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#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Journal of Hospital Medicine @JHospMedicine
Good Evening everyone! I'm @WrayCharles your moderator for tonight's #JHMChat. (First ever with 280 characters!) Go ahead and introduce yourself while we wait for others to join in...
Journal of Hospital Medicine @JHospMedicine
Good Evening everyone! I'm @WrayCharles your moderator for tonight's #JHMChat. (First ever with 280 characters!)... https://t.co/BdbvrhG2zK
Society of Hospital Medicine @SocietyHospMed
#JHMChat starts NOW! Join the conversation w/ @JHospMedicine @micah_prochaska @WolfsonD, then claim #CME: https://t.co/frGbksWMwF https://t.co/JuSkVGZDbE
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@laxswamy @tony_breu @FutureDocs @bornk @Brian_M_Wong @HemeHillis @ChrisMoriates @WolfsonD @micah_prochaska @WrayCharles @JHospMedicine bummer! #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat starts NOW! Join the conversation w/ @JHospMedicine @micah_prochaska @WolfsonD, then claim #CME: https://t.co/frGbksW…
Journal of Hospital Medicine @JHospMedicine
Don't forget to tag your tweets with #JHMChat! Topic 1 (T1) up in a few moments…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@JHospMedicine @WrayCharles #JHMchat #280characters !
Daniel Wolfson @WolfsonD
#JHMChat Glad to participate & discuss terrific paper
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat joining from Portland, OR and @OHSUIMRes
Journal of Hospital Medicine @JHospMedicine
Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation for bringing you #JHMChat tonight - another #CME edition!
Rebecca Jaffe, MD @RJmdphilly
Hi! Rebecca Jaffe here from freezing philly. Where they close school because of almost frozen rain. Trying to learn how to use Tweetdeck and feeling baffled. #JHMChat
Micah Prochaska @micah_prochaska
#JHMCHAT Glad to be here. Thank your for inviting me.
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@RJmdphilly #JHMchat tweetdeck-you can do it!
Shoshana Herzig, MD, MPH @ShaniHerzig
@tony_breu @FutureDocs @bornk @Brian_M_Wong @HemeHillis @ChrisMoriates @WolfsonD @micah_prochaska @WrayCharles @JHospMedicine A chat without TB?? We’ll miss you. #jhmchat
Vinny Arora MD MAPP @FutureDocs
Excited for #JHMChat w @WolfsonD @micah_prochaska —and thx to @WrayCharles for moderating this one!
Journal of Hospital Medicine @JHospMedicine
We welcome @micah_prochaska as our guest author and @wolfsonD, COO of @ABIMFoundation to tonight's discussion #JHMChat https://t.co/ii4ssxC6ke
Journal of Hospital Medicine @JHospMedicine
Happy to have in on the conversation, @micah_prochaska! #JHMChat https://t.co/3nTCHN7CHY
Journal of Hospital Medicine @JHospMedicine
Be sure to register for #CME for participation in tonight's #JHMChat - sign up here!--> https://t.co/eF9tllCeAu
Journal of Hospital Medicine @JHospMedicine
Be sure to register for #CME for participation in tonight's #JHMChat - sign up here!--> https://t.co/eF9tllCeAu https://t.co/AslaQK93tf
Journal of Hospital Medicine @JHospMedicine
Now that housekeeping is out of the way, let's get started... #JHMChat
Amit Pahwa @Pahwa
Amit Pahwa from @Hopkins_GIM @HopkinsMedicine @Hopkins_DOM_HVC #JHMChat
Journal of Hospital Medicine @JHospMedicine
Topic 1 on tonight's #JHMChat: https://t.co/4fHS9QqJNV
Micah Prochaska @micah_prochaska
#JHMCHAT just to be sure, but we have 2 authors here tonight: at @FutureDocs also an author on this paper.
Daniel Wolfson @WolfsonD
RT @JHospMedicine: Topic 1 on tonight's #JHMChat: https://t.co/4fHS9QqJNV
Society of Hospital Medicine @SocietyHospMed
#JHMChat T1 is live - join the conversation! #ChoosingWisely https://t.co/4og3oUvYFZ
Daniel Wolfson @WolfsonD
63% were adopters - early on in this change is a positive sign. https://t.co/44LTnmhnSO
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Topic 1 on tonight's #JHMChat: https://t.co/4fHS9QqJNV
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Be sure to register for #CME for participation in tonight's #JHMChat - sign up here!--> https://t.co/eF9tllCeAu https://…
Lonika #wearyourmask Sood @sood_lonika
@JHospMedicine T1 unclear whether bias starts if ER follows troponin only/not protocol. Does choosing wisely include er folks? #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: We welcome @micah_prochaska as our guest author and @wolfsonD, COO of @ABIMFoundation to tonight's discussion #JHMChat h…
Vinny Arora MD MAPP @FutureDocs
@ShaniHerzig @tony_breu @bornk @Brian_M_Wong @HemeHillis @ChrisMoriates @WolfsonD @micah_prochaska @WrayCharles @JHospMedicine Alas The show must go on #JHMchat let’s do TB proud !
