#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Avital O'Glasser, MD FACP FHM @aoglasser
@gracefarris out here on west coast it's dinner time w 2 young kids! #JHMChat
Shoshana Herzig @ShaniHerzig
Happening now! #jhmchat https://t.co/ybr4lxRcmW
Society of Hospital Medicine @SHMLive
#JHMChat on #IHT w/ @JHospMedicine @FutureDocs @leorahorwitzmd starts NOW! Join the conversation, then claim #CME: https://t.co/PmiaIfuoX1 https://t.co/hTxF6w4jOS
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 on Predictors & Variability of Inter Hospital Transfers by @DrStephMueller https://t.co/lLu8PtTieJ
J Hospital Medicine @JHospMedicine
T1 up in a moment #JHMChat -welcome to #ptsafety #pinksocks #CMEchat #hscm #hcldr #choosingwisely tweeters -remember tag tweets #JHMChat
J Hospital Medicine @JHospMedicine
Special welcome to @leorahorwitzmd handoff expert who will serve as tonight's expert commentator for #JHMChat on inter-hospital transfers
J Hospital Medicine @JHospMedicine
Tonight's #JHMChat article on Predictors & Variability of Inter Hospital Transfers by @DrStephMueller... https://t.co/cvLAxXQRSZ
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat on #IHT w/ @JHospMedicine @FutureDocs @leorahorwitzmd starts NOW! Join the conversation, then claim #CME:…
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:…
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: T1 up in a moment #JHMChat -welcome to #ptsafety #pinksocks #CMEchat #hscm #hcldr #choosingwisely tweeters -remember tag…
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-h…
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat Avi O'Glasser here from @OHSUIMRes @OHSUSOM
Stephanie Mueller @drstephmueller
Joining from hotel room with slow internet connection, so may be slow, but happy to join! #jhmchat
J 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 @gracefarris: Getting ready #jhmchat https://t.co/CX8o4hTAXt
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 @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, FACP, FHM @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 @WrayCharles
@DrStephMueller is there any other kind of hotel internet connection? #jhmchat
J Hospital Medicine @JHospMedicine
RT @WolfsonD: #JHMChat Glad to join this chat @JHospMedicine @ABIMFoundation proud to be an ongoing partner We are #choosingwisely
J Hospital Medicine @JHospMedicine
RT @gracefarris: Getting ready #jhmchat https://t.co/CX8o4hTAXt
Grace Farris MD @gracefarris
Grace Farris joining in from NYC #jhmchat https://t.co/gPcC2yKZy0
Vineet Chopra @vineet_chopra
Signing in and ready for an exciting #JHMChat with @DrStephMueller and @leorahorwitzmd
J 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 !
Charlie M. Wray @WrayCharles
RT @gracefarris: Grace Farris joining in from NYC #jhmchat https://t.co/gPcC2yKZy0
Laura Paletta-Hobbs, MD, FHM @palettala
Laura Paletta-Hobbs from @VCUHealth in Richmond VA #JHMChat
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: Just a reminder for all of our regulars and new tweeters to #JHMChat - remember to hashtag your tweets #JHMChat so we se…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Finally...someone else from @VCUHealth Hospital Medicine Service! https://t.co/B6Et0gqKlD
J 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 @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. Thoug…
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 se…
Society of Hospital Medicine @SHMLive
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
J Hospital Medicine @JHospMedicine
RT @tony_breu: @JHospMedicine @DrStephMueller It was all those hospitals in the Northeast! #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: T1 is live! Join in for tonight's #JHMChat on #IHT! https://t.co/x27PFoDi8W
Lakshman Swamy @laxswamy
Lurking while working with @rbganatra - this topic has been a constant challenge @BostonChiefs #JHMChat
J Hospital Medicine @JHospMedicine
RT @leorahorwitzmd: @JHospMedicine @DrStephMueller T1 wonder if higher rates among hosp in health systems, shorter distance from referral c…
Michelle Brooks, MD, FACP, FHM @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 @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
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMChat it seems that access to inpatient specialists, let alone outpt, is big factor, esp in Oregon with huge rural referral area
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, FACP, FHM @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
J 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…
J Hospital Medicine @JHospMedicine
RT @leorahorwitzmd: @tony_breu @JHospMedicine @DrStephMueller Right - Northeast is fairly dense with hospitals; transfers maybe easier... #…
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T1 - There doesn't seem to be a standard for #IHT. Culture may also play a role. #JHMChat
J Hospital Medicine @JHospMedicine
RT @laxswamy: Lurking while working with @rbganatra - this topic has been a constant challenge @BostonChiefs #JHMChat
J Hospital Medicine @JHospMedicine
