#PHMFellowJC Transcript
Healthcare social media transcript of the #PHMFellowJC hashtag.
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See #PHMFellowJC Influencers/Analytics.
| Profile | Tweet |
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 | #PHMFellowJC @PHMFellowJC Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national survey about transition practices from pediatric to adult inpatient care. Objectives and Discussion questions below. We will be starting shortly! https://t.co/aytl45WZDO |
 | Kate Kyler, MD @kedkyler RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national survey about transition practices from pediatric to adult inpatient care. Objectives and Discussion questions below. We will be starting shortly! https://t.co/aytl45WZDO |
| #PHMFellowJC @PHMFellowJC We're excited for @AJenkins_MD, #medpeds @CincyPHMFellows, to be our guest moderator tonight. She developed all the material and will be commenting from her personal account. First, introduce yourself as a reply or retweet. Remember to use #PHMFellowJC in all tweets/replies. |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national survey about transition practices from pediatric to adult inpatient care. Objectives and Discussion questions below. We will be starting shortly! https://t.co/aytl45WZDO |
| #PHMFellowJC @PHMFellowJC For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#PHMFellowJC" in anything you tweet or reply to so that others can easily follow along. Most important, have fun while sharing ideas and learning from others! https://t.co/qnP2OgGgbD |
| #PHMFellowJC @PHMFellowJC Haven't read the #PHMFellowJC paper? A key figure from Coller et al's @JHospMed article to help you. @AJenkins_MD says It describes a conceptual model for pediatric-adult inpatient care transition that was the basis for this paper's survey development. https://t.co/h4VLt3qWc5 https://t.co/I6t1gQYHB5 |
 | Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Hi everyone, I'm a #PedsHM fellow @radychildrens in San Diego. A special welcome to all the first time #PHMfellowJC participants! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @PHMFellowJC @AJenkins_MD @CincyPHMFellows Sonya, 2nd year @CincyPHMFellows. So excited for my co-fellow @AJenkins_MD for being the guest moderator and looking forward to learning a lot! #PHMFellowJC |
| Kate Kyler, MD @kedkyler @PHMFellowJC @AJenkins_MD @CincyPHMFellows Kate Kyler here, 3rd year #PedsHM fellow at @ChildrensMercy in Kansas City #PHMFellowJC. @AJenkins_MD so glad you picked this topic... the article was very informative! |
 | John @jmomdphd A few helpful tips on participating in tonight’s #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC For the purpose of this #PHMFellowJC discussion, we should define #transition. @SAHMtweets defines it as "the purposeful, planned movement from adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems" |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @PHMFellowJC: For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#PHMFellowJC" in anything you tweet or reply to so that others can easily follow along. Most important, have fun while sharing ideas and learning from others! https://t.co/qnP2OgGgbD |
 | Dan Herchline @herchd @PHMFellowJC Dan Herchline, first year fellow at CHOP here! Excited for another great discussion with #PHMFellowJC |
 | Ashley Jenkins @AJenkins_MD RT @PHMFellowJC: For the purpose of this #PHMFellowJC discussion, we should define #transition. @SAHMtweets defines it as "the purposeful, planned movement from adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems" |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @PHMFellowJC: Haven't read the #PHMFellowJC paper? A key figure from Coller et al's @JHospMed article to help you. @AJenkins_MD says It describes a conceptual model for pediatric-adult inpatient care transition that was the basis for this paper's survey development. https://t.co/h4VLt3qWc5 https://t.co/I6t1gQYHB5 |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd @PHMFellowJC Welcome back and Happy New Year, Dan! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Let's start the #PHMFellowJC discussion. Our first question has multiple parts. The main question is: T1: What transition policies does your institution have in place? https://t.co/e2GwEp7thB |
| #PHMFellowJC @PHMFellowJC @herchd Welcome Dan! So excited that you're joining us again! Looking forward to hearing how #transitions are done at CHOP!#PHMFellowJC |
| Kate Kyler, MD @kedkyler @JoySolano6 In case you feel like doing more than lurking #PHMFellowJC 😉 |
| #PHMFellowJC @PHMFellowJC T1 cont'd: Include #PHMFellowJC T1 in your tweets. a) What age limit, if any, does your institution have for admitted patients to the general pediatric service? b) What are the common reasons for admission for older patients with chronic conditions at your institution? https://t.co/DdQORPLsdg |
 | Anika Kumar, MD (she/her) @freckledpedidoc Hi. This Anika Kumar, Pediatric Hospitalist in Cleveland. I’m trying to multi-task (watching POTUS’ televised message, followed by Sen. Schumer & Speaker Pelosi’s response) #PHMFellowJC |
| John @jmomdphd T1: We’ll take patients up to 21 years of age with a few exceptions (congenital heart defects) #PHMFellowJC |
 | Laura Lawler, MD @DocLauraLawler @PHMFellowJC @AJenkins_MD @CincyPHMFellows HI! Laura Lawler, Peds Hospital Medicine chief at @christianacare in Delaware! We are a large community hospital program at 3 sites. Thanks to @AJenkins_MD & all the fellows who organize fellow chat! PS We are hiring peds & med-peds hospitalists! #PHMFellowJC |
| John @jmomdphd RT @kedkyler: @JoySolano6 In case you feel like doing more than lurking #PHMFellowJC 😉 |
| Ashley Jenkins @AJenkins_MD @kedkyler @PHMFellowJC @CincyPHMFellows @ChildrensMercy Glad you found it informative! It's always a little nerve-wracking picking an article, whether for a 'real life' or Twitter #PHMFellowJC ! |
| #PHMFellowJC @PHMFellowJC @TMarshall_MD @AJenkins_MD @CincyPHMFellows Welcome Trisha! Thanks for your support of the #PHMFellowJC guest moderator! |
| John @jmomdphd @DocLauraLawler @PHMFellowJC @AJenkins_MD @CincyPHMFellows @christianacare #PHMFellowJC: not only informative, but also may help you get a job! |
| Kate Kyler, MD @kedkyler @freckledpedidoc Yeah, definitely on my to-do list right after this chat! #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @AJenkins_MD @CincyPHMFellows Yes! Love it! #PHMFellowJC (You are already doing great, by the way.) https://t.co/lCEWKXtiiD |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc Welcome Anika! We're always so impressed by your ability to multitask during #PHMFellowJC! |
 | PHM Fellowships @PHMFellowships RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national survey about transition practices from pediatric to adult inpatient care. Objectives and Discussion questions below. We will be starting shortly! https://t.co/aytl45WZDO |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: We're excited for @AJenkins_MD, #medpeds @CincyPHMFellows, to be our guest moderator tonight. She developed all the material and will be commenting from her personal account. First, introduce yourself as a reply or retweet. Remember to use #PHMFellowJC in all tweets/replies. |
| #PHMFellowJC @PHMFellowJC @DocLauraLawler @AJenkins_MD @CincyPHMFellows @christianacare Welcome Laura! Thanks for all your insights with the #PHMFellowJC polls! |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Haven't read the #PHMFellowJC paper? A key figure from Coller et al's @JHospMed article to help you. @AJenkins_MD says It describes a conceptual model for pediatric-adult inpatient care transition that was the basis for this paper's survey development. https://t.co/h4VLt3qWc5 https://t.co/I6t1gQYHB5 |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#PHMFellowJC" in anything you tweet or reply to so that others can easily follow along. Most important, have fun while sharing ideas and learning from others! https://t.co/qnP2OgGgbD |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: For the purpose of this #PHMFellowJC discussion, we should define #transition. @SAHMtweets defines it as "the purposeful, planned movement from adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems" |
| John @jmomdphd @PHMFellowJC T1b: I’d say that most of our admissions for older patients with chronic conditions are for respiratory reasons and seizure disorders #PHMFellowJC |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Let's start the #PHMFellowJC discussion. Our first question has multiple parts. The main question is: T1: What transition policies does your institution have in place? https://t.co/e2GwEp7thB |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: T1 cont'd: T1 cont'd: Include #PHMFellowJC T1 in your tweets. a) What age limit, if any, does your institution have for admitted patients to the general pediatric service? b) What are the common reasons for admission for older patients with chronic conditions at your institution? https://t.co/DdQORPLsdg |
| Laura Lawler, MD @DocLauraLawler @jmomdphd @PHMFellowJC @AJenkins_MD @CincyPHMFellows @christianacare It’s truly amazing that Twitter connections can become important real-life connections. #PHMFellowJC |
 | Atashi Mandal @DivergentTash @PHMFellowJC @AJenkins_MD @CincyPHMFellows Atashi, Med Peds community based hospitalist in Los Angeles and Orange counties, CA. Needless to say how thrilled I am we are talking about this #phmfellowjc |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids T1: I don't think we have an official transition policy that covers the whole institution, like I've definitely admitted 21+ yo if they had chronic issues followed by peds specialists. A lot of them are MediCal/CCS which only covers up to 21 yo, though #PHMFellowJC |
