#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Society of Hospital Medicine @SocietyHospMed
#JHMChat w/ @JHospMedicine, @FutureDocs & @MinaSedrakMD is LIVE! After the chat, we'll post the link to the evaluation to claim your #CME. https://t.co/D13N7mISpt
Society of Hospital Medicine @SocietyHospMed
Glad to have you aboard for #JHMChat - looking forward to the discussion! https://t.co/uHqJO3GP9R
J Hospital Medicine @JHospMedicine
Greetings, I am @FutureDocs your moderator for tonight's #JHMChat. Please introduce yourself. T1 up in a moment...
J Hospital Medicine @JHospMedicine
Tonight's #JHMChat article- Why residents order unnecessary tests by @MinaSedrakMD See https://t.co/UvPfIXDTD4
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Interested in what others are doing to help residents move away from daily labs. #JHMChat
Tony Breu @tony_breu
Here for another #JHMChat from VA Boston.
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Greetings, I am @FutureDocs your moderator for tonight's #JHMChat. Please introduce yourself. T1 up in a moment...
Adam Rodman @AdamRodmanMD
I'm @AdamRodmanMD, from BIDMC in Boston, excited for my first #JHMchat!
J Hospital Medicine @JHospMedicine
REMINDER: tonight's #JHMChat tweeters eligible #CME AMA PRA Category 1 Credit. thx @SHMLive Register! https://t.co/YiXZjipcGc
Chris Petrilli @PetrilliMD
#JHMchat Chris Petrilli, Hospitalist at Univ of Michigan, very excited for this chat @FutureDocs @SHMLive @JHospMedicine @TWDFNR
J Hospital Medicine @JHospMedicine
welcome guest author @MinaSedrakMD ! author of why residents self report ordering unnecessary tests #JHMChat https://t.co/ojCkYevLAu
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Hi - @michellebr00ks - hospitalist and APD at VCU Health #JHMChat
Society of Hospital Medicine @SocietyHospMed
Important info to claim your #CME after tonight's #JHMChat - eval open from 10 to mid EST! https://t.co/KArQKULyRJ
J Hospital Medicine @JHospMedicine
@PetrilliMD @FutureDocs @SHMLive @TWDFNR excited to host you next time #jhmchat
Shannon K. Martin @shannonmartinmd
Hi, Shannon Martin from UChicago, excited for another fun #jhmchat!
Malvinder Parmar @wittykidney
Malvinder Parmar, no COI #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat w/ @JHospMedicine, @FutureDocs & @MinaSedrakMD is LIVE! After the chat, we'll post the link to the evaluat…
Chris Petrilli @PetrilliMD
RT @JHospMedicine: @PetrilliMD @FutureDocs @SHMLive @TWDFNR excited to host you next time #jhmchat
José Miguel Bernucci @pajarobere
RT @SHMLive: Why do #residents order unnecessary labs? We'll discuss on Monday's #JHMChat w/ @JHospMedicine, @FutureDocs &…
Society of Hospital Medicine @SocietyHospMed
Don't forget to use the #JHMChat hashtag in each of your tweets if you're participating - otherwise, others won't see your comments!
Amit Kumar Pahwa @pahwa
@pahwa from @Hopkins_GIM @Hopkins_DOM_HVC - trying to get residents to reduce blood draws in don’t bleed if you don’t need #JHMchat
Hyung (Harry) Cho, MD @HyungChoMD
Harry Cho from Mount Sinai, NY. Looking for a break from the #Elections2016 #JHMChat
J Hospital Medicine @JHospMedicine
T1: In @MinaSedrakMD et al, 90% residents report "practice habit" for ordering unnecessary tests. How can we break habit? #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Don't forget to use the #JHMChat hashtag in each of your tweets if you're participating - otherwise, others won't see your com…
J Hospital Medicine @JHospMedicine
@HyungChoMD @pahwa great to see you on #JHMChat pre #ElectionDay edition
Things We Do For No Reason @TWDFNR
RT @JHospMedicine: @PetrilliMD @FutureDocs @SHMLive @TWDFNR excited to host you next time #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T1: In @MinaSedrakMD et al, 90% residents report "practice habit" for ordering unnecessary tests. How can we break habi…
Adam Rodman @AdamRodmanMD
@HyungChoMD I want to know the candidates' views on daily labs :) #jhmchat
Tony Breu @tony_breu
Starting with the toughest one! #JHMChat https://t.co/w6iYKWiqZI
Rebecca Jaffe, MD @RJmdphilly
Hi! Rebecca Jaffe from Philly, looking forward to this #jhmchat !
Michelle Brooks, MD, FACP, FHM @michellebr00ks
The survey was interesting - maybe exposing trainees to both the cost of the labs and the savings that can result #JHMchat
Hyung (Harry) Cho, MD @HyungChoMD
#jhmchat @AdamRodmanMD pretty sure @realDonaldTrump wants to phlebotomize our HC system
Amit Kumar Pahwa @pahwa
@JHospMedicine @HyungChoMD Gots to represent @Hopkins_DOM_HVC #JHMchat
J Hospital Medicine @JHospMedicine
@FaycalTahiriMD2 @FutureDocs welcome! be sure to use #JHMChat in your tweets so we see them!
Things We Do For No Reason @TWDFNR
#JHMChat Lenny Feldman joining in!
Adam Rodman @AdamRodmanMD
T1: I like the conclusion that it starts with us setting a good example. But then we have to change our habits, which si hard #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T1: In @MinaSedrakMD et al, 90% residents report "practice habit" for ordering unnecessary tests. How can we break habi…
Amit Kumar Pahwa @pahwa
T1 - Habit is hard to break. Got to show people's it's okay not to do something. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@tony_breu @JHospMedicine @MinaSedrakMD I figured let's get into it #jhmchat life is short on twitter;)
J Hospital Medicine @JHospMedicine
RT @AdamRodmanMD: T1: I like the conclusion that it starts with us setting a good example. But then we have to change our habits, which si…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
The fear of not having the lab result if asked as a motivation to order daily labs - that was intriguing to me. #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@AdamRodmanMD agree - residents change practice habit if mentors change practice habit. Kicks the ? up the lane #JHMChat
Amit Kumar Pahwa @pahwa
and @TWDFNR represening @Hopkins_DOM_HVC #jhmchat
Malvinder Parmar @wittykidney
@JHospMedicine @MinaSedrakMD I think first senior residents & fellows need to reduce overuse to improve role modelling #JHMChat
Chris Petrilli @PetrilliMD
While education is important, as with other CW implementation successes EHR solutions are prob key-Lets think of 3 #MySonLovesSeuss #jhmchat
J Hospital Medicine @JHospMedicine
@AdamRodmanMD welcome to your first #JHMchat!
J Hospital Medicine @JHospMedicine
RT @wittykidney: @JHospMedicine @MinaSedrakMD I think first senior residents & fellows need to reduce overuse to improve role modelling #JH
Adam Rodman @AdamRodmanMD
@RJmdphilly exactly -- when i was a resident it annoyed me to be challenged about labs, but it's made me a better doctor #jhmchat
Adam Rodman @AdamRodmanMD
RT @JHospMedicine: @AdamRodmanMD welcome to your first #JHMchat!
Tony Breu @tony_breu
#JHMChat https://t.co/r1Z2Qe3SjA
J Hospital Medicine @JHospMedicine
Just a reminder to index #jhmchat https://t.co/G06Ziftlfh
Chris Petrilli @PetrilliMD
Just showing the cost of labs has shown to be effective short-term but need meaningful decision support to have lasting effect #jhmchat
Adam Rodman @AdamRodmanMD
@PetrilliMD remove daily labs from admission sets :) #jhmchat
Society of Hospital Medicine @SocietyHospMed
Join our #JHMChat now through 10pm EST as we discuss why #residents order unnecessary labs & how we can change it! #meded #choosingwisely
J Hospital Medicine @JHospMedicine
RT @Pahwa: T1 - Habit is hard to break. Got to show people's it's okay not to do something. #JHMChat
Daniel Wolfson @WolfsonD
#JHMchat Excited to hear experts on reasons for residents overuse. Perhaps ? is what are the reasons for overuse of all doc #choosingwisely
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T1 - I hate to call residents out on rounds if unnecessary labs are ordered, but sounded like the residents wanted that feedback #jhmchat
Chris Petrilli @PetrilliMD
As attending, I've deleted Morning labs - and only told the resdients AFTER rounds...showing that nothing changed.... #jhmchat
Things We Do For No Reason @TWDFNR
#JHMChat @Pahwa and @TWDFNR are creating a dashboard to give residents feedback on ordering habits in comparison to colleagues.
