#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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See #JHMChat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Society of Hospital Medicine @SocietyHospMed #JHMChat starts NOW! Join the conversation, then claim #CME: https://t.co/sirVSBHa9C https://t.co/g03rOkjfgu |
 | Journal of Hospital Medicine @JHospMedicine Don't forget to tag your tweets with #JHMChat so everyone can follow along. Topic 1 up in a moment… |
 | Tony Breu @tony_breu Tony, here from just-south-of-Boston. Excited for the discussion. #JHMChat |
 | Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat covering @futuredoc's recent article on sleep in hospitalized patients. Go ahead and introduce yourself while we wait for other to join in. Tonight's topic summarized here via @gracefarris https://t.co/DDUzZGlP9t |
 | Chris Petrilli, MD, SFHM @PetrilliMD RT @JHospMedicine: Don't forget to tag your tweets with #JHMChat so everyone can follow along. Topic 1 up in a moment… |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat starts NOW! Join the conversation, then claim #CME: #JHMChat starts NOW! Join the conversation, then claim #CME: https://t.co/sirVSBHa9C https://t.co/g03rOkjfgu |
| Chris Petrilli, MD, SFHM @PetrilliMD #JHMCHat @PetrilliMD reporting for duty. |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Don't forget to tag your tweets with #JHMChat so everyone can follow along. Topic 1 up in a moment… |
 | Jennifer Caputo-Seidler, MD @jennifermcaputo @JHospMedicine @WrayCharles @Futuredoc @gracefarris Jen from Tampa, fear I may be the only one not frozen tonight #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Greetings from Chi-beria where the temperature is dropping fast. so excited to be here to talk #siesta with #jhmchat friends https://t.co/IosBRrQtXW |
 | Med Peds Hospitalist @medpedshosp @JHospMedicine @WrayCharles @Futuredoc @gracefarris @ClevelandClinic @CleClinicMD #JHMChat |
 | Anika Kumar, MD (she/her) @freckledpedidoc Anika Kumar from Cleveland! #JHMChat |
 | Robert J. Mahoney, MD @mahoneyr @JHospMedicine @WrayCharles @Futuredoc @gracefarris Delighted for the chance to join #JHMCHat - hospitalist in progressively colder St. Louis, Missouri |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @JHospMedicine: TONIGHT at 9PM EST, #JHMChat covers #Sleep, #MedEd, and #BehavioralNudges all in one. Join as we chat w/@FutureDocs about their recent study: SIESTA (Sleep for Inpatients: Empowering Staff to Act). https://t.co/Hp2ju2OwMB. Graphic art by our own @gracefarris https://t.co/m20B1HX1P8 |
| Journal of Hospital Medicine @JHospMedicine Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight. Register now for CME --> https://t.co/0wO2swZq87 |
 | Kshitij Thakur, MD, MSc @KshitijThakurMD Kshitij from Lexington, Kentucky. #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @JHospMedicine: Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight. Register now for CME --> https://t.co/0wO2swZq87 |
| Vinny Arora MD MAPP @FutureDocs I should my coauthors @klknut and @jaybalachandran from #sleep community are virtually out there but dealing with bedtimes. in our house, school if out tomorrow so #sleep is not happening right now ironically. #jhmchat |
| Tony Breu @tony_breu Every night. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight. Register now for CME --> https://t.co/0wO2swZq87 |
| Journal of Hospital Medicine @JHospMedicine It wouldn't be a #JHMChat without the insightful and creative @gracefarris... |
| Tony Breu @tony_breu Opposite of #siesta #JHMChat |
 | Nancy H. Stewart, DO, MS (she/her) @nvhstewart Hi there! Nancy here from Omaha. #sleep #medicine fellow #JHMChat |
 | Viren Kaul, MD @virenkaul Viren from NYC! Looking forward to learning about the initiative and hear from the study authors! Well done. #JHMChat https://t.co/CoOHYMa7me |
| Journal of Hospital Medicine @JHospMedicine We welcome patients, family members, and all care providers tonight and look forward to hearing a diverse group of opinion and thoughts on tonight's #JHMChat |
 | The Blonde Broker @gracefarris @FutureDocs @klknut @jaybalachandran 😬sending my sympathies! #JHMChat |
 | Daniel Wolfson @WolfsonD #JHMchat excited to be on this chat - first of 2019. @AAN_Nursing part of #choosingwisely recommended not to wake patients unnecessarily. Sounds easy but it isn’t. A good night sleep has benefits. |
| Society of Hospital Medicine @SocietyHospMed You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
 | Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @JHospMedicine @WrayCharles @Futuredoc @gracefarris Jen, #PedsHM fellow from San Diego (also sending warm thoughts to those in colder climes) #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
| Journal of Hospital Medicine @JHospMedicine Let's get started with Topic 1 for tonight's #JHMChat: https://t.co/yFTEaWJLo0 |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: We welcome patients, family members, and all care providers tonight and look forward to hearing a diverse group of opinion and thoughts on tonight's #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @WolfsonD: #JHMchat excited to be on this chat - first of 2019. @AAN_Nursing part of #choosingwisely recommended not to wake patients unnecessarily. Sounds easy but it isn’t. A good night sleep has benefits. |
| Anika Kumar, MD (she/her) @freckledpedidoc RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
| Chris Petrilli, MD, SFHM @PetrilliMD Are any nurses on here? It’s easy for me to write “sleep protocol” but would love to hear their views on what makes them comfortable or not. Are there guidelines / policies that they use? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @ETSshow @gracefarris We're working on trying to make that happen... #JHMChat |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @JHospMedicine: Let's get started with Topic 1 for tonight's #JHMChat: Let's get started with Topic 1 for tonight's #JHMChat: https://t.co/yFTEaWJLo0 |
 | Chris Moriates, MD @ChrisMoriates Chris joining from 70degree Austin, TX (sorry, not sorry) #JHMChat |
| Society of Hospital Medicine @SocietyHospMed T1 is live - Click on #JHMChat to join in! |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @SHMLive: T1 is live - Click on #JHMChat to join in! |
| Vinny Arora MD MAPP @FutureDocs this struggle is real: when we were working with night nurses to improve #sleep for patients, they also ask for help on what they can do at home to help so we coach on that too #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @PetrilliMD: Are any nurses on here? It’s easy for me to write “sleep protocol” but would love to hear their views on what makes them comfortable or not. Are there guidelines / policies that they use? #JHMChat |
 | Mark Shapiro, MD @ETSshow Friends w/ #GIM and #JHMchat while we’re settling in, check out a Monday #MedThreads from the championship belt holder himself, @tony_breu! |
| Vinny Arora MD MAPP @FutureDocs @virenkaul thanks for being on! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
| Med Peds Hospitalist @medpedshosp A1 - mostly tremendous discomfort with uncertainty from trainees and nursing. Seems as if not getting VS or labs at 4AM we'll risk missing something relevant. Is a cultural thing. #JHMChat |
| Tony Breu @tony_breu I feel like it's gotta be overnight vital signs. #JHMChat |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine #JHMChat T1: on my 1st intern rotation, attending told me that since the patient was being admitted for Neuro issues, I had to wake up the pt every AM during pre-rounds to do a full Neuro exam, only to watch the fellows to do it again in rounds. Not a good culture to establish. |
| Robert J. Mahoney, MD @mahoneyr @JHospMedicine T1 For discussion - probably useful to distinguish between medically necessary interruptions and medically convenient interruptions #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @sucharitakher Welcome aboard, Sucharita! Glad you could join us #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
| Vinny Arora MD MAPP @FutureDocs RT @WolfsonD: #JHMchat excited to be on this chat - first of 2019. @AAN_Nursing part of #choosingwisely recommended not to wake patients unnecessarily. Sounds easy but it isn’t. A good night sleep has benefits. |
| Jennifer Caputo-Seidler, MD @jennifermcaputo @JHospMedicine Phlebotomy staffed primarily early am hours and high inpatient volume leading to radiology studies and dialysis being completed during overnight hours #JHMchat |
| Chris Petrilli, MD, SFHM @PetrilliMD @gracefarris #JHMChat @SL_Wallingford |
 | Michael Sinha @DrSinhaEsq RT @JHospMedicine: Too cold to leave the house tonight? Need CME? Join #JHMCHat at 9PM EST to discuss optimizing sleep in hospitalized patients w/@FutureDocs. https://t.co/Hp2ju2OwMB https://t.co/lMrwfCtFvq |
| Journal of Hospital Medicine @JHospMedicine @tony_breu What did you all find in this area @FutureDocs? I would have guessed the same thing, but believe you alls research showed otherwise...? #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @JHospMedicine A1: Similar to the study authors, we struggle with auto-populated #EPIC orders and labs, vitals etc occurring unnecessarily through the night #JHMChat #SIESTA |
| Mark Shapiro, MD @ETSshow Recognizing it’s even a problem that needs addressing #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine As a trainee, didn’t think I could defer doing the exam. Honestly, one of things I most looked forward to becoming an attending was not having to sneak into patient rooms to preround and accidentally waking up a patient, esp a crying baby. #JHMChat T1 |
| Chris Moriates, MD @ChrisMoriates RT @WolfsonD: #JHMchat excited to be on this chat - first of 2019. @AAN_Nursing part of #choosingwisely recommended not to wake patients unnecessarily. Sounds easy but it isn’t. A good night sleep has benefits. |
| Med Peds Hospitalist @medpedshosp @STangGirdwood @JHospMedicine Indeed. We need to revamp the culture. Create a paradigm shift #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Sadly, this is not an uncommon occurrence...#JHMChat |
| Vinny Arora MD MAPP @FutureDocs @WolfsonD @AAN_Nursing The nurses were definitely key to sustaining improvements in sleep. All were very excited to participate and improve sleep for their patients and we definitely led teaching with the #choosingwisely recommendation. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @ETSshow: Recognizing it’s even a problem that needs addressing #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc T1. I think in #Peds because children get ill very quickly there is hesitation. Although for many of my patients who are stable I’ve done Q8 vitals. I also worked at a hospital where standard floor vital signs were q4-q8. Depends on the hospital really. #JHMChat |
| Michael Sinha @DrSinhaEsq Hi #JHMChat, joining in from #Boston. Weather has been kind to us (so far)... https://t.co/zMY2wH4BhQ |
| Vinny Arora MD MAPP @FutureDocs RT @tony_breu: I feel like it's gotta be overnight vital signs. #JHMChat |