| John @jmomdphd @DivergentTash @PHMFellowJC @AJenkins_MD @CincyPHMFellows Welcome! #PHMFellowJC |
| Kate Kyler, MD @kedkyler T1: I believe we have a general age limit cut of of 21 for people with medical complexity, with some exceptions. Kids with congenital cardiac disease, neurosurgical problems, CF, some oncologic processes are a few that seem to stick around longer. #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler RT @PHMFellowJC: Let's start the #PHMFellowJC discussion. Our first question has multiple parts. The main question is: T1: What transition policies does your institution have in place? https://t.co/e2GwEp7thB |
 | momdoc @drbatraneo @PHMFellowJC Joining this discussion for first time ! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T1a: No age limit as far as I know @CincyChildrens. On #complexcare, we are thinking about #transition when pts are in their 20's, but definitely have had adults in 30's on our service. Don't tell my husband tho b/c I always tell him I don't take care of adults. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T1a: We once had a 70+ y/o who had a specialized surgery and admitted overnight. She told the nurses she felt a flutter in her heart...that led to a lot of discussion about systems based issues with caring for adults in a free-standing children's hospital. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T1a: Our heart institute has decided to be the center for adults with congenital heart dz. As a pediatric intern, I learned how to do an EKG on a neonate and next day, had to do one on a 42 y/o female. Placement of leads had its different challenges for both. |
| Dan Herchline @herchd T1 - I'm actually not certain if there is a strict cutoff age here at CHOP but most of the older patients we admit have either cardiac, onc, or medical complexity #phmfellowjc |
| Kate Kyler, MD @kedkyler RT @DivergentTash: @PHMFellowJC @AJenkins_MD @CincyPHMFellows Atashi, Med Peds community based hospitalist in Los Angeles and Orange counties, CA. Needless to say how thrilled I am we are talking about this #phmfellowjc |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T1b: For our #PedsHM #complexcare service: respiratory distress/infections, feeding intolerance/GI issues, seizures/altered mental status...this is true for adults and children on our service. |
| Anika Kumar, MD (she/her) @freckledpedidoc T1 a) we usually use a cut-off of 18. b) older patients are admitted if they follow with pediatric sub-specialists, generally those pts are admitted by our sub-specialty colleagues #PHMFellowJC |
| John @jmomdphd @drbatraneo @PHMFellowJC Welcome to #PHMFellowJC @drbatraneo |
| #PHMFellowJC @PHMFellowJC This is why we do what we do! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @DivergentTash @AJenkins_MD @CincyPHMFellows Welcome Atashi! So glad you could join us for this very important topic for #PHMFellowJC. |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC A1 (or is it T1), we do not have formal policies per se (as far as I know) but @christianacare does have a formal, transition program for young adults w/ complex needs. This is done in coordination w/ the state’s only chidlren’s hospital. #TransitionMedicine #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD What do you consider an ‘older’ patient when working in a children’s hospital or pediatric unit? #PHMFellowJC #T1 |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids T1a: theoretically 21, as mentioned above T1b: Agree with @jmomdphd re: resp issues and seizures, though would also add things like feeding tube issues, #congenitalheartdisease, etc (not always to #PedsHM, but sometimes we get consulted by the subspecialists) #PHMfellowJC |
| Kate Kyler, MD @kedkyler @STangGirdwood Wow, that beats the 40 yo I cared for once by a lot! Geri-Peds? ha! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @maxabillioncruz @CinciMedPeds Welcome to #PHMFellowJC! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @Potato_Chip @AJenkins_MD Welcome Chippy! We'd love to hear your dual perspective as a patient and healthcare trainee! #PHMFellowJC |
 | Brian may @Bmayzing @PHMFellowJC MP cheif resident at @CinciMedPeds #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @drbatraneo Thanks for joining us for #PHMFellowJC! |
| momdoc @drbatraneo @PHMFellowJC #PHMFellowJC |
| Dan Herchline @herchd @AJenkins_MD I think it depends on the issue. For kids with medical complexity, 30 seems like the upper bound but for healthy kids with no past medical, early twenties seems more appropriate #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc T1 practices at my prior employer were similar. We used 18 yrs as our cut-off because our leaning hospital had limited beds. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @STangGirdwood @CincyChildrens Interesting! Thinking about transition in their 20s sounds late to me, but we may not be providing the same kind of specialized cardiac care that Cincy does! We usually start talking about it around age 18. Endo and pulm are especially good about transitioning #PHMFellowJC |
| momdoc @drbatraneo @PHMFellowJC The age limit in our institution is 18 yrs for general pediatric admissions #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @christianacare A1/T1 part a - At the children’s hospital (where I trained a LONG time ago), I believe they still have some general policies with admission upper age limits 18-21, depending on whether a known medical problem vs new problem. But I’m not certain. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @herchd Something to look into, perhaps? Or ask your fellowship director, @chris_bonafide s? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @DocLauraLawler @jmomdphd @PHMFellowJC @AJenkins_MD @CincyPHMFellows @christianacare Yes, @STangGirdwood and I had so much fun meeting #tweetiatricians IRL at @AAPexperieNCE too! #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC Sad to say no formal transition process in place; having said that, we have a fully integrated health care delivery system, including the EMR, so information transfer is not problematic for those continuing their care here #PHMfellowjc |
 | Erin Conway @ech913 @PHMFellowJC can't wait to talk about the role of med-peds docs in inpatient transitions. I just joined Twitter tonight, lol!! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @DocLauraLawler @christianacare That's great! Can't wait to hear more!#PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: What do you consider an ‘older’ patient when working in a children’s hospital or pediatric unit? #PHMFellowJC #T1 |
| Kate Kyler, MD @kedkyler @AJenkins_MD I consider anyone 19 and older to be "old". Seems ridiculous saying it, but it's true! #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC @AJenkins_MD Yes, but just me #PHMfellowjc |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @TMarshall_MD @AJenkins_MD I had an interesting situation the other night where an adult ED was confused about admitting a previously healthy 18 yo patient who "had children's insurance" and I had to reassure them they should still be able to admit! #PHMFellowJC |
| Kate Kyler, MD @kedkyler @MikePlattMD @PHMFellowJC @AJenkins_MD @CincyPHMFellows So glad you could make it, Mike! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @Bmayzing @CinciMedPeds Welcome Brian! Looking forward to hearing your perspective as #medpeds chief. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @AJenkins_MD I would use over 26. At my current place of practice the pediatric nursing staff & pediatric residents aren’t insured to care for patients over the age of 26. That poses a serious risk to patients over the age of 26. #PHMFellowJC |
| Atashi Mandal @DivergentTash @AJenkins_MD @PHMFellowJC Anyone over 18 #phmfellowjc |
| #PHMFellowJC @PHMFellowJC Thanks for all your input so far! Let's move on to the next #PHMFellowJC question. Most of our poll responders are from free-standing children's hospitals. T2: How do you think the institutional context and roles of survey respondents might influence answers to surveys? https://t.co/oQQdvI7BGh |
| John @jmomdphd @freckledpedidoc @AJenkins_MD Very interesting point @freckledpedidoc. I’d have to look to see if there’s a restriction on our institution’s insurance coverage… #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD For those of you working at institutions with a #transition policies or age cut offs, how were those decided upon? #PHMFellowJC #T1 |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @drbatraneo Yay - another @christianacare @BayhealthDE peds hospitalist participating. This is #awesome! (Our 3 sites I referenced earlier are in 2 different health-systems.) #PHMFellowJC Dr. Batra - thanks for participating! PHM Fellow chats are are always fun & informative. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @kedkyler @CincyChildrens Same! Our endo and pulm are good about transitioning as well! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd @freckledpedidoc @AJenkins_MD Huh, I'd never even though of the potential malpractice insurance issue, though it makes sense #phmfellowJC |
| #PHMFellowJC @PHMFellowJC Thx @DocLauraLawler for pointing out in our #PHMFellowJC poll that while community hospitals w/peds units are technically hospitals-w/in-hospitals, they are not in the @hospitals4kids directory and were not recruited for the survey. T2: How do you think this affected the results? |