Rebecca Jaffe, MD @RJmdphilly
@tony_breu @FutureDocs @JHospMedicine @MinaSedrakMD both? Or each side thinks the other? #JHMChat
J Hospital Medicine @JHospMedicine
Fear is a powerful motivator? @MinaSedrakMD #jhmchat https://t.co/n9Yf2XbeVU
Faysal Tahiri M.D @faycaltahirimd2
#JHMChat # I agree sometimes the right thing to do is to do nothing! #
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @PetrilliMD: Just showing the cost of labs has shown to be effective short-term but need meaningful decision support to have lasting eff…
Adam Rodman @AdamRodmanMD
@PetrilliMD saving that one for later. or reviewing on one patient daily which labs changed management? #jhmchat
Ross Morton @signindoc
#JHMChat Former program director lurking with interest
Mina S. Sedrak @minasedrakmd
T1: Recognizing that habit begins early on in the residency training is very important #jhmchat
J Hospital Medicine @JHospMedicine
RT @RJmdphilly: @AdamRodmanMD agree - residents change practice habit if mentors change practice habit. Kicks the ? up the lane #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@AdamRodmanMD @PetrilliMD they did that when I was a resident. Oh the work arounds! Almost make me nostalgic. #JHMChat
J Hospital Medicine @JHospMedicine
RT @PetrilliMD: While education is important, as with other CW implementation successes EHR solutions are prob key-Lets think of 3 #MySonLo
Society of Hospital Medicine @SocietyHospMed
RT @WolfsonD: #JHMchat Excited to hear experts on reasons for residents overuse. Perhaps ? is what are the reasons for overuse of all doc #…
Amit Kumar Pahwa @pahwa
@tony_breu it requires change on both ends #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Fear is a powerful motivator? @MinaSedrakMD #jhmchat https://t.co/n9Yf2XbeVU
Adam Rodman @AdamRodmanMD
T1: always a challenge to not challenge resident autonomy but it def fails. Ex: team ordered porphyria work up for endometriosis #jhmchat
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat we have to change culture: role modeling and changing the conversation
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T1 - I hate to call residents out on rounds if unnecessary labs are ordered, but sounded like the residents wanted that…
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: T1: Recognizing that habit begins early on in the residency training is very important #jhmchat
Adam Rodman @AdamRodmanMD
@RJmdphilly @PetrilliMD ah, in epic, ordering the lab, changing frequency to daily, and duration "99 days". residents are tricky! #jhmchat
J Hospital Medicine @JHospMedicine
RT @HyungChoMD: #JHMChat we have to change culture: role modeling and changing the conversation
Mina S. Sedrak @minasedrakmd
T1: I remember the very first day I was an intern... my resident said... "dont forget to order labs everyday. hit copy, forward." #jhmchat
Tony Breu @tony_breu
Even the term “AM labs” suggests it is an expectation. #JHMChat
Ross Morton @signindoc
Had to draw any blood work I wanted myself as a trainee - pause for thought #JHMChat
Daniel Wolfson @WolfsonD
#jhmchat Need $ to patients & total costs at poc with options - PBMs need to provide info to aggregators. Need skills of doc @CostsofCare
Adam Rodman @AdamRodmanMD
@tony_breu good point. there's nothing routine about a needle jab every am #jhmchat
J Hospital Medicine @JHospMedicine
Keep the conversation going on T2, T3 up in a moment #JHMChat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: T1: I remember the very first day I was an intern... my resident said... "dont forget to order labs everyday. hit copy, f…
Amit Kumar Pahwa @pahwa
@MinaSedrakMD and did you? #jhmchat
Malvinder Parmar @wittykidney
Reduce use of protocols, where often physicians, not only residents, check boxes often without thinking #JHMChat
Adam Rodman @AdamRodmanMD
T1: I work in Africa six months of the year, responsible for drawing my own labs (and walking them to the lab). Volume very diff #jhmchat
Mina S. Sedrak @minasedrakmd
@signindoc I wonder how many residents would order daily labs if they had to draw it themselves each day... #jhmchat
J Hospital Medicine @JHospMedicine
RT @signindoc: Had to draw any blood work I wanted myself as a trainee - pause for thought #JHMChat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: @signindoc I wonder how many residents would order daily labs if they had to draw it themselves each day... #jhmchat
Things We Do For No Reason @TWDFNR
#JHMChat I found this week on service that our TWDFNR series was a nice resource to be able to give the residents. @TWDFNR
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat Do you mean like this order? #workarounds https://t.co/3Cfy0rAiAT
Nancy H Stewart DO, MS @nvhstewart
Excited to join the #JHMChat tonight cc @JHospMedicine
Tony Breu @tony_breu
T1: What’s missing in lab ordering culture is reason/rationale. Needed for imagine/consults. Not labs. #JHMChat
Amit Kumar Pahwa @pahwa
Look at this group on #jhmchat. If we can just change one person and that person changes another things will get better #notapyramidscheme
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Didn't Vanderbilt use number of needlesticks/patient/day as a metric? Might be interesting to track for residents #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @Pahwa: Look at this group on #jhmchat. If we can just change one person and that person changes another things will get better #notapyr
Adam Rodman @AdamRodmanMD
@tony_breu CBC: infxn Chem7: lytes #jhmchat
J Hospital Medicine @JHospMedicine
RT @tony_breu: T1: What’s missing in lab ordering culture is reason/rationale. Needed for imagine/consults. Not labs. #JHMChat
J Hospital Medicine @JHospMedicine
RT @HyungChoMD: #JHMChat Do you mean like this order? #workarounds https://t.co/3Cfy0rAiAT
Mina S. Sedrak @minasedrakmd
@tony_breu agree... residents are no longer thinking "do I need labs on this patient today?" AM labs are "standard of care" #jhmchat
Amit Kumar Pahwa @pahwa
@MinaSedrakMD @signindoc None - see when nurse pages intern lab cannot be drawn. If they need it they go do it if not cancelled #jhmchat
Hyung (Harry) Cho, MD @HyungChoMD
RT @tony_breu: Even the term “AM labs” suggests it is an expectation. #JHMChat
Adam Rodman @AdamRodmanMD
@michellebr00ks Kaiser does that where they tally radiation exposure. Would be awesome/terrifying for sticks. #jhmchat
Hyung (Harry) Cho, MD @HyungChoMD
RT @MinaSedrakMD: T1: I remember the very first day I was an intern... my resident said... "dont forget to order labs everyday. hit copy, f…
Tony Breu @tony_breu
@AdamRodmanMD And the daily phos? #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@Pahwa reminds me of @iamjohnoliver this week! #JHMChat
Daniel Wolfson @WolfsonD
Or if they were a patient for a day getting hit by needles all day or being woke up for blood draw. https://t.co/UpzEQm7caQ
Adam Rodman @AdamRodmanMD
@tony_breu "phos"?? haha, i'm not that creative #jhmchat
J Hospital Medicine @JHospMedicine
T2: Over 80% residents report lack of cost transparency. Is it as simple as $ transparency to improve? #JHMChat
Amit Kumar Pahwa @pahwa
RT @TWDFNR: #JHMChat I found this week on service that our TWDFNR series was a nice resource to be able to give the residents. @TWDFNR
J Hospital Medicine @JHospMedicine
@HyungChoMD now that sounds like dr Seuss #jhmchat
Amit Kumar Pahwa @pahwa
I think a few of us on this #jhmchat wrote a few - @tony_breu @PetrilliMD https://t.co/CZRXlddpYw
Chris Hendel @chrishendel
RT @WolfsonD: Or if they were a patient for a day getting hit by needles all day or being woke up for blood draw. https://t.co/UpzEQm7caQ
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T2 - transparency is probably the first step, but our VA lists cost, and it doesn't stop the residents #JHMChat
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat as @realDonaldTrump would say, “the system is rigged!” #trumpism
Tony Breu @tony_breu
