#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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See #JHMChat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Shoshana Herzig, MD, MPH @ShaniHerzig Happening now! #jhmchat https://t.co/ybr4lxRcmW |
 | Society of Hospital Medicine @SocietyHospMed #JHMChat on #IHT w/ @JHospMedicine @FutureDocs @leorahorwitzmd starts NOW! Join the conversation, then claim #CME: https://t.co/PmiaIfuoX1 https://t.co/hTxF6w4jOS |
 | Journal of Hospital Medicine @JHospMedicine Tonight's #JHMChat article on Predictors & Variability of Inter Hospital Transfers by @DrStephMueller https://t.co/lLu8PtTieJ |
| Journal of Hospital Medicine @JHospMedicine T1 up in a moment #JHMChat -welcome to #ptsafety #pinksocks #CMEchat #hscm #hcldr #choosingwisely tweeters -remember tag tweets #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Greetings, I am @FutureDocs your moderator for tonight's #JHMChat. Please introduce yourself. T1 up in a moment... |
| Journal of Hospital Medicine @JHospMedicine Special welcome to @leorahorwitzmd handoff expert who will serve as tonight's expert commentator for #JHMChat on inter-hospital transfers |
| Journal of Hospital Medicine @JHospMedicine Tonight's #JHMChat article on Predictors & Variability of Inter Hospital Transfers by @DrStephMueller... https://t.co/cvLAxXQRSZ |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat on #IHT w/ @JHospMedicine @FutureDocs @leorahorwitzmd starts NOW! Join the conversation, then claim #CME: https://t.co/PmiaIfuoX1 https://t.co/hTxF6w4jOS |
 | Leora Horwitz @leorahorwitzmd Leora Horwitz here from @NYULMCpophealth looking forward to tonight's #JHMChat |
 | Tony Breu @tony_breu Excited to hear about paper by @DrStephMueller #JHMChat |
 | Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Greetings, I am @FutureDocs your moderator for tonight's #JHMChat. Please introduce yourself. T1 up in a moment... |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: #JHMChat on #IHT w/ @JHospMedicine @FutureDocs @leorahorwitzmd starts NOW! Join the conversation, then claim #CME: https://t.co/PmiaIfuoX1 https://t.co/hTxF6w4jOS |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T1 up in a moment #JHMChat -welcome to #ptsafety #pinksocks #CMEchat #hscm #hcldr #choosingwisely tweeters -remember tag tweets #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Special welcome to @leorahorwitzmd handoff expert who will serve as tonight's expert commentator for #JHMChat on inter-hospital transfers |
 | Stephanie Mueller @DrStephMueller Joining from hotel room with slow internet connection, so may be slow, but happy to join! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Also we welcome @JHospMedicine author @DrStephMueller to discuss her paper on inter hospital transfers #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Also we welcome @JHospMedicine author @DrStephMueller to discuss her paper on inter hospital transfers #JHMChat |
 | Daniel Wolfson @WolfsonD #JHMChat Glad to join this chat @JHospMedicine @ABIMFoundation proud to be an ongoing partner We are #choosingwisely |
| Vinny Arora MD MAPP @FutureDocs RT @leorahorwitzmd: Leora Horwitz here from @NYULMCpophealth looking forward to tonight's #JHMChat |
| Tony Breu @tony_breu Here, as always from “sunny” Boston. #JHMChat |
 | Charlie M. Wray, DO, MS @WrayCharles Charlie Wray checking in from SF for tonight's #JHMChat. Glad to hear @leorahorwitzmd & @DrStephMueller's insights on #IHT |
| Vinny Arora MD MAPP @FutureDocs RT @DrStephMueller: Joining from hotel room with slow internet connection, so may be slow, but happy to join! #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @tony_breu: Excited to hear about paper by @DrStephMueller #JHMChat |
 | Michelle Brooks, MD, SFHM @michellebr00ks Michelle Brooks from @VCUHealth in Richmond, VA #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @WolfsonD: #JHMChat Glad to join this chat @JHospMedicine @ABIMFoundation proud to be an ongoing partner We are #choosingwisely |
| Vinny Arora MD MAPP @FutureDocs RT @WrayCharles: Charlie Wray checking in from SF for tonight's #JHMChat. Glad to hear @leorahorwitzmd & @DrStephMueller's insights on #IHT |
| Vinny Arora MD MAPP @FutureDocs RT @michellebr00ks: Michelle Brooks from @VCUHealth in Richmond, VA #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @DrStephMueller is there any other kind of hotel internet connection? #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @WolfsonD: #JHMChat Glad to join this chat @JHospMedicine @ABIMFoundation proud to be an ongoing partner We are #choosingwisely |
 | Vineet Chopra @vineet_chopra Signing in and ready for an exciting #JHMChat with @DrStephMueller and @leorahorwitzmd |
| Journal of Hospital Medicine @JHospMedicine Just a reminder for all of our regulars and new tweeters to #JHMChat - remember to hashtag your tweets #JHMChat so we see them! |
 | Laura Paletta-Hobbs, MD, FHM @palettala Hi all! Excited to join you for my first #JHMChat ! |
| Laura Paletta-Hobbs, MD, FHM @palettala Laura Paletta-Hobbs from @VCUHealth in Richmond VA #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Just a reminder for all of our regulars and new tweeters to #JHMChat - remember to hashtag your tweets #JHMChat so we see them! |
| Michelle Brooks, MD, SFHM @michellebr00ks Finally...someone else from @VCUHealth Hospital Medicine Service! https://t.co/B6Et0gqKlD |
| Journal of Hospital Medicine @JHospMedicine T1 In @DrStephMueller et al, hospital transfer rates varied even after adjusting for hospital size, teaching etc. Thoughts? #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @palettala Glad you could make it, Laura! #jhmchat |
 | Jorge A Rodriguez MD @translatedmed Jorge here from Boston @bidhospitalists #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: T1 In @DrStephMueller et al, hospital transfer rates varied even after adjusting for hospital size, teaching etc. Thoughts? #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Just a reminder for all of our regulars and new tweeters to #JHMChat - remember to hashtag your tweets #JHMChat so we see them! |
| Society of Hospital Medicine @SocietyHospMed T1 is live! Join in for tonight's #JHMChat on #IHT! https://t.co/x27PFoDi8W |
| Tony Breu @tony_breu @JHospMedicine @DrStephMueller It was all those hospitals in the Northeast! #JHMChat |
| Stephanie Mueller @DrStephMueller Our thoughts were variable IHT rates even after adj from diff in hospital culture. Other theories? #jhmchat |
