It was another exciting week here in Cincinnati as we kicked off grand rounds with a session on performance improvement during our quarterly leadership curriculum with Dr. McDonough and discussed alternatives to hospital admission and available outpatient resources in the era of high boarding with our Chair, Dr. Pancioli. We finished our day with an excellent discussion on prenatal mental health care with Dr. Wolochatiuk in her R4 Case Follow Up and on uncommon causes of disorientation in Dr. Zalesky’s Taming the SRU lecture.