Potential for short-term decrease. Not sure it’s a durable solution. #JHMChat https://t.co/ku4LoBRHhz
Amit Kumar Pahwa @pahwa
@JHospMedicine T2 - one piece of puzzle as @TWDFNR showed but still need physician to be comfortable #jhmchat
Society of Hospital Medicine @SocietyHospMed
#JHMChat is in full swing! Discussing why #residents order unnecessary labs & how we can change. #meded #choosingwisely. Join til 10p ET! https://t.co/gwc7Pgtm7j
Vinny Arora MD MAPP @FutureDocs
Live on #jhmchat - how can we improve resident lab ordering #Meded #choosingwisely https://t.co/P6eIUExXvC
Tony Breu @tony_breu
RT @Pahwa: I think a few of us on this #jhmchat wrote a few - @tony_breu @PetrilliMD https://t.co/CZRXlddpYw
Malvinder Parmar @wittykidney
#JHMChat https://t.co/N72ncPx99L
Nancy H Stewart DO, MS @nvhstewart
Changing practice should start with role modeling which can go up or down the chain. Continuous convo regarding #hvhc #JHMChat #meded
Vinny Arora MD MAPP @FutureDocs
RT @TWDFNR: #JHMChat I found this week on service that our TWDFNR series was a nice resource to be able to give the residents. @TWDFNR
Adam Rodman @AdamRodmanMD
T2 -- agreed, I like VA ordering menu. At my residency (OHSU) both VA and Epic system, wonder if there's any data comparing labs #jhmchat
Rebecca Jaffe, MD @RJmdphilly
T2 thought that was interesting finding. Most really $$ labs not ordered daily. Really low yield rpt labs are cheaper. #jhmchat
J Hospital Medicine @JHospMedicine
RT @FutureDocs: Live on #jhmchat - how can we improve resident lab ordering #Meded #choosingwisely https://t.co/P6eIUExXvC
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat is in full swing! Discussing why #residents order unnecessary labs & how we can change. #meded
Ross Morton @signindoc
.@JHospMedicine Our institution had cost of labs next to the check box - did not result in significant reduction in ordering. #JHMChat
J Hospital Medicine @JHospMedicine
@tony_breu curious why not ? #jhmchat
J Hospital Medicine @JHospMedicine
RT @tony_breu: Potential for short-term decrease. Not sure it’s a durable solution. #JHMChat https://t.co/ku4LoBRHhz
Rebecca Jaffe, MD @RJmdphilly
@Pahwa @tony_breu @PetrilliMD @TWDFNR we wrote on amylase for pancreatitis speaking of low yield labs! #JHMChat
Chris Petrilli @PetrilliMD
RT @FutureDocs: Live on #jhmchat - how can we improve resident lab ordering #Meded #choosingwisely https://t.co/P6eIUExXvC
J Hospital Medicine @JHospMedicine
RT @signindoc: .@JHospMedicine Our institution had cost of labs next to the check box - did not result in significant reduction in ordering…
Chris Petrilli @PetrilliMD
RT @SHMLive: #JHMChat is in full swing! Discussing why #residents order unnecessary labs & how we can change. #meded
Adam Rodman @AdamRodmanMD
#notalab but I'd go for cost posted next to "routine telemetry" ... #jhmchat
Tony Breu @tony_breu
Might work for send-out labs which are typically more costly. #JHMChat https://t.co/HoE851SEJu
Amit Kumar Pahwa @pahwa
@nvhs0401 Yes - good data to show Hospital Intensity index correlates with role modeling https://t.co/jSeSfRRnfr @ChrisMoriates #jhmchat
Malvinder Parmar @wittykidney
In current systems, it will be easy to show cost of each test, & give residents a fake budget for that rotation, & see how they do #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @FutureDocs: Live on #jhmchat - how can we improve resident lab ordering #Meded #choosingwisely https://t.co/P6eIUExXvC
Rebecca Jaffe, MD @RJmdphilly
#JHMChat that's what I would expect. If u want something and u aren't paying I'm guessing u order anyway. Find a way to make us pay?
J Hospital Medicine @JHospMedicine
RT @Pahwa: @JHospMedicine T2 - one piece of puzzle as @TWDFNR showed but still need physician to be comfortable #jhmchat
Chris Moriates, MD @ChrisMoriates
@AdamRodmanMD @michellebr00ks we tracked patient sticks for the Think Twice, Stick Once program @ucsf #JHMChat https://t.co/DFFhc7dXCZ
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T2 - transparency is probably the first step, but our VA lists cost, and it doesn't stop the residents #JHMChat
Chris Moriates, MD @ChrisMoriates
RT @Pahwa: @nvhs0401 Yes - good data to show Hospital Intensity index correlates with role modeling https://t.co/jSeSfRRnfr @ChrisMoriates
Tony Breu @tony_breu
After the stick shock has worn off, culture overwhelms. #JHMChat https://t.co/VuG8ee3VcM
J Hospital Medicine @JHospMedicine
RT @tony_breu: After the stick shock has worn off, culture overwhelms. #JHMChat https://t.co/VuG8ee3VcM
Adam Rodman @AdamRodmanMD
RT @ChrisMoriates: @AdamRodmanMD @michellebr00ks we tracked patient sticks for the Think Twice, Stick Once program @ucsf #JHMChat https://t…
Chris Petrilli @PetrilliMD
The actual "cost" isnt that $10-15 for a CBC it's the downstream anemia workup, colonoscopy/EGD w/ assoc possible complications... #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @tony_breu: After the stick shock has worn off, culture overwhelms. #JHMChat https://t.co/VuG8ee3VcM
Chris Moriates, MD @ChrisMoriates
RT @TWDFNR: #JHMChat I found this week on service that our TWDFNR series was a nice resource to be able to give the residents. @TWDFNR
Tony Breu @tony_breu
*sticker #JHMChat https://t.co/nxhrGan9Sx
Daniel Wolfson @WolfsonD
#JHMchat @ASCP_Chicago is taking an active role in #choosewisely Professionals wanting to do good medicine - no incentive to do more
Adam Rodman @AdamRodmanMD
@tony_breu I really think that's it. It's culture, which is far harder to change #jhmchat
Mina S. Sedrak @minasedrakmd
T2: The overwhelming free responses to the question "what is the solution" to excessive testing was 'show me the money!' #jhmchat
Vinny Arora MD MAPP @FutureDocs
@RJmdphilly #jhmchat interesting thought to have skin in the game
Vinny Arora MD MAPP @FutureDocs
RT @wittykidney: In current systems, it will be easy to show cost of each test, & give residents a fake budget for that rotation, & see how…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @ChrisMoriates: @AdamRodmanMD @michellebr00ks we tracked patient sticks for the Think Twice, Stick Once program @ucsf #JHMChat https://t…
Robert Hopkins @aradultimmdoc
RT @TWDFNR: #JHMChat I found this week on service that our TWDFNR series was a nice resource to be able to give the residents. @TWDFNR
Nancy H Stewart DO, MS @nvhstewart
Posting costs of labs/tests may aid in trainee understanding of costs #hvhc #jhmchat cc @JHospMedicine @SHMLive https://t.co/MAhArWNQuc
Ross Morton @signindoc
@BuddingSprout Care to share your experience here? #JHMChat https://t.co/u4gq6K0UeW
Mina S. Sedrak @minasedrakmd
T2: residents believe that displaying costs in the EMR at the time of ordering will change their behavior #jhmchat
Nancy H Stewart DO, MS @nvhstewart
RT @Pahwa: @nvhs0401 Yes - good data to show Hospital Intensity index correlates with role modeling https://t.co/jSeSfRRnfr @ChrisMoriates
Amit Kumar Pahwa @pahwa
@AdamRodmanMD data show surgical residents who went on global health rotations ordered less when came back https://t.co/MsjqCVMDVr #jhmchat
Mina S. Sedrak @minasedrakmd
T2: but what they say will change their behavior and what actually happens may be quiet different #jhmchat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: T2: The overwhelming free responses to the question "what is the solution" to excessive testing was 'show me the money!'…
Nancy H Stewart DO, MS @nvhstewart
I like this idea!! https://t.co/xuKzFYJX7w
Nancy H Stewart DO, MS @nvhstewart
RT @ChrisMoriates: @AdamRodmanMD @michellebr00ks we tracked patient sticks for the Think Twice, Stick Once program @ucsf #JHMChat https://t…
Tony Breu @tony_breu
It’s an intuitive solution. But the interns/residents/attendings are the payer. #JHMChat https://t.co/Oqwcg5dLUn
Ross Morton @signindoc
Very reasonable. If your unit saves money on tests, can it be spent elsewhere? #jhmchat https://t.co/UhBlXJvIb9
J Hospital Medicine @JHospMedicine