 | Rebecca Jaffe, MD @RJmdphilly RT @SHMLive: T1 is live - Click on #JHMChat to join in! |
| Journal of Hospital Medicine @JHospMedicine RT @STangGirdwood: @JHospMedicine #JHMChat T1: @JHospMedicine #JHMChat T1: on my 1st intern rotation, attending told me that since the patient was being admitted for Neuro issues, I had to wake up the pt every AM during pre-rounds to do a full Neuro exam, only to watch the fellows to do it again in rounds. Not a good culture to establish. |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @JHospMedicine T1 For discussion - probably useful to distinguish between medically necessary interruptions and medically convenient interruptions #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly RT @PetrilliMD: Are any nurses on here? It’s easy for me to write “sleep protocol” but would love to hear their views on what makes them comfortable or not. Are there guidelines / policies that they use? #JHMChat |
| Viren Kaul, MD @virenkaul @JHospMedicine Quite a few actually (not restricted to one institution!), more in ICUs these: 1. Buy in and implementation across settings (ICU vs floors) 2. Disturbance around rooms 3. Procedures 4. Distribution of nursing care 5. Visitation (sometimes/rarely) #JHMchat |
| Chris Moriates, MD @ChrisMoriates Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: @WolfsonD @AAN_Nursing The nurses were definitely key to sustaining improvements in sleep. All were very excited to participate and improve sleep for their patients and we definitely led teaching with the #choosingwisely recommendation. #JHMChat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD A1: Our goal to have all labs resulted by the time we start our day at 7am thus super early labs starting 3 am sometimes #JHMChat |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat |
| The Blonde Broker @gracefarris @FutureDocs @WolfsonD @AAN_Nursing What were nurses and staff most reluctant to leave behind? #JHMChat |
| Viren Kaul, MD @virenkaul @nvhstewart @JHospMedicine Thing is this was happening before the computer overlords too over our lives too!!! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs This was very interesting - #EHR automated bad human processes. Because our vitals were q4h, our EHR was autodefaulted and no one even knew that it could be changed until we started asking our IT folks. #jhmchat |
| Tony Breu @tony_breu @ChrisMoriates @FutureDocs And it didn't even require any second letter usages! #JHMChat |
| Jennifer Caputo-Seidler, MD @jennifermcaputo @freckledpedidoc Yes, my EMR has an option to write for vitals frequency as routine, seems like we could make floor policies more sleep friendly #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @jennifermcaputo @JHospMedicine Yes!! I think most institutions struggle with this! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat |
| Rebecca Jaffe, MD @RJmdphilly #JHMchat - Rebecca joining late in PHL. fingers crossed bed time will stick... |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @JHospMedicine T1: TBH, I don’t know if we’ve looked at it as an institution (yet). Anticipated issues incl meds (those asthmatics really do need q2-4 hr albuterol though), double rooms, alarms esp on CR monitors, and many kids may not be great sleepers anyway, esp babies 😪#jhmchat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD This is definitely very creative #SIESTA #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @tony_breu If you're outside of ICU and not getting a blood transfusion - how often do 2 AM vital signs change management? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @freckledpedidoc @JHospMedicine After 8 am, I don’t feel so bad, especially when the whole team is rounding together. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @virenkaul: @JHospMedicine Quite a few actually (not restricted to one institution!), more in ICUs these: 1. Buy in and implementation across settings (ICU vs floors) 2. Disturbance around rooms 3. Procedures 4. Distribution of nursing care 5. Visitation (sometimes/rarely) #JHMchat |
| Vinny Arora MD MAPP @FutureDocs yes this is very key. we used clinical judgment to determine who needed to be woken up since that seemed like an easy initial test. #jhmchat |
| Viren Kaul, MD @virenkaul RT @DrJenChen4kids: @JHospMedicine T1: @JHospMedicine T1: TBH, I don’t know if we’ve looked at it as an institution (yet). Anticipated issues incl meds (those asthmatics really do need q2-4 hr albuterol though), double rooms, alarms esp on CR monitors, and many kids may not be great sleepers anyway, esp babies 😪#jhmchat |
| Chris Petrilli, MD, SFHM @PetrilliMD @FutureDocs #JHMCHat we could just get everyone an @AppleSupport Watch |
| Med Peds Hospitalist @medpedshosp @FutureDocs We autodefaulted #ehr to our already flawed customs #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @STangGirdwood: @JHospMedicine #JHMChat T1: @JHospMedicine #JHMChat T1: on my 1st intern rotation, attending told me that since the patient was being admitted for Neuro issues, I had to wake up the pt every AM during pre-rounds to do a full Neuro exam, only to watch the fellows to do it again in rounds. Not a good culture to establish. |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @JHospMedicine: Interesting take: Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat |
 | Kristina Dzara, PhD, MMSc @KristinaDzara RT @JHospMedicine: Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat covering @futuredoc's recent article on sleep in hospitalized patients. Go ahead and introduce yourself while we wait for other to join in. Tonight's topic summarized here via @gracefarris https://t.co/DDUzZGlP9t |
| The Blonde Broker @gracefarris RT @FutureDocs: This was very interesting - #EHR automated bad human processes. Because our vitals were q4h, our EHR was autodefaulted and no one even knew that it could be changed until we started asking our IT folks. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @drkshitijthakur: This is definitely very creative #SIESTA #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @FutureDocs Has anyone ever studied the utility of q4 vs q8 (or even q12) vital signs? Seems like cost of care would be higher, and we should be able to figure out ROI #JHMChat |
| Med Peds Hospitalist @medpedshosp @gracefarris @virenkaul @nvhstewart @JHospMedicine And @AppleSupport is also overlording us #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @RJmdphilly Glad you could make it! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Aww thank you. I should mention I have a secret weapon I use to help me with acronyms #jhmchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine I think there are certain patients that do need to be seen before rounds: the watchers, the one with tenuous respiratory status, but others that could wait. I tell my interns that we can always do discovery rounds for those they don’t see during predounds. #JHMchat |
 | Jackcy Jacob @jac2thersq Greetings from frigid Albany, NY - first time on a tweet chat and trying to keep up with some great answers! #JHMchat |
 | Elizabeth Williams MD 👩⚕️ @no_ill_Williams RT @JHospMedicine: Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat covering @futuredoc's recent article on sleep in hospitalized patients. Go ahead and introduce yourself while we wait for other to join in. Tonight's topic summarized here via @gracefarris https://t.co/DDUzZGlP9t |
| Viren Kaul, MD @virenkaul @gracefarris @nvhstewart @JHospMedicine #JHMchat Struggling with ordersets and autopopulates like: https://t.co/CKivfI6gk9 |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @mahoneyr @tony_breu #rarely #JHMChat cc @micah_prochaska |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: Aww thank you. I should mention I have a secret weapon I use to help me with acronyms #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly T1 - ironically I keep getting into convos with our safety folks where they want to make our default VS MORE aggressive ("if you're sick enough to be in hospital you are sick enough for q4 VS") #JHMchat |
 | MedEdBot @MedEdBot RT @JHospMedicine: Interesting take: Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat |
| Robert J. Mahoney, MD @mahoneyr @FutureDocs You'll find out whether a nighttime test is medically necessary if you consistently page the physician/provider with the nighttime results #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @jac2thersq Welcome aboard, Jackcy! Glad you could join us for tonights #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @mahoneyr: @FutureDocs You'll find out whether a nighttime test is medically necessary if you consistently page the physician/provider with the nighttime results #JHMChat |
| Chris Petrilli, MD, SFHM @PetrilliMD RT @mahoneyr: @FutureDocs You'll find out whether a nighttime test is medically necessary if you consistently page the physician/provider with the nighttime results #JHMChat |
| Vinny Arora MD MAPP @FutureDocs I also want to acknowledge my research staff Sam Anderson and Lisa Spampinato who crowdsourced the logo for our study which we used on marketing materials to announce the project #siesta #jhmchat https://t.co/BeHT7Qvp01 |
| Anika Kumar, MD (she/her) @freckledpedidoc @FutureDocs At an institution I worked at it was “vitals per routine care” which on the regular nursing floor was Q8 with BPs once daily. If I wanted vitals/BPs more frequently I had to order them. We treated vitals like a central line. “Does this kid need Q4 VS?” #JHMChat |
| Journal of Hospital Medicine @JHospMedicine This is why we enjoy having @mahoneyr join us for #JHMChat's... |
| Rebecca Jaffe, MD @RJmdphilly We have tried some mini tests of change around this issue re prerounds - how do you optimize a team to reduce redundancy, maintain safety, and enhance learning? @gretchendiemer @MichaelAntzis @projsolve #JHMChat |
| Viren Kaul, MD @virenkaul @FutureDocs That is? Don’t stop st that now Vinny! #JHMchat |
| Michael Sinha @DrSinhaEsq #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessive alarms/beeps in patient spaces, etc. #ChoosingWisely helps but hospital culture/environment must support sleep as well! |
| Journal of Hospital Medicine @JHospMedicine Topic 2 coming up momentarily... #JHMChat |
| Med Peds Hospitalist @medpedshosp @mahoneyr @FutureDocs Brilliant! Is it really that important? Then we'll wake you up at 4 w the results #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @jac2thersq Hi Jackcy! glad you made it to #jhmchat :) #hmieducators withdrawal |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @JHospMedicine Boo for bad example-setting 😑 It’s like how sometimes #neurosurgery wants frequent neuro checks and I try to ask if it’s really necessary to wake the kid up every 2-4 hours. If you’re really that neurologically unstable, should probably be in #PedsICU #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: I also want to acknowledge my research staff Sam Anderson and Lisa Spampinato who crowdsourced the logo for our study which we used on marketing materials to announce the project #siesta #jhmchat https://t.co/BeHT7Qvp01 |