RT @FutureDocs: There was an interesting section on "transfer culture" in discussion #jhmchat https://t.co/mMzUV7zVqz
Stephanie Mueller @drstephmueller
@leorahorwitzmd @tony_breu @JHospMedicine #JHMchat though previous article by Iwashyna looked at ICU txs - not straightforward by zip code
Society of Hospital Medicine @SHMLive
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
J Hospital Medicine @JHospMedicine
RT @DrStephMueller: @leorahorwitzmd @tony_breu @JHospMedicine #JHMchat though previous article by Iwashyna looked at ICU txs - not straight…
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
J Hospital Medicine @JHospMedicine
Medicaid patients less likely to be transferred in paper @DrStephMueller #jhmchat https://t.co/RiA6vjTXV0
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMchat though it's interesting that transfer rate lowest in "west", but density hospitals in CA not equal Oregon?
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, FACP, FHM @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
J Hospital Medicine @JHospMedicine
RT @gracefarris: Grace Farris joining in from NYC #jhmchat https://t.co/gPcC2yKZy0
Grace Farris MD @gracefarris
@leorahorwitzmd @vineet_chopra Or are 'too sick'? #JHMchat
Stephanie Mueller @drstephmueller
Or less likely to be selected for transfer #JHMchat https://t.co/eEhBNOrmgl
Charlie M. Wray @WrayCharles
RT @leorahorwitzmd: @vineet_chopra Well in this study Medicaid lower rates of transfer - do think some pts harder to get accepted than othe…
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, FACP, FHM @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 @SHMLive
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
Avital O'Glasser, MD FACP FHM @aoglasser
@DrStephMueller @leorahorwitzmd we've had barriers w DC planning 4 out-of-state Medicaid, ex. Northern CA, so case management screens pre-transfer #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
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @JHospMedicine @DrStephMueller Were straight Medicaid patients analyzed, or only dual-eligible? (Paper implies latter) #JHMCh
J Hospital Medicine @JHospMedicine
RT @DrStephMueller: @mahoneyr @JHospMedicine Dual eligible #JHMchat
Grace Farris MD @gracefarris
@FutureDocs I wonder where residents fit in... at my new hospital residents can arrange #iht #jhmchat
J Hospital Medicine @JHospMedicine
RT @aoglasser: @DrStephMueller @leorahorwitzmd we've had barriers w DC planning 4 out-of-state Medicaid, ex. Northern CA, so case…
J 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
J Hospital Medicine @JHospMedicine
RT @leorahorwitzmd: @DrStephMueller Indeed, bias possible (likely) on both ends #JHMChat
J 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
J 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 @SHMLive
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
J Hospital Medicine @JHospMedicine
T2 in @DrStephMueller et al, younger pts, fewer hospitalizations assoc w higher transfer rates. thoughts? #JHMChat
Lakshman Swamy @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, FACP, FHM @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
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @laxswamy @tony_breu @JHospMedicine @DrStephMueller ditto #JHMChat
Lakshman Swamy @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
Society of Hospital Medicine @SHMLive
#JHMChat T2 is up! https://t.co/nJvArnuMKt
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
Shoshana Herzig @ShaniHerzig
@DrStephMueller @gracefarris @FutureDocs Would be interesting to compare within hospital differences to between hospital differences with respect to race... #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @palettala #jhmchat absolutely agree. wasn't privy to transfer calls as resident, huge learning curve as new attending
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 @aoglasser: @FutureDocs @palettala #jhmchat absolutely agree. wasn't privy to transfer calls as resident, huge learning curve as new att…
Vinny Arora MD MAPP @FutureDocs
RT @ShaniHerzig: @DrStephMueller @gracefarris @FutureDocs Would be interesting to compare within hospital differences to between hos…
Stephanie Mueller @drstephmueller
@JHospMedicine We felt threshold effect. Pts sometimes too sick for transfer #JHMchat
Lakshman Swamy @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, FACP, FHM @michellebr00ks
T2 - maybe the institution becomes so familiar with the patient that they don't transfer? #JHMchat
J Hospital Medicine @JHospMedicine
RT @DrStephMueller: @JHospMedicine We felt threshold effect. Pts sometimes too sick for transfer #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @palettala now I try to let residents listen on speaker phone if I happen to get a page from our transfer center when I'm attending #JHMChat
Stephanie Mueller @drstephmueller
@JHospMedicine Secondary analysis supports this too #JHMchat
J Hospital Medicine @JHospMedicine
RT @tony_breu: @leorahorwitzmd @laxswamy @JHospMedicine @DrStephMueller Transfer out of VA is likely driven 95% by availability of…
J 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?
