The Impact of a Machine Learning Early Warning Score on Hospital Mortality: A Multicenter Clinical Intervention Trial.

Objectives: To determine the impact of a machine learning early warning risk score, electronic Cardiac Arrest Risk Triage (eCART), on mortality for elevated-risk adult inpatients.

Design: A pragmatic pre- and post-intervention study conducted over the same 10-month period in 2 consecutive years.

Setting: Four-hospital community-academic health system.

Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch.

Objective: We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol.

Methods: This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021.

An operationally implementable model for predicting the effects of an infectious disease on a comprehensive regional healthcare system.

An operationally implementable predictive model has been developed to forecast the number of COVID-19 infections in the patient population, hospital floor and ICU censuses, ventilator and related supply chain demand. The model is intended for clinical, operational, financial and supply chain leaders and executives of a comprehensive healthcare system responsible for making decisions that depend on epidemiological contingencies. This paper describes the model that was implemented at NorthShore University HealthSystem and is applicable to any communicable disease whose risk of reinfection for the duration of the pandemic is negligible.

Safe Transitions and Congregate Living in the Age of COVID-19: A Retrospective Cohort Study.

Background: COVID-19 represents a grave risk to residents in skilled nursing facilities (SNFs).

Objective: To determine whether establishment of an appropriate-use committee was associated with a reduction in SNF utilization.

Designs, Setting, And Participants: Retrospective cohort study at NorthShore University HealthSystem, a multihospital integrated health system in northern Illinois.

Clinical Analytics Prediction Engine (CAPE): Development, electronic health record integration and prospective validation of hospital mortality, 180-day mortality and 30-day readmission risk prediction models.

Background: Numerous predictive models in the literature stratify patients by risk of mortality and readmission. Few prediction models have been developed to optimize impact while sustaining sufficient performance.

Objective: We aimed to derive models for hospital mortality, 180-day mortality and 30-day readmission, implement these models within our electronic health record and prospectively validate these models for use across an entire health system.

Spinal and paraspinal fungal infections associated with contaminated methylprednisolone injections.

Background: A nationwide outbreak of fungal infections was traced to injection of Exserohilum-contaminated methylprednisolone. We describe our experience with patients who developed spinal or paraspinal infection after injection of contaminated methylprednisolone.

Methods: Data were assembled from the Michigan Department of Community Health, electronic medical records, and magnetic resonance imaging (MRI) reports.

Implementation of a mortality prediction rule for real-time decision making: feasibility and validity.

Background: A previously published, retrospectively derived prediction rule for death within 30 days of hospital admission has the potential to launch parallel interdisciplinary team activities. Whether or not patient care improves will depend on the validity of prospectively generated predictions, and the feasibility of generating them on demand for a critical proportion of inpatients.

Objective: To determine the feasibility of generating mortality predictions on admission and to validate their accuracy using the scoring weights of the retrospective rule.

Project BOOST implementation: lessons learned.

Objectives: Enhancing care coordination and reducing hospital readmissions have been a focus of multiple quality improvement (QI) initiatives. Project BOOST (Better Outcomes by Optimizing Safe Transitions) aims to enhance the discharge transition from hospital to home. Previous research indicates that QI initiatives originating externally often face difficulties gaining momentum or effecting lasting change in a hospital.

Who Signs Up for and Engages in a Peer Support Heart Failure Self-management Intervention.

Background: Many programs for patients with heart failure (HF) fail to improve clinical outcomes in part because of low rates of patient enrollment and engagement. A better understanding of patient characteristics associated with willingness to enroll and then engage in HF self-management programs will improve the design and targeting of programs.

Methods And Results: Analyses of screening, baseline, and engagement data from a randomized controlled effectiveness trial of an HF peer self-management support program were conducted.

Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization.

Background: Rehospitalization is a prominent target for healthcare quality improvement and performance-based reimbursement. The generalizability of existing evidence on best practices is unknown.

Objective: To determine the effect of Project BOOST (Better Outcomes for Older adults through Safe Transitions) on rehospitalization rates and length of stay.

Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate.

Importance: Injection of contaminated methylprednisolone has resulted in an unprecedented nationwide outbreak of Exserohilum rostratum fungal infections, manifested initially as meningitis and/or basilar stroke. Insidious onset of spinal or paraspinal infection at the injection site has been increasingly reported and is occurring months after receipt of injection with the contaminated drug. The clinical findings are often subtle and similar to those that led the patient to undergo the methylprednisolone injection.