@MinaSedrakMD curious if that was surprising to you? #jhmchat
Adam Rodman @AdamRodmanMD
@Pahwa that was my personal experience... but that's a great idea for a study in internal medicine residents! #jhmchat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Had an attending that gave us $$$$$ - overtime we ordered an expensive test, he would take one away. I lost by day 4 or 5 of 28. #jhmchat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: T2: residents believe that displaying costs in the EMR at the time of ordering will change their behavior #jhmchat
Tony Breu @tony_breu
I could see this for MRI and other high(er) cost items. #JHMChat https://t.co/6mdZXG1Dq4
Adam Rodman @AdamRodmanMD
RT @Pahwa: @AdamRodmanMD data show surgical residents who went on global health rotations ordered less when came back https://t.co/MsjqCVM…
Vinny Arora MD MAPP @FutureDocs
Yes the author speaks the truth #jhmchat https://t.co/IEe1avS5Cm
Amit Kumar Pahwa @pahwa
@AdamRodmanMD @tony_breu true but as @ChrisMoriates said @SHMLive #HM16 recycling bins are now everywhere but weren't few yrs ago #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T2 - a cost-benefit analysis with funds going back to residents for future QI work somehow would be interesting #jhmchat
Malvinder Parmar @wittykidney
Attendings need to first change the attitude, without this it won't work. #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @FutureDocs: Yes the author speaks the truth #jhmchat https://t.co/IEe1avS5Cm
Vinny Arora MD MAPP @FutureDocs
@Pahwa @AdamRodmanMD wow that's the best rationale if seen for funding #globalhealth rotations #JHMChat
Ross Morton @signindoc
@nvhs0401 @JHospMedicine @SHMLive May improve understanding, but does it change behaviour @BuddingSprout ? #jhmchat
Adam Rodman @AdamRodmanMD
@michellebr00ks or even take the "soul cycle" approach -- list different residents' spending on a leaderboard? #mostlykidding #jhmchat
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs it's like paying on credit #JHMChat
Amit Kumar Pahwa @pahwa
@tony_breu funny you said that - @TWDFNR showed radiology ordering didn't change at least inpatient https://t.co/Clls8jTyjh #JHMChat
Nancy H Stewart DO, MS @nvhstewart
If this is so, why isn't it posted everywhere and on each #EMR ?#meded #jhmchat @SHMLive @JHospMedicine https://t.co/kFkEhBYADG
J Hospital Medicine @JHospMedicine
What our author @MinaSedrakMD was surprised by #JHMchat https://t.co/357gJzyX5u
Rebecca Jaffe, MD @RJmdphilly
@MinaSedrakMD and do you buy it? They already KNOW it costs $. Why is the # such a surprise/motivator? #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @signindoc: @nvhs0401 @JHospMedicine @SHMLive May improve understanding, but does it change behaviour @BuddingSprout ? #jhmchat
Chris Petrilli @PetrilliMD
@michellebr00ks #JHMChat JAMA. 2016;316(10):1061-1072. (funds to physicians)
Nancy H Stewart DO, MS @nvhstewart
@signindoc that is the million dollar question and solution! https://t.co/jLwoJ1Ngxp
Tony Breu @tony_breu
It’s rare to want to display chargemaster costs. #JHMChat https://t.co/YuEQXInE5e
Mina S. Sedrak @minasedrakmd
Nope I dont buy it ... agree with @RJmdphilly @jjaeger3 #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@MinaSedrakMD I agree. I don't think seeing the cost will change - I think uncertainty is the enemy. And "fear" of attending. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: What our author @MinaSedrakMD was surprised by #JHMchat https://t.co/357gJzyX5u
Things We Do For No Reason @TWDFNR
@RJmdphilly @MinaSedrakMD feels like funny $. No explicit connection. #JHMchat
OHSU IM Residency @OHSUIMRes
RT @wittykidney: Attendings need to first change the attitude, without this it won't work. #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @JHospMedicine: What our author @MinaSedrakMD was surprised by #JHMchat https://t.co/357gJzyX5u
Vinny Arora MD MAPP @FutureDocs
On that note...hang tight #jhmchat https://t.co/usvj3kfQnH
Daniel Wolfson @WolfsonD
Behavior is said to be a manifestation of attitudes. Changing mind-set and culture get overlooked. First aim of #choosewisely https://t.co/aai3bzs49J
Tony Breu @tony_breu
@Pahwa @RJmdphilly @PetrilliMD @TWDFNR Lenny strikes again! #JHMChat
J Hospital Medicine @JHospMedicine
T3 One third residents reported attendings role modeling restraint would help. How can we teach faculty to do this? #JHMChat
Chris Petrilli @PetrilliMD
#JHMchat @Pahwa @RJmdphilly @tony_breu @TWDFNR It's alright...w/ only 140 characters it's tough...no wonder nobody wants to acquire twitter
Mina S. Sedrak @minasedrakmd
"Fear" of attending is a big driver of true behavior @RJmdphilly #JHMChat
OHSU IM Residency @OHSUIMRes
Better late than never! Joining #JHMChat from Portland, Oregon!
Adam Rodman @AdamRodmanMD
Step 1 -- we do a better job! #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T3 One third residents reported attendings role modeling restraint would help. How can we teach faculty to do this? #JHM
Malvinder Parmar @wittykidney
@Pahwa @tony_breu @TWDFNR important contributors- trying to make diagnosis ASAP; rule out medicine; trying to overcome nature #JHMChat
Shannon K. Martin @shannonmartinmd
Even though cost list illuminating, still hard to translate $$lab to what pt will see, maybe disconnect in play for residents? #jhmchat https://t.co/QDFq4Vkhnb
Adam Rodman @AdamRodmanMD
@OHSUIMRes why hello there, OHSU alum representing from Boston! #jhmchat
Things We Do For No Reason @TWDFNR
#JHMchat BID labs at least for pts diuresing. What are practice patterns at your place?
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat fear of repercussion is a driver. need to change conversation >> positive reinforcement for not checking daily labs
Vinny Arora MD MAPP @FutureDocs
Seems like although residents said transparency would help, concern old habits die hard prevails #jhmchat @MinaSedrakMD
Daniel Wolfson @WolfsonD
RT @JHospMedicine: T3 One third residents reported attendings role modeling restraint would help. How can we teach faculty to do this? #JHM
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T3 One third residents reported attendings role modeling restraint would help. How can we teach faculty to do this? #JHM
Mina S. Sedrak @minasedrakmd
RT @FutureDocs: Seems like although residents said transparency would help, concern old habits die hard prevails #jhmchat @MinaSedrakMD
Mina S. Sedrak @minasedrakmd
RT @HyungChoMD: #JHMChat fear of repercussion is a driver. need to change conversation >> positive reinforcement for not checking daily labs
Adam Rodman @AdamRodmanMD
@TWDFNR really? BID for diuresis? is there evidence that twice daily lyte replacement improves outcome (truly curious)? #jhmchat
Ross Morton @signindoc
.@JHospMedicine Create an expectation of "show your working". ask Faculty to explain their choice of tests and test frequency. #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@PetrilliMD September? You're much more up to date than I am. #JHMChat
Tony Breu @tony_breu
Of course, doesn’t mean we shouldn’t do it! #JHMChat https://t.co/NndQBdg6xk
Elliot Tapper @ebtapper
How about a flag screen w/ppv or npo? If low clin value, big impact. Worked for ceruloplasmin https://t.co/EoDb9OWbxx #JHMChat @SHMLive
Nancy H Stewart DO, MS @nvhstewart
Good question- in the litigious society we practice in, changing attending practice likely quite challenging #jhmchat #meded #hvhc https://t.co/rrG5X7vrQI
Chris Moreland @cjmoreland
To role model, we have to do it in our own practice. Then need to make practice visible to residents (e.g., think out loud). https://t.co/fFl0fxBTKC
J Hospital Medicine @JHospMedicine
RT @signindoc: .@JHospMedicine Create an expectation of "show your working". ask Faculty to explain their choice of tests and test frequen…
Chris Petrilli @PetrilliMD
@TWDFNR #jhmchat BID labs are my biggest pet peeve on service right now...maybe the first day to look for MASSIVE losses, then just supp...