Amit Pahwa @Pahwa
T1 - can't get away from how it's always done. We tried to go only troponin here but some cardiologists want to keep ck-mb #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat T1--makes you wonder how much was driven by order sets, ex. one click and get more than just troponin...
Vinny Arora MD MAPP @FutureDocs
RT @Pahwa: T1 - can't get away from how it's always done. We tried to go only troponin here but some cardiologists want to keep ck-mb #JHMC…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat T1 or orders adjacent on order set, so each to click multiple orders
Journal of Hospital Medicine @JHospMedicine
Interesting question...@micah_prochaska, was your study granular enough to assess WHERE these labs were ordered? #jhmchat https://t.co/CiVVROpIEL
Gretchen Diemer @gretchendiemer
@Pahwa We fear change. #jhmchat #oldhabitsdiehard
Lonika #wearyourmask Sood @sood_lonika
@Pahwa T1: agree- culture is huge as is collective practice. Not seen many ck here for 4+ years #JHMchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat I feel like pre-populated, one-click order sets lead to so much unnecessary testing
Rebecca Jaffe, MD @RJmdphilly
T1 - Education as weak improvement strategy? #JHMChat https://t.co/DP9AxtS88S
Vinny Arora MD MAPP @FutureDocs
@sood_lonika @JHospMedicine EM definitely part of solution on troponin only ordering - we worked to remove from ER cardiac panel but took lots buy in #JHMChat
Lonika #wearyourmask Sood @sood_lonika
@gretchendiemer @Pahwa Or we are too lazy to change sometimes ;) #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @sood_lonika: @Pahwa T1: agree- culture is huge as is collective practice. Not seen many ck here for 4+ years #JHMchat
Daniel Wolfson @WolfsonD
T1: need more than education to change automatic trained responses. First need adaptive change - shared purpose, values. https://t.co/JKNU2ZNH7k
Shoshana Herzig, MD, MPH @ShaniHerzig
@SHMLive I believe CK-MB is more specific in the setting of renal failure, which many of our patients have. True? False? This is why I sometimes still check it, and I think partly why cardiologists do... #jhmchat
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs @sood_lonika @JHospMedicine Potential weakness of CW format where recommendations are specialty specific? A lot of shared/cross specialty decision making makes adherence difficult. #JHMChat
Journal of Hospital Medicine @JHospMedicine
Begs the question as to who is involved in creating these order sets #jhmchat https://t.co/dyiP6zFKuA
Journal of Hospital Medicine @JHospMedicine
RT @ShaniHerzig: @SHMLive I believe CK-MB is more specific in the setting of renal failure, which many of our patients have. True? False? T…
Rebecca Jaffe, MD @RJmdphilly
Usually a kernel of truth in why we do what we do... #JHMChat https://t.co/zzleS3RSqM
@HyungChoMD @HyungChoMD
#jhmchat T1 whenever we try running a report for a common lab test, there's over a dozen order sets that drive it - from different departments
Journal of Hospital Medicine @JHospMedicine
Great point @RJmdphilly, are the silos of #ChoosingWisely one of its weaknesses #JHMChat. @WolfsonD, thoughts? https://t.co/gUa1GfCZTa
Vinny Arora MD MAPP @FutureDocs
Common myth! Not so with newer troponin assay per @UpToDate #JHMchat https://t.co/3zkPGwof66
Gretchen Diemer @gretchendiemer
@JHospMedicine And how often the are updated? Is there active curation of order sets as new evidence becomes available? #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs @UpToDate #JHMchat I think I was just reading the same uptodate article!
Lonika #wearyourmask Sood @sood_lonika
@RJmdphilly @FutureDocs @JHospMedicine T1: local example of using ehr inCW...made telemetry order set slightly hard to use.. unnecessary telenorders reduced significantly #jhmchat
Journal of Hospital Medicine @JHospMedicine
RT @FutureDocs: Common myth! Not so with newer troponin assay per @UpToDate #JHMchat https://t.co/3zkPGwof66
Shoshana Herzig, MD, MPH @ShaniHerzig
@FutureDocs @UpToDate Awesome - learning in action! #JustsaynotoCKMB #jhmchat
Rebecca Jaffe, MD @RJmdphilly
@gretchendiemer @JHospMedicine ugh current headache. How often is ANY care practice updates/reviewed? How is accountability for this managed? #ClinicalReferenceCards are killing me. #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@JHospMedicine @RJmdphilly @WolfsonD #JHMchat I see that question w the #periopmedicine related CW recommendations--cross so many different societies and specialties!
Journal of Hospital Medicine @JHospMedicine
Topic 2 coming up shortly...#JHMChat
Daniel Wolfson @WolfsonD
T1 #JHMChat Need intervention to change long held practices. Automatic responses - hard set patterns. Alerts, change in order sets, peer comparisons. Use #ChoosingWisely for adaptive change - common purpose/values - concrete items to implement
Lonika #wearyourmask Sood @sood_lonika
@HyungChoMD T1: true.. and some are an if condition met order... so sometimes no troponins drawn overnight! #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@ShaniHerzig @FutureDocs @UpToDate #JHMchat great hashtag, there's gotta be a meme or a GIF in there somewhere...