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @laxswamy @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs What a luxury to be able to accep…
J 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
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @FutureDocs @palettala now I try to let residents listen on speaker phone if I happen to get a page from our transf…
Lakshman Swamy @laxswamy
@mahoneyr @leorahorwitzmd @tony_breu @JHospMedicine @DrStephMueller @BostonChiefs We are mostly limited by bed availability. #JHMChat
Charlie M. Wray @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
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @DrStephMueller #jhmchat hear hear! we get folks living 8 hour drive away. often not "warned" about transfer and logistics of getting back home
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
Lakshman Swamy @laxswamy
@leorahorwitzmd @WolfsonD you should hear some of the pass-offs I've gotten from OSH attendings. Training definitely needed. #JHMChat
Michelle Brooks, MD, FACP, FHM @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
Avital O'Glasser, MD FACP FHM @aoglasser
@DrStephMueller @JHospMedicine #JHMChat I feel the opposite. rarely get young transfers, usually very sick, very complex, often triaged to ICU over ward!
Shoshana Herzig @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 @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 @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
Grace Farris MD @gracefarris
When I used to accept #IHT the idea of being 'too sick' for #iht is interesting #JHMChat https://t.co/qji01I3E4X
J Hospital Medicine @JHospMedicine
Pediatrics core compentencies in @JHospMedicine include transfers of care #jhmchat https://t.co/nPq0w5Rrly @leorahorwitzmd
Lakshman Swamy @laxswamy
@tony_breu @mahoneyr @leorahorwitzmd @JHospMedicine @DrStephMueller @BostonChiefs definitely, the main reason we are involved is to ensure veteran safety. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @WolfsonD #JHMchat ditto. we're encouraged to get specialist on the line, ex. to confirm availability or appropriateness of procedure...
Laura Paletta-Hobbs, MD, FHM @palettala
@leorahorwitzmd @aoglasser @FutureDocs I'm working on a formal curriculum... would love to have collaborators #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @WolfsonD #JHMchat like the transfer for double-balloon enteroscopy...that can't be done for 2 weeks...
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 @WrayCharles
@leorahorwitzmd @aoglasser @FutureDocs @palettala cc @GStetsonMD #jhmchat
Michelle Brooks, MD, FACP, FHM @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
Grace Farris MD @gracefarris
@michellebr00ks @leorahorwitzmd @aoglasser @FutureDocs @palettala Yes-usually VS are from many hrs ago #JHMChat
J 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 p…
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @DrStephMueller @JHospMedicine #JHMChat yes, to both...?
