Background Third year internal medicine residents participating in a quality improvement rotation identified gaps between the Joint Commission’s ORYX quality guidelines and clinical practices for the inpatient management of heart failure (HF) at the William S. Middleton Memorial Veterans Hospital. Residents focused on the performance metrics associated with tobacco cessation counseling documentation, ejection fraction assessment, and angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) prescriptions. Methods After analyzing data collected by the External Peer Review Program (EPRP), residents reviewed the institution’s admissions and discharge processes with the aim of improving quality and compliance. In redesigning these processes, residents created an admissions template and a discharge face sheet and compared specific ORYX measure compliance rates before and after institution-wide implementation. Results Following implementation of the tobacco cessation admissions template, 100% of HF patients who used tobacco received documented cessation counseling, compared with 59% prior to intervention (p<0.01, n=32). Following implementation of the mandatory discharge face sheet, 97% of HF patients (compared with 92% pre-intervention, p>0.05) received comprehensive discharge instruction; LV function assessment went from 98% to 100% (p>0.05); and ACEI/ARB prescription for left ventricular systolic dysfunction at discharge (or documentation of a contra-indication) went from 82% to 100% (p<0.01, n=48). Discussion By implementing a standardized admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality performance measures. By strengthening residents’ learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care.

Type 2 diabetes has become a leading cause of morbidity and mortality world over. Magnesium homeostasis has been hypothesized to be a link between insulin resistance type 2 diabetes mellitus, hypertension and CAD. This study was under taken to evaluate the relationship between serum magnesium and diabetes mellitus without and with complications. We found significantly low levels of serum magnesium in patients with DM when compared to control. Further significantly low levels of serum magnesium were found in patients with diabetic complications when compared with diabetic patients without complications. Hence it is concluded that the lower levels of serum magnesium may have a bearing on the complication and morbidity in patients of DM, and estimation of serum levels of magnesium may be helpful to monitor the severity of complications in diabetic patients.

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By implementing a standardised admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality-performance measures. By strengthening residents' learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care.