Vinny Arora MD MAPP @FutureDocs
#JHMchat both ckmb and troponin challenge in renal patients but troponin still preferred @ShaniHerzig @micah_prochaska https://t.co/QNezGYf7zG
Journal of Hospital Medicine @JHospMedicine
Topic 2 in tonight's #JHMChat: https://t.co/UMWedMOtx8
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gretchendiemer @JHospMedicine #JHMchat not just how often some clinical decision trigger the update, but also the time to accomplish it. Can take so long with Epic support sometimes.
Journal of Hospital Medicine @JHospMedicine
RT @WolfsonD: T1 #JHMChat Need intervention to change long held practices. Automatic responses - hard set patterns. Alerts, change in order…
Amit Pahwa @Pahwa
RT @FutureDocs: #JHMchat both ckmb and troponin challenge in renal patients but troponin still preferred @ShaniHerzig @micah_prochaska htt…
Journal of Hospital Medicine @JHospMedicine
RT @FutureDocs: #JHMchat both ckmb and troponin challenge in renal patients but troponin still preferred @ShaniHerzig @micah_prochaska htt…
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Topic 2 in tonight's #JHMChat: https://t.co/UMWedMOtx8
Vinny Arora MD MAPP @FutureDocs
I should disclose a former @MedChiefs resident taught me this! “Reverse” rounds #JHMChat https://t.co/wESHJhH33o
Amit Pahwa @Pahwa
T2 - has to be buy in from all those involved - just to remove thrombophilia workup had to talk to 4-5 different specialists - Heme (IM and Peds), OB, Neuro, Stroke, etc, etc #jhmchat
Jihoon Baang @jbaang
@FutureDocs @ShaniHerzig @micah_prochaska Troponin kinetics key in differentiating cause of troponin leak. #jhmchat https://t.co/lesjs9upu1
Daniel Wolfson @WolfsonD
T1: Need muti-speciality conversations - needs team conversations - need focus on patient’s illness #ChoosingWisely https://t.co/JZdM1cDL9j
Lonika #wearyourmask Sood @sood_lonika
@JHospMedicine T2: hate to say this but our community hospital does not follow CW...#JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @jbaang: @FutureDocs @ShaniHerzig @micah_prochaska Troponin kinetics key in differentiating cause of troponin leak. #jhmchat https://t.c…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@Pahwa #JHMChat agree with multi-specialty buy-in, w my #periopmedicine stuff, it's hospitalist, anesth, surgeons, maybe others
Shoshana Herzig, MD, MPH @ShaniHerzig
@FutureDocs @micah_prochaska So looking for dynamic change in troponin is the answer in CKD and otherwise #jhmchat
Lonika #wearyourmask Sood @sood_lonika
@jbaang @FutureDocs @ShaniHerzig @micah_prochaska How about demand mediatedtype 2 nstemi #JHMchat
Rebecca Jaffe, MD @RJmdphilly
@sood_lonika @JHospMedicine that's ok, our academic medical center is struggling too (though maybe doing ok with trop/CK. lets not talk about MRIs though) #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @ShaniHerzig: @FutureDocs @micah_prochaska So looking for dynamic change in troponin is the answer in CKD and otherwise #jhmchat
Journal of Hospital Medicine @JHospMedicine
@sood_lonika Don't feel bad, this study proves that even the #ivorytowers aren't perfect in implementing #JHMchat
Shoshana Herzig, MD, MPH @ShaniHerzig
@JHospMedicine @sood_lonika Ha ha clearly so! :) #jhmchat
Rebecca Jaffe, MD @RJmdphilly
T2 - have a champion (person or department) willing to drive conversations and own new care processes. Incorporate interventions other than education. Access to data!! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@micah_prochaska, can you comment at all on the regional heterogeneity that you all saw? #JHMchat https://t.co/ckdakFtCCp
Shoshana Herzig, MD, MPH @ShaniHerzig
RT @jbaang: @FutureDocs @ShaniHerzig @micah_prochaska Troponin kinetics key in differentiating cause of troponin leak. #jhmchat https://t.c…
Micah Prochaska @micah_prochaska
@JHospMedicine @sood_lonika All the hospitals in our study were academic medical centers and their affiliate hospitals!! #JHMchat
Jihoon Baang @jbaang
@JHospMedicine Respected attendings leading by example. In a hierarchical culture like medicine, a respected attendings action and words critical element of culture change. #jhmchat
Guilherme Barcellos @brhospitalist
RT @WolfsonD: T1 #JHMChat Need intervention to change long held practices. Automatic responses - hard set patterns. Alerts, change in order…
Daniel Wolfson @WolfsonD
T1 #JHMChat Focus on early adopters & mid adapters & let peers talk to others. Why are we doing something different from you - academic detailing another strategy.