| Kate Kyler, MD @kedkyler @freckledpedidoc @AJenkins_MD That's something I've never considered. I wonder if that is a typical cut off or not? #PHMFellowJC |
 | Jacqueline Walker @jackiewalkermd @PHMFellowJC T1. No true age limits to my knowledge. Most pts transition at 18, and almost all do by 21. Exceptions are pts with underlying medical complexity (chronic conditions originating in childhood, genetic/metabolic, tech dependence, etc). #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @MikePlattMD @AJenkins_MD @CincyPHMFellows Welcome! Thanks for multitasking while participating in #PHMFellowJC! |
| Ashley Jenkins @AJenkins_MD I’m also curious how many of you would you consider surveying adult hospitals about inpatient #TransitionMedicine related topics on a national level? #PHMFellowJC #T2 |
| Dan Herchline @herchd @freckledpedidoc @AJenkins_MD I hadn't really considered the issue of trainees being insured up til a certain age. Is this something that is typically made known to trainees? #PHMFellowJC |
| momdoc @drbatraneo RT @DocLauraLawler: @PHMFellowJC @drbatraneo Yay - another @christianacare @BayhealthDE peds hospitalist participating. This is #awesome! (Our 3 sites I referenced earlier are in 2 different health-systems.) #PHMFellowJC Dr. Batra - thanks for participating! PHM Fellow chats are are always fun & informative. |
| Anika Kumar, MD (she/her) @freckledpedidoc @DrJenChen4kids @jmomdphd @AJenkins_MD Yes. It becomes a patient safety issue. #PHMfellowJC |
| Erin Conway @ech913 RT @PHMFellowJC: For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#PHMFellowJC" in anything you tweet or reply to so that others can easily follow along. Most important, have fun while sharing ideas and learning from others! https://t.co/qnP2OgGgbD |
| Ashley Jenkins @AJenkins_MD How do you, including @tigerlily0401 @SBCCincy @cghoover8 and other patients and families, think patients and families feel about or respond to inpatient #transition policies or age cut offs? #PHMFellowJC #T1 |
| #PHMFellowJC @PHMFellowJC @DivergentTash A smooth process for information transfer is key. Something to talk more about in T4. #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @christianacare I did some live-tweeting during a peds Grand Rounds last year about our #TransitionMedicine program by Dr. Wright. It is not an inpatient focused program, but a more general transitions program. #PHMFellowJC 1/2 https://t.co/H6XrMs3Fvf |
 | Med Peds Hospitalist @medpedshosp RT @PHMFellowJC: Haven't read the #PHMFellowJC paper? A key figure from Coller et al's @JHospMed article to help you. @AJenkins_MD says It describes a conceptual model for pediatric-adult inpatient care transition that was the basis for this paper's survey development. https://t.co/h4VLt3qWc5 https://t.co/I6t1gQYHB5 |
| #PHMFellowJC @PHMFellowJC @ech913 Thanks for joining Twitter for this very important #PHMFellowJC topic. Hope you learn something! |
| Anika Kumar, MD (she/her) @freckledpedidoc @herchd @AJenkins_MD I do not know if trainees are traditionally made aware. However, it is something our residency leadership has shared with the PHM physicians #PHMfellowJC |
| Kate Kyler, MD @kedkyler T2: Large free-standing childrens hospitals may care for a larger number of medically complex teens, making them more likely to have formal transition care process models #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc @AJenkins_MD That's a great point about insurance and liability of the providers who care for "older" patients. Thanks for the insight Anika! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @freckledpedidoc: @AJenkins_MD I would use over 26. At my current place of practice the pediatric nursing staff & pediatric residents aren’t insured to care for patients over the age of 26. That poses a serious risk to patients over the age of 26. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: For those of you working at institutions with a #transition policies or age cut offs, how were those decided upon? #PHMFellowJC #T1 |
| Kate Kyler, MD @kedkyler @JoySolano6 @PHMFellowJC @AJenkins_MD @CincyPHMFellows Wooooo yay Joy! Welcome! #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @jmomdphd @freckledpedidoc For some it may also be driven by state and insurance. @DrJenChen4kids does Medi-cal put limitations on if it will cover hospitalization of an adult at a children’s hospital? #PHMfellowJC #T1 |
| Brian may @Bmayzing #PHMFellowJC T2 hard to say who’s responding surveys with such drastic variability with subspecialty care. Patients transition at different times based on complexity hard to get full picture of hospital process. #subspecialtysilo |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids T2: Having trained mainly in freestanding children's hospitals, I feel like we don't think about #transition care enough, but it's starting to move. I've asked families of older pts if they've thought about changing PCPs or conservatorship for certain cases #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @christianacare Separate from this program (though coordinated?), our med-peds hospitalists (which I tweeted about earlier this wk) have recently begun innovative inpt approach to complex care, which is including some work w/ young adults w/ compelx needs. Program is very new. #PHMFellowJC 2/2 |
| Ashley Jenkins @AJenkins_MD @PHMFellowJC @DivergentTash I’m excited to hear what folks have to say about possible outcomes to measure and track! #PHMFellowJC #T4 |
| Atashi Mandal @DivergentTash @PHMFellowJC @DocLauraLawler @hospitals4kids And most of the represented hospitals were academic facilities in urban areas. I think all of this illuminates the challenges in identifying and creating these processes in the community setting #phmfellowjc |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T2: I'd think that if you are part of a hospital-w/in-hospital and have interaction w/ adult colleagues, #transition would occur earlier. Allowing patients to meet future doctors would be so much easier. Outside of #medpeds colleagues, I don't know adults docs. |
| Kate Kyler, MD @kedkyler @AJenkins_MD Super interesting and important questions could be answered! One of the other hospitalists in our group (one of our med-peds colleagues) is working on some transition of care stuff. I'll have to chat with him about this! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T2: I wonder how much clinical time you have (like 100% clinical vs. someone who has a lot of admin time) would change your perception about #transition practices. As I'm currently only 25% clinical, I wonder if I think about certain clinical issues less often. |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @freckledpedidoc @jmomdphd @AJenkins_MD I feel like adult size becomes a patient safety issue even before age sometimes (e.g. if you have a 300lb teenager admitted for something) #PHMfellowJC |
| John @jmomdphd @DrJenChen4kids T2: I agree @DrJenChen4kids. We likely don’t think of it as much as we should at our free-standing hospital. I wonder if having an adult present would encourage us to start the process earlier #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @jackiewalkermd Thanks for joining us and providing your perspective! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @AJenkins_MD looking to make connections and set up collaborations. #whywedowhatwedo #PHMFellowJC |
| John @jmomdphd @DrJenChen4kids @freckledpedidoc @AJenkins_MD I feel as though @STangGirdwood could have her own #PHMFellowJC on this topic as it pertains to medication dosing... |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC T2. I wonder if people at free-standing children’s hospitals may be inclined to follow chronic complex kids longer/until older ages? May have known the patients forever and feel comfortable with their management so less rush to transition? #PHMFellowJC |
| momdoc @drbatraneo @freckledpedidoc @PHMFellowJC @AJenkins_MD I think outpatient care might be able to take care upto 26 yrs, what is the age limit for gen Peds inpatients ? Would like to know from others in different institutions? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @JoySolano6 @AJenkins_MD @CincyPHMFellows Hi Joy! Thanks for joining us #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash @PHMFellowJC @DocLauraLawler @hospitals4kids Absolutely! Past work has also demonstrated that kids, including adolescents and young adults #AYA, receive care in facilities other than children’s hospitals. It will be super important in future work to look at community and rural sites! #PHMfellowJC #T2 |
| #PHMFellowJC @PHMFellowJC Yes, we'd love some patient and family input to #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd Certain subspecialists are definitely thinking about it more, e.g. hematology/oncology for patients with sickle cell or young adults with cancer #AYACSM @sicklecelldoc @StefThomasMD @c_diazepine #PHMFellowJC |
| Kate Kyler, MD @kedkyler @jmomdphd @DrJenChen4kids I feel like the transition conversations are usually driven by the main subspecialists managing the care of these medically complex teens at our institution. Peds HM and inpt providers should def be part of the conversation, though! #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc T2 I have worked at a Leaning Hospital & a Hospital within a Hospital. Transition was challenging in both settings. I think it is a systems issue and if you have strong champions with important discussions in leadership transition is successful. #PHMFellowJC #PHMFellowJC |
