#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 Hello #PHMFellowJC followers and first timers! Thanks for joining us to discuss tonight’s article! Please take a moment to introduce yourself in the comments with your role and institution. Remember to use #PHMFellowJC in all your tweets. https://t.co/CeXAkJk4DJ |
| #PHMFellowJC @PHMFellowJC Tonight’s #PHMFellowJC will be moderated by @jmomdphd! He is a second-year #PedsHM fellow with @AllChildrens @JHACHPHM and one of the co-founding moderators of #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Welcome Joy! #PHMFellowJC |
 | Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC Hi everyone, I'm Jennifer, finishing up #PedsHM fellowship @radychildrens #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Welcome @DrJenChen4kids! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Let's get started with tonight's #PHMFellowJC chat! Remember to use #PHMFellowJC and Q1 in all your tweets and retweets! Q1: What programs or initiatives do you have at your institution to prevent unplanned readmissions for children with medical complexity? https://t.co/lD2b38tyNe |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @PHMFellowJC Sonya, 2nd yr from @CincyPHMFellows! Just got out of rehearsal and about to drive home, so won’t be able to participate as much as usual during #PHMFellowJC! Thanks goodness for predrafted tweets (@TinaKSosa 😂) and ability to chime in later (advantage of Twitter journal clubs). |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMfellowJC A1: @radychildrens actually has a great home care program including RNs and SW that tries to do a lot of troubleshooting w families at home, or triage to PCP/specialty clinics, trying to avoid ED visits/admissions if possible |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC Q1: one really cool initiative led by @JoThomsonMD, @MedEdLisa, @AbbyMusial & @brekluck is doing follow-up d/c calls w/families of children of medical complexity to see if any issues that have come up since d/c (f/u, meds). Our amazing @CincyPHM APRNs made calls. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood They presented a poster @ #PAS2019 and Dr Butts presented at the @CincyPedsRes research day just this afternoon! They’ve helped resolved issues for families - not sure if they prevented readmissions or return to ER but certainly could have! #PHMFellowJC Q1 https://t.co/gQOKoAf3yp |
 | Meghan Fanta, MD @meghanfanta @PHMFellowJC I’m Meghan Fanta, soon to be a first year fellow with the @CincyPHMFellows! Current chief resident @UMNChildrens. #PHMFellowJC |
 | John @jmomdphd #PHMFellowJC Q1: We have a home care program designed to support children with medical complexity. What we don’t have is a dedicated outpatient clinic to capture these children except for a few multidisciplinary specialty clinics. |
| John @jmomdphd RT @STangGirdwood: They presented a poster @ #PAS2019 and Dr Butts presented at the @CincyPedsRes research day just this afternoon! They’ve helped resolved issues for families - not sure if they prevented readmissions or return to ER but certainly could have! #PHMFellowJC Q1 https://t.co/gQOKoAf3yp |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @radychildrens Many of our complex patients also follow up with specific PCPs (eg @NancyGraffMD @DrJaimeFriedman) that have a lot of experience caring for medically complex kids #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Welcome to #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Q1: Are the phone calls standardized? Disease specific? #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @PHMFellowJC #PHMFellowJC Q1: it’s for our complex care team. And there is a standard script to address certain issues. Currently taking a hiatus from the calls to figure out how to beat optimize. #yellowteam |
| John @jmomdphd @STangGirdwood @PHMFellowJC #PHMFellowJC Q1: We are attempting to offer standardized discharge follow-up calls. One issue I see is that our nurses are unable to answer medical questions and instead must refer back to pediatrician. |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: @radychildrens Many of our complex patients also follow up with specific PCPs (eg @NancyGraffMD @DrJaimeFriedman) that have a lot of experience caring for medically complex kids #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Welcome to #PHMFellowJC @MikePlattMD! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd @PHMFellowJC #PHMFellowJC: We have our NPs make the calls and they provide care on the inpatient team so often know the patients well. We also learned that many families were able to resolve the issues on their own! Not many issues had to go to the attendings. |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @PHMFellowJC We don't have a specific complex care team (though we've been talking about one for ages) - I feel many of us working at tertiary children's centers have a different idea of what counts as "complex care" vs community #PedsHM #PHMFellowJC |
