#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Society of Hospital Medicine @SocietyHospMed
#JHMChat starts NOW! Join the conversation, then claim #CME: https://t.co/sirVSBHa9C https://t.co/g03rOkjfgu
J 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 hospi…
Chris Petrilli @PetrilliMD
RT @JHospMedicine: Don't forget to tag your tweets with #JHMChat so everyone can follow along. Topic 1 up in a moment…
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat starts NOW! Join the conversation, then claim #CME: https://t.co/sirVSBHa9C https://t.co/g03rOkjfgu
Chris Petrilli @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 @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
Anika Kumar, MD @freckledpedidoc
Anika Kumar from Cleveland! #JHMChat
Med Peds Hospitalist @medpedshosp
@JHospMedicine @WrayCharles @Futuredoc @gracefarris @ClevelandClinic @CleClinicMD #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 @PetrilliMD
RT @JHospMedicine: TONIGHT at 9PM EST, #JHMChat covers #Sleep, #MedEd, and #BehavioralNudges all in one. Join as we chat w/@FutureDocs abou…
J Hospital Medicine @JHospMedicine
Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight. Register now for CME --> https://t.co/0wO2swZq87
Grace Farris MD @gracefarris
Grace here in NYC #JHMChat I don’t like nighttime interruptions in the hospital or at home https://t.co/5kInFbW3j9
Kshitij Thakur @drkshitijthakur
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 C…
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 C…
J 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 @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
J 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
Grace Farris MD @gracefarris
@FutureDocs @klknut @jaybalachandran 😬sending my sympathies! #JHMChat
Society of Hospital Medicine @SocietyHospMed
You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5
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.
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: Grace here in NYC #JHMChat I don’t like nighttime interruptions in the hospital or at home https://t.co/5kInFbW3j9
Jennifer K. Chen, MD FAAP @DrJenChen4kids
@JHospMedicine @WrayCharles @Futuredoc @gracefarris Jen, #PedsHM fellow from San Diego (also sending warm thoughts to those in colder climes) #JHMchat
J Hospital Medicine @JHospMedicine
Let's get started with Topic 1 for tonight's #JHMChat: https://t.co/yFTEaWJLo0
Med Peds Hospitalist @medpedshosp
RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5
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 opini…
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 un…
Grace Farris MD @gracefarris
@tony_breu No hugs or docusate at 4am thx! #JHMChat
Anika Kumar, MD @freckledpedidoc
RT @SHMLive: You can claim #CME at the end of tonight's #JHMChat by following this link: https://t.co/EG2uLAyIS5
Chris Petrilli @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
Grace Farris MD @gracefarris
RT @JHospMedicine: We welcome patients, family members, and all care providers tonight and look forward to hearing a diverse group of opini…
J Hospital Medicine @JHospMedicine
@ETSshow @gracefarris We're working on trying to make that happen... #JHMChat
Chris Petrilli @PetrilliMD
RT @JHospMedicine: Let's get started with Topic 1 for tonight's #JHMChat: https://t.co/yFTEaWJLo0
Grace Farris MD @gracefarris
RT @WolfsonD: #JHMchat excited to be on this chat - first of 2019. @AAN_Nursing part of #choosingwisely recommended not to wake patients un…
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!
Sucharita Kher MD @sucharitakher
Sucharita from Boston; director for our med #inpatient services ; look forward to learning and hearing #JHMChat
Chris Petrilli @PetrilliMD
RT @SHMLive: T1 is live - Click on #JHMChat to join in! https://t.co/1BcNMpGTCm
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
J 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 co…
Grace Farris MD @gracefarris
Agree #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
J Hospital Medicine @JHospMedicine
RT @SHMLive: 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
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T1 For discussion - probably useful to distinguish between medically necessary interruptions and medically convenient interruptions #JHMChat
Sonya TG @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.