| momdoc @drbatraneo @MAhealthforkids @AJenkins_MD I think that’s the point adult specialists would be at a loss for special care pediatrics #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DocLauraLawler @PHMFellowJC @christianacare I saw you tweet about it and alerted @AJenkins_MD to it! #PHMFellowJC #lovemesometwitter |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC Sure! As @kedkyler can tell you, I’m not tech savvy, but I’m trying. 😂 #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @hospitals4kids T2-Why I’d agree, peds units in community🏥 s often feel like our own hospital w/in a 🏥, most such small units truly are not children’s hospitals w/in a 🏥. Such descriptions would implies a larger pediatric facility with most subspecialties, PICU, surgery,etc. 1/X #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @jmomdphd @freckledpedidoc For some it may also be driven by state and insurance. @DrJenChen4kids does Medi-cal put limitations on if it will cover hospitalization of an adult at a children’s hospital? #PHMfellowJC #T1 |
| Dan Herchline @herchd @PHMFellowJC Are there any current metrics for patient satisfaction that currently deal with this issue included in Press Ganey, etc? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @PHMFellowJC @DivergentTash I’m excited to hear what folks have to say about possible outcomes to measure and track! #PHMFellowJC #T4 |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @AJenkins_MD @jmomdphd @freckledpedidoc It's tricky: CCS (which covers many complex kids) stops at 21 and the insurance they get after that is variable. That said, we've definitely "kept" adult-age patients because that's what was better for the patient #PHMfellowJC |
| Med Peds Hospitalist @medpedshosp @freckledpedidoc @AJenkins_MD In addition, there is liability based on age- Adolescent Medicine staff don’t see these patients w Eating Disorders when they are older than 26 y/o. These are admitted to the adult side where they may indirectly provide input but are under the hospitalists care #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD #medpeds folks, have you encountered any adult healthcare systems that have specific inpatient #TransitionMedicine policies? @pdunbar20 @sophiestream @DonJohnelly @HdivaMedPeds @peacock_md @DrKittyMD @kimche @thomaswdavismd #PHMFellowJC #T2 |
| #PHMFellowJC @PHMFellowJC RT @DivergentTash: @PHMFellowJC @DocLauraLawler @hospitals4kids And most of the represented hospitals were academic facilities in urban areas. I think all of this illuminates the challenges in identifying and creating these processes in the community setting #phmfellowjc |
| Anika Kumar, MD (she/her) @freckledpedidoc @jmomdphd @drbatraneo @PHMFellowJC @AJenkins_MD It is based on the hospital system. Our outpatient providers and inpatient providers are insured beyond 26 years. It’s our residents & nursing staff. #PHMfellowJC |
| Kate Kyler, MD @kedkyler @freckledpedidoc From an inpatient perspective, it's difficult to know WHO to talk to on the adult medicine side of things, since we're not directly affiliated with a single adult hospital. I'm sure my med-peds colleagues would be helpful with navigating this issue #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @medpedshosp @AJenkins_MD Listen to this guy... he is one of my Med-Peds colleagues #PHMfellowJC |
| Atashi Mandal @DivergentTash Something interesting I’ve observed is that with my IM colleagues, there is always a big worry about liability coverage for any patient under 18. This doesn’t seem to hinder peds from taking care of young adults over 18. But should there be a cutoff for peds? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @drbatraneo: @freckledpedidoc @PHMFellowJC @AJenkins_MD I think outpatient care might be able to take care upto 26 yrs, what is the age limit for gen Peds inpatients ? Would like to know from others in different institutions? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Great discussion everyone! Let's move on to #PHMFellowJC T3- another multipart question. Our poll showed that many of you think about transitioning patients to adult care, which is great! T3: What role do you think pediatric hospitalists should play in the transition process? https://t.co/NDu7jgSvVH |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @DivergentTash @PHMFellowJC @DocLauraLawler @hospitals4kids Absolutely! Past work has also demonstrated that kids, including adolescents and young adults #AYA, receive care in facilities other than children’s hospitals. It will be super important in future work to look at community and rural sites! #PHMfellowJC #T2 |
| Ashley Jenkins @AJenkins_MD @freckledpedidoc @jmomdphd @drbatraneo @PHMFellowJC Many of you are bringing up a key point...caring for adults in a pediatric setting isn't just a physician issue. So much of their care is provided by other staff! It isn't just the medical content, it's having the right equipment, developmental models, etc! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Love it! Champions of #transitions! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Additional questions for #PHMFellowJC T3: a) What components of #transition could or should be addressed during hospitalization? b) What barriers prevent pediatric hospitalists from addressing #transition? Remember to include #PHMFellowJC T3 in your tweets and replies! https://t.co/J46fBtOaZz |
| Ashley Jenkins @AJenkins_MD @DrJenChen4kids @jmomdphd @freckledpedidoc Can I push a little and have you define what 'better' for the patient meant? When there isn't a standard approach important to learn from others how these #TransitionMedicine boundaries are defined! #PHMFellowJC #T13 |
| Kate Kyler, MD @kedkyler RT @AJenkins_MD: @freckledpedidoc @jmomdphd @drbatraneo @PHMFellowJC Many of you are bringing up a key point...caring for adults in a pediatric setting isn't just a physician issue. So much of their care is provided by other staff! It isn't just the medical content, it's having the right equipment, developmental models, etc! #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @hospitals4kids T2 (cont’d): Article is a great assessment of what formal children’s 🏥s are doing, but is limited to formal children’s 🏥s. Learning community 🏥 perspective is also important, though some of most important, relevant ?s in community 🏥s may be different. #PHMFellowJC 2/X |
| #PHMFellowJC @PHMFellowJC @MikePlattMD @freckledpedidoc @AJenkins_MD Interesting point. Never even considered the possibility of going from a Peds floor bed to adult ICU. #PHMFellowJC |
| John @jmomdphd @AJenkins_MD @DrJenChen4kids @freckledpedidoc No pushing or shoving during #PHMFellowJC lol |
| Kate Kyler, MD @kedkyler T3: I think asking the family if any of their primary subspecialist docs have brought it up is a great first step that I currently don't take. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: @PHMFellowJC Are there any current metrics for patient satisfaction that currently deal with this issue included in Press Ganey, etc? #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @AJenkins_MD @pdunbar20 @sophiestream @DonJohnelly @HdivaMedPeds @peacock_md @DrKittyMD @kimche @thomaswdavismd I think UW in Seattle has a formal program - led by Dr. Susan Hunt #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @medpedshosp: @freckledpedidoc @AJenkins_MD In addition, there is liability based on age- Adolescent Medicine staff don’t see these patients w Eating Disorders when they are older than 26 y/o. These are admitted to the adult side where they may indirectly provide input but are under the hospitalists care #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @PHMFellowJC @MikePlattMD @freckledpedidoc We tend to see more PICU or CCU to MICU transfers, depending on the patient. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @kedkyler: @freckledpedidoc From an inpatient perspective, it's difficult to know WHO to talk to on the adult medicine side of things, since we're not directly affiliated with a single adult hospital. I'm sure my med-peds colleagues would be helpful with navigating this issue #PHMFellowJC |
| Dan Herchline @herchd T3: I have often found it difficult to discuss transition during hospitalizations because I feel like it may add additional stress to families when they may already be under duress with the hospitalization itself. #phmfellowjc |
| Kate Kyler, MD @kedkyler A bigger and more complicated issue is how to establish a connection with the receiving inpatient team for each patient. The article talks about the adult docs visiting pt in peds hospital and vice versa! How amazing would that be?! #PHMFellowJC |
| John @jmomdphd @PHMFellowJC One of the barriers I’ve noticed is lack of continuity. A patient may see multiple hospitalists in any given year. I think a key intervention is to standardize documentation of transition so any provider knows where to pick up #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @MikePlattMD @freckledpedidoc We also struggle with various subspecialists having different levels of comfort performing procedures on adults. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @AJenkins_MD @jmomdphd @freckledpedidoc Often it's complex kids who have been followed by our specialists for years, and there's no one on the adult side taking over (yet). Sometimes also the patient is still kind of kid-size (e.g. have some genetic disorder) so that makes adult MDs even less comfortable #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC If a hospital-in- hospital setting, involving IM specialists in the care of older patients, probably at least 16-18 yo, would be a great opportunity to begin a transition. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC @MikePlattMD @AJenkins_MD I’ve accepted patients as a Hospitalist from the Adult ICU to the Pediatric IMC or the Pediatric Floor. Those were extenuating circumstances but I’ve seen what Mike is describing happen in reverse #PHMfellowJC |