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMCh
Vinny Arora MD MAPP @FutureDocs
RT @leorahorwitzmd: @aoglasser @FutureDocs @palettala Really nice example of creating learning on the fly - wonder if we should formalize c…
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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMCh
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMCh
Vinny Arora MD MAPP @FutureDocs
Don't get me started #JHMChat cc @jeannemfarnan @ShannonMartinMD @MedChiefs https://t.co/HfxCnTH4a0
Lakshman Swamy @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, FACP, FHM @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
Grace Farris MD @gracefarris
@DrStephMueller do you think racial disparity offsets the poor outcomes from that #iht study @ShaniHerzig collab on #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
Avital O'Glasser, MD FACP FHM @aoglasser
@vineet_chopra #JHMchat absolutely agree! luckily many of our referring hospitals now also on Epic, so we can "see" records
ThomasB @thbeckjordenmn
RT @JHospMedicine: New adult hospital medicine core competencies include transfers in "Transitions of Care" https://t.co/7T82adS5kW #JHMCh
J Hospital Medicine @JHospMedicine
Great convo. T3 up in a moment on #JHMChat- remember to hashtag your tweets.
Avital O'Glasser, MD FACP FHM @aoglasser
@DrStephMueller #JHMChat yes!
J 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.…
J Hospital Medicine @JHospMedicine
RT @leorahorwitzmd: @vineet_chopra YES. Another common issue is delay btwn acceptance and arrival - often totally different clinical pictur…
J 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 m…
Society of Hospital Medicine @SHMLive
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
@tony_breu @FutureDocs @jeannemfarnan @ShannonMartinMD @MedChiefs We do, its called a PGY-1 #workaround #JHMChat
Charlie M. Wray @WrayCharles
@mahoneyr @aoglasser @WolfsonD Can't hold that against 'em. My mechanic says the same thing #jhmchat
Rebecca Jaffe @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
J Hospital Medicine @JHospMedicine
T3 Given differences in hospital transfer rates, should transfer patients be treated differently in measuring quality #JHMChat
Society of Hospital Medicine @SHMLive
Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @laxswamy @vineet_chopra or having mechanism for the medical transport drivers to radio/call in if patient changes en route, ie redirect to ICU #JHMchat
Lakshman Swamy @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
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @leorahorwitzmd @laxswamy @vineet_chopra #jhmchat we rotate attending on "transfer center duty" & often insist on "next day" update if transfer doesn't occur in 24 hours
Rebecca Jaffe @RJmdphilly
RT @JHospMedicine: T3 Given differences in hospital transfer rates, should transfer patients be treated differently in measuring quality #…
Lakshman Swamy @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 @SHMLive
T3 is live! There's still time to join in tonight's #JHMChat on #IHT! https://t.co/YOE5eMvwCa
Lakshman Swamy @laxswamy
@mahoneyr @WrayCharles @aoglasser @WolfsonD Because the pt is sick and needs a doctor is usually good enough for me #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @WrayCharles @mahoneyr @WolfsonD surgery pt to med is variable. often referring calls medicine, doesn't know what pt complexity our surgery services routinely admit #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
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @WrayCharles @mahoneyr @WolfsonD it's a chance to explain the dozens of surgical services at the university hospital #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
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs #JHMchat what a great idea!
Leora Horwitz @leorahorwitzmd
@JHospMedicine For context, CMS outcome measures include tx patients, attribute mortality to 1st hospital but readmission to last #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs #JHMchat had attending in residency who always said route admit H&P AND DCsummary to referring to help them close the loop
Vinny Arora MD MAPP @FutureDocs
Great question for expert discussant @leorahorwitzmd #jhmchat https://t.co/ql8ImRLXaV
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T3 - maybe the OSH should shoulder some of the quality burden. Might make them more vigilant in transferring info #jhmchat
Lakshman Swamy @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 #jhm
Vinny Arora MD MAPP @FutureDocs
RT @leorahorwitzmd: @JHospMedicine For context, CMS outcome measures include tx patients, attribute mortality to 1st hospital but readmissi…
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
Avital O'Glasser, MD FACP FHM @aoglasser
@michellebr00ks @leorahorwitzmd @FutureDocs @palettala #JHMchat absolutely. hugely about art of triage!
