#PHMFellowJC Transcript

Healthcare social media transcript of the #PHMFellowJC hashtag.
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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, MSc @kedkyler
RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national surve…
#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 TG @STangGirdwood
RT @PHMFellowJC: Welcome to the first #PHMFellowJC of 2019. We will be discussing Coller et al's @JHospMedicine article on a national surve…
#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
#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
Dr. Jennifer Chen, MD FAAP @DrJenChen4kids
Hi everyone, I'm a #PedsHM fellow @radychildrens in San Diego. A special welcome to all the first time #PHMfellowJC participants!
Sonya TG @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, MSc @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 TG @STangGirdwood
RT @PHMFellowJC: For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#P
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,…
Sonya TG @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…
Dr. Jennifer Chen, MD FAAP @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, MSc @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 @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 😉 https://t.co/RdKW3xIweX
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, MSc @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 surve…
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: We're excited for @AJenkins_MD, #medpeds @CincyPHMFellows, to be our guest moderator tonight. She developed all the materi…
#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…
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 "#P
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: For the purpose of this #PHMFellowJC discussion, we should define #transition. @SAHMtweets defines it as "the purposeful,…
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 transitio…
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: T1 cont'd: Include #PHMFellowJC T1 in your tweets. a) What age limit, if any, does your institution have for admitted pat…
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 @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
Maximilian Cruz @maxabillioncruz
@PHMFellowJC 2nd year MP resident at @CinciMedPeds #PHMFellowJC
Kate Kyler, MD, MSc @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 transitio…
drbatraneo @drbatraneo
@PHMFellowJC Joining this discussion for first time ! #PHMFellowJC
Sonya TG @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 TG @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.
Sonya TG @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.
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, MSc @kedkyler
RT @DivergentTash: @PHMFellowJC @AJenkins_MD @CincyPHMFellows Atashi, Med Peds community based hospitalist in Los Angeles and Orange counti…
Sonya TG @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 @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
Claudia William, MD @DrCSWilliam
RT @PHMFellowJC: Happy New Year #PedsHM Community! Join us for our 1st #PHMFellowJC of 2019 on Tues, 1/8, 9 pm EST. @AJenkinsMD, Med-Peds H…
#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 @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, MSc @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 @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!
drbatraneo @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 @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, MSc @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
drbatraneo @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
Mike Platt, MD @MikePlattMD
@PHMFellowJC @AJenkins_MD @CincyPHMFellows Good evening. I'm Mike Platt; Associated PHM Fellowship Director at Children's Mercy Kansas City. Also, watching college basketball. #PHMFellowJC
Dr. Jennifer Chen, MD FAAP @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
Ech913 @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, MSc @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 @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, MSc @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 @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 TG @STangGirdwood
@kedkyler @CincyChildrens Same! Our endo and pulm are good about transitioning as well! #PHMFellowJC
Dr. Jennifer Chen, MD FAAP @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, MSc @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
drbatraneo @drbatraneo
RT @DocLauraLawler: @PHMFellowJC @drbatraneo Yay - another @christianacare @BayhealthDE peds hospitalist participating. This is #awesome! (…
Joy Solano @joylynnsolano
@PHMFellowJC @AJenkins_MD @CincyPHMFellows Hey it's Joy Solano, PHM fellow at Children's Mercy Kansas City! #PHMFellowJC
Anika Kumar, MD @freckledpedidoc
@DrJenChen4kids @jmomdphd @AJenkins_MD Yes. It becomes a patient safety issue. #PHMfellowJC
Ech913 @ech913
RT @PHMFellowJC: For those who might need some tips on how to participate in #PHMFellowJC, please review the sheet below. Always write "#P
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
Maximilian Cruz @maxabillioncruz
@AJenkins_MD #T1 my simple measuring stick is anyone who could walk into (adult) ED across the street and not get confused looks from providers when their age pops up on ED board #PHMFellowJC
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…
#PHMFellowJC @PHMFellowJC
@ech913 Thanks for joining Twitter for this very important #PHMFellowJC topic. Hope you learn something!
Anika Kumar, MD @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, MSc @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 ar…
#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? #PHMFel
Kate Kyler, MD, MSc @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 @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 TG @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.
Sonya TG @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.