| Leora Horwitz @leorahorwitzmd @JHospMedicine @DrStephMueller T1 wonder if higher rates among hosp in health systems, shorter distance from referral center? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @JHospMedicine @DrStephMueller It was all those hospitals in the Northeast! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: T1 is live! Join in for tonight's #JHMChat on #IHT! https://t.co/x27PFoDi8W |
 | Lakshman Swamy (laxswamy@bsky.social) @laxswamy Lurking while working with @rbganatra - this topic has been a constant challenge @BostonChiefs #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @JHospMedicine @DrStephMueller T1 wonder if higher rates among hosp in health systems, shorter distance from referral center? #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks T1 - There doesn't seem to be a standard for #IHT. Culture may also play a role. #JHMChat |
| Leora Horwitz @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller Right - Northeast is fairly dense with hospitals; transfers maybe easier... #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles Maybe b/c #IHT r driven by providers & not institutions? Study not granular enough to pick this up? At my place, we all do it diff #jhmchat https://t.co/xzgl9CWcFX |
| Vinny Arora MD MAPP @FutureDocs There was an interesting section on "transfer culture" in discussion #jhmchat https://t.co/mMzUV7zVqz |
| Laura Paletta-Hobbs, MD, FHM @palettala Wonder if it has to do with other factors like hospital capacity and diversion? We sometimes have to go on transfer restrictions #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks T1 - if there's high variability, there's probably not a standard process - hence the article's premise. #IHT #JHMChat |
| Tony Breu @tony_breu @leorahorwitzmd @JHospMedicine @DrStephMueller Do hospitals in the Northeast have more “capacity” than other places? How much is driven by “accepting” hospital? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @WrayCharles: Maybe b/c #IHT r driven by providers & not institutions? Study not granular enough to pick this up? At my place, we all do it diff #jhmchat https://t.co/xzgl9CWcFX |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @tony_breu @JHospMedicine @DrStephMueller Right - Northeast is fairly dense with hospitals; transfers maybe easier... #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @michellebr00ks: T1 - There doesn't seem to be a standard for #IHT. Culture may also play a role. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @laxswamy: Lurking while working with @rbganatra - this topic has been a constant challenge @BostonChiefs #JHMChat |
| Stephanie Mueller @DrStephMueller @leorahorwitzmd @tony_breu @JHospMedicine #JHMchat though previous article by Iwashyna looked at ICU txs - not straightforward by zip code |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: There was an interesting section on "transfer culture" in discussion #jhmchat https://t.co/mMzUV7zVqz |
| Society of Hospital Medicine @SocietyHospMed RT @DrStephMueller: Our thoughts were variable IHT rates even after adj from diff in hospital culture. Other theories? #jhmchat |
| Vineet Chopra @vineet_chopra IT1 are payor and insurance status associated with rates of #IHT? directionality debatable. #JHMChat https://t.co/K2fQnI2tPo |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: @leorahorwitzmd @tony_breu @JHospMedicine #JHMchat though previous article by Iwashyna looked at ICU txs - not straightforward by zip code |
| Vineet Chopra @vineet_chopra @DrStephMueller @JHospMedicine @leorahorwitzmd @tony_breu PREMIER data v granular but challenge is everything is associated statistically. Not sure if clinically signification. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Medicaid patients less likely to be transferred in paper @DrStephMueller #jhmchat https://t.co/RiA6vjTXV0 |
| Leora Horwitz @leorahorwitzmd @vineet_chopra Well in this study Medicaid lower rates of transfer - do think some pts harder to get accepted than others #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks @vineet_chopra T1 - This article seemed to imply the opposite - Medicaid patients less likely to transfer. Seems opposite to my observations. #JHMChat |
| Tony Breu @tony_breu @leorahorwitzmd @vineet_chopra Absolutely. I imagine that “accepting” hospital is both a medical and financial decision. #JHMChat |
| Daniel Wolfson @WolfsonD #JHMChat What is the WHY in this topic - what are the effects on quality and safety. I get the affordability & increased services. |
 | Smart Hospitalist @dr_hospitalist #jhmchat I worked both in rural small hospital and big academic center, main problem is lack of subspecialists in rural hospitals |
| Stephanie Mueller @DrStephMueller Or less likely to be selected for transfer #JHMchat https://t.co/eEhBNOrmgl |
| Charlie M. Wray, DO, MS @WrayCharles RT @leorahorwitzmd: @vineet_chopra Well in this study Medicaid lower rates of transfer - do think some pts harder to get accepted than others #JHMChat |
| Vinny Arora MD MAPP @FutureDocs This is too close to home @jeannemfarnan #jhmchat https://t.co/jfT1KCVXi1 |
 | Robert J. Mahoney, MD @mahoneyr @JHospMedicine @DrStephMueller Were straight Medicaid patients analyzed, or only dual-eligible? (Paper implies latter) #JHMChat |
| Leora Horwitz @leorahorwitzmd @palettala Would be great follow-up - test assoc w/capacity, occupancy rates - wonder re: degree of supply driven demand #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks @leorahorwitzmd @vineet_chopra Or are more providers worried about getting in trouble with EMTALA? #JHMChat |
| Smart Hospitalist @dr_hospitalist #jhmchat hospitalists in rural hospitals "don't feel comfortable" with sicker/more complicated patient - no sense of patient ownership |
| Society of Hospital Medicine @SocietyHospMed Don't forget to use the #JHMChat hashtag in each of your tweets! |
| Leora Horwitz @leorahorwitzmd @DrStephMueller Indeed, bias possible (likely) on both ends #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @JHospMedicine @DrStephMueller Big difference between Medicaid primary and Medicaid co-insured #JHMChat |
| Smart Hospitalist @dr_hospitalist #jhmchat + fear of medical-legal claims |
| Stephanie Mueller @DrStephMueller @mahoneyr @JHospMedicine Dual eligible #JHMchat |
| Vinny Arora MD MAPP @FutureDocs I wondered the same thing #jhmchat regional variation in bed avail didn't seem to explain. Or something else? https://t.co/K4v3bRRkWa |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @JHospMedicine @DrStephMueller Were straight Medicaid patients analyzed, or only dual-eligible? (Paper implies latter) #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: @mahoneyr @JHospMedicine Dual eligible #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: Or less likely to be selected for transfer #JHMchat https://t.co/eEhBNOrmgl |