 | Megan Young, MD @Megany221 @FutureDocs #JHMChat as a geriatrician I spend most of my inpatient time teaching trainees to stop doing stuff (including Q4 hr vitals overnight). #mattersmost #deliriumprevention @sharon_inouye @JamesCHudspeth |
| Vinny Arora MD MAPP @FutureDocs RT @DrSinhaEsq: #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessive alarms/beeps in patient spaces, etc. #ChoosingWisely helps but hospital culture/environment must support sleep as well! |
| Journal of Hospital Medicine @JHospMedicine Topic 2 for tonight's #JHMChat... https://t.co/pOcbUWpy3O |
| Rebecca Jaffe, MD @RJmdphilly @jennifermcaputo @JHospMedicine dialysis overnight??? (mind blown) #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @RJmdphilly: We have tried some mini tests of change around this issue re prerounds - how do you optimize a team to reduce redundancy, maintain safety, and enhance learning? @gretchendiemer @MichaelAntzis @projsolve #JHMChat |
 | 𝗖𝗵𝗲𝘁𝗵𝗮𝗻 𝗦𝗮𝗿𝗮𝗯𝘂, MD @chethanr RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @DrJenChen4kids: @STangGirdwood @JHospMedicine Boo for bad example-setting 😑 It’s like how sometimes #neurosurgery wants frequent neuro checks and I try to ask if it’s really necessary to wake the kid up every 2-4 hours. If you’re really that neurologically unstable, should probably be in #PedsICU #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Topic 2 for tonight's #JHMChat... https://t.co/pOcbUWpy3O |
| Med Peds Hospitalist @medpedshosp @LukeDKimMD #JHMChat |
| Viren Kaul, MD @virenkaul Recently tried to turn the alarm down on the bedside monitor for a patient. Apparently wouldn’t go down below the 3/10 setting, at which level it was annoying enough to jar my head while doing a CVC near it for just 20 mins. How are people supposed to sleep? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Love having our #Pediatrics colleagues weigh-in on #JHMChat. Feel like they bring a unique perspective & experience that can only improve the care of adults... |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @FutureDocs @CHeSS_UChicago Sam and Lisa are amazing! 🙌🏻🙌🏻🙌🏻#JHMChat |
| Robert J. Mahoney, MD @mahoneyr @medpedshosp @FutureDocs If I could remove the diastolic blood pressure from vital signs, I would - I get a lot of pages about it and can't remember the last time I did something about it specifically #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: I also want to acknowledge my research staff Sam Anderson and Lisa Spampinato who crowdsourced the logo for our study which we used on marketing materials to announce the project #siesta #jhmchat https://t.co/BeHT7Qvp01 |
| Rebecca Jaffe, MD @RJmdphilly @ChrisMoriates @FutureDocs Seriously I think there is a gene for acronyms #JHMCHat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jac2thersq @JHospMedicine There’s also some discomfort on learners’ part in having to come up with a plan on the spot when they discover a new finding, but I think it’s a skill they need to develop. How many times I walk into the room seeing something I don’t expect and asked what the plan is. #JHMChat |
| Jennifer Caputo-Seidler, MD @jennifermcaputo @RJmdphilly @JHospMedicine Unfortunately it’s happening all the time, starting between 9pm and midnight, 3-4 hr dialysis plus transport, patient definitely not getting any sleep #JHMChat |
| Med Peds Hospitalist @medpedshosp A2: By teaching the effect of sleep deprivation on wellness, pain thresholds, delirium, etc. #JHMChat |
| Daniel Wolfson @WolfsonD #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Spoken like a true geriatrician... #JHMChat |
| Vinny Arora MD MAPP @FutureDocs We have repeated the Horror Room another @JHospMedicine paper https://t.co/rxMsfg5lrd by using audio of very loud noise in the room (peak noise in rooms is 100 dB as loud as a chain saw!) https://t.co/2sCnNe7AIL #jhmchat |
 | Lakshman Swamy (laxswamy@bsky.social) @laxswamy @nvhstewart @mahoneyr @tony_breu @micah_prochaska It totally depends on the patient. Floor patient with sepsis that is signed out as a watcher better be getting 4am vitals! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @WolfsonD: #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc RT @JHospMedicine: Love having our #Pediatrics colleagues weigh-in on #JHMChat. Feel like they bring a unique perspective & experience that can only improve the care of adults... |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: We have repeated the Horror Room another @JHospMedicine paper https://t.co/rxMsfg5lrd by using audio of very loud noise in the room (peak noise in rooms is 100 dB as loud as a chain saw!) https://t.co/2sCnNe7AIL #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @freckledpedidoc: @FutureDocs At an institution I worked at it was “vitals per routine care” which on the regular nursing floor was Q8 with BPs once daily. If I wanted vitals/BPs more frequently I had to order them. We treated vitals like a central line. “Does this kid need Q4 VS?” #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @jennifermcaputo @JHospMedicine wow - that really is rough I think if we suggested that (as a solution to other problems, though TERRIBLE for sleep) there would be a full on revolt. What do you think @WhyBeMD1? #jhmCHAT |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: We have repeated the Horror Room another @JHospMedicine paper https://t.co/rxMsfg5lrd by using audio of very loud noise in the room (peak noise in rooms is 100 dB as loud as a chain saw!) https://t.co/2sCnNe7AIL #jhmchat |
| Vinny Arora MD MAPP @FutureDocs @RJmdphilly @ChrisMoriates my last name is a palindrome so maybe that is part of it #jhmchat |
| Tony Breu @tony_breu @laxswamy @DrKerbel Sudden cardiac death can occur between the 2pm and 8pm vital sign check just as easily... #jhmchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrJenChen4kids @JHospMedicine When you’re waking the patient up so frequently overnight for Neuro checks...are they altered because they haven’t slept or because of true neurological decline? 🤷🏻♀️ I’m not the most coherent when I am paged in the middle of the night on call. #JHMchat |
 | EN Marcus @ErinNMarcusMD RT @DrSinhaEsq: #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessive alarms/beeps in patient spaces, etc. #ChoosingWisely helps but hospital culture/environment must support sleep as well! |
| Journal of Hospital Medicine @JHospMedicine RT @JHospMedicine: Topic 2 for tonight's #JHMChat... https://t.co/pOcbUWpy3O |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @JHospMedicine T2: Because all of us #medtwitter folks know what it’s like to be sleep-deprived? 🤪 Seriously though, proper rest is crucial for all of us to be at our best function/healing potential. #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @Megany221: @FutureDocs #JHMChat as a geriatrician I spend most of my inpatient time teaching trainees to stop doing stuff (including Q4 hr vitals overnight). #mattersmost #deliriumprevention @sharon_inouye @JamesCHudspeth |
| Journal of Hospital Medicine @JHospMedicine RT @STangGirdwood: @DrJenChen4kids @JHospMedicine When you’re waking the patient up so frequently overnight for Neuro checks...are they altered because they haven’t slept or because of true neurological decline? 🤷🏻♀️ I’m not the most coherent when I am paged in the middle of the night on call. #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @nvhstewart @tony_breu @micah_prochaska What if 4 AM vitals were opt-in? You could look at the midnight vitals and then determine whether you are are looking for something specific, or ride it out for 6 or 8 hours that one time? #JHMchat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @STangGirdwood @DrJenChen4kids @JHospMedicine Then we wonder why patients have hospital induced delirium #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @DrJenChen4kids: @JHospMedicine T2: @JHospMedicine T2: Because all of us #medtwitter folks know what it’s like to be sleep-deprived? 🤪 Seriously though, proper rest is crucial for all of us to be at our best function/healing potential. #jhmchat |
| Viren Kaul, MD @virenkaul A2: The impact of poor sleep on: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS amongst other harms is a good place to start. We all want our patients to do better, why not start with the simple things! #JHMChat |
| Tony Breu @tony_breu @laxswamy @nvhstewart @mahoneyr @micah_prochaska An interesting question would be how often we increase the frequency of vital signs in response to a borderline value. Often, it seems to set it and forget it when it comes to VS frequency. #JHMchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @JHospMedicine T2b: We try to keep the patient on a “normal” schedule as much as possible - sometimes for the teens that means making them wake up when we round at 9 rather than sleep until noon! #jhmchat |
| Viren Kaul, MD @virenkaul RT @medpedshosp: A2: A2: By teaching the effect of sleep deprivation on wellness, pain thresholds, delirium, etc. #JHMChat |
| Viren Kaul, MD @virenkaul RT @FutureDocs: We have repeated the Horror Room another @JHospMedicine paper https://t.co/rxMsfg5lrd by using audio of very loud noise in the room (peak noise in rooms is 100 dB as loud as a chain saw!) https://t.co/2sCnNe7AIL #jhmchat |
 | Fedes @fedescarini Hi from Buenos Aires Argentina. Do U feel #SIesta is suitable for ICU? #delirium prevention woul benefit from better sleep #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @DrJenChen4kids @JHospMedicine I think peds does so many things right... we lose compassion and common sense for adults #jhmchat |
| Anika Kumar, MD (she/her) @freckledpedidoc T2. At my prior institution it became a concern for our Peds Onc pts. The nurses & pts advocated for change. So The entire hospital changed practice to order labs at 8am, unless of course there was a clinical reason for earlier studies #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @tony_breu @laxswamy @nvhstewart @micah_prochaska Although how often does that encourage us to set arbitrary thresholds? "His systolic is 88 - if he gets to 85 then I'll do something" #JHMChat |
| Vinny Arora MD MAPP @FutureDocs I am reminded we have a video that we made on this! we are working on a website with all of our tools but if anyone is interested in our toolkit please email siesta@uchicago.edu for information #JHMChat cc @atanksley was our star so provided she approves:) |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jennifermcaputo @JHospMedicine We had an initiative started by @TchouMd to try to delay blood draws to the hours of 10a-4p, both to reduce unnecessary tests that end up getting cancelled on rounds and reduce times waking up patients. #JHMCHat |
| Journal of Hospital Medicine @JHospMedicine @virenkaul Great points, Viren! @hmkyale covered this material in a #JHMChat a few months ago when he discussed post-hospitalization syndrome in this article: https://t.co/j2zSEHPRyl |