Kate Kyler, MD, MSc @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
Dr. Jennifer Chen, MD FAAP @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
drbatraneo @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 @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, MSc @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 @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
Mike Platt, MD @MikePlattMD
@freckledpedidoc @AJenkins_MD Also worth considering institutions that have access to adult ICU resources if needed. This is not an option at my current institution, but in residency we could (albeit rarely) transfer a patient internally to the adult ICU from a Peds floor bed. #PHMFellowJC
drbatraneo @drbatraneo
@MAhealthforkids @AJenkins_MD I think that’s the point adult specialists would be at a loss for special care pediatrics #PHMFellowJC
Sonya TG @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 limita…
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! #PHMF
Dr. Jennifer Chen, MD FAAP @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 are…
Anika Kumar, MD @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, MSc @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 @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…
#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, includi…
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, MSc @kedkyler
RT @AJenkins_MD: @freckledpedidoc @jmomdphd @drbatraneo @PHMFellowJC Many of you are bringing up a key point...caring for adults in a pedia…
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, MSc @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…
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 pati…
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, s…
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, MSc @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 @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 @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 TG @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 TG @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 @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
Maximilian Cruz @maxabillioncruz
@PHMFellowJC T3 #PHMFellowJC I think this is a very difficult question- depends on what underlying patient complexity is, and what they are hospitalized for. For complex patients primary subspecialists must be involved. 1/2
Mike Platt, MD @MikePlattMD
T3b: As with many long term care discussions, hospitalists may be hesitant to address transitions in an acute setting as we may perceive families may not be receptive or perceive us as trying to "pass the buck" #PHMFellowJC
Kate Kyler, MD, MSc @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 @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, MSc @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 @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: I have often found it difficult to discuss transition during hospitalizations because I feel like it may add additional str…
#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…
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 ye…
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 @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
Maximilian Cruz @maxabillioncruz
@PHMFellowJC 2/2 should be some standardized trigger to initiate these discussions i.e. if medically complex pt >15 yo hospitalized some component of transition should be addressed- would help if standardized/algorithmic approach created in coordination with subspecialists #PHMFellowJC
drbatraneo @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 lea…
Joy Solano @joylynnsolano
@PHMFellowJC Pediatric hospitalists need to be aware of where a patient is within their transition process/timeline, especially when it comes to discharge planning (follow up appointments, communication of important events in the hospital, which ER to go to if sx return) #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 f…
Dr. Jennifer Chen, MD FAAP @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 ad…
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: Great discussion everyone! Let's move on to #PHMFellowJC T3- another multipart question. Our poll showed that many of y…
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: Additional questions for #PHMFellowJC T3: a) What components of #transition could or should be addressed during hospitali…
#PHMFellowJC @PHMFellowJC
RT @Bmayzing: #PHMFellowJC T3 transition is a process needs more support for residency training re: specific counseling among #pediatricmil
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, MSc @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 @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
Chippy @Potato_Chip
@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 @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
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
Dr. Jennifer Chen, MD FAAP @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
#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,…
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, MSc @kedkyler
RT @Bmayzing: #PHMFellowJC T3 transition is a process needs more support for residency training re: specific counseling among #pediatricmil
#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
Mike Platt, MD @MikePlattMD
@kedkyler @jmomdphd @PHMFellowJC The hospitalist, by virtue of proximity, may be able to coordinate discussions with subspecialists on this topic. I've seen this work well with our metabolism patients, since they are typically admitted to the Gen Peds service. #PHMFellowJC
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 prov…
#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 @Bus
#PHMFellowJC @PHMFellowJC
RT @TMarshall_MD: @herchd Interesting point. There are likely times when this conversation would not be effective or counterproductive and…
Kate Kyler, MD, MSc @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): Eg in community 🏥s, for acute care (esp non-complex/chronic), the ?s are usua…
Anika Kumar, MD @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.
