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...

World Hypertension Day

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...

On “Direct to Physician Journal Marketing”

To the Editor: An interesting threefold (by my observation) phenomenon is under way in the medical publication field: an explosion of new journals around the world that are pure ‘‘pay to publish’’ (ie, Open Access) as the business model; direct-to-physician invitations to join the new journals’ editorial boards; and...

Commentary on “Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure”

The rising cost of health care has been a problem in the United States for decades. As our population ages, healthcare costs continue to rise, becoming increasingly burdensome for our...

Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure

Objectives: Consultation is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consultation on hospital outcomes and resource utilization in CHF is unknown. The objectives of our study were to determine the effect of consultation on outcomes in CHF...

Can Computers Be Made to Respect the Art of Medicine?

To the Editor: One of the common criticisms of the application of automated medical decision pathways is that although they may yield the correct answer in the case of straightforward clinical presentations, they fail to capture the nuances of more complex scenarios in which human clinical judgment and the...

Dissemination Approaches to Participating Primary Care Providers in a Quality Improvement Program Addressing Opioid Use in Central Appalachia

Objectives: Practice-based research networks (PBRNs) have been described as new clinical laboratories for primary care research and dissemination. PBRNs, however, have struggled to disseminate research results in a meaningful way to participating providers and clinics. Methods: The Central Appalachia Inter-Professional Pain Education Collaborative was developed to work with PBRN...

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity

Objectives: To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. Methods: All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention)...