| Journal of Hospital Medicine @JHospMedicine RT @virenkaul: A2: The impact of poor sleep on: A2: The impact of poor sleep on: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS amongst other harms is a good place to start. We all want our patients to do better, why not start with the simple things! #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @DrKerbel Totally different. This is using regular vitals to monitor a *high risk* patient where a trend could matter and you could intervene early. I've certainly seen cases where the absence of vital signs led to a patient not being prioritized on rounds and acuity worsened. #JHMChat |
| Viren Kaul, MD @virenkaul @tony_breu @laxswamy @DrKerbel Sentinel events can lead to lot of good changes, but other times we end up instituting relatively inane rules, and then we forget why, and add a few more. And down the rabbit hole we go! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: I am reminded we have a video that we made on this! we are working on a website with all of our tools but if anyone is interested in our toolkit please email siesta@uchicago.edu for information #JHMChat cc @atanksley was our star so provided she approves:) |
| Viren Kaul, MD @virenkaul RT @JHospMedicine: @virenkaul Great points, Viren! @hmkyale covered this material in a #JHMChat a few months ago when he discussed post-hospitalization syndrome in this article: https://t.co/j2zSEHPRyl |
| Rebecca Jaffe, MD @RJmdphilly Make everyone try to sleep in the hospital 1 night (kidding not kidding) #JHMChat The added benefits (#empathy) of overnight call, momming (and dadding), and delivering a baby once or twice... |
| Robert J. Mahoney, MD @mahoneyr @JHospMedicine T2 Toughest word here is "important". Do we mean 1) Clinically useful? 2) Financially worthwhile? 3) Emotionally helpful? #JHMchat |
| Michael Sinha @DrSinhaEsq #JHMchat All of this. Sleep is critical to the successful treatment of, and recovery from, serious illness requiring hospitalization. |
| Med Peds Hospitalist @medpedshosp Our #delirium carepath includes getting labs at 2200 and omitting 4am VS #JHMChat |
| Tony Breu @tony_breu @laxswamy @DrKerbel Agreed. A high-risk patient ought to have more frequent monitoring. #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @RJmdphilly: Make everyone try to sleep in the hospital 1 night (kidding not kidding) #JHMChat The added benefits (#empathy) of overnight call, momming (and dadding), and delivering a baby once or twice... |
| Vinny Arora MD MAPP @FutureDocs #JHMChat Kudos to anyone who changed lab ordering time. We tried in SIESTA but failed. We took another year and finally did it with @NatalieTapaskar @UCM_HDS #choosingwisely winner & @hvpaa young leader! Order SMART (Sleep: Making Appropriate Reductions to Timing & Testing) |
| Michael Sinha @DrSinhaEsq RT @JHospMedicine: @virenkaul Great points, Viren! @hmkyale covered this material in a #JHMChat a few months ago when he discussed post-hospitalization syndrome in this article: https://t.co/j2zSEHPRyl |
| Chris Moriates, MD @ChrisMoriates I think this is what it takes: An entire hospital commitment, otherwise it is too big of a leap for too many doctors and nurses and everybody else to change the default #JHMchat #SIESTA |
| Jackcy Jacob @jac2thersq T2: Perhaps this was mentioned, but does the waking patients up early for labs trend correlate with the goal for dc before noon? and if that goal is depriortized, maybe we can stop checking labs at 0400.. @JHospMedicine #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @medpedshosp: Our #delirium carepath includes getting labs at 2200 and omitting 4am VS #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrSinhaEsq: #JHMchat All of this. Sleep is critical to the successful treatment of, and recovery from, serious illness requiring hospitalization. |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @JHospMedicine T2 Toughest word here is "important". Do we mean 1) Clinically useful? 2) Financially worthwhile? 3) Emotionally helpful? #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @tony_breu @DrKerbel I remain surprised how many clinically relevant interventions start when I happen to walk into the room and see something I don't like. No vitals or labs involved. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs @fedescarini Interestingly many interventions have been tried in ICU patients. fewer in general ward patients. @jaybalachandran and several of my collaborators are ICU doctors. #jhmchat truth is newer noninvasive monitors will help |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to their adult jobs too? #PedsHM has certainly learned a lot from our adult colleagues #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @virenkaul: A2: The impact of poor sleep on: A2: The impact of poor sleep on: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS amongst other harms is a good place to start. We all want our patients to do better, why not start with the simple things! #JHMChat |
 | Lynne Maxwell MD, FAAP @ubudoc RT @FutureDocs: Aww thank you. I should mention I have a secret weapon I use to help me with acronyms #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly RT @DrJenChen4kids: @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to their adult jobs too? #PedsHM has certainly learned a lot from our adult colleagues #JHMchat |
 | Charlie M. Wray, DO, MS @WrayCharles @RJmdphilly I've been arguing this for years! After my kids were both hospitalized, my empathy for sleep in the hospital went through the roof #JHMChat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @medpedshosp I am very interested to know how 10 pm labs work. Does the nocturnist address all the abnormal labs overnight or they wait for day team?#JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: @fedescarini Interestingly many interventions have been tried in ICU patients. fewer in general ward patients. @jaybalachandran and several of my collaborators are ICU doctors. #jhmchat truth is newer noninvasive monitors will help |
| Vinny Arora MD MAPP @FutureDocs We thought about this in our study but there was a lot of anxiety about forgetting to order vitals on someone you want to order them on. Also most docs in house at night are covering and busy. #jhmchat |
| Med Peds Hospitalist @medpedshosp RT @DrJenChen4kids: @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to their adult jobs too? #PedsHM has certainly learned a lot from our adult colleagues #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @laxswamy @tony_breu @DrKerbel I remain surprised how many clinically relevant interventions start when I happen to walk into the room and see something I don't like. No vitals or labs involved. #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa We have multiple floors where AM labs are drawn at 2100. A bit more work for the night folks repleting potassium but otherwise no conceivable clinical distinction. #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: @fedescarini Interestingly many interventions have been tried in ICU patients. fewer in general ward patients. @jaybalachandran and several of my collaborators are ICU doctors. #jhmchat truth is newer noninvasive monitors will help |
| Journal of Hospital Medicine @JHospMedicine RT @DrJenChen4kids: @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to their adult jobs too? #PedsHM has certainly learned a lot from our adult colleagues #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @DrJenChen4kids @JHospMedicine At the Acute Rehab Hospital I attend at our pts are on a schedule and I try to adopt that practice for many of my Acute care patients who have prolonged stays, especially our eating disorder pts. #JHMChat |
| Fedes @fedescarini @FutureDocs @jaybalachandran A real challenge in the ICU setting. Very sleep deprived and low quality sleep all over. Many interruptions. And hard to study too since you can not do polysomnography. We usually rely on scales like que RCSQ, whats your take on that? #JHMChat |
| Viren Kaul, MD @virenkaul I think a safety analysis of such interventions would be interesting. The fear of missed changes in patients will often supersede the goal of less disturbance. Know of a good safety analysis @FutureDocs @laxswamy @tony_breu @nvhstewart @freckledpedidoc ?? #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @FutureDocs That may be part of the significance test. If you forget to order them, you either aren't paying attention or you don't really need them. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @ChrisMoriates: I think this is what it takes: I think this is what it takes: An entire hospital commitment, otherwise it is too big of a leap for too many doctors and nurses and everybody else to change the default #JHMchat #SIESTA |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: #JHMChat Kudos to anyone who changed lab ordering time. We tried in SIESTA but failed. We took another year and finally did it with @NatalieTapaskar @UCM_HDS #choosingwisely winner & @hvpaa young leader! Order SMART (Sleep: Making Appropriate Reductions to Timing & Testing) |
| Vinny Arora MD MAPP @FutureDocs @Megany221 @sharon_inouye @JamesCHudspeth I started my career in aging :) not a geriatrician but with @constancefungmd developed ACOVE hospital care measures- she is now a sleep -geriatrician! #jhmchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine #JHMChat T2: patient satisfaction scores can often be an important driver to change. But also, recognizing the number of patients who get started on #melatonin to help with sleep inpatient or other drugs to address hospital-induced #delirium that often prolong hospital stays. |
| Med Peds Hospitalist @medpedshosp @drkshitijthakur Yes. As these are pts w high risk for delirium, you assign the task to the on call person. I mostly do teaching service, so it's the overnight team who checks it #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @WrayCharles I feel like there is a health mentors lesson here @nethrankamd - longitudinal IPE course where pts teach students... How can we get physicians in training to empathize with their patients like they do with their family? #jhmchat (all comes back to burnout/emoutional exhaustion) |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @mahoneyr @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa Don’t you think the 9pm labs just defeats the purpose if the night nurse is going to come in at 1 am to give you K and Mag. #JHMchat |
| Viren Kaul, MD @virenkaul RT @RJmdphilly: @WrayCharles I feel like there is a health mentors lesson here @nethrankamd - longitudinal IPE course where pts teach students... How can we get physicians in training to empathize with their patients like they do with their family? #jhmchat (all comes back to burnout/emoutional exhaustion) |
 | Rachel Johnson @DoubleDawgMD RT @ChrisMoriates: I think this is what it takes: I think this is what it takes: An entire hospital commitment, otherwise it is too big of a leap for too many doctors and nurses and everybody else to change the default #JHMchat #SIESTA |