Journal of Hospital Medicine @JHospMedicine
RT @jbaang: @JHospMedicine Respected attendings leading by example. In a hierarchical culture like medicine, a respected attendings action…
Rebecca Jaffe, MD @RJmdphilly
@VizientInc https://t.co/sC6QZBT2RY
Guilherme Barcellos @brhospitalist
RT @ShaniHerzig: @FutureDocs @micah_prochaska So looking for dynamic change in troponin is the answer in CKD and otherwise #jhmchat
Guilherme Barcellos @brhospitalist
RT @FutureDocs: #JHMchat both ckmb and troponin challenge in renal patients but troponin still preferred @ShaniHerzig @micah_prochaska htt…
Journal of Hospital Medicine @JHospMedicine
RT @WolfsonD: T1 #JHMChat Focus on early adopters & mid adapters & let peers talk to others. Why are we doing something different from you…
Micah Prochaska @micah_prochaska
@JHospMedicine Of the hospitals that improved their troponin ordering (middle tertile), there were a few hospitals that really drove the regional improvements seen (ie midwest). #jhmchat
Journal of Hospital Medicine @JHospMedicine
RT @micah_prochaska: @JHospMedicine Of the hospitals that improved their troponin ordering (middle tertile), there were a few hospitals tha…
Gretchen Diemer @gretchendiemer
RT @jbaang: @FutureDocs @ShaniHerzig @micah_prochaska Troponin kinetics key in differentiating cause of troponin leak. #jhmchat https://t.c…
Journal of Hospital Medicine @JHospMedicine
Topic 3 coming up... #JHMChat
Lonika #wearyourmask Sood @sood_lonika
@micah_prochaska @JHospMedicine Would be interesting to see impact in community settings. Methinks hospitalists have a lot more say in ehr/practice here #JHMchat
Daniel Wolfson @WolfsonD
T2 #JHMChat What is the role of leadership - not just in the C-suite but from microsystems & bottom up/locally. The role of young faculty & residents & medical students - leading the way
Journal of Hospital Medicine @JHospMedicine
Topic 3 for tonight's #JHMChat: https://t.co/D4SEmfkOVI
Rebecca Jaffe, MD @RJmdphilly
@jbaang @JHospMedicine Interesting example tonight with @FutureDocs and @ShaniHerzig - event if #RespectedAttending isn't sure of the answer we all learn better when there is inquiry on rounds. Challenge learners to find evidence. #JHMChat @greenQoDay
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat can't say it's been successful, but we still push back about routine "preop coags" (INR and PTT)
Rebecca Jaffe, MD @RJmdphilly
@aoglasser Key to success. Persistence #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @RJmdphilly: @jbaang @JHospMedicine Interesting example tonight with @FutureDocs and @ShaniHerzig - event if #RespectedAttending isn't s…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat love this! https://t.co/0LZzfxh1if
Gretchen Diemer @gretchendiemer
RT @aoglasser: #JHMchat can't say it's been successful, but we still push back about routine "preop coags" (INR and PTT)
Gretchen Diemer @gretchendiemer
And preop UA!! #JHMChat https://t.co/Srd2AcAno3
Chris Petrilli @PetrilliMD
@JHospMedicine #jhmchat T3: daily labs has been a major challenge to implement - people seem to fear not reporting the 7th vital sign.
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@RJmdphilly #JHMchat, and, ala your last tweet, education. Get the data that coags don't change management in pts but rarely, and may not even be best bleeding diathesis screening test
Amit Pahwa @Pahwa
Not ordering folate @tony_breu @DocLennyF @TWDFNR #jhmchat
Journal of Hospital Medicine @JHospMedicine
So true @WolfsonD, as @FutureDocs can comment -- the impetus of this study and idea came from a trainee... #JHMchat https://t.co/keFHxbIUDT
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gretchendiemer #JHMChat yes! those damn pre-op UAs
Vinny Arora MD MAPP @FutureDocs
RT @jbaang: @JHospMedicine Respected attendings leading by example. In a hierarchical culture like medicine, a respected attendings action…
Society of Hospital Medicine @SocietyHospMed
T3 is live! It's not too late to join tonight's #JHMChat! https://t.co/j4SheoWiiY
Daniel Wolfson @WolfsonD
T3 #JHMChat We have seen a focus on imaging, labs, antibiotics, telemetry & blood
Gretchen Diemer @gretchendiemer
And say what you will do with the result of any and all testing. If you won't change your management, don't do the test! #JHMChat https://t.co/B4WouDREYN
Rebecca Jaffe, MD @RJmdphilly
@Pahwa @tony_breu @DocLennyF @TWDFNR But there was that one time... #JHMChat #ChoosingWisely
Vinny Arora MD MAPP @FutureDocs
RT @WolfsonD: T2 #JHMChat What is the role of leadership - not just in the C-suite but from microsystems & bottom up/locally. The role of y…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gretchendiemer #JHMchat and speaking of order sets, once saw urine HCG ordered pre-op...on ~60yo woman s/p hysterectomy
Lonika #wearyourmask Sood @sood_lonika
T3: telemetry #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
RT @JHospMedicine: So true @WolfsonD, as @FutureDocs can comment -- the impetus of this study and idea came from a trainee... #JHMchat http…
Journal of Hospital Medicine @JHospMedicine
RT @PetrilliMD: @JHospMedicine #jhmchat T3: daily labs has been a major challenge to implement - people seem to fear not reporting the 7th…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
RT @gretchendiemer: And say what you will do with the result of any and all testing. If you won't change your management, don't do the test…
Micah Prochaska @micah_prochaska
@aoglasser @gretchendiemer Pre-Op UA=So Painful #JHMchat
Gretchen Diemer @gretchendiemer
@aoglasser Was it positive? Because that'd be a case report for sure! #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gretchendiemer #JHMchat i challenge learners on any test-what will you do is positive, negative, or equivocal???
