#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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| Profile | Tweet |
|---|---|
 | J 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... |
| J 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 @aoglasser @laxswamy @tony_breu @FutureDocs @bornk @Brian_M_Wong @HemeHillis @ChrisMoriates @WolfsonD @micah_prochaska @WrayCharles @JHospMedicine bummer! #JHMChat |
| J Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat starts NOW! Join the conversation w/ @JHospMedicine @micah_prochaska @WolfsonD, then claim #CME: https://t.co/frGbksW… |
| J 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 @aoglasser @JHospMedicine @WrayCharles #JHMchat #280characters ! |
 | Daniel Wolfson @WolfsonD #JHMChat Glad to participate & discuss terrific paper |
| Avital O'Glasser, MD FACP FHM @aoglasser #JHMchat joining from Portland, OR and @OHSUIMRes |
| J Hospital Medicine @JHospMedicine Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation for bringing you #JHMChat tonight - another #CME edition! |
 | Rebecca Jaffe @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 @aoglasser @RJmdphilly #JHMchat tweetdeck-you can do it! |
 | Shoshana Herzig @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! |
| J 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 |
| J Hospital Medicine @JHospMedicine Happy to have in on the conversation, @micah_prochaska! #JHMChat https://t.co/3nTCHN7CHY |
| J Hospital Medicine @JHospMedicine Be sure to register for #CME for participation in tonight's #JHMChat - sign up here!--> https://t.co/eF9tllCeAu |
| J 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 |
| J Hospital Medicine @JHospMedicine Now that housekeeping is out of the way, let's get started... #JHMChat |
 | Amit Kumar Pahwa @pahwa Amit Pahwa from @Hopkins_GIM @HopkinsMedicine @Hopkins_DOM_HVC #JHMChat |
| J 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://… |
| 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… |
 | Lonika Sood, MD, MHPE @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 @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 Kumar 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 |
| 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 @aoglasser #JHMchat T1--makes you wonder how much was driven by order sets, ex. one click and get more than just troponin... |
| Avital O'Glasser, MD FACP FHM @aoglasser #JHMchat T1 or orders adjacent on order set, so each to click multiple orders |
| J 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 Sood, MD, MHPE @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 @aoglasser #JHMchat I feel like pre-populated, one-click order sets lead to so much unnecessary testing |
| Rebecca Jaffe @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 Sood, MD, MHPE @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 @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 @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 |
 | Geri Kaperak @seniorpupmama 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… |
| J Hospital Medicine @JHospMedicine Begs the question as to who is involved in creating these order sets #jhmchat https://t.co/dyiP6zFKuA |
| J 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 @RJmdphilly Usually a kernel of truth in why we do what we do... #JHMChat https://t.co/zzleS3RSqM |
 | Hyung (Harry) Cho, MD @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 |
| J 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 @aoglasser @FutureDocs @UpToDate #JHMchat I think I was just reading the same uptodate article! |
| Lonika Sood, MD, MHPE @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 |
| J Hospital Medicine @JHospMedicine RT @FutureDocs: Common myth! Not so with newer troponin assay per @UpToDate #JHMchat https://t.co/3zkPGwof66 |
| Shoshana Herzig @ShaniHerzig @FutureDocs @UpToDate Awesome - learning in action! #JustsaynotoCKMB #jhmchat |
| Rebecca Jaffe @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 @aoglasser @JHospMedicine @RJmdphilly @WolfsonD #JHMchat I see that question w the #periopmedicine related CW recommendations--cross so many different societies and specialties! |
| J 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 Sood, MD, MHPE @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 @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 |
| J Hospital Medicine @JHospMedicine Topic 2 in tonight's #JHMChat: https://t.co/UMWedMOtx8 |
| Avital O'Glasser, MD FACP FHM @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. |
| J Hospital Medicine @JHospMedicine RT @WolfsonD: T1 #JHMChat Need intervention to change long held practices. Automatic responses - hard set patterns. Alerts, change in order… |
| Amit Kumar Pahwa @pahwa RT @FutureDocs: #JHMchat both ckmb and troponin challenge in renal patients but troponin still preferred @ShaniHerzig @micah_prochaska htt… |
| J 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 Kumar 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 |