| John @jmomdphd RT @DrJenChen4kids: @STangGirdwood @PHMFellowJC We don't have a specific complex care team (though we've been talking about one for ages) - I feel many of us working at tertiary children's centers have a different idea of what counts as "complex care" vs community #PedsHM #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @joylynnsolano @DrJenChen4kids @radychildrens @NancyGraffMD @DrJaimeFriedman @EJGoodwinMD #PHMFellowJC: @EJGoodwinMD is a graduate of @CincyPedsRes. We also have a complex care clinic and the attending frequently visits his patients when admitted and is enormous help at discharge. |
| #PHMFellowJC @PHMFellowJC Great start to the discussion! On to question 2: Q2: Were you surprised by any variables that were NOT included in the final risk score? Use #PHMFellowJC and Q2 in all your tweets! https://t.co/CU1atWMPlE |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @joylynnsolano @radychildrens @NancyGraffMD @DrJaimeFriedman @EJGoodwinMD Ha, that reminds me of admitting my own (complex) clinic patients to myself as a resident @ChildrensLA! I actually really miss being able to provide that continuity #PHMFellowJC #GenPedsAtHeart |
 | Sarah Marsicek MD @docmarsicek #PHMFellowJC A1: @jmomdphd and I sit on the @JHACHPHM read missions committee, where we critically review all 7-day readmissions with the hope to identify areas for improvement. Our hospital is also working on a readmission algorithm to identify those at risk of readmission. |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: @joylynnsolano @radychildrens @NancyGraffMD @DrJaimeFriedman @EJGoodwinMD Ha, that reminds me of admitting my own (complex) clinic patients to myself as a resident @ChildrensLA! I actually really miss being able to provide that continuity #PHMFellowJC #GenPedsAtHeart |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC Q2: I was surprised that no sociodemographic factors were significant to be included in the risk model. Not sure what factors I expected tho, maybe age? Also surprised that technology assistance didnt end up significant - but then having services at d/c did. |
| John @jmomdphd RT @docmarsicek: #PHMFellowJC A1: #PHMFellowJC A1: @jmomdphd and I sit on the @JHACHPHM read missions committee, where we critically review all 7-day readmissions with the hope to identify areas for improvement. Our hospital is also working on a readmission algorithm to identify those at risk of readmission. |
| Sarah Marsicek MD @docmarsicek A1: @JHACHPHM also has a rule that all discharge paperwork and discharge med recs must be reviewed and verified by the attending hospitalist prior to putting a discharge in, which helps ensure more thorough discharge instructions and correct discharge medications. #PHMFellowJC |
| John @jmomdphd @STangGirdwood #PHMFellowJC Q2: I was also surprised that there were no sociodemographic factors. |
 | Dan Herchline @herchd Agreed! Can’t tell if I’m just so used to those being part of most studies that it seems weird without. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: Agreed! Can’t tell if I’m just so used to those being part of most studies that it seems weird without. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMfellowJC Q2: Besides the sociodemographic factors, I think would also have been interesting to see other factors like distance from hospital - we have a huge catchment area around San Diego so access to care may be more tricky than in the Boston area |
| John @jmomdphd #PHMFellowJC Q2: Another model presented at PAS2019 also found that social determinants of health were not significantly associated with readmission risk |
| Sarah Marsicek MD @docmarsicek @jmomdphd @STangGirdwood Agreed @jmomdphd-they should also include parental #ACEs... Sorry-I can’t help myself! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC #PHMFellowJC Q2: Great point @DrJenChen4kids! This model focused only on data that could be obtained from the EHR. Could theoretically pull a zip code and do post-hoc data scrubbing to get distance to hospital |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @docmarsicek @jmomdphd @STangGirdwood Good point Sarah! Stressed parents/caretakers greatly affect children's care! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: @docmarsicek @jmomdphd @STangGirdwood Good point Sarah! Stressed parents/caretakers greatly affect children's care! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @joylynnsolano @docmarsicek @JHACHPHM Agree that this would be ideal (I've caught even senior residents making significant mistakes on discharge med rec that took more time to fix later) but not always possible esp during high census season #PHMFellowJC |
| John @jmomdphd #PHMFellowJC Q2: I was also surprised to not see other patient factors such as # of new prescriptions, # of new chronic diagnoses, presence of NEW technology |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @herchd: Agreed! Can’t tell if I’m just so used to those being part of most studies that it seems weird without. #PHMFellowJC |
| John @jmomdphd #PHMFellowJC Q2: But then again, maybe all that’s captured by the number of CCC categories (which was significant in this model) |