| Leora Horwitz @leorahorwitzmd @FutureDocs Possible CA on its own would look like Northeast; but prob not - West does have very diff culture/practice patterns in general #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @DrStephMueller Indeed, bias possible (likely) on both ends #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @michellebr00ks: @leorahorwitzmd @vineet_chopra Or are more providers worried about getting in trouble with EMTALA? #JHMChat |
| Stephanie Mueller @DrStephMueller What are thoughts on differences in IHT by race? Shown in other studies also. Health disparity? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Great discussion! T2 on inter hospital transfers coming up #JHMchat |
| Stephanie Mueller @DrStephMueller @gracefarris @FutureDocs True residents can play a role on transferring + receiving #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Great discussion! T2 on inter hospital transfers coming up #JHMchat |
| Vinny Arora MD MAPP @FutureDocs Yes in other papers we have seen residency programs in west were early adopters of value curricula for example #jhmchat https://t.co/w1s3kkugDg |
| Leora Horwitz @leorahorwitzmd @DrStephMueller Yes and notably persists despite adj for severity of illness, insurance status, prior hosp #JHMChat |
| Journal of Hospital Medicine @JHospMedicine T2 in @DrStephMueller et al, younger pts, fewer hospitalizations assoc w higher transfer rates. thoughts? #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @JHospMedicine @DrStephMueller Interesting how different this topic is when viewed from the VA perspective! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Oh yes they can #meded #jhmchat https://t.co/eF2j8zSXOj |
| Leora Horwitz @leorahorwitzmd @laxswamy @tony_breu @JHospMedicine @DrStephMueller Curious, how so? #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Indexing #jhmchat https://t.co/ranxpq1zar |
| Michelle Brooks, MD, SFHM @michellebr00ks @DrStephMueller @gracefarris @FutureDocs T1 - Our hospitalists rarely transfer out (VA mainly). Our hospitalist group accepts a lot. Residents aren't usually involved. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs T2 is live #jhmchat https://t.co/whcfm6NUyC |
| Laura Paletta-Hobbs, MD, FHM @palettala @DrStephMueller @gracefarris @FutureDocs #jhmchat I've been designing a learning module for our residents to help learn the ropes of taking transfer requests. we never transfer out |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller At @BostonChiefs we accept all OSH transfers to med, so we see all of them- from outside VAs as well as community hospitals. #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @DrStephMueller Family will want to have access to transportation to receiving hospital, which may be many miles from originating hospital #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Varies across programs & unit at our hospital #jhmchat icu fellows / surgery residents v involved. IM residents not. https://t.co/y6fJapQBAL |
| Tony Breu @tony_breu @leorahorwitzmd @laxswamy @JHospMedicine @DrStephMueller Transfer out of VA is likely driven 95% by availability of resources (e.g. ERCP) and 5% by patient preference. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed #JHMChat T2 is up! https://t.co/nJvArnuMKt |
| Shoshana Herzig, MD, MPH @ShaniHerzig @DrStephMueller @gracefarris @FutureDocs Would be interesting to compare within hospital differences to between hospital differences with respect to race... #JHMChat |
| Leora Horwitz @leorahorwitzmd Some systems explicitly designed for IHT - i.e. Elmhurst Hosp (@NYCHealthSystem) takes all Rikers pts, then tx men to @BellevueHosp #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @ShaniHerzig: @DrStephMueller @gracefarris @FutureDocs Would be interesting to compare within hospital differences to between hospital differences with respect to race... #JHMChat |
| Stephanie Mueller @DrStephMueller @JHospMedicine We felt threshold effect. Pts sometimes too sick for transfer #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs Many transfers to get pts back into VA care from OSH. Others to get svcs that only our VA has. Sometimes pt request. #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks T2 - maybe the institution becomes so familiar with the patient that they don't transfer? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: @JHospMedicine We felt threshold effect. Pts sometimes too sick for transfer #JHMchat |
| Stephanie Mueller @DrStephMueller @JHospMedicine Secondary analysis supports this too #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @leorahorwitzmd @laxswamy @JHospMedicine @DrStephMueller Transfer out of VA is likely driven 95% by availability of resources (e.g. ERCP) and 5% by patient preference. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat T2 is up! https://t.co/nJvArnuMKt |
| Leora Horwitz @leorahorwitzmd @DrStephMueller @JHospMedicine Yes, we have seen this in other studies too #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs What a luxury to be able to accept every outside hospital transfer. Many facilities do not have capacity. Particularly VA. #JHMChat |
| Daniel Wolfson @WolfsonD #JHMChat So what are the attributes of a good transfer? And how does it impact care on the receiving hospital? |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs What a luxury to be able to accept every outside hospital transfer. Many facilities do not have capacity. Particularly VA. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: @JHospMedicine Secondary analysis supports this too #JHMchat |
| Leora Horwitz @leorahorwitzmd @DrStephMueller @JHospMedicine Impt implications for quality meas - hosp sometimes complain penalized for taking transfers, but actually sickest not transferred #JHMChat |
| Tony Breu @tony_breu @mahoneyr @laxswamy @leorahorwitzmd @JHospMedicine @DrStephMueller @BostonChiefs To clarify for @laxswamy - while chief residents accept all transfer that come, they don’t accept *all transfer requests. #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs We are mostly limited by bed availability. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @WolfsonD: #JHMChat So what are the attributes of a good transfer? And how does it impact care on the receiving hospital? |