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: T3 is live! It's not too late to join tonight's #JHMChat! https://t.co/j4SheoWiiY
Chris Petrilli @PetrilliMD
@aoglasser @gretchendiemer #jhmchat we were actually able to sit down with our ortho colleagues to get them on board. They didn’t really care once we showed them the evidence. It was a huge win! And since all Pre-Op go through hospitalist run Clinic - it’s easy to ensure compliance.
Jihoon Baang @jbaang
@PetrilliMD @JHospMedicine My experience has been residents do what attendings want. They know I hate daily labs so they avoid. They know some like daily labs so they check daily... it is a struggle though #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gretchendiemer #JHMchat the patient rightfully stood her grow and refused to be treated so idiotically
Gretchen Diemer @gretchendiemer
RT @aoglasser: @gretchendiemer #JHMchat i challenge learners on any test-what will you do is positive, negative, or equivocal???
Chris Petrilli @PetrilliMD
RT @aoglasser: @gretchendiemer #JHMchat i challenge learners on any test-what will you do is positive, negative, or equivocal???
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@PetrilliMD @gretchendiemer #JHMchat we keep trying to do that, but feel like still back sliding in certain areas, ugh
Rebecca Jaffe, MD @RJmdphilly
@WolfsonD that about covers it =) #JHMChat
Gretchen Diemer @gretchendiemer
@PetrilliMD @aoglasser #oldhabitsdiehard #jhmchat
Vinny Arora MD MAPP @FutureDocs
T3 we are working on daily labs in stable patients and it’s not an easy one to change - some docs “love labs” #JHMchat @UCM_HDS #choosingwisely
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@PetrilliMD @gretchendiemer #JHMchat we also don't have complete autonomy over all labs done in our pre-op clinic, since others can order labs to be released in our clinic.
Shoshana Herzig, MD, MPH @ShaniHerzig
T3: getting people to not treat asymptomatic bacteriuria #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @jbaang: @PetrilliMD @JHospMedicine My experience has been residents do what attendings want. They know I hate daily labs so they avoid.…
Journal of Hospital Medicine @JHospMedicine
A reoccurring theme in tonight's #JHMChat appears to be that people respond to evidence and leadership (attending) buy-in... https://t.co/GfxfFdJuUN
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs @UCM_HDS #JHMchat ...until their patient develops an iatrogenic anemia...
Journal of Hospital Medicine @JHospMedicine
A reoccurring theme in tonight's #JHMChat appears to be that people respond to evidence and leadership... https://t.co/hNGxOudRxS
Daniel Wolfson @WolfsonD
#JHMChat The role of professionalism - driving force - working in the best interest of patients - need to stop blaming payment systems for lack of changec
Vinny Arora MD MAPP @FutureDocs
RT @ShaniHerzig: T3: getting people to not treat asymptomatic bacteriuria #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@ShaniHerzig #JHMchat and THAT is also part of the pre-op UA issue, esp before hardware implantation
Guilherme Barcellos @brhospitalist
#jhmchat I recently worked in a hospital where in one click doctors order not only troponin and CKMB, but also myoglobin and LDL... I wasn't able to change this... 😤
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
RT @WolfsonD: #JHMChat The role of professionalism - driving force - working in the best interest of patients - need to stop blaming paymen…
Chris Petrilli @PetrilliMD
@jbaang @JHospMedicine #jhmchat agreed. the struggle is real. That’s why soap-v being adopted universally as part of culture would be a huge win! I don’t know attendings that want them - but it’s just not explicitly stated otherwise.
Grace Farris MD @gracefarris
T3, sorry to be arriving late (bedtime) we are working on docusate at @MSWSL_Library #JHMChat
Jerónimo Xavier Cassanello @xass76
RT @ShaniHerzig: @SHMLive I believe CK-MB is more specific in the setting of renal failure, which many of our patients have. True? False? T…
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs @UCM_HDS Where is @gracefarris ? Need a cartoon of someone trying to tear my daily labs out of my cold dead hands... #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @WolfsonD: #JHMChat The role of professionalism - driving force - working in the best interest of patients - need to stop blaming paymen…
Society of Hospital Medicine @SocietyHospMed
Don't forget to claim #CME immediately following #JHMChat: https://t.co/2B0DZ6mKKp
Rebecca Jaffe, MD @RJmdphilly
@JHospMedicine and interventions across departments #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMCHat @gracefarris literally just joined! And I had same thoughts about needing a cartoon, too! https://t.co/LXTj2hgcwR
Vinny Arora MD MAPP @FutureDocs
@aoglasser @UCM_HDS Pretty sure that’s the vicious cycle bc then you order more labs ! #jhmchat
Micah Prochaska @micah_prochaska
@FutureDocs @UCM_HDS I notice that when docs need/order 1 lab, they then just order the rainbow. theres gotta be downstream negative effects from that. #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @RJmdphilly: @FutureDocs @UCM_HDS Where is @gracefarris ? Need a cartoon of someone trying to tear my daily labs out of my cold dead han…
Lonika #wearyourmask Sood @sood_lonika
@brhospitalist So much harder to cancel labs than to order them... #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs @UCM_HDS #JHMchat yeah... including the T&S you need for their transfusion...