J 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: https://t.co/EG2uLAyIS5
Grace Farris MD @gracefarris
RT @FutureDocs: this struggle is real: when we were working with night nurses to improve #sleep for patients, they also ask for help on wha…
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 un…
Jennifer Caputo @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 @PetrilliMD
@gracefarris #JHMChat @SL_Wallingford
Michael Sinha MD, JD, MPH @DrSinhaEsq
RT @JHospMedicine: Too cold to leave the house tonight? Need CME? Join #JHMCHat at 9PM EST to discuss optimizing sleep in hospitalized pati…
J 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 @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 TG @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
Grace Farris MD @gracefarris
Yes—the vitals #JHMChat
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 un…
Sucharita Kher MD @sucharitakher
@JHospMedicine A1: early morning labs 🧪 #JHMChat
Med Peds Hospitalist @medpedshosp
@STangGirdwood @JHospMedicine Indeed. We need to revamp the culture. Create a paradigm shift #JHMchat
J 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
Grace Farris MD @gracefarris
This is true—more convenient for AM labs to be super AM #JHMChat
J Hospital Medicine @JHospMedicine
RT @ETSshow: Recognizing it’s even a problem that needs addressing #JHMchat https://t.co/TsX5NKTjVB
Anika Kumar, MD @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 MD, JD, MPH @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 https://t.co/SAhG4Hnixb
Rebecca Jaffe, MD @RJmdphilly
RT @SHMLive: T1 is live - Click on #JHMChat to join in! https://t.co/1BcNMpGTCm
J Hospital Medicine @JHospMedicine
RT @STangGirdwood: @JHospMedicine #JHMChat T1: on my 1st intern rotation, attending told me that since the patient was being admitted for N…
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @JHospMedicine T1 For discussion - probably useful to distinguish between medically necessary interruptions and medically con…
Grace Farris MD @gracefarris
This👇 #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 co…
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
Grace Farris MD @gracefarris
RT @ETSshow: Recognizing it’s even a problem that needs addressing #JHMchat https://t.co/TsX5NKTjVB
Chris Moriates, MD @ChrisMoriates
Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat
J Hospital Medicine @JHospMedicine
RT @FutureDocs: @WolfsonD @AAN_Nursing The nurses were definitely key to sustaining improvements in sleep. All were very excited to partici…
Kshitij Thakur @drkshitijthakur
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 @PetrilliMD
RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat
Grace Farris MD @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
Sucharita Kher MD @sucharitakher
@PetrilliMD @JHospMedicine #jhmchat 👍🏽how was the response from residents and did you get pushback?
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
Grace Farris MD @gracefarris
@DrSinhaEsq Ha!#JHMChat
Grace Farris MD @gracefarris
RT @virenkaul: @JHospMedicine Quite a few actually (not restricted to one institution!), more in ICUs these: 1. Buy in and implementation a…
Tony Breu @tony_breu
@ChrisMoriates @FutureDocs And it didn't even require any second letter usages! #JHMChat
Jennifer Caputo @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 @nvhstewart
@jennifermcaputo @JHospMedicine Yes!! I think most institutions struggle with this! #JHMChat
J 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...
Jennifer K. Chen, MD FAAP @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 @drkshitijthakur
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
Grace Farris MD @gracefarris
RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat
Sonya TG @STangGirdwood
@freckledpedidoc @JHospMedicine After 8 am, I don’t feel so bad, especially when the whole team is rounding together. #JHMchat
J Hospital Medicine @JHospMedicine
RT @ChrisMoriates: Can we just take a moment to admire the @FutureDocs acronym brilliance of #SIESTA? #JHMChat
J Hospital Medicine @JHospMedicine
RT @virenkaul: @JHospMedicine Quite a few actually (not restricted to one institution!), more in ICUs these: 1. Buy in and implementation a…
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: TBH, I don’t know if we’ve looked at it as an institution (yet). Anticipated issues incl meds (those…
Chris Petrilli @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: on my 1st intern rotation, attending told me that since the patient was being admitted for N…
Chris Petrilli @PetrilliMD
RT @JHospMedicine: Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat https://t.co/nFWY1eGN…
Grace Farris MD @gracefarris
@virenkaul @nvhstewart @JHospMedicine Computer overlords! What a turn of phrase! #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 hospi…
Grace Farris MD @gracefarris
RT @FutureDocs: This was very interesting - #EHR automated bad human processes. Because our vitals were q4h, our EHR was autodefaulted and…
J Hospital Medicine @JHospMedicine
RT @drkshitijthakur: This is definitely very creative #SIESTA #JHMchat https://t.co/2uRLSryN6E
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
Grace Farris MD @gracefarris
@RJmdphilly Don’t jinx it @RJmdphilly ! 🤞 #JHMChat
Med Peds Hospitalist @medpedshosp
@gracefarris @virenkaul @nvhstewart @JHospMedicine And @AppleSupport is also overlording us #JHMChat
J 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 TG @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
Grace Farris MD @gracefarris
RT @FutureDocs: yes this is very key. we used clinical judgment to determine who needed to be woken up since that seemed like an easy initi…
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 hospi…
Grace Farris MD @gracefarris
RT @mahoneyr: @FutureDocs Has anyone ever studied the utility of q4 vs q8 (or even q12) vital signs? Seems like cost of care would be highe…
Viren Kaul, MD @virenkaul
@gracefarris @nvhstewart @JHospMedicine #JHMchat Struggling with ordersets and autopopulates like: https://t.co/CKivfI6gk9
Nancy H Stewart DO, MS @nvhstewart
@mahoneyr @tony_breu #rarely #JHMChat cc @micah_prochaska
J Hospital Medicine @JHospMedicine
RT @FutureDocs: Aww thank you. I should mention I have a secret weapon I use to help me with acronyms #jhmchat https://t.co/P5jYEN0gjs
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: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat https://t.co/nFWY1eGN…
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
J 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 w…
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
Chris Petrilli @PetrilliMD
RT @mahoneyr: @FutureDocs You'll find out whether a nighttime test is medically necessary if you consistently page the physician/provider w…
Anika Kumar, MD @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
J 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 MD, JD, MPH @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!