| Robert J. Mahoney, MD @mahoneyr @WolfsonD There should be a specific reason for the transfer. And that reason should be something the receiving facility actually provides. #JHMChat |
| Stephanie Mueller @DrStephMueller @WolfsonD Looking at this with next set of studies. V important Qs #JHMchat https://t.co/apcfUncySQ |
| Leora Horwitz @leorahorwitzmd @WolfsonD Interesting comments that residents not trained in transfers - should be added to curric? #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @tony_breu @laxswamy @leorahorwitzmd @JHospMedicine @DrStephMueller @BostonChiefs That makes sense. I thought there was a secret VA with a whole bunch of beds we didn't know about. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Wide variation in resident involved w transfers- could use APDIM survey to characterize and link to actual rates #jhmchat |
| Stephanie Mueller @DrStephMueller @laxswamy @mahoneyr @leorahorwitzmd @tony_breu @JHospMedicine @BostonChiefs Us too #JHMChat |
| Tony Breu @tony_breu @leorahorwitzmd @WolfsonD How about we hospitalists get some training first! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Hi Karyn! Indexing #jhmchat https://t.co/PPUBnT6QyU |
| Michelle Brooks, MD, SFHM @michellebr00ks @leorahorwitzmd @DrStephMueller @JHospMedicine In our mortality reviews, #IHT was a predictor. Made us re-eval our transfer process, improve availability of transfer records #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @leorahorwitzmd @WolfsonD you should hear some of the pass-offs I've gotten from OSH attendings. Training definitely needed. #JHMChat |
| Shoshana Herzig, MD, MPH @ShaniHerzig @DrStephMueller @JHospMedicine Or maybe stakes so much higher with younger patients (so many #QALYs) so willing to try everything/anything. #JHMChat |
| Leora Horwitz @leorahorwitzmd @aoglasser @FutureDocs @palettala Really nice example of creating learning on the fly - wonder if we should formalize competency #JHMChat |
 | Joshua Allen-Dicker MD MPH @DrJoshuaAD RT @WolfsonD: #JHMChat So what are the attributes of a good transfer? And how does it impact care on the receiving hospital? |
| Charlie M. Wray, DO, MS @WrayCharles Didn't accept my first #IHT until I was an attending. I doubt I was an outlier #jhmchat. Education definitely needed! https://t.co/sA2QoGrdFQ |
| Leora Horwitz @leorahorwitzmd @FutureDocs Like this idea! #JHMChat |
| Stephanie Mueller @DrStephMueller Not youngest pts but middle category age group most likely transferred. Sick, not too sick #jhmchat |
| Vineet Chopra @vineet_chopra RT @FutureDocs: Wide variation in resident involved w transfers- could use APDIM survey to characterize and link to actual rates #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @DrStephMueller @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @BostonChiefs Most are limited by bed availability. Particularly on the medicine service lines, which are often de-prioritized for resources #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Pediatrics core compentencies in @JHospMedicine include transfers of care #jhmchat https://t.co/nPq0w5Rrly @leorahorwitzmd |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @mahoneyr @leorahorwitzmd @JHospMedicine @DrStephMueller @BostonChiefs definitely, the main reason we are involved is to ensure veteran safety. #JHMChat |
| Laura Paletta-Hobbs, MD, FHM @palettala @leorahorwitzmd @aoglasser @FutureDocs I'm working on a formal curriculum... would love to have collaborators #jhmchat |
| Leora Horwitz @leorahorwitzmd @aoglasser @DrStephMueller @JHospMedicine Availability heuristic? Or maybe types of transfer pts differs systematically by hospital? #JHMChat |
| Stephanie Mueller @DrStephMueller @michellebr00ks @leorahorwitzmd @JHospMedicine Probably confounded by illness severity, but yes, also possibly component of transfer contributing? #JHMchat |
| Charlie M. Wray, DO, MS @WrayCharles @leorahorwitzmd @aoglasser @FutureDocs @palettala cc @GStetsonMD #jhmchat |
| Michelle Brooks, MD, SFHM @michellebr00ks @leorahorwitzmd @aoglasser @FutureDocs @palettala Steepest learning curve - trying to assess the patient over the phone, decide if they have a tertiary need, and determine LOC. #JHMChat |
| Leora Horwitz @leorahorwitzmd @michellebr00ks @DrStephMueller @JHospMedicine Any useful tips to share re: improvements? #JHMChat |
| Daniel Wolfson @WolfsonD #JHMChat So what is your hypothesis? Good communication - institution, pat/family, explicit reason/goals, the quality of care at receiver. https://t.co/YDXH2hKuNe |
| Vineet Chopra @vineet_chopra System is also broken. Come in at night with stacks of RN notes. No recent MD notes or DC summ. Unsafe practice. #JHMChat #iht https://t.co/zSejw6sOEk |
| Laura Paletta-Hobbs, MD, FHM @palettala @gracefarris It's funny because it's true... #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @aoglasser @WolfsonD Although this can be tricky -- most specialists will say "I can't tell if we'll do something until I see the patient". #JHMChat |
| Leora Horwitz @leorahorwitzmd @JHospMedicine Same for adult med, but not specified as interhospital transfers... wonder if different skills needed? (Probably not, actually) #JHMChat |
| Journal of Hospital Medicine @JHospMedicine New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMChat |
| Leora Horwitz @leorahorwitzmd @vineet_chopra YES. Another common issue is delay btwn acceptance and arrival - often totally different clinical picture then #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @michellebr00ks: @leorahorwitzmd @aoglasser @FutureDocs @palettala Steepest learning curve - trying to assess the patient over the phone, decide if they have a tertiary need, and determine LOC. #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @leorahorwitzmd: @aoglasser @FutureDocs @palettala Really nice example of creating learning on the fly - wonder if we should formalize competency #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @palettala: @leorahorwitzmd @aoglasser @FutureDocs I'm working on a formal curriculum... would love to have collaborators #jhmchat |
| Stephanie Mueller @DrStephMueller Always middle of night d/t hospital flow/when beds open up. Not safest. #JHMchat https://t.co/JODPsJOevW |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Don't get me started #JHMChat cc @jeannemfarnan @ShannonMartinMD @MedChiefs https://t.co/HfxCnTH4a0 |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @leorahorwitzmd @vineet_chopra This is the hardest thing for us to triage -OK, pt is safe now, but hospital is 60 miles away and the bed isn't available yet... #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks @leorahorwitzmd @vineet_chopra Without any updates! We don't transfer out a ton, but I would be embarrassed if a pt I transferred showed up sicker than billed. #JHMChat |