Daniel Wolfson @WolfsonD
RT @JHospMedicine: A reoccurring theme in tonight's #JHMChat appears to be that people respond to evidence and leadership... https://t.co/h…
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs @aoglasser @UCM_HDS Whats the iron level? Oh and a #folate #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@Pahwa #JHMchat at our institution, neurosurgery esp for anything intracranial
Journal of Hospital Medicine @JHospMedicine
Topic 4 on its way... #JHMChat
Jihoon Baang @jbaang
@ShaniHerzig My experience has been, if you see a bug it is difficult to ignore and many will find a symptom to justify treatment. The solution I tell people is don’t check the urine if they are not having symptoms, which I think is easier for most to do #jhmchat
Grace Farris MD @gracefarris
@RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Gretchen Diemer @gretchendiemer
@jbaang @PetrilliMD @JHospMedicine They learn what they see!! #JHMChat
Daniel Wolfson @WolfsonD
Also doing what is right for patients - #professionalism - the core of #choosingwisely https://t.co/74fIJ0BRTH
Journal of Hospital Medicine @JHospMedicine
Final topic/question for tonight #JHMChat: https://t.co/UeN7bBUwpp
Grace Farris MD @gracefarris
RT @RJmdphilly: @FutureDocs @UCM_HDS Where is @gracefarris ? Need a cartoon of someone trying to tear my daily labs out of my cold dead han…
@HyungChoMD @HyungChoMD
RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Grace Farris MD @gracefarris
RT @aoglasser: #JHMCHat @gracefarris literally just joined! And I had same thoughts about needing a cartoon, too! https://t.co/LXTj2hgcwR
Vinny Arora MD MAPP @FutureDocs
Key is involving empowering patients who can drive change in #ChoosingWisely - Great example improving sleep in hospital #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Final topic/question for tonight #JHMChat: https://t.co/UeN7bBUwpp
JigsyMD @JigsyMD
@FutureDocs @UCM_HDS I wonder how much of daily lab ordering depends on the availability of phlebotomy later in the day should you need that BMP, etc. #JHMchat
Daniel Wolfson @WolfsonD
RT @FutureDocs: Key is involving empowering patients who can drive change in #ChoosingWisely - Great example improving sleep in hospital…
Guilherme Barcellos @brhospitalist
RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Shoshana Herzig, MD, MPH @ShaniHerzig
RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat T4 feel lots of benefit from CW (esp the references for each recommendation, so I can do my own reading)
Rebecca Jaffe, MD @RJmdphilly
RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8
Grace Farris MD @gracefarris
It’s hard! Docs love their docusate! #JHMchat https://t.co/uHgNPYEjZb
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat T4 I feel the CW rec that comes up in "real world" very often, to the benefit of pt and caregiver counseling, is no DHT with dementia
Amit Pahwa @Pahwa
Definitely has improved. Now we have LISTS to show people why we don't need something #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gracefarris #JHMchat for more than just impacted cerumen? :)
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Final topic/question for tonight #JHMChat: https://t.co/UeN7bBUwpp
Grace Farris MD @gracefarris
RT @FutureDocs: Key is involving empowering patients who can drive change in #ChoosingWisely - Great example improving sleep in hospital…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gracefarris #JHMchat I think @greenQoDay & @OHSUIMRes did a twitter chat on docusate and cerumen a while back, will have to dig it up! @RJmdphilly
Lonika #wearyourmask Sood @sood_lonika
@JHospMedicine T4: made the hospitalist an advocate for patients, not only dc specialist but cw specialist; opened up conversation .. #JHMchat
JigsyMD @JigsyMD
@gracefarris I think its availability bias - everyone remembers that one time they had to disimpact and blamed it on the colace. #JHMchat
Lonika #wearyourmask Sood @sood_lonika
@JHospMedicine T4 ...wasteful care; helped us defend best practices #JHMchat
Shoshana Herzig, MD, MPH @ShaniHerzig
It’s possible to reduce the frequency of unnecessary UAs! #jhmchat https://t.co/3OuEif06wt
Rebecca Jaffe, MD @RJmdphilly
CW empowers the early adopters to take on some really hard challenges at the local level. #JHMChat https://t.co/w34ZzoOjNG
Grace Farris MD @gracefarris
#JHMchat T4 agree. Legitimizes these efforts. https://t.co/keqlYQuoi8
Journal of Hospital Medicine @JHospMedicine
RT @sood_lonika: @JHospMedicine T4: made the hospitalist an advocate for patients, not only dc specialist but cw specialist; opened up conv…
Journal of Hospital Medicine @JHospMedicine
RT @RJmdphilly: CW empowers the early adopters to take on some really hard challenges at the local level. #JHMChat https://t.co/w34ZzoOjNG
Daniel Wolfson @WolfsonD
T4 #JHMChat Question points out need to monitor use & adverse events. Haven’t seen evidence of poor health outcomes but not good balance scorecards in research studies
Vinny Arora MD MAPP @FutureDocs
T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#ChoosingWisely means knowing when to not order and when to order! #JHMchat
Rebecca Jaffe, MD @RJmdphilly
@aoglasser @gracefarris @greenQoDay @OHSUIMRes I don't think that was me but boy am I interested in this one! #JHMChat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@gracefarris @greenQoDay @OHSUIMRes @RJmdphilly #JHMchat my bad, it was @BostonChiefs thread started here https://t.co/rAR47a8xLt
Grace Farris MD @gracefarris
Yes! Some order it two tabs tid! Put down the docusate! #JHMchat 💩 https://t.co/U1GgINKEyH
Anika Kumar, MD @freckledpedidoc
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Gretchen Diemer @gretchendiemer
#jhmchat T3: https://t.co/0FgBm08nVB for those looking for other high value resources-ACP collaboration with American Societyfor Nuclear Medicine on cardiac testing.