Leora Horwitz @leorahorwitzmd
T3 current rationale for mortality is admit hosp has opp to stabilize pt, decide re: transfer #JHMChat
Rebecca Jaffe @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, FACP, FHM @michellebr00ks
Anyone have any success in a IHT follow-up conversation? "Hey, you're patient has this..." #jhmchat
J 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
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs #JHMchat he also insisted we not say "OSH transfer" in notes but aim for more professional "transferred from referring hospital X/doctor Y"
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @leorahorwitzmd @JHospMedicine And Vizient measures tend to penalize hospitals that don't/can't transfer patients o…
Michelle Brooks, MD, FACP, FHM @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
Avital O'Glasser, MD FACP FHM @aoglasser
@michellebr00ks I sometimes make a point to route my admit note/dc summary #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, FACP, FHM @michellebr00ks
My smart colleague @bqueenhoo diagnosed her over the phone with HLH. Accepted for transfer, followed up with me later. 2/2 #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly @mahoneyr @WrayCharles #JHMchat it's great that we can get images pushed from almost all referring hospitals. saves on a lot of unnecessary transfers!
Shoshana Herzig @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
J 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 @RJmdphilly
@mahoneyr yup. What I call a good doctor. The kind of person I want to do my bypass #jhmchat
J 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 ev…
J Hospital Medicine @JHospMedicine
RT @aoglasser: @RJmdphilly @mahoneyr @WrayCharles #JHMchat it's great that we can get images pushed from almost all referring hosp…
Stephanie Mueller @drstephmueller
@leorahorwitzmd @RJmdphilly Agree. Is there room for tele consult? How would that be billed? #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @RJmdphilly our specialists also required to be on call for the transfer center #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 @RJmdphilly
RT @DrStephMueller: @leorahorwitzmd @RJmdphilly Agree. Is there room for tele consult? How would that be billed? #JHMchat
J Hospital Medicine @JHospMedicine
Ok we are cruising along... T4 coming up in #JHMChat in 1 min!
Grace Farris MD @gracefarris
RT @ShaniHerzig: @gracefarris @DrStephMueller we adjusted for race and found worse outcomes #jhmchat https://t.co/3uIOKIu8AY
Leora Horwitz @leorahorwitzmd
@aoglasser @RJmdphilly @mahoneyr @WrayCharles Really? What mechanism? Via HIE? #JHMChat
J 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
Avital O'Glasser, MD FACP FHM @aoglasser
@DrStephMueller @leorahorwitzmd @RJmdphilly #JHMchat ooo! our hosp had certain services hugely expand telemedicine transfer/consult role! stroke, peds ICU
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: Ok we are cruising along... T4 coming up in #JHMChat in 1 min!
Avital O'Glasser, MD FACP FHM @aoglasser
@DrStephMueller @leorahorwitzmd @RJmdphilly #JHMchat the "accepting" doc could "see"/"do" neuro exam; critically ill kiddos could be visualized and triaged
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@vineet_chopra hahahaha...#mediumbucks #JHMChat
Rebecca Jaffe @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
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly @mahoneyr #JHMchat...have had a lot of 24-48hr turn around for inappropriate transfers that started that way...
Michelle Brooks, MD, FACP, FHM @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
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @RJmdphilly @mahoneyr @WrayCharles #JHMchat don't know all the details, but here's link https://t.co/rUWSxNIjq9
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T4 How can we improve standardization of patient transfers nationwide? #ptexp #Ptsafety #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @RJmdphilly @mahoneyr @WrayCharles #JHMchat I know there's some type of secure 2-way audiovisual link
Michelle Brooks, MD, FACP, FHM @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
Vinny Arora MD MAPP @FutureDocs
. @WolfsonD @CostsofCare in case you have not seen you will laugh or cry #choosingwisely #jhmchat https://t.co/0Tec9dsSur
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
RT @michellebr00ks: @FutureDocs @leorahorwitzmd Loved this...was searching for it. "we can send stacks of nursing notes" I think is in ther…
Rebecca Jaffe @RJmdphilly
@aoglasser @leorahorwitzmd @mahoneyr @WrayCharles we have it too. So far only surgeons have links. #irony #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @leorahorwitzmd #JHMChat! YES! this one! I think i first saw during a cardiac ICU rotation as resident...