| Journal of Hospital Medicine @JHospMedicine Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd |
| Michael Sinha @DrSinhaEsq #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @freckledpedidoc @JHospMedicine Yes, our eating disorder patients also have a defined schedule. Other patients we often ask #childlife to help us develop a schedule and incentives (yay sticker charts), esp for the kids that have prolonged hospitalizations #JHMchat |
| Viren Kaul, MD @virenkaul RT @FutureDocs: @Megany221 @sharon_inouye @JamesCHudspeth I started my career in aging :) not a geriatrician but with @constancefungmd developed ACOVE hospital care measures- she is now a sleep -geriatrician! #jhmchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @JHospMedicine A2: Agree we all know that #sleep is important but the key is #education of #patients #trainees #nurses on #sleep and #health and restorative benefits of increased sleep. In the hospital, we have a captive audience for said education #JHMChat |
| Med Peds Hospitalist @medpedshosp @drkshitijthakur And also, early in AM we already have the labs available. Which sometimes doesn't happen w 4am labs. A CMP can sometimes take up to 8hr to come back. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @virenkaul: I think a safety analysis of such interventions would be interesting. The fear of missed changes in patients will often supersede the goal of less disturbance. Know of a good safety analysis @FutureDocs @laxswamy @tony_breu @nvhstewart @freckledpedidoc ?? #JHMchat |
| Charlie M. Wray, DO, MS @WrayCharles RT @DrSinhaEsq: #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Vinny Arora MD MAPP @FutureDocs I do want to add here that most hospitals have #ptexp offices as ours does led by @SueMurphyptexp - they have been great partners for making the case for improving sleep in our hospital and getting us HCAHPS data #jhmchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @virenkaul @FutureDocs @laxswamy @tony_breu @nvhstewart I agree with you 100% Viren, especially for #Peds! However if we approach VS like we do access or continuous pulse oximetry (the pet peeve of every Peds Hospitalist), we may find see our patients do well. We can do a study together 😉 #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @drkshitijthakur @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa Maybe - although hanging potassium and/or magnesium is still slightly less invasive than a 21g needle in your arm (or the waste/draw/flush cycle on a central line). Or maybe that K of 3.1 can be repleted with morning meds #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @nvhstewart: @JHospMedicine A2: @JHospMedicine A2: Agree we all know that #sleep is important but the key is #education of #patients #trainees #nurses on #sleep and #health and restorative benefits of increased sleep. In the hospital, we have a captive audience for said education #JHMChat |
| The Blonde Broker @gracefarris RT @FutureDocs: I do want to add here that most hospitals have #ptexp offices as ours does led by @SueMurphyptexp - they have been great partners for making the case for improving sleep in our hospital and getting us HCAHPS data #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @DrSinhaEsq: #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd |
| Tony Breu @tony_breu @DrSinhaEsq @purduepharma What's interesting about this idea is how often I ask "how did you sleep?" as part of 'small talk' and not as a way to gauge how my patient is doing. Or, how we are helping him/her to feel better. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs 10p labs did not work for our residents and hospitalist because of this. we have had more traction with 6am @NatalieTapaskar #jhmchat |
| Jennifer Caputo-Seidler, MD @jennifermcaputo A3: interested to hear what others have to say for this one, I’m not aware of any interventions that have been tried or are currently in practice at my hospital to improve sleep #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: I do want to add here that most hospitals have #ptexp offices as ours does led by @SueMurphyptexp - they have been great partners for making the case for improving sleep in our hospital and getting us HCAHPS data #jhmchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @RJmdphilly @medpedshosp My first overnight in an ICU was staying with my grandma after she had a Whipple when I was an MS1 - it made me very aware of sleep issues through the rest of my training so far! #JHMchat |
| Med Peds Hospitalist @medpedshosp A3: we give melatonin 3 to 6 mg about at 8PM. Avoid the 4AM VS. And don't get daily labs - only q48 or q72 if needed at all. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly Can't say it's been a high enough priority but I'd like to see a way around "dumb" automatic timing for meds, culture change re lab timing, physiologic day/night cues (decreased lights, decreased noise) as a start #JHMChat |
| Viren Kaul, MD @virenkaul @freckledpedidoc @FutureDocs @laxswamy @tony_breu @nvhstewart Would love that, but it makes one think right? Of the fear / anxiety is comin from missing things, let’s address that! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs IMHO A real discharge before noon means that the decision to discharge was made before 4AM #jhmchat |
| Charlie M. Wray, DO, MS @WrayCharles The importance of identifying stakeholders and other leaders if you're looking to enact change. Especially important of historically rigid environments, like hospitals #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @ChrisMoriates: I think this is what it takes: I think this is what it takes: An entire hospital commitment, otherwise it is too big of a leap for too many doctors and nurses and everybody else to change the default #JHMchat #SIESTA |
| Jackcy Jacob @jac2thersq Discovery Rounds - as a way to prevent unnecessary, redundant pre-rounding on stable patients that could use the rest=time for healing instead #siesta @FutureDocs #JHMChat @JHospMedicine thanks @STangGirdwood |
| Robert J. Mahoney, MD @mahoneyr @DrSinhaEsq @purduepharma This might be possible if we improve our technology to make it an objective measure - there are mattresses that can easily measure heart rate, respiratory rate, and movement to determine sleep/wake. Would need to make a substantial case for ROI on this, though. #JHMchat |
 | aMcD @a_donna RT @FutureDocs: 10p labs did not work for our residents and hospitalist because of this. we have had more traction with 6am @NatalieTapaskar #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @jac2thersq: Discovery Rounds - as a way to prevent unnecessary, redundant pre-rounding on stable patients that could use the rest=time for healing instead #siesta @FutureDocs #JHMChat @JHospMedicine thanks @STangGirdwood |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @mahoneyr @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa I agree hanging K is not as bad as blood work but when we talking about overnight vitals being bad for sleep a night time electrolyte replacement is definitely worse #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @RJmdphilly: Can't say it's been a high enough priority but I'd like to see a way around "dumb" automatic timing for meds, culture change re lab timing, physiologic day/night cues (decreased lights, decreased noise) as a start #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @tony_breu @DrKerbel You walk into that room a lot sooner if the vitals bring the patient to the top of the list! #JHMChat |
| Med Peds Hospitalist @medpedshosp @mahoneyr @DrSinhaEsq @purduepharma I would ask @Berci #JHMChat |
| Jennifer Caputo-Seidler, MD @jennifermcaputo @medpedshosp So much seems to be breaking culture routines such as ordering daily labs on every patient, I like this strategy #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: IMHO A real discharge before noon means that the decision to discharge was made before 4AM #jhmchat |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: 10p labs did not work for our residents and hospitalist because of this. we have had more traction with 6am @NatalieTapaskar #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly @medpedshosp @drkshitijthakur Assume the overnight team needs good anticipatory guidance re what can wait for morning (ie - no 2am K rider)? #JHMCHat |
| Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine T3. At the Acute Rehab Hospital I work at we have schedules for the kids. I have found that it works well for our patients with prolonged stays at the Acute care hospital, especially those patients who have been in the #PedsICU or have required frequent surgeries #JHMChat |
| Tony Breu @tony_breu I only think of sleep in those with delirium. It's keeping awake during the day and aiding with sleep at night. I am horrible at thinking beyond these patients. #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @drkshitijthakur @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa True. So order that potassium repletion for 0800. I dare anyone to show me a mortality difference outside of ICU #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @tony_breu @DrKerbel Also I'm happy to DC telemetry for my GIB on the floor bc the clinical signs including vitals are what raise attention, not the Tele. So now we're losing that too? 🤔 #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly Oh also a sunset time on non-urgent lasix in patients without a catheter (which should be most of them btw) #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine #JHMChat T3: buy-in from an entire unit, like @freckledpedidoc mentioned for her Heme-Onc floor. Our #PedsICU had a 2-3pm quiet hour when only limited patient care could be done, and it was respected unit-wise. If the ICU could do it for even an hour, other units could too! |
| Vinny Arora MD MAPP @FutureDocs Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w high MEWS score about to have an adverse event were woken up twice for vitals. same as low risk patient #jhmchat https://t.co/mNowZLe1KJ |
| Vinny Arora MD MAPP @FutureDocs so the problem is more than just overtreatment - its not using that same effort to do more frequent checks on those that need to be seen at night #jhmchat |
| Med Peds Hospitalist @medpedshosp @drkshitijthakur @mahoneyr @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa And many pts c/o K causing burning pain in the veins #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @jennifermcaputo: @medpedshosp So much seems to be breaking culture routines such as ordering daily labs on every patient, I like this strategy #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @tony_breu @DrKerbel I guess the ones with the abnormal vitals are less surprising. But surprise happens nonetheless. #JHMchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @JHospMedicine T3: Haven’t officially studied it, but retime meds or tube feeds to minimize disturbances overnight, take off CR monitor or pulse ox as soon as reasonable, sometimes note “ok to skip vital checks when asleep” so it’s clear for RNs #JHMchat |