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @HyungChoMD: #JHMChat fear of repercussion is a driver. need to change conversation >> positive reinforcement for not checking daily labs
Mina S. Sedrak @minasedrakmd
RT @cjmoreland: To role model, we have to do it in our own practice. Then need to make practice visible to residents (e.g., think o…
Things We Do For No Reason @TWDFNR
@TWDFNR #JHMChat the hidden curriculum is extremely powerful
Daniel Wolfson @WolfsonD
Let young faculty emerge as leaders they understand systems and implications for their children https://t.co/3fKD622ypC
Kelsey Murray @doctorakelso21
Agree, future intern here 🤞 @RJmdphilly @MinaSedrakMD Uncertainty, unknown about possible disease progression, typical scenarios #jhmchat
Tony Breu @tony_breu
Does any use checklists on rounds? If so, does it include discussion of labs for following day? #JHMChat https://t.co/WTWzrZiRGr
Vinny Arora MD MAPP @FutureDocs
RT @WolfsonD: Let young faculty emerge as leaders they understand systems and implications for their children https://t.co/3fKD622ypC
Vinny Arora MD MAPP @FutureDocs
Some #jhmchat wisdom https://t.co/heYHRr7hb0
John B. Bulger @johnbbulger
@RJmdphilly @FutureDocs Someone else's credit... #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T3: faculty development is key. We can change - had a die-hard "labbie" change her practice within the past year. #choosingwisely #JHMChat https://t.co/uJtfip5JqK
Amit Kumar Pahwa @pahwa
@AdamRodmanMD @TWDFNR No -accf guidelines heart failure explicitly states once a day sufficient - i do order more frequently K < 3 #JHMChat
Chris Moreland @cjmoreland
How about asking faculty to discuss lab ordering practices w/ one another in front of learners? Town hall style? On rounds? #JHMChat https://t.co/fFl0fxBTKC
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T3: faculty development is key. We can change - had a die-hard "labbie" change her practice within the past year.…
Ross Morton @signindoc
.@tony_breu As an "old guy" no problem with old habits as long as I can explain them. "We always do it this way" no good #JHMChat
J Hospital Medicine @JHospMedicine
@michellebr00ks be curious about intensity of fac dev #jhmchat
J Hospital Medicine @JHospMedicine
RT @cjmoreland: How about asking faculty to discuss lab ordering practices w/ one another in front of learners? Town hall style? On…
Mina S. Sedrak @minasedrakmd
@TWDFNR yes. hidden curriculum and unspoken expectations. attending are in a power position to influence resident behavior #jhmchat
Nancy H Stewart DO, MS @nvhstewart
RT @FutureDocs: Some #jhmchat wisdom https://t.co/heYHRr7hb0
Tony Breu @tony_breu
Even then, many order entire chem panel, not just K. #JHMChat https://t.co/UT0rgdSnzu
Amit Kumar Pahwa @pahwa
@tony_breu I will sometimes say what labs DON'T we need tomorrow, but when service busy alas laziness sets in #JHMchat
Society of Hospital Medicine @SocietyHospMed
RT @FutureDocs: Some #jhmchat wisdom https://t.co/heYHRr7hb0
Rebecca Jaffe, MD @RJmdphilly
Treat the team as a patient. Round on it every day - problem list: safety, efficiency, utilization #JHMChat
Adam Rodman @AdamRodmanMD
@MinaSedrakMD how do you address this with your residents on rounds? #jhmchat
Malvinder Parmar @wittykidney
T2: few suggestions, wrote last year, still applicable #JHMChat https://t.co/ww9GaSMWH5
Kelsey Murray @doctorakelso21
not ordering labs "for teaching purposes" #jhmchat
Chris Petrilli @PetrilliMD
People always talk about legal worries...but iatrongenic anemia + assoc mortality is real Arch Intern Med. 2011;171(18):1646-1653 #jhmchat
Vinny Arora MD MAPP @FutureDocs
@tony_breu @JHospMedicine #JHMChat I use one that @WrayCharles taught me re overuse- FLIP -Foley labs Indicatioms for tele & prophy
Rebecca Jaffe, MD @RJmdphilly
@MinaSedrakMD @TWDFNR always wonder about the "fear of being yelled at" - does that happen? Or is it hypersensitivity to feedback? #jhmchat
J Hospital Medicine @JHospMedicine
RT @wittykidney: T2: few suggestions, wrote last year, still applicable #JHMChat https://t.co/ww9GaSMWH5
J Hospital Medicine @JHospMedicine
RT @RJmdphilly: Treat the team as a patient. Round on it every day - problem list: safety, efficiency, utilization #JHMChat
OHSU IM Residency @OHSUIMRes
@JHospMedicine asking "what labs do we need today/tomorrow" should be on daily topics list, just like DVT prophet, DC planning #JHMChat
John Limouze @johnlimouze
@FutureDocs But these aren't old habits in the usual sense; new residents learn them every year. #jhmchat
J Hospital Medicine @JHospMedicine
RT @Pahwa: @tony_breu I will sometimes say what labs DON'T we need tomorrow, but when service busy alas laziness sets in #JHMchat
Nancy H Stewart DO, MS @nvhstewart
RT @wittykidney: T2: few suggestions, wrote last year, still applicable #JHMChat https://t.co/ww9GaSMWH5
Shannon K. Martin @shannonmartinmd
RT @RJmdphilly: Treat the team as a patient. Round on it every day - problem list: safety, efficiency, utilization #JHMChat
John B. Bulger @johnbbulger
@JHospMedicine #JHMChat Reward value not volume
Nancy H Stewart DO, MS @nvhstewart
Yes agreed!! https://t.co/652VcJYrt8
J Hospital Medicine @JHospMedicine
RT @johnbbulger: @JHospMedicine #JHMChat Reward value not volume
Tony Breu @tony_breu
@Pahwa Agree 100%. I’m trying to use checklist currently. Intertia and other “priorities" set in. And I care about this stuff! #JHMChat
J Hospital Medicine @JHospMedicine
RT @OHSUIMRes: @JHospMedicine asking "what labs do we need today/tomorrow" should be on daily topics list, just like DVT prophet, DC planni…
Ross Morton @signindoc
.@tony_breu Yep EUC (electrolytes, urea. creatinine) count as one test! #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @FutureDocs: @tony_breu @JHospMedicine #JHMChat I use one that @WrayCharles taught me re overuse- FLIP -Foley labs Indicatioms for tele…
J Hospital Medicine @JHospMedicine
RT @HyungChoMD: #JHMChat fear of repercussion is a driver. need to change conversation >> positive reinforcement for not checking daily labs
OHSU IM Residency @OHSUIMRes
@michellebr00ks #JHMChat attendings could use Socratic Method rather than pimping: "what info were you hoping to gain by ordering that lab?"
Rebecca Jaffe, MD @RJmdphilly
@JeffIMchiefs https://t.co/MgtZ6KR138
Mina S. Sedrak @minasedrakmd
@AdamRodmanMD 1. share expectations 2. incorporate teaching points that discourage low-value care 3. make high-value care decisions #JHMChat
Shannon K. Martin @shannonmartinmd
RT @OHSUIMRes: @JHospMedicine asking "what labs do we need today/tomorrow" should be on daily topics list, just like DVT prophet, DC planni…
Chris Petrilli @PetrilliMD
@PetrilliMD #JHMChat sorry JHM :) J Hosp Med. 2013 Sep;8(9):506-12 iatrogenic anemia mortality (the better citation!)
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@JHospMedicine I think it was mainly going to Hospital Medicine 2014 that changed her practice. #choosingwisely #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @PetrilliMD: People always talk about legal worries...but iatrongenic anemia + assoc mortality is real Arch Intern Med. 2011;171(18):164…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @wittykidney: T2: few suggestions, wrote last year, still applicable #JHMChat https://t.co/ww9GaSMWH5
Daniel Wolfson @WolfsonD
.@TalmadgeKing @UCSFDHM Quote: Tell me why you need that test rather than why didn't you do that test. https://t.co/ZgNKsfPpZ1
Chris Moreland @cjmoreland
RT @PetrilliMD: People always talk about legal worries...but iatrongenic anemia + assoc mortality is real Arch Intern Med. 2011;171(18):164…
Hyung (Harry) Cho, MD @HyungChoMD
#JHMchat Sorry, I can’t stop the #trumpism #Memes - “Make hospital mornings great again! - stop daily labs!” https://t.co/fdmJ3PwVHS
J Hospital Medicine @JHospMedicine
T4 Lots of talk on discomfort with diagnostic uncertainty- #3 reason for unnecessary test orders. Solutions for residents? #JHMChat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: @AdamRodmanMD 1. share expectations 2. incorporate teaching points that discourage low-value care 3. make high-value care…
Adam Rodman @AdamRodmanMD
@MinaSedrakMD i think that's why your article is so interesting -- the residents KNOW they're making low-value care decisions #jhmchat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @PetrilliMD: @PetrilliMD #JHMChat sorry JHM :) J Hosp Med. 2013 Sep;8(9):506-12 iatrogenic anemia mortality (the better citation!)
Malvinder Parmar @wittykidney
@PetrilliMD don't scope patient with megaloblastic or hemolytic anemia. Often anemia KJR is scope #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@gretchendiemer @JeffIMchiefs https://t.co/nqMd39itAC
Nancy H Stewart DO, MS @nvhstewart
RT @AdamRodmanMD: @MinaSedrakMD i think that's why your article is so interesting -- the residents KNOW they're making low-value care decis…
Amit Kumar Pahwa @pahwa
I love this term "labbie"! #JHMChat https://t.co/mxtpmq82Tq
Adam Rodman @AdamRodmanMD
@JHospMedicine T4: be comfortable with it yourself :) #selfimprovement #jhmchat
J Hospital Medicine @JHospMedicine
Nice save:) #jhmchat https://t.co/qqgNN6z0ST
Society of Hospital Medicine @SocietyHospMed
Moving right along on tonight's #JHMChat! Join in if you haven't already - there's still time! https://t.co/cQOhd8ndWS
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @FutureDocs: @tony_breu @JHospMedicine #JHMChat I use one that @WrayCharles taught me re overuse- FLIP -Foley labs Indicatioms for tele…
Things We Do For No Reason @TWDFNR
@michellebr00ks @JHospMedicine #JHMChat will have high value care track at HM17!