| Stephanie Mueller @DrStephMueller @leorahorwitzmd @vineet_chopra Anecdotally yes. Doing study looking at this as predictor of outcome among IHT its #JHMchat |
| Tony Breu @tony_breu @FutureDocs @jeannemfarnan @ShannonMartinMD @MedChiefs If only we had a universal EHR! #JHMChat |
 | ThomasB @thbeckjordenmn RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Great convo. T3 up in a moment on #JHMChat- remember to hashtag your tweets. |
| Journal of Hospital Medicine @JHospMedicine RT @vineet_chopra: System is also broken. Come in at night with stacks of RN notes. No recent MD notes or DC summ. Unsafe practice. #JHMChat #iht https://t.co/zSejw6sOEk |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @vineet_chopra YES. Another common issue is delay btwn acceptance and arrival - often totally different clinical picture then #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @laxswamy: @leorahorwitzmd @vineet_chopra This is the hardest thing for us to triage -OK, pt is safe now, but hospital is 60 miles away and the bed isn't available yet... #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Great convo. T3 up in a moment on #JHMChat- remember to hashtag your tweets. |
| Leora Horwitz @leorahorwitzmd @laxswamy @vineet_chopra Right. Some hospitals have started mandating "just in time" final update before putting pt in ambulance... #JHMChat |
| Stephanie Mueller @DrStephMueller @gracefarris @ShaniHerzig Possibly though hard to say based on study design. Warrant further investig #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @FutureDocs @jeannemfarnan @ShannonMartinMD @MedChiefs We do, its called a PGY-1 #workaround #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @mahoneyr @aoglasser @WolfsonD Can't hold that against 'em. My mechanic says the same thing #jhmchat |
 | Rebecca Jaffe, MD @RJmdphilly Late to #JHMChat!! |
| Vinny Arora MD MAPP @FutureDocs RT @tony_breu: @FutureDocs @jeannemfarnan @ShannonMartinMD @MedChiefs If only we had a universal EHR! #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @leorahorwitzmd @laxswamy @vineet_chopra But the "just in time" update involves the transferring nurse looking up this morning's vital signs to call report. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine T3 Given differences in hospital transfer rates, should transfer patients be treated differently in measuring quality #JHMChat |
| Society of Hospital Medicine @SocietyHospMed Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @WrayCharles @mahoneyr @aoglasser @WolfsonD Recurring issue - surgical pt who may or may not need surgery... IHT to medicine. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @laxswamy @tony_breu @jeannemfarnan @ShannonMartinMD @MedChiefs or a med student asking for outside records sadly #jhmchat |
| Stephanie Mueller @DrStephMueller @leorahorwitzmd @laxswamy @vineet_chopra In our hospital nurse-to-nurse update but no mandatory physician update. Trying to change that. #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly RT @JHospMedicine: T3 Given differences in hospital transfer rates, should transfer patients be treated differently in measuring quality #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @aoglasser @leorahorwitzmd @vineet_chopra except there is this pesky problem of transferring to a higher (or different) level of care. is this a prob for others? #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @WrayCharles @aoglasser @WolfsonD I have yet to hear a good reason why we should be admitting patients to medicine service lines to get surgery consults #JHMChat |
| Society of Hospital Medicine @SocietyHospMed T3 is live! There's still time to join in tonight's #JHMChat on #IHT! https://t.co/YOE5eMvwCa |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @WrayCharles @aoglasser @WolfsonD Because the pt is sick and needs a doctor is usually good enough for me #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @WrayCharles @aoglasser @WolfsonD Agree, it can be hard. But there are many "hard stops" for various interventions that we know long before patients arrive. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Recently we revisited original transferring dr notes on complex transfer pt in Care Everywhere to help make dx #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @WrayCharles @aoglasser @WolfsonD But what if you're the wrong doctor? Which you are if you are a medicine physician taking care of a surgical patient. #JHMChat |
| Leora Horwitz @leorahorwitzmd @JHospMedicine For context, CMS outcome measures include tx patients, attribute mortality to 1st hospital but readmission to last #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Great question for expert discussant @leorahorwitzmd #jhmchat https://t.co/ql8ImRLXaV |
| Michelle Brooks, MD, SFHM @michellebr00ks T3 - maybe the OSH should shoulder some of the quality burden. Might make them more vigilant in transferring info #jhmchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @WrayCharles @aoglasser @WolfsonD Of course, yes, but in most cases, pt is elderly, complicated, needs medicine involved regardless. At 4am, I want an internist! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @michellebr00ks: T3 - maybe the OSH should shoulder some of the quality burden. Might make them more vigilant in transferring info #jhmchat |
| Laura Paletta-Hobbs, MD, FHM @palettala @mahoneyr @laxswamy @WrayCharles @aoglasser @WolfsonD I'll often get the requester in touch with the right doctor - or I'll call them to see if it is reasonable. #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @leorahorwitzmd: @JHospMedicine For context, CMS outcome measures include tx patients, attribute mortality to 1st hospital but readmission to last #JHMChat |
| Leora Horwitz @leorahorwitzmd T3 current rationale for mortality is admit hosp has opp to stabilize pt, decide re: transfer #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly Then had doc to doc call to see if txf worth all our time, incl patient. Surgeon also spoke to patient. #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @leorahorwitzmd @JHospMedicine And Vizient measures tend to penalize hospitals that don't/can't transfer patients out. Longer LOS indices, etc. Particularly ICU. #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks Anyone have any success in a IHT follow-up conversation? "Hey, you're patient has this..." #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Important pearl from expert discussant re T3 #jhmchat https://t.co/2V11XG5zQt |