| Tony Breu @tony_breu RT @FutureDocs: Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w high MEWS score about to have an adverse event were woken up twice for vitals. same as low risk patient #jhmchat https://t.co/mNowZLe1KJ |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w high MEWS score about to have an adverse event were woken up twice for vitals. same as low risk patient #jhmchat https://t.co/mNowZLe1KJ |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w high MEWS score about to have an adverse event were woken up twice for vitals. same as low risk patient #jhmchat https://t.co/mNowZLe1KJ |
| Michael Sinha @DrSinhaEsq @jac2thersq @JHospMedicine Would ask whether AM labs are truly needed if we are planning a morning discharge... are the results likely to change that plan? #ChoosingWisely #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @freckledpedidoc @virenkaul @FutureDocs @laxswamy @tony_breu @nvhstewart Less can be more with grown ups too!!! #JHMChat |
| Mark Shapiro, MD @ETSshow T3 Most important intervention & step forward was getting buy-in from nursing at front lines/leaders. Went to their meetings, rounded at night, reviewed “right ? to right MD at right time” concept. #JHMchat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @mahoneyr @FutureDocs @NatalieTapaskar @UCM_HDS @hvpaa Mostly#TWDFNR #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @tony_breu @DrKerbel I honestly can't remember the last GI bleed I took care of where telemetry made any difference in management. #JHMChat |
 | CHeSS @CHeSS_UChicago Check out @FutureDocs on the #jhmchat happening now! |
| Jennifer Caputo-Seidler, MD @jennifermcaputo @STangGirdwood @JHospMedicine @freckledpedidoc Our onc floor also best in hospital at limiting unnecessary overnight care, it’s a culture and requires buy in from physicians, nurses, and management #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @tony_breu @DrSinhaEsq @purduepharma YES!!! I actually told my last intern not to ask if he wasn't prepared to change SOMETHING for the next night in order to help them sleep better if the patient answered "horribly" #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrJenChen4kids @JHospMedicine It would be helpful as part of reviewing new orders on rounds for the team to discuss who can have vital signs skipped overnight. We don’t put in those orders not because it can’t be done but because we don’t think about it routinely until a nurse asks. #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @tony_breu @DrKerbel 💯 Because of regular vitals and eval by nurse and MD. But many will hesitate to DC the telemetry. I can DC it because the above is what really matters. I would not take that away for any pt I considered high risk at night. "they're called vitals for a reason" #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @STangGirdwood @JHospMedicine Quiet time is key. In our Peds Units, lights go out at 9 or 10pm and aren’t on again til 6am. It at least promotes sleep (even if we are doing VS at 12 & 4am). #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @jennifermcaputo: @STangGirdwood @JHospMedicine @freckledpedidoc Our onc floor also best in hospital at limiting unnecessary overnight care, it’s a culture and requires buy in from physicians, nurses, and management #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @FutureDocs: Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w high MEWS score about to have an adverse event were woken up twice for vitals. same as low risk patient #jhmchat https://t.co/mNowZLe1KJ |
| Robert J. Mahoney, MD @mahoneyr 100% agree. On a medical service, just about anyone who goes home by noon should have gone home the night before. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @CHeSS_UChicago: Check out @FutureDocs on the #jhmchat happening now! |
| Viren Kaul, MD @virenkaul A3: - Post round MedRecs to ensure removal of standing Q6/8 meds (QID/TID if possible) - 🔽 alarm sounds (esp within room) - addressing pain/lines/tubes in protocolized fashion.Get those foleys out - asking about sleep EVERY MORNING and addressing it as an IP team! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs For those who need a quick review of what we did in SIESTA see the thread below and email siesta@uchicago.edu for our toolkit #JHMChat https://t.co/XPj8cx6Hvx |
| Vinny Arora MD MAPP @FutureDocs RT @jac2thersq: Discovery Rounds - as a way to prevent unnecessary, redundant pre-rounding on stable patients that could use the rest=time for healing instead #siesta @FutureDocs #JHMChat @JHospMedicine thanks @STangGirdwood |
| Journal of Hospital Medicine @JHospMedicine RT @ETSshow: T3 Most important intervention & step forward was getting buy-in from nursing at front lines/leaders. Went to their meetings, rounded at night, reviewed “right ? to right MD at right time” concept. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @mahoneyr: 100% agree. On a medical service, just about anyone who goes home by noon should have gone home the night before. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: so the problem is more than just overtreatment - its not using that same effort to do more frequent checks on those that need to be seen at night #jhmchat |
| Fedes @fedescarini RT @JHospMedicine: Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @virenkaul: A3: A3: - Post round MedRecs to ensure removal of standing Q6/8 meds (QID/TID if possible) - 🔽 alarm sounds (esp within room) - addressing pain/lines/tubes in protocolized fashion.Get those foleys out - asking about sleep EVERY MORNING and addressing it as an IP team! #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wake up at 2am to give their kid meds, so why are we? #JHMChat |
| Michael Sinha @DrSinhaEsq Informal rounds with nursing staff early in the evening... addresses overnight patient care needs from 7-9 pm, not 2-4 am #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @jac2thersq @FutureDocs @JHospMedicine @STangGirdwood Discovery rounds are essential for the attending. My job is not just to assess the team when everything's neatly tied up. My job is also to assess how they respond to the unexpected. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @mahoneyr @drkshitijthakur @NatalieTapaskar @UCM_HDS @hvpaa wow its like #truthordare #jhmchat edition :) |
| Med Peds Hospitalist @medpedshosp @laxswamy @mahoneyr @tony_breu @DrKerbel That's why having governing rules around telemetry is useful. We have BPA to consider DC it it if not eventful in the first 48h of use. #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @freckledpedidoc: @STangGirdwood @JHospMedicine Quiet time is key. In our Peds Units, lights go out at 9 or 10pm and aren’t on again til 6am. It at least promotes sleep (even if we are doing VS at 12 & 4am). #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @gracefarris Any lumping night time interventions too. I remember when in hospital after delivering - RN, then tech, then CM, then RN for something else. Was ready to throw a diaper at the next person through the door. #JHMchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @JHospMedicine I’ve tried to make it a habit to check the monitor, IV pump, etc as part of my “exam” on rounds. When the team goes through the plan for a patient who doesn’t need CR monitor, I’ll specifically ask “Do you think they need monitors?” if they didn’t mention it #JHMchat |
| Journal of Hospital Medicine @JHospMedicine While MedReconciliation is specific for meds, do we need to do a more thorough "intervention reconciliation"...? #JHMChat |
| Viren Kaul, MD @virenkaul RT @DrSinhaEsq: Informal rounds with nursing staff early in the evening... addresses overnight patient care needs from 7-9 pm, not 2-4 am #JHMchat |
| Mark Shapiro, MD @ETSshow T3 Also need to recog that “I barely slept last night!” is extremely common & daily complaint. We all heard it 3-6 times on rounds this am. Answer is not to give meds. Answer is rational plan in moment to address why they couldn’t sleep w/ RN buy-in. Reasons often vary. #JHMCHat |
| Med Peds Hospitalist @medpedshosp RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wake up at 2am to give their kid meds, so why are we? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wake up at 2am to give their kid meds, so why are we? #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska I think the nurse could report the MN vital signs - because they're apparently that important - and then have a conversation about when the next set should happen. #JHMchat |
 | Ted Cybulski MD, PhD @tdwck RT @JHospMedicine: Interesting take: Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrSinhaEsq: Informal rounds with nursing staff early in the evening... addresses overnight patient care needs from 7-9 pm, not 2-4 am #JHMchat |
| Vinny Arora MD MAPP @FutureDocs cc @WrayCharles and I have strong opinions about telemetry too #jhmchat -- in terms of alarms its one of the worst for alert fatigue too |
| Vinny Arora MD MAPP @FutureDocs RT @DrJenChen4kids: @STangGirdwood @JHospMedicine I’ve tried to make it a habit to check the monitor, IV pump, etc as part of my “exam” on rounds. When the team goes through the plan for a patient who doesn’t need CR monitor, I’ll specifically ask “Do you think they need monitors?” if they didn’t mention it #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @jac2thersq @FutureDocs @JHospMedicine @STangGirdwood Tell me more - I have a feeling this is similar to what we were trying...do you have a reference? Where does the term come from? #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @freckledpedidoc @STangGirdwood @JHospMedicine YES! Same thing with feeds - I’m not expecting a parent to really do q3h feeds including overnight at home unless it’s a young baby who should be feeding frequently #JHMchat |
 | Leonard Javier ⌬🔻🇵🇸 @STPbasileo RT @tony_breu: I feel like it's gotta be overnight vital signs. #JHMChat |
| Med Peds Hospitalist @medpedshosp @JHospMedicine Yes - reevaluate necessity of: Central lines, Foley, Telemetry, VS at 4am, daily labs, etc. #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrJenChen4kids @JHospMedicine #JHMChat: yes, that’s the beauty of rounding in the room - being cued by what you see like monitors and IVF. But I’m not good about looking at the nursing orders that came with the default order set and seeing if those can be changed to. |
| Vinny Arora MD MAPP @FutureDocs I have often thought that new moms are most in need of sleep interventions postpartum and coaching on how to handle the extreme sleep loss they are about to face at home #jhmchat cc @neel_shah |
 | Kristen Young @kristenyoung @STangGirdwood @jennifermcaputo @JHospMedicine @TchouMd Any effect on LOS by delaying blood draws to a more reasonable hour? (that is the push back I have heard in the past) #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @DrSinhaEsq: #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Vinny Arora MD MAPP @FutureDocs @DrSinhaEsq @purduepharma I LOVE THIS! #jhmchat |
