Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Clinical pathways are evidence-based guidelines adapted to local settings. They have been shown to improve patient outcomes and reduce resource utilization. However, it is unknown how physicians integrate clinical pathways into their clinical reasoning. ⋯ Clinical pathways are part of many clinicians' diagnostic processes. Pathways can standardize care, influence the diagnostic process, and express local institutional culture. Further research is required to ascertain the optimal clinical pathway design to augment and not inhibit the clinician's diagnostic process.
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Patterns in access to specialists among patients in skilled nursing facilities (SNFs) have not been previously described. ⋯ There is a racial/ethnic disparity in subspecialty follow-up after hospital discharge to SNF that is associated with a higher rate of subsequent ED visits by BIPOC patients.
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Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing. ⋯ We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.