| Ashley Jenkins @AJenkins_MD Looking at Table 1 in the Coller et al. article, what #TransitionMedicine core elements do you think hospitalists could address? Does it matter if you’re #medpeds or not? #PHMFellowJC #T3 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T3: Yes, we should definitely play a role. But do I think about #transition enough? Definitely not. I often only think about it when I feel at my limits in my clinical care/knowledge and/or ashamedly frustrated with patient/family issues. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T3: a major barrier is not knowing when it is appropriate to #transition (@AJenkins_MD). For example, a 30 kg 30 y/o might be better served in a children's hospital because we manage patients of that size more frequently than the adult world - i.e. mg/kg dosing. |
| Brian may @Bmayzing #PHMFellowJC T3 transition is a process needs more support for residency training re: specific counseling among #pediatricmilestones . Over 18 is too late. Waiting on MP docs is too late. People need to hear consistent message from all providers |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jackiewalkermd @PHMFellowJC Yes, and the patients/families often don't want to transition to adult care either! #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC #Transitions is a systems issue, not just a #physician issue...involves nursing and all staff and many other variables. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @jmomdphd @PHMFellowJC Totally agree, John. I'm not sure if the role of the hospitalist is to lead the efforts of transition, or rather to play an integral part with the primary subspecialists or PCP leading the effort and making connections? What does everyone think? #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC Also, as part of the discharge planning process, we can reach out to IM pcp’s and specialists to set up follow up appointments and use that opportunity for information transfer #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @kedkyler @freckledpedidoc One of the roles of our #MedPeds hospitalist-staffed adult care consult team, developed by @BusymomJen is to provide this bridge and help determine WHO to talk to. #PHMFellowJC #T3 |
 | Trisha Marshall @TMarshall_MD @herchd Interesting point. There are likely times when this conversation would not be effective or counterproductive and possibly cause a breakdown in rapport with patients/families if they feel they are being abandoned by the providers they have seen their whole lives... #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @drbatraneo @MAhealthforkids @AJenkins_MD Glad you could join us for #PHMfellowJC @MAhealthforkids! |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @hospitals4kids T2 (cont’d): Eg in community 🏥s, for acute care (esp non-complex/chronic), the ?s are usually not “Will we admit this teen/young adult to this 🏥 ?” Rather, which doctor/team will admit, where will we admit, & which specialists will care for the patient? 3/X #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Remember that most patients (children's and adults) are not taken care of at #academic hospitals. Important to learn the perspective of #community hospitals. Thanks @DocLauraLawler! #PHMFellowJC |
| Kate Kyler, MD @kedkyler @DrJenChen4kids @jackiewalkermd @PHMFellowJC Yes, with all the contact they have with their peds providers over the years, it's hard to blame them. But with these sort of process models in place for transition, it sets the families up for a successful relationship in the adult world, too #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd @PHMFellowJC Good question Dan, I don't know if those questions get included in hospital-wide patient satisfaction surveys #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: T3: T3: I have often found it difficult to discuss transition during hospitalizations because I feel like it may add additional stress to families when they may already be under duress with the hospitalization itself. #phmfellowjc |
| #PHMFellowJC @PHMFellowJC RT @kedkyler: A bigger and more complicated issue is how to establish a connection with the receiving inpatient team for each patient. The article talks about the adult docs visiting pt in peds hospital and vice versa! How amazing would that be?! #PHMFellowJC |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC T3. Time is a major barrier on the PHM side. But we should at least begin the conversation, and I think a phone call to the outpatient medical home provider would go a long way to ensuring the transition discussion continues. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @jmomdphd: @PHMFellowJC One of the barriers I’ve noticed is lack of continuity. A patient may see multiple hospitalists in any given year. I think a key intervention is to standardize documentation of transition so any provider knows where to pick up #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @STangGirdwood It's tough! I think we should ALWAYS be thinking about #transition; however, that does not always mean a patient should ultimately transfer their care. It's about being transparent and intentional in deciding the when, where, and why a person receives their care. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC T3 at my institution pediatric hospitalists respond to rapid responses. If I am responding to a rapid response but my nurses/residents aren’t insured to care for a pt based on age it’s an issue so we have definitely had that discussion when we co-manage surgical pts #PHMfellowJC |
| momdoc @drbatraneo @kedkyler @PHMFellowJC @freckledpedidoc It’s also specialty and provider specific Some adult doctors are comfortable with 3 hrs and above , some are not They will discuss some issues but some will not even listen to the story for a “curbside” #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @DivergentTash: @PHMFellowJC If a hospital-in- hospital setting, involving IM specialists in the care of older patients, probably at least 16-18 yo, would be a great opportunity to begin a transition. #PHMFellowJC |
| Atashi Mandal @DivergentTash And, there is an elephant in the room none of us want to admit, which is the extremely disparate cultures present on the adult and peds wards. I think having peds folks shadow round on the adult side and vice verse would be an enlightening experience #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC T3(a) Very interesting question. First of all, it depends on the culture of the hospital. We can always initiate a conversation w thw subspecialist (e.g. Neurology) properly inquiring what are the current processes implemented to transition a given patient. #PHMFellowJC |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Thanks for all your input so far! Let's move on to the next #PHMFellowJC question. Most of our poll responders are from free-standing children's hospitals. T2: How do you think the institutional context and roles of survey respondents might influence answers to surveys? https://t.co/oQQdvI7BGh |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @DivergentTash We have some subgroups of kids that get taken care of by adults, e.g. trauma cases > 14 yo go to an adult trauma center. I've also sent kids (even babies) to the UCSD burn unit but that's more subspecialized #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc @MikePlattMD @AJenkins_MD Wow! That's also a scenario that I didn't think happened. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: Looking at Table 1 in the Coller et al. article, what #TransitionMedicine core elements do you think hospitalists could address? Does it matter if you’re #medpeds or not? #PHMFellowJC #T3 |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Great discussion everyone! Let's move on to #PHMFellowJC T3- another multipart question. Our poll showed that many of you think about transitioning patients to adult care, which is great! T3: What role do you think pediatric hospitalists should play in the transition process? https://t.co/NDu7jgSvVH |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Additional questions for #PHMFellowJC T3: a) What components of #transition could or should be addressed during hospitalization? b) What barriers prevent pediatric hospitalists from addressing #transition? Remember to include #PHMFellowJC T3 in your tweets and replies! https://t.co/J46fBtOaZz |
| #PHMFellowJC @PHMFellowJC RT @Bmayzing: #PHMFellowJC T3 transition is a process needs more support for residency training re: #PHMFellowJC T3 transition is a process needs more support for residency training re: specific counseling among #pediatricmilestones . Over 18 is too late. Waiting on MP docs is too late. People need to hear consistent message from all providers |
| Ashley Jenkins @AJenkins_MD @jmomdphd @PHMFellowJC A really neat QI project done I believe @BostonChildrens with @DrKittyMD and others revolved around making sure all #transition aged adults had a healthcare proxy documented. There are somewhat simple but important things that could (and should?) be addressed. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @AJenkins_MD @freckledpedidoc @BusymomJen That consult team sounds fabulous! Such a great way to utilize the expertise of our med-peds colleagues while they work in a pediatric setting #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @DrJenChen4kids @jackiewalkermd @PHMFellowJC And others do. We had a cardiac 18 year old patient who wanted to go to the adult unit bc he would get a private room (he would’ve had a roommate on the pediatric unit) #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC @Bmayzing as the #medpeds chief of @cincypedsres, how would you train the residents to address #transition? #PHMFellowJC |