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T4 Lots of talk on discomfort with diagnostic uncertainty- #3 reason for unnecessary test orders. Solutions for resident…
Kelsey Murray @doctorakelso21
@JHospMedicine more about predictive values of lab tests & lessons in how to find, use, interpret-had IM attending that did this! #jhmchat
Tony Breu @tony_breu
And say it out loud. Often. #JHMChat https://t.co/IlIKCR8wcg
Rebecca Jaffe, MD @RJmdphilly
T4 systems fix - make it easier to get labs later in the day if needed, after discussion w team #JHMChat
OHSU IM Residency @OHSUIMRes
@JHospMedicine #JHMChat create safe space to be honest about uncertainty with attendings!
Vinny Arora MD MAPP @FutureDocs
. @HyungChoMD restraint trumps overuse #JHMChat #Election2016 @MinaSedrakMD
Vinny Arora MD MAPP @FutureDocs
RT @TWDFNR: @michellebr00ks @JHospMedicine #JHMChat will have high value care track at HM17!
Mina S. Sedrak @minasedrakmd
"build a wall around AM labs order set" @FutureDocs @HyungChoMD #JHMChat
Amit Kumar Pahwa @pahwa
@TWDFNR & @tony_breu doing the #TWDFNR talks #jhmchat
J Hospital Medicine @JHospMedicine
RT @TWDFNR: @michellebr00ks @JHospMedicine #JHMChat will have high value care track at HM17!
Chris Petrilli @PetrilliMD
RT @JHospMedicine: Nice save:) #jhmchat https://t.co/qqgNN6z0ST
J Hospital Medicine @JHospMedicine
RT @tony_breu: And say it out loud. Often. #JHMChat https://t.co/IlIKCR8wcg
Adam Rodman @AdamRodmanMD
@doctorakelso21 @JHospMedicine I always do iron deficiency lab characteristics with my residents. i see a lot more "ferritin only" #jhmchat
John B. Bulger @johnbbulger
T4 @JHospMedicine Uneccesary labs add to dx uncertainty more than they solve it. #JHMChat Ask, what am I going to do with the result?
J Hospital Medicine @JHospMedicine
RT @SHMLive: Moving right along on tonight's #JHMChat! Join in if you haven't already - there's still time! https://t.co/cQOhd8ndWS
Chris Petrilli @PetrilliMD
RT @JHospMedicine: Nice save:) #jhmchat https://t.co/qqgNN6z0ST
J Hospital Medicine @JHospMedicine
RT @johnbbulger: T4 @JHospMedicine Uneccesary labs add to dx uncertainty more than they solve it. #JHMChat Ask, what am I going to do with…
Adam Rodman @AdamRodmanMD
@johnbbulger @JHospMedicine the dreaded "d-dimer for no reason" #jhmchat
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat Involve the real players in the game - RNs, phlebotomists, AND patients #cocreation
Hyung (Harry) Cho, MD @HyungChoMD
RT @MinaSedrakMD: "build a wall around AM labs order set" @FutureDocs @HyungChoMD #JHMChat
J Hospital Medicine @JHospMedicine
Great idea for #JHMChat https://t.co/AeNaJDimtJ
J Hospital Medicine @JHospMedicine
RT @doctorakelso21: @JHospMedicine more about predictive values of lab tests & lessons in how to find, use, interpret-had IM attending that…
John B. Bulger @johnbbulger
T2: Don't order today what you can consider tomorrow. #JHMChat
Shannon K. Martin @shannonmartinmd
Another role for role modeling and faculty development - think out thought process/reason, demonstrate way to work thru uncertainty #jhmchat https://t.co/33uFJHUI5h
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T4: maybe teach restraint with low hanging fruit 1st (amylase in pancreatitis, CK in chest pain, ammonia in hepatic encephalopathy) #jhmchat
J Hospital Medicine @JHospMedicine
Amazing @SHMLive was the intervention! #JHMChat https://t.co/G23YthIFUq
J Hospital Medicine @JHospMedicine
RT @ShannonMartinMD: Another role for role modeling and faculty development - think out thought process/reason, demonstrate way to work…
J Hospital Medicine @JHospMedicine
RT @HyungChoMD: #JHMChat Involve the real players in the game - RNs, phlebotomists, AND patients #cocreation
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: "build a wall around AM labs order set" @FutureDocs @HyungChoMD #JHMChat
DrMommyK @ktranda8
RT @SHMLive: We're getting ready to talk about why #residents order unnecessary labs w/ @MinaSedrakMD on #JHMChat! Join us at 9…
Vinny Arora MD MAPP @FutureDocs
RT @MinaSedrakMD: "build a wall around AM labs order set" @FutureDocs @HyungChoMD #JHMChat
Ross Morton @signindoc
.@OHSUIMRes @JHospMedicine At the start of rotation outline expectations for testing. Make it part of orientation so all are clear #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@AdamRodmanMD proBNP to eval volume status. Knife/heart #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @FutureDocs: . @HyungChoMD restraint trumps overuse #JHMChat #Election2016 @MinaSedrakMD
Mina S. Sedrak @minasedrakmd
most residents KNEW they were ordering "unnecessary labs" but what does "unnecessary" really mean? #jhmchat
J Hospital Medicine @JHospMedicine
RT @signindoc: .@OHSUIMRes @JHospMedicine At the start of rotation outline expectations for testing. Make it part of orientation so all are…
Mina S. Sedrak @minasedrakmd
would what one resident thinks is "unnecessary" be the same if you were an intern or a resident #jhmchat
Daniel Wolfson @WolfsonD
#jhmchat @TalmadgeKing @UCSFMedicine Quote: Why do you need that test rather than why didn't you do that test #choosewisely https://t.co/pPRqfkE0wQ
Rebecca Jaffe, MD @RJmdphilly
@ShannonMartinMD @JHospMedicine ah but that would require time for teaching #jhmchat #greenQOD
Malvinder Parmar @wittykidney
Avoid KJR practices, Use negative Jendrassik maneuver #JHMChat
Tony Breu @tony_breu
@signindoc @OHSUIMRes @JHospMedicine This is great recommendation. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Amazing @SHMLive was the intervention! #JHMChat https://t.co/G23YthIFUq
Amit Kumar Pahwa @pahwa
I think we all have to be like JD and Kelso in this episode - https://t.co/wG0L0OiSqL #jhmchat
J Hospital Medicine @JHospMedicine
Great question from our first author @MinaSedrakMD for #JHMChat participants https://t.co/oSOxtRTDsG
Nancy H Stewart DO, MS @nvhstewart
RT @ShannonMartinMD: Another role for role modeling and faculty development - think out thought process/reason, demonstrate way to work…
Mina S. Sedrak @minasedrakmd
would a test deemed "unnecessary" by resident be also considered unnecessary by attendings or even patients... #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @MinaSedrakMD: most residents KNEW they were ordering "unnecessary labs" but what does "unnecessary" really mean? #jhmchat
Adam Rodman @AdamRodmanMD
@MinaSedrakMD right ... need to be understanding also that residents are learners. sometimes a wonky test is just that #jhmchat
Things We Do For No Reason @TWDFNR
@michellebr00ks #JHMChat all @TWDFNR topics!