| Stephanie Mueller @DrStephMueller @michellebr00ks Yes or at least close loop communication so transferring docs can hear how pts did #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @leorahorwitzmd @JHospMedicine And Vizient measures tend to penalize hospitals that don't/can't transfer patients out. Longer LOS indices, etc. Particularly ICU. #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks Part of what lured me back to an academic center is a patient I had tried to diagnose for 3 weeks...every consultant involved...1/ #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly Then you have to find a specialist who's willing to put in all that effort "on spec" #JHMChat |
| Leora Horwitz @leorahorwitzmd @RJmdphilly This is a HUGELY important point - very rarely does receiving proceduralist talk to pt to see if proc/tx even desired #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Nice! There was a famous parody of outside hospital #jhmchat but I digress... https://t.co/zNoyTFIQv1 |
| Michelle Brooks, MD, SFHM @michellebr00ks My smart colleague @bqueenhoo diagnosed her over the phone with HLH. Accepted for transfer, followed up with me later. 2/2 #jhmchat |
| Shoshana Herzig, MD, MPH @ShaniHerzig @gracefarris @DrStephMueller we adjusted for race and found worse outcomes #jhmchat https://t.co/3uIOKIu8AY |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @WrayCharles @aoglasser @WolfsonD Unless your appendix has ruptured. Then you do not want an internist. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @RJmdphilly: Then had doc to doc call to see if txf worth all our time, incl patient. Surgeon also spoke to patient. #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr yup. What I call a good doctor. The kind of person I want to do my bypass #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @RJmdphilly This is a HUGELY important point - very rarely does receiving proceduralist talk to pt to see if proc/tx even desired #JHMChat |
| Stephanie Mueller @DrStephMueller @leorahorwitzmd @RJmdphilly Agree. Is there room for tele consult? How would that be billed? #JHMchat |
| Leora Horwitz @leorahorwitzmd @FutureDocs Well, since you bring it up (assuming this is the one you mean) https://t.co/P3JZZ7kgBg #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly RT @DrStephMueller: @leorahorwitzmd @RJmdphilly Agree. Is there room for tele consult? How would that be billed? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Ok we are cruising along... T4 coming up in #JHMChat in 1 min! |
| Leora Horwitz @leorahorwitzmd @aoglasser @RJmdphilly @mahoneyr @WrayCharles Really? What mechanism? Via HIE? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine T4 How can we improve standardization of patient transfers nationwide? #ptexp #Ptsafety #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @aoglasser @RJmdphilly This helps, but they very often find it easier to authorize transfer and sort it out later than thoughtfully decide on the transfer #JHMChat |
| Vineet Chopra @vineet_chopra You may be the only one. Then again, that's why we get paid the medium bucks. #JHMChat https://t.co/6678swI9ZX |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Ok we are cruising along... T4 coming up in #JHMChat in 1 min! |
| Michelle Brooks, MD, SFHM @michellebr00ks @vineet_chopra hahahaha...#mediumbucks #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr @aoglasser sure - but waste of resources #JHMchat |
| Vinny Arora MD MAPP @FutureDocs @leorahorwitzmd Well since you bring it up here it is https://t.co/LgKwrGl5nM - best part is CEO at .38sec "we can cath you" #JHMChat |
| Vineet Chopra @vineet_chopra Not uncommon for pt to show up needing step down or higher LOC than billed. Conundrum in the middle of the night. #nobeds #nojoy #JHMChat https://t.co/iZE1F198mZ |
| Michelle Brooks, MD, SFHM @michellebr00ks T4 - some guidelines might be nice. #jhmchat |
| Robert J. Mahoney, MD @mahoneyr T4 1. Thoughtful consideration (on both sides) of reason for transfer 2. Standardized "transfer record set" from HIM #JHMChat https://t.co/J9CpSaLCHz |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: T4 How can we improve standardization of patient transfers nationwide? #ptexp #Ptsafety #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks @FutureDocs @leorahorwitzmd Loved this...was searching for it. "we can send stacks of nursing notes" I think is in there. #JHMChat |
| Stephanie Mueller @DrStephMueller T4-first figure out best practices, then standardize, tailoring to hospital #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly @aoglasser Agree. Hard to make specialist "feel" that when he/she spends five minutes with the patient, then moves on and writes "D/C home" #JHMChat |
| Vinny Arora MD MAPP @FutureDocs . @WolfsonD @CostsofCare in case you have not seen you will laugh or cry #choosingwisely #jhmchat https://t.co/0Tec9dsSur |
| Vinny Arora MD MAPP @FutureDocs RT @michellebr00ks: @FutureDocs @leorahorwitzmd Loved this...was searching for it. "we can send stacks of nursing notes" I think is in there. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @aoglasser @leorahorwitzmd @mahoneyr @WrayCharles we have it too. So far only surgeons have links. #irony #jhmchat |
| Vineet Chopra @vineet_chopra I'm not sure we will ever have evidence for guidelines: but #appropriateness criteria @RANDCorporation @UCLA method is possible #JHMChat https://t.co/qk3T1Mjiok |
| Leora Horwitz @leorahorwitzmd T4 - @arjunvenkatesh, Sarwat Chaudhry @YaleMed working on this via @AHRQNews Patient Safety Learning Lab grant #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks T4 we have a transfer checklist. Use is variable, but includes things like "is your patient on vasopressors?" to help LOC decisions #jhmchat |
| Jorge A Rodriguez MD @translatedmed T4 There might be a role for a "IHT checklist". #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: T4 1. Thoughtful consideration (on both sides) of reason for transfer 2. Standardized "transfer record set" from HIM #JHMChat https://t.co/J9CpSaLCHz |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @vineet_chopra What can you do when accepting MD thinks appropriate to send to our ED for re-eval given long transit, but transfer is from inpt? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @translatedmed: T4 There might be a role for a "IHT checklist". #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @michellebr00ks: T4 we have a transfer checklist. Use is variable, but includes things like "is your patient on vasopressors?" to help LOC decisions #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: T4 - @arjunvenkatesh, Sarwat Chaudhry @YaleMed working on this via @AHRQNews Patient Safety Learning Lab grant #JHMChat |