Maximilian Cruz @maxabillioncruz
@DivergentTash @AJenkins_MD @PHMFellowJC there is no substitute for knowing first-hand the facility/culture pt is transitioning into. I think under-appreciated aspect of transitions has nothing to do with the medical care but facilities/ancillary services themselves #PHMFellowJC #T3
#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 pa…
Dr. Jennifer Chen, MD FAAP @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
#PHMFellowJC @PHMFellowJC
RT @JoySolano6: @PHMFellowJC Pediatric hospitalists need to be aware of where a patient is within their transition process/timeline, especi…
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, MSc @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
Maximilian Cruz @maxabillioncruz
@DivergentTash @AJenkins_MD @PHMFellowJC 2/4 recently senioring adult HM and admitted 30+ yo CP pt to our team, first admission after starting transition. Incredibly kind family, I'll never forget their faces as they sat next to her in ED- a very different experience in adult ED. #PHMFellowJC #T3
Chippy @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
Dr. Jennifer Chen, MD FAAP @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, MSc @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 @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, MSc @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 speci…
Dr. Jennifer Chen, MD FAAP @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
Kate Kyler, MD, MSc @kedkyler
RT @maxabillioncruz: @DivergentTash @AJenkins_MD @PHMFellowJC 2/4 recently senioring adult HM and admitted 30+ yo CP pt to our team, first…
Maximilian Cruz @maxabillioncruz
@DivergentTash @AJenkins_MD @PHMFellowJC 3/4 Had nothing to do with medical care- said they received fantastic care. Just new environment, darker walls, smellier smells, louder noises.... and that is often their entrance to the adult world. Wonder if something as simple as tours of hospital for.... #PHMFellowJC #T3
Sonya TG @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 @freckledpedidoc
@PHMFellowJC The hidden curriculum creeps into all conversations #PHMfellowJC
J 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 surve…
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…
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
#PHMFellowJC @PHMFellowJC
RT @maxabillioncruz: @DivergentTash @AJenkins_MD @PHMFellowJC there is no substitute for knowing first-hand the facility/culture pt is tran…
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 return…
Kate Kyler, MD, MSc @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
Chippy @Potato_Chip
@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 transitio…
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
Maximilian Cruz @maxabillioncruz
@DivergentTash @AJenkins_MD @PHMFellowJC 4/4 families/caregivers of medically complex pts making transition. For many of them they never know how close they are to next ED visit and this makes the healthcare facility an always present thought in their mind- a "home away from home" #PHMFellowJC #T3
Dr. Jennifer Chen, MD FAAP @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?
John @jmomdphd
RT @maxabillioncruz: @DivergentTash @AJenkins_MD @PHMFellowJC 4/4 families/caregivers of medically complex pts making transition. For many…
Kate Kyler, MD, MSc @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 t…
#PHMFellowJC @PHMFellowJC
@RebeccaSteuart @AJenkins_MD @DivergentTash Welcome Rebecca! Thanks for your input!#PHMFellowJC
Anika Kumar, MD @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…
#PHMFellowJC @PHMFellowJC
RT @jmomdphd: T3: Have you ever had families (or providers) claim that the adult provider will be less accessible or less accommodating tha…
John @jmomdphd
RT @JoySolano6: @PHMFellowJC Pediatric hospitalists need to be aware of where a patient is within their transition process/timeline, especi…
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 g…
Dr. Jennifer Chen, MD FAAP @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…
Kate Kyler, MD, MSc @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 t…
PHM Fellowships @PHMFellowships
RT @PHMFellowJC: Thanks to all those who participated in tonight's #PHMFellowJC discussion on the #transition practices from pediatric to a…
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…
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…
#PHMFellowJC @PHMFellowJC
RT @herchd: @PHMFellowJC Some adult institutions are starting to open hospitalist run clinics for patients recently discharged. Could this…
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
Maximilian Cruz @maxabillioncruz
@kedkyler @DivergentTash @AJenkins_MD @PHMFellowJC Exactly!! Clearly it must provide some comfort that it is seemingly "standard" in this arena, would think it could similarly play some role here! #PHMFellowJC #T3
Anika Kumar, MD @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 @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
Chippy @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
#PHMFellowJC @PHMFellowJC
RT @Potato_Chip: @AJenkins_MD @DrJenChen4kids @jackiewalkermd @PHMFellowJC I think meeting the providers before officially transitioning wo…
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…
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 #tran
Kate Kyler, MD, MSc @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 @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, MSc @kedkyler
RT @herchd: @PHMFellowJC Some adult institutions are starting to open hospitalist run clinics for patients recently discharged. Could this…
Kate Kyler, MD, MSc @kedkyler
@AJenkins_MD @PHMFellowJC @JoySolano6 You just dominated that chat! Thanks for picking a great topic! I learned loads. #PHMFellowJC
Maximilian Cruz @maxabillioncruz
@Potato_Chip @AJenkins_MD @DrJenChen4kids @jackiewalkermd @PHMFellowJC 1/2 How do u think latter could have been achieved w/out turning u off as a young adult? In med school did an away at UNC in sickle cell clinic, under a now-retired MP doc who I thought did awesome job w/this-every visit regardless of age directed all questions.. #PHMFellowJC #T2
Dr. Jennifer Chen, MD FAAP @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 attent…
Ashley Jenkins @AJenkins_MD
RT @DocLauraLawler: @PHMFellowJC T4-Family is always important part of transition. Young adults w/ complex needs & their families are often…
Sonya TG @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
Maximilian Cruz @maxabillioncruz
@Potato_Chip @AJenkins_MD @DrJenChen4kids @jackiewalkermd @PHMFellowJC 2/2 to the child, "how often are you taking meds?" "do you remember what we talked about last clinic visit?" etc, was remarkable seeing how early kids started to take ownership of their care (obviously not *all*, but many!) #PHMFellowJC #T3
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 @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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