Up to 25% of patients with ulcerative colitis (UC) will require hospitalization for severe disease, resulting in over 36,000 annual UC-related hospitalizations in the U.S. Hospitalization is a high-stakes, vulnerable event in a patient’s disease course. Disease severity of this magnitude increases the risk of colectomy and venous thromboembolism, and usually commits the patient to both a corticosteroid course and biologic therapy with the associated side effects and risks. Although inpatient quality measures and evidence-based management recommendations exist, there is variation in care delivery at our institution (Table 1).