Clostridium difficile infection (CDI) is the most common cause of healthcare-associated infection (HAI) in acute care facilities, and accounts for nearly 500,000 infections and 29,000 deaths in the United States annually. In addition, the economic burden of CDI is also high, with annual CDI-related health care costs in the U.S. as much as $5 billion for acute care facilities alone.[1] Along with other HAIs, many CDIs are generally considered preventable adverse events, and thus represent abundant opportunities for intervention.

We have developed a novel electronic dashboard that provides real-time feedback on inpatient clinical performance and are currently testing its ability to change physician behavior with a randomized control trial. We propose expanding the capabilities of the dashboard and the scope of the randomized control trial.

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Background:   Pneumocystis pneumonia (PCP) is a dreaded complication in immunocompromised patients, associated with significant morbidity and mortality.  Because the risk of severe adverse events related to trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis is estimated at ~3.1%, patients should only receive PCP prophylaxis when the projected risk of PCP exceeds 3.5% in a population of patients like them, but data around appropriate PCP prophylaxis is sparse and provider practices are widely variable.

Background: Avoiding repeated complete blood count (CBC) tests in the face of clinical and lab stability is a focus of the Choosing Wisely initiatives endorsed by the Society of Hospital Medicine. While the concept is sound, few data exist to define which patients’ care is least likely to benefit from repeat CBC testing.