 | Ji 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 Sood, MD, MHPE @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 @aoglasser @Pahwa #JHMChat agree with multi-specialty buy-in, w my #periopmedicine stuff, it's hospitalist, anesth, surgeons, maybe others |
| Shoshana Herzig @ShaniHerzig @FutureDocs @micah_prochaska So looking for dynamic change in troponin is the answer in CKD and otherwise #jhmchat |
| Lonika Sood, MD, MHPE @sood_lonika @jbaang @FutureDocs @ShaniHerzig @micah_prochaska How about demand mediatedtype 2 nstemi #JHMchat |
| Rebecca Jaffe @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 |
| J Hospital Medicine @JHospMedicine @sood_lonika Don't feel bad, this study proves that even the #ivorytowers aren't perfect in implementing #JHMchat |
| Shoshana Herzig @ShaniHerzig @JHospMedicine @sood_lonika Ha ha clearly so! :) #jhmchat |
| Rebecca Jaffe @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 |
| J 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 @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 |
| Ji 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. |
| J Hospital Medicine @JHospMedicine RT @jbaang: @JHospMedicine Respected attendings leading by example. In a hierarchical culture like medicine, a respected attendings action… |
| Rebecca Jaffe @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… |
| J 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 |
| J 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… |
| J Hospital Medicine @JHospMedicine Topic 3 coming up... #JHMChat |
| Lonika Sood, MD, MHPE @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 |
| J Hospital Medicine @JHospMedicine Topic 3 for tonight's #JHMChat: https://t.co/D4SEmfkOVI |
| Rebecca Jaffe @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 @aoglasser #JHMchat can't say it's been successful, but we still push back about routine "preop coags" (INR and PTT) |
| Rebecca Jaffe @RJmdphilly @aoglasser Key to success. Persistence #JHMChat |
| J 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 @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 |
| Avital O'Glasser, MD FACP FHM @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 |
 | 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. |
| Amit Kumar Pahwa @pahwa Not ordering folate @tony_breu @DocLennyF @TWDFNR #jhmchat |
| J 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 @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 |
| Rebecca Jaffe @RJmdphilly @Pahwa @tony_breu @DocLennyF @TWDFNR But there was that one time... #JHMChat #ChoosingWisely |
| 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 |
| 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 @aoglasser @gretchendiemer #JHMchat and speaking of order sets, once saw urine HCG ordered pre-op...on ~60yo woman s/p hysterectomy |
| Lonika Sood, MD, MHPE @sood_lonika T3: telemetry #JHMChat |
| Avital O'Glasser, MD FACP FHM @aoglasser RT @JHospMedicine: So true @WolfsonD, as @FutureDocs can comment -- the impetus of this study and idea came from a trainee... #JHMchat http… |
| J 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 @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 @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. |
| Ji 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 @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 @aoglasser @PetrilliMD @gretchendiemer #JHMchat we keep trying to do that, but feel like still back sliding in certain areas, ugh |
| Rebecca Jaffe @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 @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 @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.… |
| J 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 @aoglasser @FutureDocs @UCM_HDS #JHMchat ...until their patient develops an iatrogenic anemia... |
| J 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 @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 @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 |
 | Jeronimo 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 @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 |
| J 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 @RJmdphilly @JHospMedicine and interventions across departments #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @aoglasser @UCM_HDS Pretty sure that’s the vicious cycle bc then you order more labs ! #jhmchat |
| Avital O'Glasser, MD FACP FHM @aoglasser #JHMCHat @gracefarris literally just joined! And I had same thoughts about needing a cartoon, too! https://t.co/LXTj2hgcwR |
| 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 Sood, MD, MHPE @sood_lonika @brhospitalist So much harder to cancel labs than to order them... #JHMChat |
| Avital O'Glasser, MD FACP FHM @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 @RJmdphilly @FutureDocs @aoglasser @UCM_HDS Whats the iron level? Oh and a #folate #JHMChat |