Amit Kumar Pahwa @pahwa
@HyungChoMD we did for our @Hopkins_DOM_HVC "don't bleed if you don't need" initiative. very eye opening to all of us #Jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @MinaSedrakMD: would a test deemed "unnecessary" by resident be also considered unnecessary by attendings or even patients... #jhmchat
OHSU IM Residency @OHSUIMRes
One of the most informative facts re burden of labs--patients get charged for each phlebotomy! Bundle labs if can #JHMChat
Hyung (Harry) Cho, MD @HyungChoMD
@Pahwa @Hopkins_DOM_HVC love the title #JHMChat
Kelsey Murray @doctorakelso21
@JHospMedicine I also think better knowledge/ease with what could be followed up outpt - discuss with pcp / better d/c comunication #jhmchat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@Pahwa I think we would be BFF - favorite episode of Scrubs and @iamjohnoliver. #JHMChat
J Hospital Medicine @JHospMedicine
Yes like a syllabus for teaching restraint #JHMChat https://t.co/8vf8ZC7ljI
Adam Rodman @AdamRodmanMD
@OHSUIMRes "Know what labs can wait" #almostallofthem #jhmchat
Amit Kumar Pahwa @pahwa
@MinaSedrakMD sounds like a follow up study! #JHMchat
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T4: maybe teach restraint with low hanging fruit 1st (amylase in pancreatitis, CK in chest pain, ammonia in hepatic enc…
Malvinder Parmar @wittykidney
@michellebr00ks & don't use over sensitive tests routinely or inappropriate settings #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @Pahwa: @HyungChoMD we did for our @Hopkins_DOM_HVC "don't bleed if you don't need" initiative. very eye opening to all of us #Jhmchat
J Hospital Medicine @JHospMedicine
RT @Pahwa: @HyungChoMD we did for our @Hopkins_DOM_HVC "don't bleed if you don't need" initiative. very eye opening to all of us #Jhmchat
Tony Breu @tony_breu
No, but that’s ok. We ask our learners to “make a commitment” regarding diagnoses. We can ask for the same regarding testing #JHMChat https://t.co/7aZNSiPEML
OHSU IM Residency @OHSUIMRes
#JHMChat does anyone's facility have "lab add on" option, i.e. Tube already at lab, avoid repeat phlebotomy. We do.
Adam Rodman @AdamRodmanMD
@wittykidney @michellebr00ks FOBT as inpatient! #jhmchat
OHSU IM Residency @OHSUIMRes
RT @AdamRodmanMD: @OHSUIMRes "Know what labs can wait" #almostallofthem #jhmchat
OHSU IM Residency @OHSUIMRes
RT @signindoc: .@OHSUIMRes @JHospMedicine At the start of rotation outline expectations for testing. Make it part of orientation so all are…
Adam Rodman @AdamRodmanMD
@OHSUIMRes we do too. always encourage that, if only to minimize discomfort. #jhmchat
Adam Rodman @AdamRodmanMD
Just like police officers get tazed so they know what it feels like, maybe residents should get stuck when they start? #jhmchat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Labbies are going to want the labs. INR of 1 for 4 days straight, not on warfarin? #nbd #amINR #unnecessarylabs #JHMChat
OHSU IM Residency @OHSUIMRes
#JHMChat take time to research "lab manual", what goes in green top, lavender top, know "operating characteristics" of each lab
J Hospital Medicine @JHospMedicine
RT @OHSUIMRes: #JHMChat take time to research "lab manual", what goes in green top, lavender top, know "operating characteristics" of each…
Rebecca Jaffe, MD @RJmdphilly
@OHSUIMRes again, make it easier to get there test later if needed. Then don't have to decide the night before #JHMChat
Sinai Hospitalist @mshshospitalist
@Pahwa We have NO LABS by @drtsega - "Necessity Of Labs Assessed BedSide” w nurses & docs discussing w patients together #JHMChat
Ross Morton @signindoc
Yes, although another piece of paper required! #JHMChat https://t.co/msSR4fMhPX
J Hospital Medicine @JHospMedicine
Time has flown! 5 min left for #JHMChat - please share closing thoughts on ways we can prevent residents from ordering unnecessary labs
OHSU IM Residency @OHSUIMRes
#JHMChat also get handle on what's done in-house v send out, also sense of turn-around time. If checking cause curious, necessary to wait??
Malvinder Parmar @wittykidney
@doctorakelso21 @JHospMedicine give nature some time to heal or resolve issue, provided there is appropriate follow up #JHMChat
OHSU IM Residency @OHSUIMRes
RT @HyungChoMD: #JHMChat fear of repercussion is a driver. need to change conversation >> positive reinforcement for not checking daily labs
J Hospital Medicine @JHospMedicine
RT @wittykidney: @doctorakelso21 @JHospMedicine give nature some time to heal or resolve issue, provided there is appropriate follow up #J
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Time has flown! 5 min left for #JHMChat - please share closing thoughts on ways we can prevent residents from ordering u…
Omi @Omi_082
RT @MinaSedrakMD: would a test deemed "unnecessary" by resident be also considered unnecessary by attendings or even patients... #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Time has flown! 5 min left for #JHMChat - please share closing thoughts on ways we can prevent residents from ordering u…
Amit Kumar Pahwa @pahwa
@mshshospitalist @drtsega you guys love the acronyms!! #jhmchat
Rebecca Jaffe, MD @RJmdphilly
@mshshospitalist @Pahwa @drtsega we have "no labs in am" order so nightfloat doesn't have to re-decide when called #JHMChat
J Hospital Medicine @JHospMedicine
RT @mshshospitalist: @Pahwa We have NO LABS by @drtsega - "Necessity Of Labs Assessed BedSide” w nurses & docs discussing w patients togeth…
OHSU IM Residency @OHSUIMRes
@michellebr00ks #JHMChat love this idea! Also CPK and CKMB in addition to troponin, PTT in addition to INR
J Hospital Medicine @JHospMedicine
RT @tony_breu: No, but that’s ok. We ask our learners to “make a commitment” regarding diagnoses. We can ask for the same regardin…
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: would a test deemed "unnecessary" by resident be also considered unnecessary by attendings or even patients... #jhmchat
Mina S. Sedrak @minasedrakmd
@RJmdphilly @mshshospitalist @Pahwa @drtsega that's brilliant #JHMChat
J Hospital Medicine @JHospMedicine
RT @WolfsonD: #jhmchat @TalmadgeKing @UCSFMedicine Quote: Why do you need that test rather than why didn't you do that test…
John B. Bulger @johnbbulger
@OHSUIMRes Yes #JHMChat @GeisingerHealth
OHSU IM Residency @OHSUIMRes
@signindoc #JHMChat had patient advocate for themselves! "I already got stuck today, is that really necessary???"
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Closing thoughts - provide costs, role model cost-conscious care, track some data, positive reinforcement for restraint #JHMChat
Adam Rodman @AdamRodmanMD
@RJmdphilly @mshshospitalist @Pahwa @drtsega really like that idea #jhmchat
Amit Kumar Pahwa @pahwa
@AdamRodmanMD @TWDFNR possibly intern orientation activity? Osler cheech on you! #JHMChat
Omi @Omi_082
RT @MinaSedrakMD: most residents KNEW they were ordering "unnecessary labs" but what does "unnecessary" really mean? #jhmchat
Ross Morton @signindoc
RT @OHSUIMRes: @signindoc #JHMChat had patient advocate for themselves! "I already got stuck today, is that really necessary???"
Nancy H Stewart DO, MS @nvhstewart
Lab "add on" not as easy as it sounds- often lab requires "different color tube" so still need to redraw. Must think before order. #JHMChat
Adam Rodman @AdamRodmanMD
Closing thought #1: It's starts with us, role modeling. CT#2: this was AWESOME, can't wait til next #JHMChat!!!!
Rebecca Jaffe, MD @RJmdphilly
@MinaSedrakMD @mshshospitalist @Pahwa @drtsega not my idea @JHospMedicine interested in a study ;) #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @mshshospitalist: @Pahwa We have NO LABS by @drtsega - "Necessity Of Labs Assessed BedSide” w nurses & docs discussing w patients togeth…
Vinny Arora MD MAPP @FutureDocs
Love integrating restraint into handoff- 2 of my favorite things :) #jhmchat https://t.co/uv9Y1Sd1KB
Gretchen Diemer @gretchendiemer
@HyungChoMD critical thinking about what question it answers! #JHMChat
Hyung (Harry) Cho, MD @HyungChoMD
#JHMChat gotta love all the enthusiasm 4 reducing unnecessary labs set forth by @johnbbulger & #ChoosingWisely
John B. Bulger @johnbbulger
@Pahwa @HyungChoMD @Hopkins_DOM_HVC DRacula: Bleeding them into the lab. #JHMChat
J Hospital Medicine @JHospMedicine
RT @AdamRodmanMD: Closing thought #1: It's starts with us, role modeling. CT#2: this was AWESOME, can't wait til next #JHMChat!!!!
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: Closing thoughts - provide costs, role model cost-conscious care, track some data, positive reinforcement for restraint…
Nancy H Stewart DO, MS @nvhstewart
Yes!! I had a patient ask this to my resident just last week! https://t.co/qZEpfDZy3v
J Hospital Medicine @JHospMedicine
RT @OHSUIMRes: @signindoc #JHMChat had patient advocate for themselves! "I already got stuck today, is that really necessary???"
