St. John Macomb-Oakland Hospital is a 376 bed facility located in Warren, Michigan. Our hospital joined the HMS collaborative in 2012. Our HMS team includes Dr. Dado as physician champion, Alexa Hodgins as our quality administrative lead, and Jenifer Kadlitz as the clinical data abstractor. Drs. Berg and Johnson are also involved with the HMS-related work as well as MLP Jodi Zych, PA. We have implemented the following initiatives related to HMS to improve the quality of care for hospitalized medical patients: Continuous auditing of VTE/PE appropriateness and compliance of ordering and use, Creating assistive physician ordering tool to ensure proper level of VTE prophylaxis on admission. Working on IT fix for when a PICC is being ordered to reduce the number of multi-lumen PICCs, PICCs less than 5 days, and PICCs placed in Nephrology patients with eGFR <45.