| Avital O'Glasser, MD FACP FHM @aoglasser @Pahwa #JHMchat at our institution, neurosurgery esp for anything intracranial |
| J Hospital Medicine @JHospMedicine Topic 4 on its way... #JHMChat |
| Ji 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 |
| J 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… |
| Hyung (Harry) Cho, MD @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 |
 | Jigar Contractor @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 @ShaniHerzig RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8 |
| Avital O'Glasser, MD FACP FHM @aoglasser #JHMchat T4 feel lots of benefit from CW (esp the references for each recommendation, so I can do my own reading) |
| Grace Farris MD @gracefarris It’s hard! Docs love their docusate! #JHMchat https://t.co/uHgNPYEjZb |
| Rebecca Jaffe @RJmdphilly RT @gracefarris: @RJmdphilly @FutureDocs @UCM_HDS Lol all I have is this- #JHMchat https://t.co/mEhvs0fon8 |
| Avital O'Glasser, MD FACP FHM @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 Kumar Pahwa @pahwa Definitely has improved. Now we have LISTS to show people why we don't need something #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Final topic/question for tonight #JHMChat: https://t.co/UeN7bBUwpp |
| Avital O'Glasser, MD FACP FHM @aoglasser @gracefarris #JHMchat for more than just impacted cerumen? :) |
| 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 @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 Sood, MD, MHPE @sood_lonika @JHospMedicine T4: made the hospitalist an advocate for patients, not only dc specialist but cw specialist; opened up conversation .. #JHMchat |
| Jigar Contractor @jigsymd @gracefarris I think its availability bias - everyone remembers that one time they had to disimpact and blamed it on the colace. #JHMchat |
| Lonika Sood, MD, MHPE @sood_lonika @JHospMedicine T4 ...wasteful care; helped us defend best practices #JHMchat |
| Shoshana Herzig @ShaniHerzig It’s possible to reduce the frequency of unnecessary UAs! #jhmchat https://t.co/3OuEif06wt |
| Rebecca Jaffe @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 |
| J 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… |
| J 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 @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 @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 @aoglasser @RJmdphilly @gracefarris @greenQoDay @OHSUIMRes #JHMchat and continued here... mid-June, definitely some senioritis going on... https://t.co/mo7CnUFm4j |
| Rebecca Jaffe @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 @aoglasser @FutureDocs #JHMchat agree, sometimes choosing wisely means choosing TO DO IT! |
| Avital O'Glasser, MD FACP FHM @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 @aoglasser @FutureDocs #JHMChat https://t.co/Tsdkl7Sycg |
| J 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 @RJmdphilly @gretchendiemer @aoglasser @gracefarris @greenQoDay @OHSUIMRes Leave it to hopsitalists to take a sophisticated discussion and make it about #poop #JHMChat |
| J Hospital Medicine @JHospMedicine Well, we have about 10 minutes left in our discussion. Any final key points or thoughts on tonight's discussion? #JHMChat |
| J 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 @aoglasser #JHMChat #ChoosingWisely https://t.co/JjaBMR7RUJ |
| Gretchen Diemer @gretchendiemer @RJmdphilly @aoglasser @gracefarris @greenQoDay @OHSUIMRes #Ihavekids #jhmchat |
| Rebecca Jaffe @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 @aoglasser @RJmdphilly @gretchendiemer @gracefarris @greenQoDay @OHSUIMRes 😂😂😂 #JHMchat |
| Jigar Contractor @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… |
| Ji 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… |
| J 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 @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… |
| Jigar Contractor @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 |
| J 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 Sood, MD, MHPE @sood_lonika Talk to your group.. change culture #JHMChat |
| Rebecca Jaffe @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 |
| Jigar Contractor @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 @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… |
| J Hospital Medicine @JHospMedicine RT @RJmdphilly: #JHMChat take homes - Engage specialists across CW specialty lines. Allow CW to galvanize early adopters to be local champi… |
| J 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 |
| J Hospital Medicine @JHospMedicine RT @micah_prochaska: Thank you @WolfsonD @JHospMedicine #JHMCHAT |
| Jigar Contractor @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 |
| J 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 |
| J 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 FM Residency @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 FM Residency @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 |
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