| Tony Breu @tony_breu @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those who accept. Needs are not the same. #JHMChat |
| Daniel Wolfson @WolfsonD #jhmchat Context matters - mix of specialists, number of beds, occupancy rates, culture, rural. Effect protocols - patterns of practice https://t.co/A4IMtis5hS |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @vineet_chopra I can't seem to get a straight answer on the legality of this. Would love to hear something definitive. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly These should be state law...or something similar but more...functional. #JHMChat https://t.co/CmheWo8x3z |
| Vinny Arora MD MAPP @FutureDocs RT @WolfsonD: #jhmchat Context matters - mix of specialists, number of beds, occupancy rates, culture, rural. Effect protocols - patterns of practice https://t.co/A4IMtis5hS |
| Vinny Arora MD MAPP @FutureDocs RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those who accept. Needs are not the same. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @leorahorwitzmd: T4 - @arjunvenkatesh, Sarwat Chaudhry @YaleMed working on this via @AHRQNews Patient Safety Learning Lab grant #JHMChat |
| Leora Horwitz @leorahorwitzmd @tony_breu @gracefarris @DrStephMueller Agree; remember also that appropriate/necessary sometimes to ask sending hosp to give tx, do additional tests meanwhile #JHMChat |
| Jorge A Rodriguez MD @translatedmed T4 Standardized IHT checklist would probably help with #meded around IHT. #jhmchat |
| Michelle Brooks, MD, SFHM @michellebr00ks RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those who accept. Needs are not the same. #JHMChat |
| Vineet Chopra @vineet_chopra I am fairly certain you could get in trouble if caught. But I'd rather the pt stop in ED 4 eval than arrive and crump on floor. #JHMChat https://t.co/bVnr7NYmeR |
| Tony Breu @tony_breu @leorahorwitzmd @gracefarris @DrStephMueller This is not dissimilar to the “ask” we have of ED after acceptance. “Can you just send urine osm, please?” #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks @laxswamy @vineet_chopra That's an EMTALA violation -- cannot transfer to lower level of care. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly T4 - mandatory feedback to senders. These are like autopsies. #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks RT @RJmdphilly: These should be state law...or something similar but more...functional. #JHMChat https://t.co/CmheWo8x3z |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T4 How can we improve standardization of patient transfers nationwide? #ptexp #Ptsafety #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @vineet_chopra I have to think there is a way we can enlist EMS personnel to say, "this patient is not appropriate for where they're going". #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks RT @RJmdphilly: T4 - mandatory feedback to senders. These are like autopsies. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @RJmdphilly: T4 - mandatory feedback to senders. These are like autopsies. #JHMChat |
| Vineet Chopra @vineet_chopra But are you transferring to lower level? Or asking that the pt stop and be eval'd before going to floor? Many community hospitals do this. https://t.co/cLyeOoUtyF |
| Vinny Arora MD MAPP @FutureDocs @RJmdphilly love this idea #jhmchat |
| Journal of Hospital Medicine @JHospMedicine 5 min left- please add your closing thoughts for tonight's #JHMChat on interhospital transfers #ptsafety |
| Journal of Hospital Medicine @JHospMedicine Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu |
| Journal of Hospital Medicine @JHospMedicine Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded... https://t.co/b3s2hDXhgO |
| Daniel Wolfson @WolfsonD RT @FutureDocs: @leorahorwitzmd Well since you bring it up here it is https://t.co/LgKwrGl5nM - best part is CEO at .38sec "we can cath you" #JHMChat |
| Daniel Wolfson @WolfsonD RT @FutureDocs: . @WolfsonD @CostsofCare in case you have not seen you will laugh or cry #choosingwisely #jhmchat https://t.co/0Tec9dsSur |
| Vinny Arora MD MAPP @FutureDocs And the scans - we need the images and reports to avoid over radiating the patient #jhmchat @WolfsonD https://t.co/MSOvU6onrK |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: 5 min left- please add your closing thoughts for tonight's #JHMChat on interhospital transfers #ptsafety |
| Leora Horwitz @leorahorwitzmd @RJmdphilly Yes - at min we could send them the discharge summary just like we send to next receiving MD #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu |
| Rebecca Jaffe, MD @RJmdphilly @gretchendiemer @estewart2099 @JeffIMchiefs https://t.co/giZ7XVLFo6 |
| Michelle Brooks, MD, SFHM @michellebr00ks @vineet_chopra Have to accept to higher level of care if there's a doubt. They technically cannot be re-eval'ed in the ED. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed Mark your calendar for the next #JHMChat! https://t.co/erdQVq7OXl |
| Vineet Chopra @vineet_chopra RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @michellebr00ks @vineet_chopra ED is lower level of care than inpatient? This certainly creates pt safety risks for transfers. #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @FutureDocs @WolfsonD But for whatever reason it's not enough to have the images - you have to make them look like we got them for people to trust them. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @leorahorwitzmd that would actually be a really easy way to automate (assuming my dc summaries actually make it out the door). #jhmchat |
| Leora Horwitz @leorahorwitzmd What a fabulous discussion; I have learned so much. Thanks to @DrStephMueller for writing such an interesting paper! #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @aoglasser The key is sorting out which referring doctors are looking for help, and which ones are looking for respite. #JHMChat |
| Tony Breu @tony_breu @leorahorwitzmd @DrStephMueller Yes! Thank you @DrStephMueller for advancing our understanding of #IHT. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @leorahorwitzmd: @RJmdphilly Yes - at min we could send them the discharge summary just like we send to next receiving MD #JHMChat |