J 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
Jennifer K. Chen, MD FAAP @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…
Vinny Arora MD MAPP @FutureDocs
RT @DrSinhaEsq: #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessi…
Megan Young @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
J Hospital Medicine @JHospMedicine
Topic 2 for tonight's #JHMChat... https://t.co/pOcbUWpy3O
Sucharita Kher MD @sucharitakher
T1: overnight Nebs! I usually suggest residents to specifically ask for scheduling Nebs qXhrs WHEN AWAKE as long as patient on pathway to improvement #jhmchat
Rebecca Jaffe, MD @RJmdphilly
@jennifermcaputo @JHospMedicine dialysis overnight??? (mind blown) #JHMchat
J 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, m…
Chethan Sarabu @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…
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
J 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...
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
Nancy H Stewart DO, MS @nvhstewart
@FutureDocs @CHeSS_UChicago Sam and Lisa are amazing! 🙌🏻🙌🏻🙌🏻#JHMChat
J 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…
Rebecca Jaffe, MD @RJmdphilly
@ChrisMoriates @FutureDocs Seriously I think there is a gene for acronyms #JHMCHat
Sonya TG @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 @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
Daniel Wolfson @WolfsonD
#JHMchat
Med Peds Hospitalist @medpedshosp
A2: By teaching the effect of sleep deprivation on wellness, pain thresholds, delirium, etc. #JHMChat
Stefan Tigges @StefanTigges
RT @gracefarris: Grace here in NYC #JHMChat I don’t like nighttime interruptions in the hospital or at home https://t.co/5kInFbW3j9
J 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
@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
J Hospital Medicine @JHospMedicine
RT @WolfsonD: #JHMchat https://t.co/uk7XQfo91g
Anika Kumar, MD @freckledpedidoc
RT @JHospMedicine: Love having our #Pediatrics colleagues weigh-in on #JHMChat. Feel like they bring a unique perspective & experience that…
J 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…
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 w…
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…
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 TG @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
Erin N. Marcus @ErinNMarcusMD
RT @DrSinhaEsq: #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessi…
J Hospital Medicine @JHospMedicine
RT @JHospMedicine: Topic 2 for tonight's #JHMChat... https://t.co/pOcbUWpy3O
Jennifer K. Chen, MD FAAP @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…
Grace Farris MD @gracefarris
RT @JHospMedicine: Spoken like a true geriatrician... #JHMChat https://t.co/XiBghFumL0
J Hospital Medicine @JHospMedicine
RT @STangGirdwood: @DrJenChen4kids @JHospMedicine When you’re waking the patient up so frequently overnight for Neuro checks...are they alt…
Grace Farris MD @gracefarris
RT @mahoneyr: @medpedshosp @FutureDocs If I could remove the diastolic blood pressure from vital signs, I would - I get a lot of pages abou…
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 @drkshitijthakur
@STangGirdwood @DrJenChen4kids @JHospMedicine Then we wonder why patients have hospital induced delirium #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @DrJenChen4kids: @JHospMedicine T2: Because all of us #medtwitter folks know what it’s like to be sleep-deprived? 🤪 Seriously though, pr…
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
Jennifer K. Chen, MD FAAP @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: 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…
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 @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 TG @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
J 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
J Hospital Medicine @JHospMedicine
RT @virenkaul: A2: The impact of poor sleep on: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS am…
Lakshman Swamy @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
Grace Farris MD @gracefarris