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, FACP, FHM @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
Grace Farris MD @gracefarris
@DrStephMueller Best practices is def a good start #iht #JHMChat
J Hospital Medicine @JHospMedicine
RT @mahoneyr: T4 1. Thoughtful consideration (on both sides) of reason for transfer 2. Standardized "transfer record set" from HI…
Lakshman Swamy @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
Avital O'Glasser, MD FACP FHM @aoglasser
T4 #JHMchat agree with checklist. We're supposed to ask vitals, isolation needs, labs (ie are they critically hyperkalemic or not...)
J Hospital Medicine @JHospMedicine
RT @gracefarris: @DrStephMueller Best practices is def a good start #iht #JHMChat
J Hospital Medicine @JHospMedicine
RT @translatedmed: T4 There might be a role for a "IHT checklist". #jhmchat
J 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 L…
Grace Farris MD @gracefarris
RT @translatedmed: T4 There might be a role for a "IHT checklist". #jhmchat
J 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 @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 -…
Vinny Arora MD MAPP @FutureDocs
RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those…
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMChat T4 professional standards for truth telling...biggest irk is being lied to so I accept the patient...
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
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMChat T4 professional standards for truth telling...biggest irk is being lied to so I accept the patient...
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those…
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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat the supposedly intubated patient who showed up in the ICU NOT intubated...
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, FACP, FHM @michellebr00ks
@laxswamy @vineet_chopra That's an EMTALA violation -- cannot transfer to lower level of care. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @FutureDocs #JHMchat he also insisted we not say "OSH transfer" in notes but aim for more professional "transferred…
Rebecca Jaffe @RJmdphilly
T4 - mandatory feedback to senders. These are like autopsies. #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @RJmdphilly: These should be state law...or something similar but more...functional. #JHMChat https://t.co/CmheWo8x3z
Society of Hospital Medicine @SHMLive
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, FACP, FHM @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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat T4 also need template for meds on transfer, including last time and doses! big quality issue, ie antibiotics, heparin gtt rate...
Vinny Arora MD MAPP @FutureDocs
@RJmdphilly love this idea #jhmchat
J Hospital Medicine @JHospMedicine
Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.co/eF9tllCeAu
J Hospital Medicine @JHospMedicine
5 min left- please add your closing thoughts for tonight's #JHMChat on interhospital transfers #ptsafety
J 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 yo…
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.c…
Rebecca Jaffe @RJmdphilly
@gretchendiemer @estewart2099 @JeffIMchiefs https://t.co/giZ7XVLFo6
Michelle Brooks, MD, FACP, FHM @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 @SHMLive
Mark your calendar for the next #JHMChat! https://t.co/erdQVq7OXl
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat final thoughts-the best advice I got from more senior attending re transfers-the referring doc is being humble, asking for help
Vineet Chopra @vineet_chopra
RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.c…
Lakshman Swamy @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 @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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat final thoughts-framing Qs for more info on pt when getting pushback-"we have lots of units, including ICUs I don't admit to" triage
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
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat final thoughts-the best advice I got from more senior attending re transfers-the referring doc is being humble, ask…
Tony Breu @tony_breu
@leorahorwitzmd @DrStephMueller Yes! Thank you @DrStephMueller for advancing our understanding of #IHT. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @mahoneyr: @aoglasser The key is sorting out which referring doctors are looking for help, and which ones are looking for respite. #JHMC
J 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
J 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/MSOvU6on…
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat T4 also need template for meds on transfer, including last time and doses! big quality issue, ie antibiotics, hepar…