Guilherme Barcellos @brhospitalist
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@RJmdphilly @gracefarris @greenQoDay @OHSUIMRes #JHMchat and continued here... mid-June, definitely some senioritis going on... https://t.co/mo7CnUFm4j
Rebecca Jaffe, MD @RJmdphilly
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs #JHMchat agree, sometimes choosing wisely means choosing TO DO IT!
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs #JHMchat it's choosing "wisely", not choosing "against"
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @FutureDocs #JHMchat it's choosing "wisely", not choosing "against"
Gretchen Diemer @gretchendiemer
@RJmdphilly @aoglasser @gracefarris @greenQoDay @OHSUIMRes I'm sort of crushed to learn docusate doesn't help. #poopingisimportant #jhmchat
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@FutureDocs #JHMChat https://t.co/Tsdkl7Sycg
Journal of Hospital Medicine @JHospMedicine
Great point, @WolfonD! #JHMchat https://t.co/Q6qYGfq5ja
Shreya P. Trivedi MD @ShreyaTrivediMD
@JHospMedicine 1 challenge is #choosingwisely aims to disseminate practices changes to clinicians w/o efforts to educate patients about best practices. What if it aimed to educate both parties? Would clinicans and docs be on the same page more? #JHMchat
Grace Farris MD @gracefarris
RT @RJmdphilly: CW empowers the early adopters to take on some really hard challenges at the local level. #JHMChat https://t.co/w34ZzoOjNG
Rebecca Jaffe, MD @RJmdphilly
@gretchendiemer @aoglasser @gracefarris @greenQoDay @OHSUIMRes Leave it to hopsitalists to take a sophisticated discussion and make it about #poop #JHMChat
Journal of Hospital Medicine @JHospMedicine
Well, we have about 10 minutes left in our discussion. Any final key points or thoughts on tonight's discussion? #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMChat #ChoosingWisely https://t.co/JjaBMR7RUJ
Gretchen Diemer @gretchendiemer
@RJmdphilly @aoglasser @gracefarris @greenQoDay @OHSUIMRes #Ihavekids #jhmchat
Rebecca Jaffe, MD @RJmdphilly
#JHMChat https://t.co/n5MMJL8h62
Grace Farris MD @gracefarris
Don’t be crushed! Polyethylene glycol has got your back! #JHMchat https://t.co/DvmgGCOzdk
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@RJmdphilly @gretchendiemer @gracefarris @greenQoDay @OHSUIMRes 😂😂😂 #JHMchat
JigsyMD @JigsyMD
Besides the time wasted administering it TID, we often delay starting appropriate treatment because we think we are doing something! #JHMchat https://t.co/8GXTW5fkH2
PatrickMurphy @patdocmurphy
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Jihoon Baang @jbaang
@JHospMedicine Opened my eyes to the many ”things we do for no reason”. Overall patients are liking it more because they are getting less sticks, less vital signs checked, less stickers on their body (telemetry) leading to better sleep. #jhmchat
Grace Farris MD @gracefarris
RT @RJmdphilly: @gretchendiemer @aoglasser @gracefarris @greenQoDay @OHSUIMRes Leave it to hopsitalists to take a sophisticated discussion…
Journal of Hospital Medicine @JHospMedicine
RT @jbaang: @JHospMedicine Opened my eyes to the many ”things we do for no reason”. Overall patients are liking it more because they are ge…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
#JHMchat final thoughts-use CW as a prompt for thoughtful exploration and analysis, great starting points--read the entire paragraph, not just the one-liner!