RT @virenkaul: A2: The impact of poor sleep on: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS am…
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
J 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 inte…
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-hos…
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 MD, JD, MPH @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
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)
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 overni…
Michael Sinha MD, JD, MPH @DrSinhaEsq
RT @JHospMedicine: @virenkaul Great points, Viren! @hmkyale covered this material in a #JHMChat a few months ago when he discussed post-hos…
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
J Hospital Medicine @JHospMedicine
RT @medpedshosp: Our #delirium carepath includes getting labs at 2200 and omitting 4am VS #JHMChat
J Hospital Medicine @JHospMedicine
RT @DrSinhaEsq: #JHMchat All of this. Sleep is critical to the successful treatment of, and recovery from, serious illness requiring hospit…
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @JHospMedicine T2 Toughest word here is "important". Do we mean 1) Clinically useful? 2) Financially worthwhile? 3) Emotional…
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
Jennifer K. Chen, MD FAAP @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: immunity, insulin resistance, respiratory ability, delirium leading to prolonged MV, LOS am…
JACKMOM @ubudoc
RT @FutureDocs: Aww thank you. I should mention I have a secret weapon I use to help me with acronyms #jhmchat https://t.co/P5jYEN0gjs
Rebecca Jaffe, MD @RJmdphilly
RT @DrJenChen4kids: @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to t…
Charlie M. Wray @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 @drkshitijthakur
@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
J Hospital Medicine @JHospMedicine
RT @FutureDocs: @fedescarini Interestingly many interventions have been tried in ICU patients. fewer in general ward patients. @jaybalachan
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 t…
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @laxswamy @tony_breu @DrKerbel I remain surprised how many clinically relevant interventions start when I happen to walk into…
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. @jaybalachan
J Hospital Medicine @JHospMedicine
RT @DrJenChen4kids: @RJmdphilly @JHospMedicine Curious if/how #medpeds folks like @medpedshosp carry some of the good things from peds to t…
Grace Farris MD @gracefarris
RT @RJmdphilly: Make everyone try to sleep in the hospital 1 night (kidding not kidding) #JHMChat The added benefits (#empathy) of overni…
Grace Farris MD @gracefarris
RT @mahoneyr: @JHospMedicine T2 Toughest word here is "important". Do we mean 1) Clinically useful? 2) Financially worthwhile? 3) Emotional…
Anika Kumar, MD @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
J Hospital Medicine @JHospMedicine
RT @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…
Grace Farris MD @gracefarris
RT @FutureDocs: @fedescarini Interestingly many interventions have been tried in ICU patients. fewer in general ward patients. @jaybalachan
Grace Farris MD @gracefarris
RT @WrayCharles: @RJmdphilly I've been arguing this for years! After my kids were both hospitalized, my empathy for sleep in the hospital w…
J 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…
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 TG @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 @drkshitijthakur
@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
Grace Farris MD @gracefarris
RT @FutureDocs: @Megany221 @sharon_inouye @JamesCHudspeth I started my career in aging :) not a geriatrician but with @constancefungmd deve…
Viren Kaul, MD @virenkaul
RT @RJmdphilly: @WrayCharles I feel like there is a health mentors lesson here @nethrankamd - longitudinal IPE course where pts teach stude…
Rachel Johnson @DoubleDawgMD
RT @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…
J Hospital Medicine @JHospMedicine
Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd
Michael Sinha MD, JD, MPH @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!