 | Zachary Berrens @ALifeInParadox @STangGirdwood @AJenkins_MD #PHMFellowJC T3: (1/2) Zach Berrens, not a hospitalitist, but an interloping intensivist. One major barrier I think we face as generalists, is that the patients that may benefit most from #transition are those with high utilization - those with chronic conditions. |
| Atashi Mandal @DivergentTash @AJenkins_MD @PHMFellowJC Not to sound biased, but having a meds peds liaison would be extremely helpful, as we have contacts on the adult side and are intimately aware of how the care will and will not change after the transition #PHMFellowJC |
 | Salty AF 🫁♻️ @saltylungs @DrJenChen4kids @jackiewalkermd @PHMFellowJC Definitely agree with this. As a patient, I finally transitioned at 20yo to adult care and I did not look forward to it! #PHMfellowJC |
 | Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @PHMFellowJC @herchd Nothing firm #PHMFellowJC, although 18+ would not be admitted if completely unknown to CHOP. The larger question around transition comes up much more often for the specialty services, especially if there are not great adult options for the condition in the area e.g sickle cell dz |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids T3: As I mentioned before, I start asking patients/families at least about transitioning their outpatient care if they're 17-18 yo, e.g. identifying a new PCP #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC T3(b) A barrier can be the cultural elements in the hospital. And the lack of expertise among the adult specialists to manage specific diseases (e.g. mitochondrial dz - our institutional experts are actually Peds Neuro guys). #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @MikePlattMD Family #input and #perspective in the #transition process is important! #PHMFellowjC |
| #PHMFellowJC @PHMFellowJC RT @kedkyler: @jmomdphd @PHMFellowJC Totally agree, John. I'm not sure if the role of the hospitalist is to lead the efforts of transition, or rather to play an integral part with the primary subspecialists or PCP leading the effort and making connections? What does everyone think? #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @Bmayzing And the reality is there aren' enough #medpeds docs to tackle all of transition. @Bmayzing how can #medpeds providers help build #transition capacity in both the pediatric and adult 'worlds'? #PHMFellowJC |
| Kate Kyler, MD @kedkyler RT @Bmayzing: #PHMFellowJC T3 transition is a process needs more support for residency training re: #PHMFellowJC T3 transition is a process needs more support for residency training re: specific counseling among #pediatricmilestones . Over 18 is too late. Waiting on MP docs is too late. People need to hear consistent message from all providers |
| #PHMFellowJC @PHMFellowJC This is has been a great discussion so far! Last question for #PHMFellowJC. T4: What measures could be tracked to help guide inpatient healthcare transition quality improvement efforts? What barriers would prevent tracking these measures? Include #PHMFellowJC T4 in your tweets https://t.co/JnIxqsXM7H |
| Med Peds Hospitalist @medpedshosp RT @AJenkins_MD: @Bmayzing And the reality is there aren' enough #medpeds docs to tackle all of transition. @Bmayzing how can #medpeds providers help build #transition capacity in both the pediatric and adult 'worlds'? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @DivergentTash That's a great practical approach! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @kedkyler @freckledpedidoc One of the roles of our #MedPeds hospitalist-staffed adult care consult team, developed by @BusymomJen is to provide this bridge and help determine WHO to talk to. #PHMFellowJC #T3 |
| #PHMFellowJC @PHMFellowJC RT @TMarshall_MD: @herchd Interesting point. There are likely times when this conversation would not be effective or counterproductive and possibly cause a breakdown in rapport with patients/families if they feel they are being abandoned by the providers they have seen their whole lives... #PHMFellowJC |
| Kate Kyler, MD @kedkyler @Potato_Chip @DrJenChen4kids @jackiewalkermd @PHMFellowJC @Potato_Chip how did that transition go for you? Thank you for your input! #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @kedkyler @AJenkins_MD I think of 18-21 as “older” pts for peds. Having said that, I feel it’s w/in our scope of practice as peds hospitalists. To plug our med-peds hospitalists colleagues again, they are always accessible for peds or adult hospitalists to reach out to them for ?s. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @DocLauraLawler: @PHMFellowJC @hospitals4kids T2 (cont’d): @PHMFellowJC @hospitals4kids T2 (cont’d): Eg in community 🏥s, for acute care (esp non-complex/chronic), the ?s are usually not “Will we admit this teen/young adult to this 🏥 ?” Rather, which doctor/team will admit, where will we admit, & which specialists will care for the patient? 3/X #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @herchd @PHMFellowJC I don’t believe so. At least they weren’t 3 years ago when my prior institution was looking into it #PHMfellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash @PHMFellowJC Sometimes at hospital discharge all it takes is suggesting one subspecialist to follow up with on the adult side that helps start the process. #PHMFellowJC #T3 |
| Zachary Berrens @ALifeInParadox @STangGirdwood @AJenkins_MD #PHMFellowJC T3: Peds subscpecialists (in my experience) often have a hard time giving up a patient with whom they have a relationship. When I have brought #transition up, it is at best met with dismissal, and often with hostility. |
| #PHMFellowJC @PHMFellowJC Yes, engaging the outpatient provider is key! Communication between inpatient and outpatient, peds and adult need to be prioritized! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @STangGirdwood It's tough! I think we should ALWAYS be thinking about #transition; however, that does not always mean a patient should ultimately transfer their care. It's about being transparent and intentional in deciding the when, where, and why a person receives their care. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @sicklecelldoc @jmomdphd @StefThomasMD @c_diazepine I think that's a key issue for a lot of subspecialists dealing with patients in #transition, even in large urban centers so definitely harder in community setting! #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @Potato_Chip @DrJenChen4kids @jackiewalkermd @PHMFellowJC Do you remember what about it you didn't look forward to? Any way you can think that inpatient providers could have helped along the way? #TransitionMedicine #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC One of the measures mentioned in the article was tracking the patient through the transition. In that case, who “owns” the patient would be a key factor. This is where commercial ACO’s and other managed care models could play a role. #phmfellowjc |
| Laura Lawler, MD @DocLauraLawler @kedkyler @AJenkins_MD At our community 🏥, 18-21 go to adult service usually, but there are many exceptions. This is especially true b/c we can work together as team depending on staffing/census needs. Other exception is w/ complex pts/transitions pts, peds sometimes cares for pts > 21. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @MikePlattMD @jmomdphd @PHMFellowJC True! Since we're commonly caring for these teens on the inpatient side and are generally skilled at corralling consultants/subspecialists, I think hospitalists could at least help connect other providers in getting the process of transition completed. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC T4 - Metrics.... well, one can be having a formal appointment or conversation w the adult specialist prior to the transition.#PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Great idea! Adult and peds docs shadowing each other on rounds! What do you think #medpeds? Would it be a good learning experience for both? #PHMFellowJC |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC T4. If a firm plan is established for transition to adult care, I would want to know if the pt ever returned to peds providers/hospitals and why. (What went wrong?) #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @ALifeInParadox @STangGirdwood During critical illness bring up change can be hard. I struggle so much with the when and how to bring up any component of transition when someone is in the hospital when there are years of provider relationships at the institution. #PHMFellowJC |
| Salty AF 🫁♻️ @saltylungs @kedkyler @DrJenChen4kids @jackiewalkermd @PHMFellowJC Good question. I have CF and that was 13 years ago that I transitioned so my hospital was still trying to sort out how to do it. It was hard going from a very supportive peds clinic team that I trusted to a new adult clinic w/diff protocols and such. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @DivergentTash Adult #EM vs #PedsEM too! In residency we had a lot of patients who had already transitioned to adult care but would still come back to our ER because they knew they would get seen and treated more quickly (eg for something like sickle cell crisis) #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @ALifeInParadox @STangGirdwood @AJenkins_MD Thanks for joining and providing a #PedsICU perspective! #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash 100% agree with this! I also think there are various perceptions, both positive and negative, that exist of the 'other side'. #PHMFellowJC |