| Jorge A Rodriguez MD @translatedmed Study notes racial disparities in IHT, which bring up interesting Qs around health equity that need a closer look. #unconsciousbias #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: And the scans - we need the images and reports to avoid over radiating the patient #jhmchat @WolfsonD https://t.co/MSOvU6onrK |
| Stephanie Mueller @DrStephMueller Thanks for all the thoughtful comments! Many ideas for more projects on #IHT #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @RJmdphilly: T4 - mandatory feedback to senders. These are like autopsies. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @translatedmed: T4 Standardized IHT checklist would probably help with #meded around IHT. #jhmchat |
 | @KarynDoc@mstdn.party @karynbaum Don't forget to ask to have the images pushed from outside PACS system to yours! Often very easy. #jhmchat https://t.co/LZvScYDieX |
| Journal of Hospital Medicine @JHospMedicine RT @WolfsonD: #jhmchat Context matters - mix of specialists, number of beds, occupancy rates, culture, rural. Effect protocols - patterns of practice https://t.co/A4IMtis5hS |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those who accept. Needs are not the same. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @leorahorwitzmd @DrStephMueller Yes! Thank you @DrStephMueller for advancing our understanding of #IHT. #JHMChat |
| Tony Breu @tony_breu @gracefarris @leorahorwitzmd @DrStephMueller Don’t forget the folate. #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @tony_breu @gracefarris @leorahorwitzmd @DrStephMueller What was the stool guaiac? #JHMChat |
| Vineet Chopra @vineet_chopra Completely agree. Always happy to help if someone asks for it. It is the reason we all became #hospitalists. #jhmchat https://t.co/3XGSe4oFCY |
| Journal of Hospital Medicine @JHospMedicine Great point we ran out of time! #jhmchat https://t.co/HzRY7KK5LS |
| Leora Horwitz @leorahorwitzmd @tony_breu @gracefarris @DrStephMueller OK, OK. But seriously along "asking for help" lines, often receiving hosp has expertise sending hosp lacks; guidance welcomed #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrStephMueller: Thanks for all the thoughtful comments! Many ideas for more projects on #IHT #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Great point we ran out of time! #jhmchat https://t.co/HzRY7KK5LS https://t.co/N3Pn9NcpkF |
| Journal of Hospital Medicine @JHospMedicine RT @karynbaum: Don't forget to ask to have the images pushed from outside PACS system to yours! Often very easy. #jhmchat https://t.co/LZvScYDieX |
| Robert J. Mahoney, MD @mahoneyr @aoglasser This sometimes works. And when it doesn't, it speaks volumes. #JHMChat |
 | Sanjay Saint @sanjaysaint 1 thing I learned as a chief resident about transfers: transferring MD is wrong about 1 key fact. But only find out when pt arrives 😳 https://t.co/pLOOnTabQv |
| Society of Hospital Medicine @SocietyHospMed Thanks to @JHospMedicine @FutureDocs @leorahorwitzmd @ABIMFoundation @CostsofCare for your participation in tonight's #JHMChat! |
| Journal of Hospital Medicine @JHospMedicine Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation for bringing you #JHMChat tonight - #CME edition! |
| Tony Breu @tony_breu @JHospMedicine @FutureDocs @nate_houchens @WrayCharles Can’t wait! @WrayCharles @sanjaysaint #JHMChat |
| Vineet Chopra @vineet_chopra I love it when the #CDs come and we have to figure out if compatible with #PACS systems, etc. https://t.co/pVXU5yRyjv |
| Robert J. Mahoney, MD @mahoneyr @gracefarris @laxswamy @vineet_chopra Something about emergency treatment and labor. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Special thanks to all of you for an amazing #JHMChat esp expert discussant @leorahorwitzmd and author @DrStephMueller |
 | EAM, MD 🦉🕸 @emilyannemxd RT @translatedmed: Study notes racial disparities in IHT, which bring up interesting Qs around health equity that need a closer look. #unconsciousbias #jhmchat |
| Michelle Brooks, MD, SFHM @michellebr00ks Great discussion everyone! Have a good night! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: Thanks to @JHospMedicine @FutureDocs @leorahorwitzmd @ABIMFoundation @CostsofCare for your participation in tonight's #JHMChat! |
 | (((Howard Forman))) @thehowie @FutureDocs @WolfsonD Demand 2nd reads from admitted institution radiology when clinically nec . Use cloud transfer to have all appropriate imaging. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @JHospMedicine: Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation for bringing you #JHMChat tonight - #CME edition! |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO |
| Michelle Brooks, MD, SFHM @michellebr00ks @laxswamy @vineet_chopra It's considered an outpatient setting. So...yes. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu |
| Robert J. Mahoney, MD @mahoneyr @gracefarris @laxswamy @vineet_chopra Most of the time it means, "you better pay close attention to what I'm telling you." #JHMChat |
| Vineet Chopra @vineet_chopra Thx #JHMChat participants for a terrific discussion on #IHT! |
 | Nate Houchens @nate_houchens RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu |
| Society of Hospital Medicine @SocietyHospMed #JHMChat #CME evaluation is now open! Find it here: https://t.co/aVrAWnxUvN @JHospMedicine |
| Journal of Hospital Medicine @JHospMedicine ICYMI #VisualAbstract from tonight's #jhmchat! Look for full transcript tomorrow! https://t.co/Jh5om0EZkn |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat #CME evaluation is now open! Find it here: #JHMChat #CME evaluation is now open! Find it here: https://t.co/aVrAWnxUvN @JHospMedicine |
| Journal of Hospital Medicine @JHospMedicine ICYMI #VisualAbstract from tonight's #jhmchat! Look for full transcript tomorrow! https://t.co/Jh5om0EZkn https://t.co/qBQESK51Cf |
| Society of Hospital Medicine @SocietyHospMed RT @vineet_chopra: Thx #JHMChat participants for a terrific discussion on #IHT! |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: ICYMI #VisualAbstract from tonight's #jhmchat! Look for full transcript tomorrow! https://t.co/Jh5om0EZkn https://t.co/qBQESK51Cf |
 | Holly Kirkland-Walsh @KirklandWalsh RT @michellebr00ks: T3 - maybe the OSH should shoulder some of the quality burden. Might make them more vigilant in transferring info #jhmchat |
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