| Viren Kaul, MD @virenkaul @JHospMedicine Big believer in checklists. But w/o adding more to the care team’s work, it is easy to integrate simple tasks in the work flow. issue can sometimes be differing styles among rounding teams/attendings/local culture/resources etc! But yes, an intervention Rec = 👍🏽✔️✔️ #JHmchat |
 | Scott Nass, MD MPA🌻 🇵🇸 @scottnassmd In medicine, nothing should ever be routine. Every action should be thoughtful. As I tell my residents, if there is no benefit, then there can only be risk; and even the risk of risk is risk! #theyloveme #JHMChat |
 | Jeffrey Thompson @TWINJT RT @mahoneyr: 100% agree. On a medical service, just about anyone who goes home by noon should have gone home the night before. #JHMchat |
| Viren Kaul, MD @virenkaul RT @FutureDocs: cc @WrayCharles and I have strong opinions about telemetry too #jhmchat -- in terms of alarms its one of the worst for alert fatigue too |
| Vinny Arora MD MAPP @FutureDocs RT @scottnassmd: In medicine, nothing should ever be routine. Every action should be thoughtful. As I tell my residents, if there is no benefit, then there can only be risk; and even the risk of risk is risk! #theyloveme #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @STangGirdwood: @DrJenChen4kids @JHospMedicine #JHMChat: @DrJenChen4kids @JHospMedicine #JHMChat: yes, that’s the beauty of rounding in the room - being cued by what you see like monitors and IVF. But I’m not good about looking at the nursing orders that came with the default order set and seeing if those can be changed to. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrJenChen4kids @JHospMedicine #JHMchat: another area for improvement is to remove the IV as soon as possible since there are JHACO requirements on how often to check for infiltration, etc. But we often keep until discharge “just in case” |
| Journal of Hospital Medicine @JHospMedicine RT @medpedshosp: @JHospMedicine Yes - reevaluate necessity of: @JHospMedicine Yes - reevaluate necessity of: Central lines, Foley, Telemetry, VS at 4am, daily labs, etc. #JHMChat |
| Viren Kaul, MD @virenkaul RT @DrSinhaEsq: #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Rebecca Jaffe, MD @RJmdphilly @laxswamy @mahoneyr @tony_breu @DrKerbel No - I think you have a default VS and can dial up or down depending on d and level of concern. GIB coming off tele? VS q4 please. Awaiting placement? VS daily. Somewhere in between? Q6 to Q8 may suffice. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @freckledpedidoc Give @FutureDocs some time and she'll come up with something snappy #JHMChat |
| Fedes @fedescarini RT @virenkaul: A3: A3: - Post round MedRecs to ensure removal of standing Q6/8 meds (QID/TID if possible) - 🔽 alarm sounds (esp within room) - addressing pain/lines/tubes in protocolized fashion.Get those foleys out - asking about sleep EVERY MORNING and addressing it as an IP team! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @virenkaul: @JHospMedicine Big believer in checklists. But w/o adding more to the care team’s work, it is easy to integrate simple tasks in the work flow. issue can sometimes be differing styles among rounding teams/attendings/local culture/resources etc! But yes, an intervention Rec = 👍🏽✔️✔️ #JHmchat |
| Journal of Hospital Medicine @JHospMedicine @kristenyoung @STangGirdwood @jennifermcaputo @TchouMd great question? Wonder if @FutureDocs is studying this as we speak...? #jhmchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @RJmdphilly @jac2thersq @FutureDocs @JHospMedicine #JHMchat: I remember one of my residency PDs/#PedsICU attendings use it. She implemented it during high census when residents couldn’t see everyone before rounds. But I think it could be implemented at all times - prioritize the watchers, the respiratory patients, etc. |
 | Samir S. Shah @SamirShahMD RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5 |
| Robert J. Mahoney, MD @mahoneyr @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska The most important conversation for doctors and nurses is with the patient. Second most important conversation is with each other. Any chance to promote that is worthwhile. Maybe decrease charting requirements on night shift so that nurses and doctors have time to talk #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @laxswamy @mahoneyr @tony_breu @DrKerbel Though this raises the interesting question of our "analytic" surveillance scores for patient deterioration - need some data to feed the beast. That said we could make these systems better with timely entry of the data we DO have too. #JHMChat |
| Mark Shapiro, MD @ETSshow What about protocol vitals? If normal after certain period of time, can drop to q8, then q12. #JHMCHat |
| Journal of Hospital Medicine @JHospMedicine Well, we have about 10 minutes left in our discussion. Any final key points or thoughts for tonights #JHMChat? |
| Vinny Arora MD MAPP @FutureDocs see another @JHospMedicine paper on teaching from the built environment -- we called it Guerilla Teaching and use it a lot @ShannonMartinMD @jeannemfarnan https://t.co/iiYcHm2FWD #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska You will likely dispense with unnecessary q4h vital signs pretty quickly at that point. #JHMchat |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @STangGirdwood @DrJenChen4kids @JHospMedicine Need a technology whereby the IV machine beeps remotely near Nursing desk instead of patient’s room, every time it’s not working properly. Patients always complain about the IV machine. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: While MedReconciliation is specific for meds, do we need to do a more thorough "intervention reconciliation"...? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @RJmdphilly @jac2thersq @FutureDocs @JHospMedicine I’m going to try to talk about it with my team the next time I’m on service as part of my expectations talk and see if we can come up with a list of the “must-see” patients during pre-Rounds. #JHMchat |
| Med Peds Hospitalist @medpedshosp And this is one of the most important interventiona that we are aiming to do 100% - bedside MD-RN rounding #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @freckledpedidoc @JHospMedicine WOW I may be forced to reveal my secret -- hint it involves Scrabble #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Well, we have about 10 minutes left in our discussion. Any final key points or thoughts for tonights #JHMChat? |
| Mark Shapiro, MD @ETSshow @mahoneyr @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska When I’m the night doc and cruise around the floors, every nurse is charting at a monitor. They look lonely and isolated. Hospital equivalent of Rime of Ancient Mariner. #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @RJmdphilly @mahoneyr @tony_breu @DrKerbel Exactly. Also, if anything hospital patients are getting sicker and need actual observation, and stays are getting shorter with more care at home. So the round the clock observation might actually matter more too in the future. #JHMChat |
| Tony Breu @tony_breu I really need to thank @FutureDocs and her team for doing this study. So important. And, I hope, sparks necessary change. #siesta #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @STangGirdwood: @RJmdphilly @jac2thersq @FutureDocs @JHospMedicine I’m going to try to talk about it with my team the next time I’m on service as part of my expectations talk and see if we can come up with a list of the “must-see” patients during pre-Rounds. #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @FutureDocs: see another @JHospMedicine paper on teaching from the built environment -- we called it Guerilla Teaching and use it a lot @ShannonMartinMD @jeannemfarnan https://t.co/iiYcHm2FWD #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @RJmdphilly @freckledpedidoc @virenkaul @FutureDocs @laxswamy @tony_breu 🙌🏻🙌🏻 #JHMChat |
| Viren Kaul, MD @virenkaul @scubalyssious I hear you my friend! #JHMchat https://t.co/b9IaDvegMP |
| Journal of Hospital Medicine @JHospMedicine Big thanks to @gracefarris for her wonderful artwork which helps highlight this important research and get the word out on these important topics #JHMChat https://t.co/fsLFswp8DK |
 | Irving Amukasa @iamukasa RT @FutureDocs: For any #ptexp #nurses #epatients #EHR friends please join in - all voices welcome #jhmchat starts in 5 min on SIESTA how to improve sleep in hospitalized patients |
| Fedes @fedescarini @JHospMedicine How do you measure sleep quality? #JHMChat? |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @mahoneyr: @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska The most important conversation for doctors and nurses is with the patient. Second most important conversation is with each other. Any chance to promote that is worthwhile. Maybe decrease charting requirements on night shift so that nurses and doctors have time to talk #JHMchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @medpedshosp @laxswamy @mahoneyr @tony_breu @DrKerbel We have a BPA to d/c pulse ox if patient has been on room air for several hours (eg bronchiolitic weaning off O2, so they obviously needed closer monitoring at first) but I don’t think we have one for vitals! #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine @kristenyoung @jennifermcaputo @TchouMd @FutureDocs I know the residents and @TchouMd studied this during their longitudinal residency #QI project. @TchouMd: any consequences when we tried to delay blood draws to 10a-4pm? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: I really need to thank @FutureDocs and her team for doing this study. So important. And, I hope, sparks necessary change. #siesta #JHMChat |
| Mark Shapiro, MD @ETSshow Bravo! Hard co-sign! This is, by far, the most powerful tool Hospitalists have to drive success on virtually every inpatient measure! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @STangGirdwood: @RJmdphilly @jac2thersq @FutureDocs @JHospMedicine I’m going to try to talk about it with my team the next time I’m on service as part of my expectations talk and see if we can come up with a list of the “must-see” patients during pre-Rounds. #JHMchat |
 | Sanjay Saint @sanjaysaint “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #SleepIsGood |
| Robert J. Mahoney, MD @mahoneyr @DrJenChen4kids @STangGirdwood @JHospMedicine I call it "scanning the room". Also look for Foley Fecal containment device Outside food Visitors Unexplained luggage etc #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @ETSshow: Bravo! Hard co-sign! This is, by far, the most powerful tool Hospitalists have to drive success on virtually every inpatient measure! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs @DrJenChen4kids @medpedshosp @laxswamy @mahoneyr @tony_breu @DrKerbel cc @NicolaOrlov @davidcookmed #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly @STangGirdwood @DrJenChen4kids @JHospMedicine A check list for things NOT to do #JHMChat |