| Kate Kyler, MD @kedkyler T4: Maybe # of patients with certain disease processes known to stay longer in pediatrics despite having adult docs ready to care for them? #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC T4. Many of the sub-specialists at the institutions I’ve worked at have identified disease-specific QI metrics for their own populations (patients with Sickle Cell, T1DM, CF). None of those metrics have been standardized across the respective institutions #PHMfellowJC |
 | Rebecca Steuart, MD @RebeccaSteuart @AJenkins_MD @DivergentTash @PHMFellowJC I like this idea to choose one to start - I bet in some multi-subspecialist patient scenarios that getting the first step along the path underway makes things easier for the patient, family, and providers. But which subspecialist to recommend to transition first? #PHMFellowJC |
| Kate Kyler, MD @kedkyler @DrJenChen4kids @DivergentTash Same. #PHMFellowJC |
| John @jmomdphd T3: Have you ever had families (or providers) claim that the adult provider will be less accessible or less accommodating than pediatric subspecialists? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @Potato_Chip @DrJenChen4kids @jackiewalkermd Hi Chippy! Thanks for joining us and providing #patient perspective! #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @AJenkins_MD @Bmayzing And transition champions need to be a full time position #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @medpedshosp: @PHMFellowJC T3(b) A barrier can be the cultural elements in the hospital. And the lack of expertise among the adult specialists to manage specific diseases (e.g. mitochondrial dz - our institutional experts are actually Peds Neuro guys). #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @AJenkins_MD @jmomdphd @PHMFellowJC @BostonChildrens @DrKittyMD Great point Ashley - maybe also helping families start medical/legal process of conservatorship for patients with developmental delay that will never be able to make their own healthcare decisions #PHMfellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T4: #readmissions is definitely a "hot" measure used to track improvement efforts of inpatient care. I guess seeing if the patient comes back to children's hospital ER after official #transition (only works for #freestanding hospitals). |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC The hidden curriculum creeps into all conversations #PHMfellowJC |
 | Journal of Hospital Medicine @JHospMedicine RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national survey about transition practices from pediatric to adult inpatient care. Objectives and Discussion questions below. We will be starting shortly! https://t.co/aytl45WZDO |
| Ashley Jenkins @AJenkins_MD @TMarshall_MD @herchd Once when I was working on our adult care consult service @CincyPHM after talking with a family for about 30 minutes they said, "Oh, you're not trying to kick us out?". Was a key reminder of how even the discussion of #transition for most can be challenging. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @DivergentTash @PHMFellowJC Sometimes at hospital discharge all it takes is suggesting one subspecialist to follow up with on the adult side that helps start the process. #PHMFellowJC #T3 |
| Atashi Mandal @DivergentTash @RebeccaSteuart @AJenkins_MD @PHMFellowJC I think the subspecialist most relevant to either 1) the acute problem or 2) the major underlying chronic issue or both, would be good places to start #phmfellowjc |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC T4-In our community🏥 setting, when a complex, young adult is admitting to community🏥 for 1st time(s), peds & med-peds hospitalists have sometimes help coordinate introduction to adults specialists, coordinate transition to adult PCP, & help w/ social/psych needs. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @jackiewalkermd: @PHMFellowJC T4. If a firm plan is established for transition to adult care, I would want to know if the pt ever returned to peds providers/hospitals and why. (What went wrong?) #PHMFellowJC |
| Kate Kyler, MD @kedkyler @maxabillioncruz @DivergentTash @AJenkins_MD @PHMFellowJC Yes, like how pregnant women tour the hospital they will deliver in before the date. Just that small amount of familiarity would do wonders to allay stress on the first admission #PHMFellowJC |
| Salty AF 🫁♻️ @saltylungs @kedkyler @DrJenChen4kids @jackiewalkermd @PHMFellowJC Also, very diff experience w/hospitalization for tune ups in adult vs peds. My center now starts transitioning CFers by preparing and educating starting around 10yo I believe (formally transition 18-20) and that seems to be really successful from feedback I've heard. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @Potato_Chip: @kedkyler @DrJenChen4kids @jackiewalkermd @PHMFellowJC Good question. I have CF and that was 13 years ago that I transitioned so my hospital was still trying to sort out how to do it. It was hard going from a very supportive peds clinic team that I trusted to a new adult clinic w/diff protocols and such. #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @maxabillioncruz @DivergentTash @PHMFellowJC There is actually good evidence in the literature to support doing hospital tours, provider introductions BEFORE transfer, etc. The reasons why this doesn’t then happen during #transition and before transfer are less clear. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids T4: Considering we often have trouble even confirming correct pediatric PCP, getting patients a first appt with adult PCP or specialist would be huge. Maybe documenting a "future care plan" w appropriate adult hospital for pt to go to in future? #PHMFellowJC |
| Atashi Mandal @DivergentTash @jmomdphd Not so much worried about accessibility but rather the lack of awareness and/or sensitivity to the patient’s history and trajectory over the years #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD Especially in considering #transition from a free-standing children’s hospital to another healthcare system, how might you suggest tracking as Coller et al suggest for ‘less inconsistency’ or back-and-forth between peds and adult inpatient care? #PHMFellowJC #T4 |
| #PHMFellowJC @PHMFellowJC Thanks to all those who participated in tonight's #PHMFellowJC discussion on the #transition practices from pediatric to adult care. What last thoughts do you have? Anything you learned that you could implement? |
| Kate Kyler, MD @kedkyler @DivergentTash @RebeccaSteuart @AJenkins_MD @PHMFellowJC We have a primary care clinic that specializes in caring for kids with medical complexity... I wonder how they handle the transition? @jackiewalkermd @MikePlattMD @JoySolano6 #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC T4- From a barrier standpoint, this type of work would seem much more difficulty w/o med-peds hospitalists colleagues that know both sides of the inpatient transition, though certainly there are other ways to accomplish same type of work. #PHMFellowJC |
| John @jmomdphd RT @AJenkins_MD: @maxabillioncruz @DivergentTash @PHMFellowJC There is actually good evidence in the literature to support doing hospital tours, provider introductions BEFORE transfer, etc. The reasons why this doesn’t then happen during #transition and before transfer are less clear. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @RebeccaSteuart @AJenkins_MD @DivergentTash Welcome Rebecca! Thanks for your input!#PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @Potato_Chip @kedkyler @DrJenChen4kids @jackiewalkermd @PHMFellowJC There have been studies in the CF & sickle cell literature that discuss transition. The common thread is to start early. #PHMFellowJC |
| John @jmomdphd RT @DocLauraLawler: @PHMFellowJC T4-In our community🏥 setting, when a complex, young adult is admitting to community🏥 for 1st time(s), peds & med-peds hospitalists have sometimes help coordinate introduction to adults specialists, coordinate transition to adult PCP, & help w/ social/psych needs. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @jmomdphd: T3: T3: Have you ever had families (or providers) claim that the adult provider will be less accessible or less accommodating than pediatric subspecialists? #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash @PHMFellowJC This has been something I’ve been thinking a lot about! Do you happen to know any example of systems that have taken this approach? #PHMFellowJC |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: This is has been a great discussion so far! Last question for #PHMFellowJC. T4: What measures could be tracked to help guide inpatient healthcare transition quality improvement efforts? What barriers would prevent tracking these measures? Include #PHMFellowJC T4 in your tweets https://t.co/JnIxqsXM7H |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @medpedshosp @AJenkins_MD @Bmayzing I think there's a role here for #familymed too since they also see patients across the spectrum, but many of them are not as comfortable with complex patients or inpatient care since they have more limited training w those #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @TMarshall_MD @herchd Once when I was working on our adult care consult service @CincyPHM after talking with a family for about 30 minutes they said, "Oh, you're not trying to kick us out?". Was a key reminder of how even the discussion of #transition for most can be challenging. #PHMFellowJC |
