The phenomenon of a patient missing a medical appointment without notification is called a “no-show”. In contrast, “non-utilized appointments” are a broader phenomenon including all appointments that didn’t occur as registered – whether due to actions taken by providers or patients. Both no-shows and non-utilized appointments can lead to reduced quality of care, loss in productivity, financial losses and impaired patient outcomes. The study was carried out between August 2016 and January 2017 in the ENT, Orthopedics and General Surgery Departments of the Jerusalem-based Shaare Zedek Medical Center. The study team sought to examine the reasons for non-utilized appointments in elective operations. The study team also interviewed no-show ambulatory care patients regarding the causes of the no-show and reviewed medical records of no-show patients to determine the nature of the missed appointments. The rate of non-utilization of appointments for elective operations was 6%. The leading reasons for non-utilization of these appointments were: patient health issues, patient surgery postponement and surgery schedule overload (together accounting for 52% of cases and 72% of known reasons). The no-show rate for ambulatory clinic appointments was approximately 15%. The leading reasons for ambulatory clinic no-shows were: administrative issues, illness and forgetfulness (together accounting for 58% of all reasons). The leading types of appointments missed were:post-operation follow-ups and chronic illness follow-up (together accounting for 46% of cases and 63% of known reasons). In this study, the non-utilized appointment rate for elective operations was found to be lower than those noted in the medical literature, while the no-show rate for ambulatory visits was found to be similar to that found in the literature. There is room to question the necessity of certain types of postoperative follow-up appointments since they are at “high risk” for no-show. One promising way to reduce the no-show rate would involve improving the hospital’s information and computing systems in order to identify patients who are susceptible to a no-show incident.

Faced with a national blood culture bottle shortage, our institution formed a multidisciplinary stewardship team and implemented policy changes. This reduced orders by 60%, potentially saving $145,000 monthly, while maintaining stable in-hospital sepsis mortality rates.

Background: Empiric antibiotic selection for complicated urinary tract infections (cUTIs) is increasingly complex due to the rising prevalence of multidrug-resistant organisms. We conducted a network meta-analysis (NMA) to compare clinical efficacy and safety among existing empiric treatment options. Methods: We performed a frequentist random-effects NMA of randomized controlled trials evaluating single-agent empiric regimens for adults with cUTIs. The primary endpoints were clinical response (CR), microbiological response, and serious adverse events (AEs). Ceftriaxone served as the common comparator. Results: Forty-seven trials were identified through a systematic search. In the primary analysis of 17 studies published after the year 2000, evaluating agents currently accessible in the United States, in which baseline ceftriaxone non-susceptibility among Enterobacterales averaged approximately 15%. Ceftriaxone demonstrated CR rates comparable to broader-spectrum alternatives. Although some agents achieved higher microbiological eradication, these differences did not translate into superior clinical cure rates. Safety profiles were stable across antibiotic classes, with no significant differences in serious AEs compared to cephalosporins. Conclusions: Ceftriaxone remains an effective empiric option for hemodynamically stable adults with cUTIs in settings with comparable resistance prevalence. These findings provide evidence to support antimicrobial stewardship efforts that prioritize narrower-spectrum agents, preserving broader-spectrum therapies for patients at highest risk for resistant pathogens.

Following a global 2024 blood culture bottle shortage, we implemented a multidisciplinary stewardship intervention to reduce utilization. Upon supply normalization in 2025, a durable 34.8% reduction in utilization was maintained without increasing sepsis-related mortality, demonstrating that crisis-driven shifts can successfully establish a sustainable “new steady state.”