Randomized controlled effectiveness trial of reciprocal peer support in heart failure.

Background: Although disease management programs for patients hospitalized with heart failure (HF) are effective, they are, however, often resource intensive, limiting their uptake. Peer support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for patients with HF.

Methods And Results: In this randomized controlled trial, reciprocal peer support (RPS) arm patients participated in a HF nurse practitioner-led goal setting group session, received brief training in peer communication skills, and were paired with another participant in their cohort with whom they were encouraged to talk weekly using a telephone platform.

Mortality predictions on admission as a context for organizing care activities.

Background: Favorable health outcomes are more likely to occur when the clinical team recognizes patients at risk and intervenes in consort. Prediction rules can identify high-risk subsets, but the availability of multiple rules for various conditions present implementation and assimilation challenges.

Methods: A prediction rule for 30-day mortality at the beginning of the hospitalization was derived in a retrospective cohort of adult inpatients from a community hospital in the Midwestern United States from 2008 to 2009, using clinical laboratory values, past medical history, and diagnoses present on admission.

Evaluation of the B-SAFE campaign to reduce clinically significant warfarin-drug interactions among fee-for-service Medicare beneficiaries.

The objective of this study was to evaluate the effectiveness of a health communication campaign designed to reduce the rate of serious warfarin-related drug interactions. The B-SAFE campaign was conducted in 2009 to educate patients located in a Michigan hospital's service area about the risk of serious adverse drug events associated with warfarin. The rate of warfarin-related drug interactions among Medicare fee-for-service (FFS) patients admitted to the exposed hospital with hemorrhagic complications was compared with the rate of warfarin-related drug interactions among a similar cohort admitted to a control hospital before and after the campaign.

Making inpatient medication reconciliation patient centered, clinically relevant, and implementable: a consensus statement on key principles and necessary first steps.

This white paper identifies potential solutions to help ensure the utility and sustainability of this critical patient safety issue.

Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps.

Medication errors and adverse events caused by them are common during and after a hospitalization. The impact of these events on patient welfare and the financial burden, both to the patient and the healthcare system, are significant. In 2005, The Joint Commission put forth medication reconciliation as National Patient Safety Goal (NPSG) No.

Hospitals during recession and recovery: vulnerable institutions and quality at risk.

For generations, American hospitals have been considered recession-proof, but there is reason to believe the current economic crisis is an exception. Hospitals have shown declining financial margins and decreased admissions. The severe recession has adversely affected many hospitals' finances, creating a risk of closure and constraining plans for expansion.

Hospitalist handoffs: a systematic review and task force recommendations.

Background: Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety.

Purpose: To develop recommendations for hospitalist handoffs during shift change and service change.

Data Sources: PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies.

Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting.

Background: The status of implementation of medication reconciliation across hospitals is variable to date; the degree to which hospitalists are involved is not known.

Methods: To better describe the current state of medication reconciliation implementation, we conducted a survey of attendees of the 2006 Society of Hospital Medicine national meeting.

Results: We identified a lack of uniformity across hospitals with respect to the degree of process implementation.

Organizational structure for addressing the attributes of the ideal healthcare delivery system.

The Institute of Medicine's (IOM) report Crossing the Quality Chasm described the aims, characteristics, and components of the ideal healthcare system but did not provide the templates of organizational structures needed to achieve this vision. In this article, we review three principles of effective organizations to inform the design of a facilitative clinical care structure: a focus on the patient and caregiving team, the use of information, and connectivity with executive and operational leadership. These concepts can be realized in an organizational chart that is inverted to place patients and their care providers on top, flat with few degrees of separation between patients and executive leadership, and webbed to reflect connections to the professional and ancillary departments.

Increases in Medicare prescription drug plan costs attributable to psychotropic medications.

Objective: Older patients may regard some medications, particularly psychotropic medications, as discretionary compared with what they perceive as more "essential " nonpsychiatric medications. Patients' concerns about psychotropic medication costs under Medicare Part D may reinforce these impressions.

Design: The authors examined which Medicare prescription drug plans (PDPs) would be least expensive for beneficiaries considering the costs of 1) all medications; and 2) only nonpsychiatric medications.