Jennifer K. Chen, MD FAAP @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 deve…
Grace Farris MD @gracefarris
RT @RJmdphilly: @WrayCharles I feel like there is a health mentors lesson here @nethrankamd - longitudinal IPE course where pts teach stude…
Nancy H Stewart DO, MS @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
J 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 supe…
Charlie M. Wray @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 @purdue
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 @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
J Hospital Medicine @JHospMedicine
RT @nvhstewart: @JHospMedicine A2: Agree we all know that #sleep is important but the key is #education of #patients #trainees #nurses on #…
Grace Farris MD @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 pa…
J 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 @purdue
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
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd
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 @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
J 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 pa…
Jennifer K. Chen, MD FAAP @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
Grace Farris MD @gracefarris
T3 Even if the change in vital sign monitoring causes pushback I think starting w vitals is key for culture change #JHMChat https://t.co/jlGib3vFzV
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 @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: An entire hospital commitment, otherwise it is too big of a leap for too many doctors and…
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 @NatalieTapaska
Grace Farris MD @gracefarris
With huge emphasis on discharge before noon... #JHMChat
PeTEA @PettyHomoMD
RT @tony_breu: I feel like it's gotta be overnight vital signs. #JHMChat https://t.co/SAhG4Hnixb
J 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…
Kshitij Thakur @drkshitijthakur
@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
J 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 chang…
Lakshman Swamy @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
Grace Farris MD @gracefarris
RT @WrayCharles: The importance of identifying stakeholders and other leaders if you're looking to enact change. Especially important of hi…
Jennifer Caputo @jennifermcaputo
@medpedshosp So much seems to be breaking culture routines such as ordering daily labs on every patient, I like this strategy #JHMChat
Grace Farris MD @gracefarris
RT @jac2thersq: Discovery Rounds - as a way to prevent unnecessary, redundant pre-rounding on stable patients that could use the rest=time…
J Hospital Medicine @JHospMedicine
RT @FutureDocs: IMHO A real discharge before noon means that the decision to discharge was made before 4AM #jhmchat https://t.co/54Dmyw4x2n
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 @NatalieTapaska
J Hospital Medicine @JHospMedicine
RT @gracefarris: T3 Even if the change in vital sign monitoring causes pushback I think starting w vitals is key for culture change #JHMCha
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 @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
Grace Farris MD @gracefarris
RT @jennifermcaputo: @medpedshosp So much seems to be breaking culture routines such as ordering daily labs on every patient, I like this s…
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
@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 TG @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
Grace Farris MD @gracefarris
RT @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 horrib…
J 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 s…
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
Jennifer K. Chen, MD FAAP @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 hi…
J 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 hi…
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 hi…
Michael Sinha MD, JD, MPH @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 @drkshitijthakur
@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!
Grace Farris MD @gracefarris
RT @FutureDocs: so the problem is more than just overtreatment - its not using that same effort to do more frequent checks on those that ne…
Grace Farris MD @gracefarris
RT @FutureDocs: Seeing a lot of discussion who needs vitals and who doesn't and default. in another study with colleagues - even those w hi…
Jennifer Caputo @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 TG @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
@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 @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
J Hospital Medicine @JHospMedicine
RT @jennifermcaputo: @STangGirdwood @JHospMedicine @freckledpedidoc Our onc floor also best in hospital at limiting unnecessary overnight c…
Sonya TG @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 hi…
J Hospital Medicine @JHospMedicine
RT @CHeSS_UChicago: Check out @FutureDocs on the #jhmchat happening now! https://t.co/Owcf3G79Fx
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
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
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
RT @jac2thersq: Discovery Rounds - as a way to prevent unnecessary, redundant pre-rounding on stable patients that could use the rest=time…
J 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,…
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 ht…
J 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 ne…
Fedes @fedescarini
RT @JHospMedicine: Moving on…Topic 3 for tonight's #JHMChat https://t.co/yAwUACePkd