Stephanie Mueller @drstephmueller
Thanks for all the thoughtful comments! Many ideas for more projects on #IHT #jhmchat
J Hospital Medicine @JHospMedicine
RT @RJmdphilly: T4 - mandatory feedback to senders. These are like autopsies. #JHMChat
J Hospital Medicine @JHospMedicine
RT @translatedmed: T4 Standardized IHT checklist would probably help with #meded around IHT. #jhmchat
Grace Farris MD @gracefarris
@tony_breu @leorahorwitzmd @DrStephMueller Just some iron studies pls #jhmchat
Karyn Baum (feeling boring today) @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
J Hospital Medicine @JHospMedicine
RT @WolfsonD: #jhmchat Context matters - mix of specialists, number of beds, occupancy rates, culture, rural. Effect protocols -…
J Hospital Medicine @JHospMedicine
RT @tony_breu: @gracefarris @DrStephMueller This is two-sided. Best practice for transferring provider and best practice for those…
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr absolutely. hence the "why need to transfer to my hospital" Q #JHMChat
J 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
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr #JHMchat sometimes saying "it sounds like you're doing every right, & I would do the exact same here" helps them feel comfortable keeping pt
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
J Hospital Medicine @JHospMedicine
Great point we ran out of time! #jhmchat https://t.co/HzRY7KK5LS
J Hospital Medicine @JHospMedicine
RT @DrStephMueller: Thanks for all the thoughtful comments! Many ideas for more projects on #IHT #jhmchat
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
J Hospital Medicine @JHospMedicine
Great point we ran out of time! #jhmchat https://t.co/HzRY7KK5LS https://t.co/N3Pn9NcpkF
J 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/LZv…
Avital O'Glasser, MD FACP FHM @aoglasser
@leorahorwitzmd @tony_breu @gracefarris @DrStephMueller #JHMchat yes! sometimes it's a CT that leads to surgical need (HCT drop after cholecystectomy), BCx, start abx and IVFs...
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @aoglasser: #JHMchat final thoughts-the best advice I got from more senior attending re transfers-the referring doc is being humble, ask…
Ralph Martello, MD @gatorpedsMD
#JHMChat :)
Robert J. Mahoney, MD @mahoneyr
@aoglasser This sometimes works. And when it doesn't, it speaks volumes. #JHMChat
Society of Hospital Medicine @SHMLive
Thanks to @JHospMedicine @FutureDocs @leorahorwitzmd @ABIMFoundation @CostsofCare for your participation in tonight's #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
Grace Farris MD @gracefarris
@mahoneyr @laxswamy @vineet_chopra Or even what EMTALA means/stands for #jhmchat
J 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
J Hospital Medicine @JHospMedicine
Special thanks to all of you for an amazing #JHMChat esp expert discussant @leorahorwitzmd and author @DrStephMueller
Emily Anne, MD 🎶 @emilyannemcd
RT @translatedmed: Study notes racial disparities in IHT, which bring up interesting Qs around health equity that need a closer look. #unco
Michelle Brooks, MD, FACP, FHM @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
J Hospital Medicine @JHospMedicine
RT @JHospMedicine: Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation for bringing you #JHMChat tonight - #CME edition!
J Hospital Medicine @JHospMedicine
RT @SHMLive: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@laxswamy @vineet_chopra It's considered an outpatient setting. So...yes. #JHMChat
Amy Edgar @profamye
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
RT @SHMLive: Don't forget to claim #CME after tonight's #JHMChat! Find the evaluation here: https://t.co/RrvqdoT8kO
Charlie M. Wray @WrayCharles
RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.c…
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.c…
Society of Hospital Medicine @SHMLive
#JHMChat #CME evaluation is now open! Find it here: https://t.co/aVrAWnxUvN @JHospMedicine
J Hospital Medicine @JHospMedicine
ICYMI #VisualAbstract from tonight's #jhmchat! Look for full transcript tomorrow! https://t.co/Jh5om0EZkn
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat #CME evaluation is now open! Find it here: https://t.co/aVrAWnxUvN @JHospMedicine
J 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 @SHMLive
RT @vineet_chopra: Thx #JHMChat participants for a terrific discussion on #IHT!
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: ICYMI #VisualAbstract from tonight's #jhmchat! Look for full transcript tomorrow! https://t.co/Jh5om0EZkn https://t.co/q…
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 #jhm
Grace Farris MD @gracefarris
RT @JHospMedicine: Next #JHMChat July 24th 9pET on exemplary clinical teaching w@sanjaysaint @nate_houchens @WrayCharles #meded https://t.c…
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