| Kate Kyler, MD @kedkyler T4: Another metric that would be interesting is the time from the first mention of transition to the ultimate hand-off to the adult side. As in no more peds clinic, ER, or inpatient stays. How long do you all think that is? Years, right? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @maxabillioncruz @DivergentTash @PHMFellowJC There is actually good evidence in the literature to support doing hospital tours, provider introductions BEFORE transfer, etc. The reasons why this doesn’t then happen during #transition and before transfer are less clear. #PHMFellowJC |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: Thanks to all those who participated in tonight's #PHMFellowJC discussion on the #transition practices from pediatric to adult care. What last thoughts do you have? Anything you learned that you could implement? |
| Dan Herchline @herchd @PHMFellowJC Some adult institutions are starting to open hospitalist run clinics for patients recently discharged. Could this be a potential venue to really dig into the transition conversation?? #PHMFellowJC |
| Atashi Mandal @DivergentTash @PHMFellowJC An understated barrier that I keep encountering is the utter lack of interest that my adult and peds colleagues exhibit in learning about each other, or even talking to each other. :-( #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: Especially in considering #transition from a free-standing children’s hospital to another healthcare system, how might you suggest tracking as Coller et al suggest for ‘less inconsistency’ or back-and-forth between peds and adult inpatient care? #PHMFellowJC #T4 |
| Ashley Jenkins @AJenkins_MD @freckledpedidoc @PHMFellowJC I wonder too how patient, families, and providers feel when other divisions use different metrics or have different policies? How can we create some standard #transition work that should also be highly dependent on an individual’s needs? #PHMFellowJC #T4 |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: @medpedshosp @AJenkins_MD @Bmayzing I think there's a role here for #familymed too since they also see patients across the spectrum, but many of them are not as comfortable with complex patients or inpatient care since they have more limited training w those #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: @PHMFellowJC Some adult institutions are starting to open hospitalist run clinics for patients recently discharged. Could this be a potential venue to really dig into the transition conversation?? #PHMFellowJC |
| Jacqueline Walker @jackiewalkermd @kedkyler @DivergentTash @RebeccaSteuart @AJenkins_MD @PHMFellowJC @MikePlattMD @JoySolano6 Was wondering the same thing @kedkyler! We should ask CMH Beacon Clinic if they have a formal protocol. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc Thanks @AJenkins_MD for a great #PHMFellowJC! Your colleagues (@kedkyler, @DrJenChen4kids, @jmomdphd & @STangGirdwood) did a great job recruiting a great guest moderator! |
| #PHMFellowJC @PHMFellowJC We can’t thank @AJenkins_MD enough for being our 1st #PHMFellowJC guest moderator & picking a topic that needs more attention. Great job Ashley! Our next session on Feb 12th at 9 pm EST will also have a guest moderator, @joysolano6. We will discuss family centered rounds. https://t.co/A672jtRm5f |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @freckledpedidoc @PHMFellowJC Totally...it's been interesting to hear from #medstudents who experience #familycenteredrounds for the first time on their peds rotation compared to their experiences on medicine or surgery #PHMfellowJC |
| Atashi Mandal @DivergentTash Yes! A post discharge clinic would be a great venue to discuss transitions in a calmer and less pressured setting #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD Creating systems that can help track outcomes over time as #AYA #transition will be key. But how do we do this effectively when #transition often involves moving between healthcare systems and changing insurance? #PHMFellowJC #T4 |
| Atashi Mandal @DivergentTash Thank you Ashley- great discussion! #PHMFellowJC |
| Salty AF 🫁♻️ @saltylungs @AJenkins_MD @DrJenChen4kids @jackiewalkermd @PHMFellowJC I think meeting the providers before officially transitioning would have been helpful. Additionally, I could have been more prepared for the responsibility of switching to adult (less oversight, more responsibility on me to monitor meds/etc) #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @Potato_Chip: @AJenkins_MD @DrJenChen4kids @jackiewalkermd @PHMFellowJC I think meeting the providers before officially transitioning would have been helpful. Additionally, I could have been more prepared for the responsibility of switching to adult (less oversight, more responsibility on me to monitor meds/etc) #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC T4-Family is always important part of transition. Young adults w/ complex needs & their families are often fearful of transition. (We all get scared of the unknown. Right?) Luxury of the time of the 🏥stay can help ⬇️ fear-or ⬆️ fear. Peds trained staff can help. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @DocLauraLawler: @PHMFellowJC T4-Family is always important part of transition. Young adults w/ complex needs & their families are often fearful of transition. (We all get scared of the unknown. Right?) Luxury of the time of the 🏥stay can help ⬇️ fear-or ⬆️ fear. Peds trained staff can help. #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @PHMFellowJC @JoySolano6 Thanks for the opportunity @PHMFellowJC to pick a topic close to my heart!! Please keep the #transition convo going! #PHMFellowJC https://t.co/w5cZipPXaM |
| #PHMFellowJC @PHMFellowJC RT @AJenkins_MD: @PHMFellowJC @JoySolano6 Thanks for the opportunity @PHMFellowJC to pick a topic close to my heart!! Please keep the #transition convo going! #PHMFellowJC https://t.co/w5cZipPXaM |
| Kate Kyler, MD @kedkyler Absolutely fantastic discussion in tonight's #PHMFellowJC. Thanks @AJenkins_MD & everyone else who participated! Be sure to join in Feb when my @ChildrensMercy co-fellow @JoySolano6 guest moderates a great discussion re: communication on family centered rounds! See you there 🤓 |
| Dan Herchline @herchd Thanks for a great discussion @AJenkins_MD - Always so thankful for incredible medpeds folks in making these challenges easier to navigate! #phmfellowjc |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids It's clear that we all still have a lot of things to think about and work to do re: #transition practices, both inpatient and outpatient! #PHMFellowJC |
| Kate Kyler, MD @kedkyler RT @herchd: @PHMFellowJC Some adult institutions are starting to open hospitalist run clinics for patients recently discharged. Could this be a potential venue to really dig into the transition conversation?? #PHMFellowJC |
| Kate Kyler, MD @kedkyler @AJenkins_MD @PHMFellowJC @JoySolano6 You just dominated that chat! Thanks for picking a great topic! I learned loads. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Thanks to all the participants for a great #PHMFellowJC, especially our guest moderator @AJenkins_MD! If any other #tweetiatricians or #medpeds folks want to chime in, please feel free to do so (we'll generate the transcript tomorrow) |
| Jacqueline Walker @jackiewalkermd @kedkyler @AJenkins_MD @ChildrensMercy @JoySolano6 Can’t wait @JoySolano6! It’s always a good time to talk about FCRs! #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash @PHMFellowJC One question I didn't get to ask was if anyone has had success in engaging internists in #transition work without #medpeds to help bridge the gap? Most patients have to #transition their care eventually, but how do we get better adult non-specialist provider buy-in? #PHMFellowJC |
| PHM Fellowships @PHMFellowships RT @PHMFellowJC: We can’t thank @AJenkins_MD enough for being our 1st #PHMFellowJC guest moderator & picking a topic that needs more attention. Great job Ashley! Our next session on Feb 12th at 9 pm EST will also have a guest moderator, @joysolano6. We will discuss family centered rounds. https://t.co/A672jtRm5f |
| Ashley Jenkins @AJenkins_MD RT @DocLauraLawler: @PHMFellowJC T4-Family is always important part of transition. Young adults w/ complex needs & their families are often fearful of transition. (We all get scared of the unknown. Right?) Luxury of the time of the 🏥stay can help ⬇️ fear-or ⬆️ fear. Peds trained staff can help. #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd @DrJenChen4kids @freckledpedidoc @AJenkins_MD Thanks for s/o @jmomdphd. Something we've talked about in our #medsafety committee (@herchd) as there are safety issues with dosing overweight kids by mg/kg instead of adult dosing. Could be issue on the adult side if they have <40 kg adults who need mg/kg dosing. #PHMFellowJC |
| Ashley Jenkins @AJenkins_MD @DivergentTash Thanks for your amazing insight during the conversation! #PHMFellowJC |
| Laura Lawler, MD @DocLauraLawler @PHMFellowJC @AJenkins_MD @JoySolano6 Another great #PHMFellowJC topic next month! Yay! Also, Dr. Ashely Jenkins did an awesome job! (& is a #Tweetiatrician😉, btw!) https://t.co/Fw5z5d5kIX |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @maxabillioncruz @Potato_Chip @AJenkins_MD @jackiewalkermd @PHMFellowJC Totally agree Max, on my outpatient specialty rotations it was amazing to see kids as young as 6 yo who could explain their own chronic diseases (CF, sickle cell, etc) in basic terms. #PHMFellowJC |
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