| Society of Hospital Medicine @SocietyHospMed Don't forget to claim #CME after tonight's #JHMChat! Click here: https://t.co/td9CQCo1eB |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: Big thanks to @gracefarris for her wonderful artwork which helps highlight this important research and get the word out on these important topics #JHMChat https://t.co/fsLFswp8DK |
| Michael Sinha @DrSinhaEsq @JHospMedicine @WrayCharles @Futuredoc @gracefarris Love the @gracefarris #VisualAbstract as well! #JHMchat |
| Med Peds Hospitalist @medpedshosp RT @sanjaysaint: “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #SleepIsGood |
| Vinny Arora MD MAPP @FutureDocs RT @tony_breu: I really need to thank @FutureDocs and her team for doing this study. So important. And, I hope, sparks necessary change. #siesta #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Big thanks to @gracefarris for her wonderful artwork which helps highlight this important research and get the word out on these important topics #JHMChat https://t.co/fsLFswp8DK |
| Viren Kaul, MD @virenkaul Once more for literally everyone, those in the front, the back and everywhere in between!!! #JHMchat |
| Charlie M. Wray, DO, MS @WrayCharles This. This technology will enact more change than anything else I can think of... #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @drkshitijthakur: @STangGirdwood @DrJenChen4kids @JHospMedicine Need a technology whereby the IV machine beeps remotely near Nursing desk instead of patient’s room, every time it’s not working properly. Patients always complain about the IV machine. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: see another @JHospMedicine paper on teaching from the built environment -- we called it Guerilla Teaching and use it a lot @ShannonMartinMD @jeannemfarnan https://t.co/iiYcHm2FWD #JHMChat |
 | Zackary Berger @DrZackaryBerger RT @drkshitijthakur: @STangGirdwood @DrJenChen4kids @JHospMedicine Need a technology whereby the IV machine beeps remotely near Nursing desk instead of patient’s room, every time it’s not working properly. Patients always complain about the IV machine. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @DrJenChen4kids @STangGirdwood @JHospMedicine I call it "scanning the room". Also look for Foley Fecal containment device Outside food Visitors Unexplained luggage etc #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Improving sleep in hospitals is a team sport - it takes doctors, nurses, phlebotomy, #ptexp to help. Using the #EHR can help tip the scales but having your nurses carry the torch was they key to making it last. #jhmchat |
| Mark Shapiro, MD @ETSshow The champ is here! @gracefarris rules. I hope my son (and all our kids) heard you #JHMchat |
 | Chi Chu @cdchu RT @mahoneyr: @DrJenChen4kids @STangGirdwood @JHospMedicine I call it "scanning the room". Also look for Foley Fecal containment device Outside food Visitors Unexplained luggage etc #JHMChat |
| The Blonde Broker @gracefarris RT @FutureDocs: Improving sleep in hospitals is a team sport - it takes doctors, nurses, phlebotomy, #ptexp to help. Using the #EHR can help tip the scales but having your nurses carry the torch was they key to making it last. #jhmchat |
| Vinny Arora MD MAPP @FutureDocs This simple thing is key to reducing overnight pages also which can help reduce workload at night #jhmchat |
| Chris Moriates, MD @ChrisMoriates RT @sanjaysaint: “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #SleepIsGood |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: Improving sleep in hospitals is a team sport - it takes doctors, nurses, phlebotomy, #ptexp to help. Using the #EHR can help tip the scales but having your nurses carry the torch was they key to making it last. #jhmchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @nvhstewart @tony_breu @micah_prochaska I wonder if it makes sense to confer a high acuity tag to some patients, which comes with a whole package: vitals, maybe better nurse ratio prioritization on rounding and labs... And if they get better they lose the label. Something between step-down and waiting for DC #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wake up at 2am to give their kid meds, so why are we? #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @freckledpedidoc @STangGirdwood @jac2thersq @FutureDocs @JHospMedicine I'm being sort of clueless - I've not hear "discovery rounds" really defined before. Can you give me a quick tutorial or reference? #JHMCHat |
| Vinny Arora MD MAPP @FutureDocs Changing the way you approach vitals is the vital first step! #siesta #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @nvhstewart @tony_breu @micah_prochaska You know who's really good at this? Nurses. We should empower them to be more powerful with their care plans. #JHMchat |
| Chris Moriates, MD @ChrisMoriates Why does this feel aspirational? This definitely should NOT be aspirational. #JHMChat #SIESTA |
 | 🥕Devesh Rai, MD🥕 @DeveshRaiMD #JHMChat Residents and attending should not expect to have the results of AM labs by 7. Also, no one should start rounding before 8. #SoundSleep #GoodRecovery |
| Vinny Arora MD MAPP @FutureDocs I have had this thought too! #jhmchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine @gracefarris @FutureDocs @SamirShahMD We need this kind of artwork for #PHMFellowJC because right now we’re limited to my bad photoshop skills. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Well, that's a wrap..Enjoyed the lively conversation on tonight's #JHMChat chat! Thanks everyone for participating! We're currently mining the pages of @JHospMedicine for our next topic. Keep you're ears open...and let your patients sleep (if you can)! |
| Vinny Arora MD MAPP @FutureDocs RT @sanjaysaint: “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #SleepIsGood |
| Rebecca Jaffe, MD @RJmdphilly RT @ChrisMoriates: Why does this feel aspirational? This definitely should NOT be aspirational. #JHMChat #SIESTA |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @JHospMedicine I feel there is a place for 4 am labs , every 4 hour vitals, night time medications etc but every patient does not need these. We need to pay attention to every patients needs and decide. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @drkshitijthakur: @JHospMedicine I feel there is a place for 4 am labs , every 4 hour vitals, night time medications etc but every patient does not need these. We need to pay attention to every patients needs and decide. #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @gracefarris @freckledpedidoc @STangGirdwood @jac2thersq @FutureDocs @JHospMedicine is there any more formal structuring than that? We have tried to work on @alvinseattle's "Rounding in flow" which is similar. #JHMCHat |
| Vinny Arora MD MAPP @FutureDocs @tony_breu @gracefarris the first step is admission - we can get you on the #siesta plan #jhmchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @nvhstewart @tony_breu @micah_prochaska Oh definitely but they're under a world of restrictions/regulations that seem to have nothing to do with what we think. Thats some long overdue policy change! But it won't happen overnight. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @ChrisMoriates: Why does this feel aspirational? This definitely should NOT be aspirational. #JHMChat #SIESTA |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @mahoneyr @STangGirdwood @JHospMedicine Ha, one time on oncology call as a resident, got paged re: ? bloody stool...coags, plt, and external exam was fine (couldn’t do rectal since neutropenic). Looked around room, found a pack of red Gatorade! #JHMchat |
| Mark Shapiro, MD @ETSshow @JHospMedicine This was great fun & excellent learning!Thanks @WrayCharles @FutureDocs @gracefarris @JHospMedicine #JHMchat |
| Michael Sinha @DrSinhaEsq RT @FutureDocs: This simple thing is key to reducing overnight pages also which can help reduce workload at night #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @JHospMedicine Thanks @JHospMedicine @WrayCharles @FutureDocs for an excellent #JHMChat! Keep warm! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @gracefarris @RJmdphilly @freckledpedidoc @jac2thersq @FutureDocs @JHospMedicine Sorry, misunderstood your question @RJmdphilly. It’s as @Gracefarris said. Intern and senior should still be reviewing vitals and notes and have a plan in place based on what they see during rounds. If anything worries them, they should definitely see them b4 rounds. #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr @laxswamy @nvhstewart @tony_breu @micah_prochaska If you have IPASS baked in then "sick" can be one VS schedule, watcher another, and stable a third. Automate? #JHMChat |
| Med Peds Hospitalist @medpedshosp RT @mahoneyr: @JHospMedicine Thanks @JHospMedicine @WrayCharles @FutureDocs for an excellent #JHMChat! Keep warm! |
| Michael Sinha @DrSinhaEsq @FutureDocs Absolutely! Substantial reduction in the number and frequency of overnight pages. #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @laxswamy @mahoneyr @nvhstewart @tony_breu @micah_prochaska pun intended? Also there's a lot of hierarchy there. RN makes bad decision? Need to make sure your culture won't lead to a world of pain. A lot of change behind one simple idea. #JHMCHat |
| Vinny Arora MD MAPP @FutureDocs Thanks for a great #JHMChat everyone! forgot here is our pocket card to remind everyone what to do. #SIESTA is an acronym but also a pocket card of strategies! email siesta@uchicago.edu for more tools. THANKS! https://t.co/9b0U7qaolL |
 | Alan J. Card @AlanJCard RT @RJmdphilly: Can't say it's been a high enough priority but I'd like to see a way around "dumb" automatic timing for meds, culture change re lab timing, physiologic day/night cues (decreased lights, decreased noise) as a start #JHMChat |
 | Mike Tchou @TchouMd @ChrisMoriates @FutureDocs If you wanted to quantify the brilliance, this guide sent to me by @KJerardiMD could be useful. Nice work @FutureDocs! #JHMchat https://t.co/VVUHvqCbkW |
| Alan J. Card @AlanJCard RT @DrSinhaEsq: #JHMChat Can we make sleep the sixth vital sign? I don't care much for the fifth vital sign since it was created by @purduepharma & others, but sleep seems important enough to document regularly! |
| Vinny Arora MD MAPP @FutureDocs RT @ETSshow: @JHospMedicine This was great fun & excellent learning!Thanks @WrayCharles @FutureDocs @gracefarris @JHospMedicine #JHMchat |
| Alan J. Card @AlanJCard RT @JHospMedicine: Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat covering @futuredoc's recent article on sleep in hospitalized patients. Go ahead and introduce yourself while we wait for other to join in. Tonight's topic summarized here via @gracefarris https://t.co/DDUzZGlP9t |
| Kshitij Thakur, MD, MSc @KshitijThakurMD @JHospMedicine Good Night everyone. It’s going to be a very cold morning for most of us. #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc Thanks @WrayCharles, @FutureDocs & @JHospMedicine for a great #JHMChat! Definitely enjoyed learning from my adult medicine colleagues! Until next time... Now back to #Peds-land! |
#JHMChat content from Twitter.