Sonya TG @STangGirdwood
RT @virenkaul: A3: - Post round MedRecs to ensure removal of standing Q6/8 meds (QID/TID if possible) - 🔽 alarm sounds (esp within room) -…
Anika Kumar, MD @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
Grace Farris MD @gracefarris
In the words of @ETSshow “hard co-sign” & “vigorous head-nodding” #JHMChat
Michael Sinha MD, JD, MPH @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…
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
Jennifer K. Chen, MD FAAP @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
Doctivist @jbcowartmd
RT @DrSinhaEsq: #JHMchat Q1/Q2/Q4 hour vitals, excessively early/frequent lab orders, lack of coordination among rounding services, excessi…
J 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 #…
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
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wa…
Med Peds Hospitalist @medpedshosp
RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wa…
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 @tdwck
RT @JHospMedicine: Interesting take: the influence of hierarchy of #MedEd taking it's toll on patient care...#JHMChat https://t.co/nFWY1eGN…
J 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 #…
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…
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
Jennifer K. Chen, MD FAAP @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
Grace Farris MD @gracefarris
RT @FutureDocs: cc @WrayCharles and I have strong opinions about telemetry too #jhmchat -- in terms of alarms its one of the worst for aler…
Leonard Javier ⌬ @STPbasileo
RT @tony_breu: I feel like it's gotta be overnight vital signs. #JHMChat https://t.co/SAhG4Hnixb
Med Peds Hospitalist @medpedshosp
@JHospMedicine Yes - reevaluate necessity of: Central lines, Foley, Telemetry, VS at 4am, daily labs, etc. #JHMChat
Sonya TG @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 @purdue
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
Grace Farris MD @gracefarris
So true! #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 ht…
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 aler…
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 ben…
J Hospital Medicine @JHospMedicine
RT @STangGirdwood: @DrJenChen4kids @JHospMedicine #JHMChat: yes, that’s the beauty of rounding in the room - being cued by what you see lik…
Sonya TG @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”
J Hospital Medicine @JHospMedicine
RT @medpedshosp: @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 @purdue
Grace Farris MD @gracefarris
RT @STangGirdwood: @DrJenChen4kids @JHospMedicine #JHMchat: another area for improvement is to remove the IV as soon as possible since ther…
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
J Hospital Medicine @JHospMedicine
@freckledpedidoc Give @FutureDocs some time and she'll come up with something snappy #JHMChat
Fedes @fedescarini
RT @virenkaul: A3: - Post round MedRecs to ensure removal of standing Q6/8 meds (QID/TID if possible) - 🔽 alarm sounds (esp within room) -…
J 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…
J Hospital Medicine @JHospMedicine
@kristenyoung @STangGirdwood @jennifermcaputo @TchouMd great question? Wonder if @FutureDocs is studying this as we speak...? #jhmchat
Sonya TG @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: 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
J 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 @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
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: While MedReconciliation is specific for meds, do we need to do a more thorough "intervention reconciliation"...? #JHMCha
Sonya TG @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
Grace Farris MD @gracefarris
RT @FutureDocs: see another @JHospMedicine paper on teaching from the built environment -- we called it Guerilla Teaching and use it a lot…
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
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 s…
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
Lakshman Swamy @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
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…
Nancy H Stewart DO, MS @nvhstewart
@RJmdphilly @freckledpedidoc @virenkaul @FutureDocs @laxswamy @tony_breu 🙌🏻🙌🏻 #JHMChat
Viren Kaul, MD @virenkaul
@scubalyssious I hear you my friend! #JHMchat https://t.co/b9IaDvegMP
J 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
Autodidact @iamukasa
RT @FutureDocs: For any #ptexp #nurses #epatients #EHR friends please join in - all voices welcome #jhmchat starts in 5 min on SIESTA how t…
Fedes @fedescarini
@JHospMedicine How do you measure sleep quality? #JHMChat?
Nancy H Stewart DO, MS @nvhstewart
RT @mahoneyr: @hover2pie @laxswamy @nvhstewart @tony_breu @micah_prochaska The most important conversation for doctors and nurses is with t…
Jennifer K. Chen, MD FAAP @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 TG @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
J 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. #…
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
J 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 s…
Grace Farris MD @gracefarris
Oh sleep! it is a gentle thing, Beloved from pole to pole! To Mary Queen the praise be given! She sent the gentle sleep from Heaven, That slid into my soul. #JHMChat
Sanjay Saint @sanjaysaint
“The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #SleepIsGood
Grace Farris MD @gracefarris
RT @tony_breu: I really need to thank @FutureDocs and her team for doing this study. So important. And, I hope, sparks necessary change. #…
