Prevalence of Discordant Procalcitonin Use at an Academic Medical Center.

Objectives: Despite multiple trials demonstrating that procalcitonin (PCT) is an effective tool for antibiotic stewardship, inconsistent application in real-world settings continues to fuel controversy regarding its clinical utility. We sought to determine rates of concordance between PCT results and antibiotic prescribing in hospitalized patients.

Methods: We performed a retrospective review of all inpatient encounters at an academic tertiary care health system with a PCT result between February 2017 and October 2019.

The Effect of Clostridioides difficile Diagnostic Stewardship Interventions on the Diagnosis of Hospital-Onset Clostridioides difficile Infections.

Background: Public reporting of Clostridioides difficile infection (CDI) using laboratory-identified events has led some institutions to revert from molecular-based tests to less sensitive testing modalities. At one academic medical center, researchers chose to use nucleic acid amplification test alone in CDI diagnosis with institutional protocols aimed at diagnostic stewardship.

Methods: A single-center, quasi-experimental study was conducted to introduce and analyze the effects of various diagnostic stewardship interventions.

UC Care Check-A Postoperative Neurosurgery Operating Room Checklist: An Interrupted Time Series Study.

Background: The effectiveness of neurosurgical operating room (OR) checklists to improve communication, safety attitudes, and clinical outcomes is uncertain.

Purpose: To develop, implement, and evaluate a post-operative neurosurgery operating room checklist.

Methods: Four large academic medical centers participated in this study.

Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers.

Background An organization's ability to identify and learn from opportunities for improvement (OFI) is key to increasing diagnostic safety. Many lack effective processes required to capitalize on these learning opportunities. We describe two parallel attempts at creating such a process and identifying generalizable lessons and learn from them.

The Impact of Unmet Communication and Education Needs on Neurosurgical Patient and Caregiver Experiences of Care: A Qualitative Exploratory Analysis.

Objective: To describe neurosurgical patient and caregiver perceptions of provider communication, the impact of patient education, and their understanding of information given to them throughout the neurosurgical care trajectory.

Methods: We organized focus groups composed of patients who had been hospitalized on the neurosurgical service at 5 urban academic tertiary referral hospitals within a large university health system, along with the patients' caregivers. During focus groups, we used semistructured questions to answer the study questions.

Evaluation of the Yale New Haven Readmission Risk Score for Pneumonia in a General Hospital Population.

Background: The Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission.

Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling.

Introduction: Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e.

Features of successful academic hospitalist programs: Insights from the SCHOLAR (SuCcessful HOspitaLists in academics and research) project.

Background: As clinical demands increase, understanding the features that allow academic hospital medicine programs (AHPs) to thrive has become increasingly important.

Objective: To develop and validate a quantifiable definition of academic success for AHPs.

Methods: A working group of academic hospitalists was formed.

Nicotine patches and quitline counseling to help hospitalized smokers stay quit: study protocol for a randomized controlled trial.

Background: Hospitalized smokers often quit smoking, voluntarily or involuntarily; most relapse soon after discharge. Extended follow-up counseling can help prevent relapse. However, it is difficult for hospitals to provide follow-up and smokers rarely leave the hospital with quitting aids (for example, nicotine patches).

Practice patterns for antibiotic de-escalation in culture-negative healthcare-associated pneumonia.

Background: Published guidelines for the treatment of healthcare-associated pneumonia (HCAP) recommend initial broad-spectrum antibiotics with appropriate de-escalation based on culture results. Guideline recommendations are based on data from intubated patients, in whom cultures are easily obtained. The approach to antibiotic de-escalation for culture-negative patients has not been addressed.

The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia.

Background: Health care-associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community-acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug-resistant organisms, and appropriate initial antibiotic therapy is associated with reduced mortality.

Methods: An online survey was distributed to faculty and housestaff at 4 academic medical centers.

Clinical judgment versus the Pneumonia Severity Index in making the admission decision.

The Pneumonia Severity Index (PSI) is a validated risk assessment tool for patients with community-acquired pneumonia (CAP). Guidelines endorse outpatient treatment for patients deemed low risk, but experience shows that such patients are frequently hospitalized. We investigated the limitations of the PSI as a triage tool by examining outcomes in patients whose disposition from the Emergency Department differed from that predicted by the PSI.

The many faces of error disclosure: a common set of elements and a definition.

Background: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed.

Community-acquired pneumonia: defining quality care.

Background: Community-acquired pneumonia (CAP) is one of 3 initial conditions for which the Joint Commission for Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services have defined quality measures. Eight "core measures" of pneumonia care have been targeted for reporting by U.S.

Cost-effectiveness evaluation of measles immunization strategies on a college campus.

Since live rubeola vaccine became available in 1963, routine immunization of children at age 15 months has been the recommended strategy for eliminating measles in the United States. However, due to increasing measles outbreaks, especially among previously immunized populations, the Immunization Practices Advisory Committee (ACIP) recently recommended modifying the one-dose measles vaccination policy to a two-dose schedule, one at 15 months and one at age 5 or 6 years. To address the present college population, ACIP recommended vaccinating all college students who lack proof of immunity.