Lakeland Hospitals at Niles and St. Joseph are located in Southwestern Michigan. Our hospital joined the HMS Collaborative in 2015. Our HMS team includes Dr. Stephen Hempel as physician champion, Debra Wolf as our quality administrative lead, and Amy Jonatzke as the clinical data abstractor. Doctors Michael Morris, and Michael Wang are also involved with the HMS related work. We have implemented the following quality initiatives related to HMS to improve the quality of care for hospitalized medical patients. Ensure patients have a VTE risk assessment completed and documented upon admission, to help in selection of appropriate VTE prevention measures. Ensure patients receiving a PICC have a documented indication for PICC placement. Reduced PICC lumen size by eliminating PICC's with lumens greater than 5 French. Vascular access nurses have been trained on insertion of midlines and ultrasound guided peripheral IV placement, to help ensure patients are receiving the appropriate device.