms Safety: Post-FOPA Repeal Era

Objectives: In this study, we determined patients’ attitudes toward discussing firearms and issues of firearms safety with emergency department physicians. We assessed whether patients feel discriminated against should physicians discuss firearms safety, and whether they believed that physician counseling may change how patients store firearms. Methods: From June to...

Outcomes and Predictors of Readmissions with GI Bleeding in Patients with Left Ventricular Assist Devices

Objectives: Gastrointestinal (GI) bleeding is a major comorbidity in patients with left ventricular assist devices (LVADs). The study aim was to estimate the rate of hospital readmissions for GI bleeding in patients with LVADs using a nationally representative database. Additionally, we evaluated the etiologies, costs, endoscopy utilization, mortality, and...

Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus

Objectives: This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs with those of PHP, enabling greater patient engagement focused on meeting individualized therapeutic goals...

OPEN: Expenditures and Quality: Hospital- and Health System–Affiliated Versus Independent Physicians in Virginia

Objectives: The American Medical Association has reported that 2016 was the first year in which fewer than half (47.1%) of all practicing physicians owned their own practice. Across the United States, there has been consolidation of physicians and hospital and health systems, resulting in questions about the effect of...

Some Thoughts on Implementing Remote Telehealth

The Department of Veterans Affairs (VA) has had a major focus on increasing access to care, including by use of telehealth. Telehealth technology has been used in direct patient care by numerous VA providers, up to and including the cabinet secretary in charge of the agency.1 The potential of...

Is It “In” to Wear Scrubs Out?

Objective: This study aimed to identify differences in perceptions between healthcare and non-healthcare personnel when it comes to wearing scrubs in non-healthcare settings. Methods: An anonymous survey with 11 closed-ended questions sent via e-mail to healthcare students and employees at The University of Texas Health San Antonio and non-healthcare...

Cost-Effectiveness Analysis of Early vs Late Diagnosis of HIV-Infected Patients in South Carolina

Objectives: It is anticipated that early diagnosis, linkage to care, initiation of antiretroviral therapy (ART), and retention in care would lead to reduced opportunistic infections, reduction in human immunodeficiency virus–related morbidity and mortality and reduced rates of HIV transmission. This would be expected to lead to a reduction in...

Patients’ Perceptions of Bedside Rounding

Objectives: Concerns regarding lack of privacy, poor patient understanding, and physician discomfort have led to a decline in rounding at the bedside. Our project explored patient perceptions of the implementation and value of bedside rounding. Methods: This mixed-methods study used semi-structured qualitative interviews and a five-item Likert survey, which...

Measuring Functional Status in Hospitalized Older Adults Through Electronic Health Record Documentation

Objectives: Hospitalization-associated disability affects up to 60% of older adults; however, standardized measures of function are not routinely used and documented. We sought to determine whether nursing documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes. Methods: A retrospective study of 2383...

Hospital Readmission Rates Following AMI: Potential Interventions to Improve Efficiency

Objectives: Quality of care utilization measures for patients admitted to the hospital with an acute myocardial infarction (AMI) include length of stay (LOS) and 30-day readmission rates. Our aim was to test whether efforts resulting in reduced LOS in patients diagnosed as having AMI would result in a higher...

Implementation of a New Guideline and Educational Sessions to Reduce Low-Value Continuous Pulse Oximetry Among Hospitalized Patients

Objectives: The use of continuous pulse oximetry (CPOX) is ubiquitous among hospitalized patients, despite limited evidence that it improves clinical outcomes. The objective of this study was to reduce the use of CPOX among hospitalized patients in the nonintensive care unit and nonprogressive care unit settings. Methods: This interventional...

Reducing the Time Spent Writing Notes Could Help Solve the Physician Shortage

To the Editor: There is concern about physician shortages, with estimates of primary care physician shortages of 44,000,1 46,000,2 or 52,0003 by the year...

Commentary on “Internal Medicine Hospitalists’ Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures”

Osteoporotic hip fractures are a public health concern in the United States. The potential sequelae of a hip fracture are far reaching and can lead to a state of chronic pain, functional dependence, diminished quality of life, increased cost burden, and premature death. A patient’s chance of a second...

Internal Medicine Hospitalists’ Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures

Objectives: Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and...

Dramatic Reduction in 30-Day Readmissions Through High-Risk Screening and Two-Phase Interdisciplinary Care

Objectives: Thirty-day readmissions are common, serious, and costly. Most important, often they are preventable. The purpose of this quality improvement study was to evaluate an interdisciplinary, two-phase intervention to reduce 30-day readmissions among high-risk medical patients. One or two high-risk patients were selected each weekday by a hospitalist using...

Healthcare Utilization by Frail, Community-Dwelling Older Veterans: A 1-Year Follow-up Study

Objectives: Frailty is a prevalent clinical syndrome associated with a high risk of adverse health outcomes, including disability, morbidity, and mortality, that has become a major challenge for the healthcare system. The aim of this prospective study was to determine the level of healthcare utilization in prefrail and frail...

The “Hand-in” Project: Jump-starting Communication Between Inpatient and Outpatient Providers

Objectives: Communication between hospitalists and primary care providers (PCPs) upon discharge has been much discussed, but the transition from outpatient to inpatient has received less attention. We questioned whether a brief, standardized e-mail from the hospitalist to the PCP upon admission could facilitate information exchange, increase communication, elucidate PCP...