Vinny Arora MD MAPP @FutureDocs
RT @jbaang: @JHospMedicine Opened my eyes to the many ”things we do for no reason”. Overall patients are liking it more because they are ge…
JigsyMD @JigsyMD
@JHospMedicine stop the docusate? #JHMchat
Daniel Wolfson @WolfsonD
#JHMChat Need treatment for carpal tunnel from tweeting but not unnecessary tests or procedures #ChoosingWisely https://t.co/OvGMKE99XM
Journal of Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat final thoughts-use CW as a prompt for thoughtful exploration and analysis, great starting points--read the entire p…
Lonika #wearyourmask Sood @sood_lonika
Talk to your group.. change culture #JHMChat
Rebecca Jaffe, MD @RJmdphilly
#JHMChat take homes - Engage specialists across CW specialty lines. Allow CW to galvanize early adopters to be local champions. Look beyond educational interventions. Consider need for balancing measures and patient engagement. And docusate doesn't work.
Vinny Arora MD MAPP @FutureDocs
One take home in this paper: what is your hospital ready for in #choosingwisely ? start there and build trust #JHMChat
Grace Farris MD @gracefarris
#JHMchat What’s next on the choosing wisely list? AMA dcs? Ammonia levels?
Grace Farris MD @gracefarris
RT @sood_lonika: Talk to your group.. change culture #JHMChat
JigsyMD @JigsyMD
RT @FutureDocs: T4 Example —I have seen some hide behind #ChoosingWisely high value care to avoid a workup that’s actually necessary —#Choo…
Avital O'Glasser, MD FACP FHM (she/her) @aoglasser
@RJmdphilly #JHMchat and look at the recommendations outside your specialty, may really apply (ex American College of Surgery)
Daniel Wolfson @WolfsonD
RT @sood_lonika: Talk to your group.. change culture #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @RJmdphilly: #JHMChat take homes - Engage specialists across CW specialty lines. Allow CW to galvanize early adopters to be local champi…
Daniel Wolfson @WolfsonD
RT @aoglasser: #JHMchat final thoughts-use CW as a prompt for thoughtful exploration and analysis, great starting points--read the entire p…
Journal of Hospital Medicine @JHospMedicine
RT @RJmdphilly: #JHMChat take homes - Engage specialists across CW specialty lines. Allow CW to galvanize early adopters to be local champi…
Journal of Hospital Medicine @JHospMedicine
That's a wrap, folks! Thanks again, @micah_prochaska & @WolfsonD for your thoughts and insights. Keep your eyes open for a coming announcement for Feb's #JHMchat! #JHMChat
Grace Farris MD @gracefarris
@Pahwa @JHospMedicine Both? #JHMchat
Society of Hospital Medicine @SocietyHospMed
Thanks to our partners @ABIMFoundation @CostsofCare! https://t.co/sZ3QMNgSsR
Micah Prochaska @micah_prochaska
Thank you @WolfsonD @JHospMedicine #JHMCHAT
Journal of Hospital Medicine @JHospMedicine
RT @micah_prochaska: Thank you @WolfsonD @JHospMedicine #JHMCHAT
JigsyMD @JigsyMD
@FutureDocs Yes I'm reminded of assessing the stages of change model! #JHMchat https://t.co/Icp9jP1KJU
Grace Farris MD @gracefarris
RT @FutureDocs: One take home in this paper: what is your hospital ready for in #choosingwisely ? start there and build trust #JHMChat
Society of Hospital Medicine @SocietyHospMed
Claim #CME for tonight's #JHMChat here: https://t.co/BHuKCRQsGg
Journal of Hospital Medicine @JHospMedicine
RT @aoglasser: @gracefarris @greenQoDay @OHSUIMRes @RJmdphilly #JHMchat my bad, it was @BostonChiefs thread started here https://t.co/rAR47…
Grace Farris MD @gracefarris
Thanks for hosting! The Q graphics were great! Thanks for the fun chat everyone! #JHMchat https://t.co/1GZCCtzwh4
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Claim #CME for tonight's #JHMChat here: https://t.co/BHuKCRQsGg
Journal of Hospital Medicine @JHospMedicine
RT @SHMLive: Claim #CME for tonight's #JHMChat here: https://t.co/BHuKCRQsGg
Daniel Wolfson @WolfsonD
Glad to participate- thank you @JHospMedicine - - great to meet @micah_prochaska. @ABIMFoundation is proud to be one of several sponsors @CostsofCare https://t.co/DmgAjREhDO
Vinny Arora MD MAPP @FutureDocs
Great to learn new things on #JHMChat #saynotodocusate @aoglasser
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: Thanks for hosting! The Q graphics were great! Thanks for the fun chat everyone! #JHMchat https://t.co/1GZCCtzwh4
Grace Farris MD @gracefarris
RT @FutureDocs: Great to learn new things on #JHMChat #saynotodocusate @aoglasser
Penn Family Medicine Residency Program @UPenn_FMRP
RT @JHospMedicine: Well, we have about 10 minutes left in our discussion. Any final key points or thoughts on tonight's discussion? #JHMChat
Penn Family Medicine Residency Program @UPenn_FMRP
RT @WolfsonD: #JHMChat Need treatment for carpal tunnel from tweeting but not unnecessary tests or procedures #ChoosingWisely https://t.co/…
Vinny Arora MD MAPP @FutureDocs
@SHMLive Love the cme mobile platform- Worked great tonight! #JHMChat
#JHMChat content from Twitter.