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 m…
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
Viren Kaul, MD @virenkaul
RT @gracefarris: Oh sleep! it is a gentle thing, Beloved from pole to pole! To Mary Queen the praise be given! She sent the gentle sleep…
Society of Hospital Medicine @SocietyHospMed
Don't forget to claim #CME after tonight's #JHMChat! Click here: https://t.co/td9CQCo1eB
Michael Sinha MD, JD, MPH @DrSinhaEsq
@JHospMedicine @WrayCharles @Futuredoc @gracefarris Love the @gracefarris #VisualAbstract as well! #JHMchat
Charlie M. Wray @WrayCharles
RT @JHospMedicine: Big thanks to @gracefarris for her wonderful artwork which helps highlight this important research and get the word out…
Grace Farris MD @gracefarris
@JHospMedicine @FutureDocs @SamirShahMD Thank you! #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 #Sleep
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. #…
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…
Viren Kaul, MD @virenkaul
Once more for literally everyone, those in the front, the back and everywhere in between!!! #JHMchat
Grace Farris MD @gracefarris
RT @sanjaysaint: “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale #JHMCHat #Sleep
Charlie M. Wray @WrayCharles
This. This technology will enact more change than anything else I can think of... #JHMChat
J Hospital Medicine @JHospMedicine
RT @drkshitijthakur: @STangGirdwood @DrJenChen4kids @JHospMedicine Need a technology whereby the IV machine beeps remotely near Nursing des…
Grace Farris MD @gracefarris
@DrSinhaEsq @JHospMedicine @WrayCharles @Futuredoc Thanks! #JHMChat
J 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…
Zackary Berger, MD, PhD @ZackBergerMDPhD
RT @drkshitijthakur: @STangGirdwood @DrJenChen4kids @JHospMedicine Need a technology whereby the IV machine beeps remotely near Nursing des…
Grace Farris MD @gracefarris
RT @WrayCharles: This. This technology will enact more change than anything else I can think of... #JHMChat https://t.co/Mn9N3hFhi4
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @DrJenChen4kids @STangGirdwood @JHospMedicine I call it "scanning the room". Also look for Foley Fecal containment device Out…
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 Out…
Grace Farris MD @gracefarris
RT @FutureDocs: Improving sleep in hospitals is a team sport - it takes doctors, nurses, phlebotomy, #ptexp to help. Using the #EHR can he…
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 #Sleep
Lakshman Swamy @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
J 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 he…
Vinny Arora MD MAPP @FutureDocs
RT @freckledpedidoc: @STangGirdwood @DrJenChen4kids @JHospMedicine I often ask about med timings on rounds. The parents are not going to wa…
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🥗🍌🥕 @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 TG @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
J 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 #Sleep
Grace Farris MD @gracefarris
@RJmdphilly @freckledpedidoc @STangGirdwood @jac2thersq @FutureDocs @JHospMedicine It’s when u round together in lieu of intern pre-rounding #JHMChat
Rebecca Jaffe, MD @RJmdphilly
RT @ChrisMoriates: Why does this feel aspirational? This definitely should NOT be aspirational. #JHMChat #SIESTA https://t.co/FqDSGroSWT
Kshitij Thakur @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
J 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 patie…
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
@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
J Hospital Medicine @JHospMedicine
RT @ChrisMoriates: Why does this feel aspirational? This definitely should NOT be aspirational. #JHMChat #SIESTA https://t.co/FqDSGroSWT
Jennifer K. Chen, MD FAAP @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
J Hospital Medicine @JHospMedicine
RT @gracefarris: Oh sleep! it is a gentle thing, Beloved from pole to pole! To Mary Queen the praise be given! She sent the gentle sleep…
Michael Sinha MD, JD, MPH @DrSinhaEsq
RT @FutureDocs: This simple thing is key to reducing overnight pages also which can help reduce workload at night #jhmchat https://t.co/HeF…
Grace Farris MD @gracefarris
RT @ETSshow: @JHospMedicine This was great fun & excellent learning!Thanks @WrayCharles @FutureDocs @gracefarris @JHospMedicine #JHMchat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine Thanks @JHospMedicine @WrayCharles @FutureDocs for an excellent #JHMChat! Keep warm!
Sonya TG @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
Grace Farris MD @gracefarris
Thanks @WrayCharles and @FutureDocs ! #JHMChat
Med Peds Hospitalist @medpedshosp
RT @mahoneyr: @JHospMedicine Thanks @JHospMedicine @WrayCharles @FutureDocs for an excellent #JHMChat! Keep warm!
Michael Sinha MD, JD, MPH @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
Rebecca Jaffe, MD @RJmdphilly
RT @gracefarris: Thanks @WrayCharles and @FutureDocs ! #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
Benjamin P. Geisler @ben_geisler
RT @gracefarris: T3 Even if the change in vital sign monitoring causes pushback I think starting w vitals is key for culture change #JHMCha
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 chang…
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 @purdue
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 hospi…
Kshitij Thakur @drkshitijthakur
@JHospMedicine Good Night everyone. It’s going to be a very cold morning for most of us. #JHMchat
Anika Kumar, MD @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.