OHSU IM Residency @OHSUIMRes
RT @RJmdphilly: @mshshospitalist @Pahwa @drtsega we have "no labs in am" order so nightfloat doesn't have to re-decide when called #JHMChat
Daniel Wolfson @WolfsonD
Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates @neel_shah @choosingwisely https://t.co/sShPS96i5F
J Hospital Medicine @JHospMedicine
REMINDER: tonight's #JHMChat tweeters eligible #CME AMA PRA Category 1 Credit. go to @SHMLive to Register! https://t.co/YiXZjipcGc
Tony Breu @tony_breu
Thank you @FutureDocs and @MinaSedrakMD for a great #JHMChat. Can’t wait for the next one.
Chris Moriates, MD @ChrisMoriates
RT @WolfsonD: Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates
OHSU IM Residency @OHSUIMRes
#JHMChat take what do if positive/negative/equivocal approach to any lab you might order. Do I really need it? Will it change management?
Nancy H Stewart DO, MS @nvhstewart
RT @michellebr00ks: Closing thoughts - provide costs, role model cost-conscious care, track some data, positive reinforcement for restraint…
Chris Petrilli @PetrilliMD
After 20+ yrs of competition in school - residents thrive in it...report cards/rankings of utilization labs/tele (indexed by DRG) #jhmchat
Hyung (Harry) Cho, MD @HyungChoMD
RT @WolfsonD: Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: REMINDER: tonight's #JHMChat tweeters eligible #CME AMA PRA Category 1 Credit. go to @SHMLive to Register! https://t.co…
Society of Hospital Medicine @SocietyHospMed
Bookmark the following link to claim your #CME after #JHMChat - the eval is open from 10 to midnight EST: https://t.co/mPGES9iJBf
Adam Rodman @AdamRodmanMD
@PetrilliMD SoulCycle Approach! (or Enterprise Car Rental) #jhmchat
J Hospital Medicine @JHospMedicine
Special thx to partners @SHMLive @CostsofCare @ABIMFoundation & guest author @MinaSedrakMD for bringing #JHMChat eve of #ElectionDay
Mina S. Sedrak @minasedrakmd
Recognize that the clinical deicisions we make on rounds have a big impact on trainees; soi we should strive to make HVC ones #jhmchat
Rebecca Jaffe, MD @RJmdphilly
Take homes 1) suspect $s won't speak as loud as reported 2) attending buy in vital 3) systems and culture fixes needed #JHMChat
J Hospital Medicine @JHospMedicine
Tune in 4 next #JHMChat Mon Jan 9th 2017 9p ET on things we do for no reason: thrombophilia worksups w/ @PetrilliMD #choosingwisely
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Special thx to partners @SHMLive @CostsofCare @ABIMFoundation & guest author @MinaSedrakMD for bringing #JHMChat eve of…
Stephanie Starr @stephrstarr
Appropriate use of labs: evidence + pt context + pt preferences, values @vmontori https://t.co/FoBkCT4vFJ
John B. Bulger @johnbbulger
20 years ago, topics like this were never discussed. #ChoosingWisely #changeisgood https://t.co/kscVtrl4U4
Avital O'Glasser, MD FACP FHM @aoglasser
See pre-op patients, already had BMP, CBC with surgeon. I have to restick for T&S... #JHMChat https://t.co/ba4FU70s2x
Society of Hospital Medicine @SocietyHospMed
@JHospMedicine @CostsofCare @ABIMFoundation @MinaSedrakMD thanks to all for another engaging, thought-provoking #JHMChat!
Daniel Wolfson @WolfsonD
RT @JHospMedicine: Special thx to partners @SHMLive @CostsofCare @ABIMFoundation & guest author @MinaSedrakMD for bringing #JHMChat eve of…
J Hospital Medicine @JHospMedicine
RT @SHMLive: @JHospMedicine @CostsofCare @ABIMFoundation @MinaSedrakMD thanks to all for another engaging, thought-provoking #JHMChat!
Nancy H Stewart DO, MS @nvhstewart
RT @WolfsonD: Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates
Amit Kumar Pahwa @pahwa
@SHMLive just did it #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Tune in 4 next #JHMChat Mon Jan 9th 2017 9p ET on things we do for no reason: thrombophilia worksups w/ @PetrilliMD #cho
OHSU IM Residency @OHSUIMRes
RT @AdamRodmanMD: Closing thought #1: It's starts with us, role modeling. CT#2: this was AWESOME, can't wait til next #JHMChat!!!!
Vinny Arora MD MAPP @FutureDocs
RT @WolfsonD: Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates
OHSU IM Residency @OHSUIMRes
RT @MinaSedrakMD: would a test deemed "unnecessary" by resident be also considered unnecessary by attendings or even patients... #jhmchat
Mina S. Sedrak @minasedrakmd
@JHospMedicine @SHMLive @CostsofCare @ABIMFoundation great discussions. very happy to be apart of tonight's #jhmchat
Tony Breu @tony_breu
@JHospMedicine @PetrilliMD No better way to ring in the new year than with a #JHMChat
OHSU IM Residency @OHSUIMRes
RT @WolfsonD: #jhmchat @TalmadgeKing @UCSFMedicine Quote: Why do you need that test rather than why didn't you do that test…
Vinny Arora MD MAPP @FutureDocs
Me too;) Thanks for your participation! #jhmchat https://t.co/QyiOEZnjzv
Adam Rodman @AdamRodmanMD
#bestCMEever #jhmchat
J Hospital Medicine @JHospMedicine
RT @MinaSedrakMD: @JHospMedicine @SHMLive @CostsofCare @ABIMFoundation great discussions. very happy to be apart of tonight's #jhmchat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Bookmark the following link to claim your #CME after #JHMChat - the eval is open from 10 to midnight EST: https://t.co/mPGES9i…
Mina S. Sedrak @minasedrakmd
@tony_breu @FutureDocs thank you for inviting me. This was great! #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @MinaSedrakMD: @JHospMedicine @SHMLive @CostsofCare @ABIMFoundation great discussions. very happy to be apart of tonight's #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Tune in 4 next #JHMChat Mon Jan 9th 2017 9p ET on things we do for no reason: thrombophilia worksups w/ @PetrilliMD #cho
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Bookmark the following link to claim your #CME after #JHMChat - the eval is open from 10 to midnight EST: https://t.co/mPGES9i…
Nancy H Stewart DO, MS @nvhstewart
Yes, thank you @FutureDocs and @MinaSedrakMD ! Enjoyed this #jhmchat and looking forward to the next one! cc @JHospMedicine @SHMLive https://t.co/6n0s6jUczC
Amit Kumar Pahwa @pahwa
@MinaSedrakMD @JHospMedicine thanks for doing great research and publishing it! #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @MinaSedrakMD: @JHospMedicine @SHMLive @CostsofCare @ABIMFoundation great discussions. very happy to be apart of tonight's #jhmchat
Mina S. Sedrak @minasedrakmd
RT @RJmdphilly: Take homes 1) suspect $s won't speak as loud as reported 2) attending buy in vital 3) systems and culture fixes needed #JHM
Society of Hospital Medicine @SocietyHospMed
Thx to @JHospMedicine, @FutureDocs, @MinaSedrakMD & partners @ABIMFoundation & @CostsofCare for another fantastic #JHMChat!
Chris Petrilli @PetrilliMD
When deciding between the college football playoff championship & #JHMChat #choosewisely @JHospMedicine @FutureDocs @TWDFNR @CoachJim4UM https://t.co/EizlZ3tG1n
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Thx to @JHospMedicine, @FutureDocs, @MinaSedrakMD & partners @ABIMFoundation & @CostsofCare for another fantastic #JHMChat!
Chris Petrilli @PetrilliMD
@AdamRodmanMD #jhmchat ... they'll pick u up!
Omi @Omi_082
RT @MinaSedrakMD: @JHospMedicine @SHMLive @CostsofCare @ABIMFoundation great discussions. very happy to be apart of tonight's #jhmchat
OHSU IM Residency @OHSUIMRes
@WolfsonD @JHospMedicine @TalmadgeKing @UCSFMedicine @johnbbulger #JHMChat exactly!
Society of Hospital Medicine @SocietyHospMed
Take the eval to claim your #CME for #JHMChat between now & midnight EST: https://t.co/mPGES9iJBf
Omi @Omi_082
RT @WolfsonD: Empower residents w support from faculty to solve the issue. Let the power be w you @FutureDocs @ChrisMoriates
kaboell @boellkeith
RT @JHospMedicine: T2: Over 80% residents report lack of cost transparency. Is it as simple as $ transparency to improve? #JHMChat
OHSU IM Residency @OHSUIMRes
@AdamRodmanMD but that is the joy of twitter chats--you can still read and interact with the "transcript"! #JHMChat
#JHMChat content from Twitter.