| #PHMFellowJC @PHMFellowJC Great points everyone! Now for question 3! Q3: What would you do differently if you knew a patient had a ‘high risk’ readmission score? Specifically, At the time of admission? During daily rounds? Prior to discharge? Don't forget to use #PHMFellowJC and T3 in all your tweets! https://t.co/6esAn9tBs8 |
| Dan Herchline @herchd Q2: Would be interesting if distance patient lives from hospital makes any difference or if care is split between different institutions. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd #PHMFellowJC Didn't seem like CCC category was quite that detailed...in my chart review on complex pts in our palliative care program, I've also been looking at "high risk" meds eg opioids, benzos where a med error could necessitate ED/readmit |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd #PHMFellowJC: I find that really interesting given the recent emphasis on addressing social determinants of health and #ACES. I haven’t read the literature on the association between #SDH and #ACES and readmissions in general population. |
| John @jmomdphd #PHMFellowJC Q3: I’ve struggled with this. I’m not yet sure what I would do differently. Do I just pay extra close attention? Would I subconsciously keep a child longer? |
| Sarah Marsicek MD @docmarsicek Q1: @JHACHPHM also has a great resident-led #QI initiative where medically complex patients have their discharge medication reconciliation reviewed by pharmacy before the attendings review it. It is a really cool project! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @joylynnsolano @docmarsicek @JHACHPHM Yup, which is why #HealthLiteracy education for trainees is so important! #PHMFellowJC |
 | Cincy PHM Fellows @CincyPHMFellows RT @meghanfanta: @PHMFellowJC I’m Meghan Fanta, soon to be a first year fellow with the @CincyPHMFellows! Current chief resident @UMNChildrens. #PHMFellowJC |
| John @jmomdphd RT @docmarsicek: Q1: Q1: @JHACHPHM also has a great resident-led #QI initiative where medically complex patients have their discharge medication reconciliation reviewed by pharmacy before the attendings review it. It is a really cool project! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @docmarsicek: Q1: Q1: @JHACHPHM also has a great resident-led #QI initiative where medically complex patients have their discharge medication reconciliation reviewed by pharmacy before the attendings review it. It is a really cool project! #PHMFellowJC |
| Dan Herchline @herchd Would anyone consider keeping patients longer if they were at higher risk of readmission? Seems like it could be a slippery slope and I also don't know what the cost of readmission vs prolonged initial stay would be. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: Would anyone consider keeping patients longer if they were at higher risk of readmission? Seems like it could be a slippery slope and I also don't know what the cost of readmission vs prolonged initial stay would be. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC Q3: Admit: consider case mgmt/SW consult to address #SDoH early Daily #FCR: Bring up discharge planning needs Prior to dc: Definitely talk to PCP, more likely to push for specialty appts to be made (not waiting for family to make) #CareCoordination |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @joylynnsolano @DrJenChen4kids @docmarsicek @JHACHPHM This goes back to our December #PHMfellowJC on readability of d/c instructions! I’m curious how it affects patient flow with having attending read d/c paperwork. We read the discharge summaries but not necessarily dc instructions. But we do use a lot of templates for dc instruct. |
| Dan Herchline @herchd @jmomdphd Change your follow-up recommendations perhaps? Unfortunately that is somewhat dependent on their outpatient providers which can sometimes be tricky. #PHMFellowJC |
| John @jmomdphd @herchd #PHMFellowJC Q3: One huge question I wish was answered: how SICK were they when they got readmitted? Some children will inherently be more likely to be readmitted…but what if I knew that a particular child is more likely to be readmitted to the PICU? |
 | Jacqueline Walker @jackiewalkermd @herchd Pondered the same thing. Would favor thorough discharge planning over actually keeping inpatient longer. #PHMFellowJC |
| Sarah Marsicek MD @docmarsicek Q4: I think parent #simulation has a great opportunity to help prevent readmissions. I know this is something still in its infancy @AllChildrens but there has been discussions about it. Any others with experience with this? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd Agreed - patients hopping between hospitals is really frustrating (happens all the time for us even across international borders!) #PHMFellowJC |
| Sarah Marsicek MD @docmarsicek JK-this is for A3... #PHMFellowJC fail... |
| Dan Herchline @herchd @MikePlattMD What are your PCP admission calls typically like? Ours are more of a "heads up" notification than anything else. #PHMFellowJC |
 | Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @docmarsicek @AllChildrens intriguing... what does sim for readmission prevention look like? #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC Q3: we’ve talked in previous months the importance of d/c planning from the start of admission to try to mitigate risk factors. We’re fortunate that our complex care team has a dedicated care manager who rounds with the team and starts working on d/c needs from day 1 |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC Also important to engage family early in discussions about what discharge criteria actually will/should be! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd @herchd For me, depends on WHY they have high readmission risk...if it's something their family/PCP can't handle easily (maybe because they live 3 hours away), might be more likely to keep an extra day, esp over weekend #PHMFellowJC |
| John @jmomdphd @chris_bonafide @docmarsicek @AllChildrens #PHMFellowJC @chris_bonafide At this point mostly simulation on utilizing life-sustaining technology. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @MikePlattMD #PHMFellowJC: we have a dedicated pharmacist on our complex care team and most subspecialty teams. They will make calendars to help families with meds |
| #PHMFellowJC @PHMFellowJC Such an excellent point! Perhaps future prediction models could include parent perception of readiness for discharge? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd @chris_bonafide @docmarsicek @AllChildrens For patients w new tech (eg trach/Gtube), parents have to go through a teaching checklist to show they're capable of handling daily care needs and basic troubleshooting (or at least know who to call for help) #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @herchd Yes, I would worry about increasing LOS without really changing risk of readmissions. #PHMFellowJC |
| Meghan Fanta, MD @meghanfanta @chris_bonafide @docmarsicek @AllChildrens #PHMFellowJC Possibly a communication simulation of family centered rounds on anticipated day of discharge. |
| #PHMFellowJC @PHMFellowJC RT @meghanfanta: @chris_bonafide @docmarsicek @AllChildrens #PHMFellowJC Possibly a communication simulation of family centered rounds on anticipated day of discharge. |
| #PHMFellowJC @PHMFellowJC RT @STangGirdwood: @herchd Yes, I would worry about increasing LOS without really changing risk of readmissions. #PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @jmomdphd @docmarsicek @AllChildrens very cool - sounds like "mock codes for home care" kind of thing? #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @jackiewalkermd: @herchd Pondered the same thing. Would favor thorough discharge planning over actually keeping inpatient longer. #PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @meghanfanta @docmarsicek @AllChildrens oh I like this too #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd @MikePlattMD For complex kids, I try to send PCPs an inbasket message/email on admission, then call at time of discharge so they have a chance to ask about any follow-up needs/plan for going home. They generally appreciate it! #PHMFellowJC |
| Dan Herchline @herchd RT @PHMFellowJC: Such an excellent point! Perhaps future prediction models could include parent perception of readiness for discharge? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Time flies when you're having fun! Last question! Q4: What are the barriers to utilizing a readmission risk score? What unintended consequences might there be? Use #PHMFellowJC and Q4! https://t.co/XjpMiyyyyt |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @docmarsicek @chris_bonafide @AllChildrens All families have to go thru trach and g-tube teaching before discharge at our institution. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC #PHMFellowJC Q3: How much readmission modeling should look at ED courses? |
| John @jmomdphd RT @meghanfanta: @chris_bonafide @docmarsicek @AllChildrens #PHMFellowJC Possibly a communication simulation of family centered rounds on anticipated day of discharge. |
| Sarah Marsicek MD @docmarsicek @STangGirdwood @chris_bonafide @AllChildrens Is it in a simulation lab or at the bedside? There are likely benefits to both. #PHMFellowJC |
| Dan Herchline @herchd @meghanfanta @chris_bonafide @docmarsicek @AllChildrens Sounds like the start of a killer fellowship #meded project! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @docmarsicek @chris_bonafide @AllChildrens At bedside, sometimes with mannequins. I don’t believe families use our sim lab. #PHMfellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jackiewalkermd @PHMFellowJC Yes, even true for non-complex kids, e.g. the cough will still be there for another week after bronchiolitis...#PHMFellowJC |
| John @jmomdphd #PHMFellowJC Q4: Right now the biggest barrier I see with readmission risk scores is that many of the factors that contribute are not immediately modifiable. Which means I’m left guessing how to intervene to improve my outcomes... |
| Dan Herchline @herchd Q4: Unfortunately I still don't think we all use consistent language when talking about complexity which makes pinning down "medically complex" difficult across institutions! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC Q4: What to include in the score (as we've discussed, might vary by patient population) and what does one do with it after, aka does it trigger some specific action from the care team? Depending on EMR build, might also be tricky to calculate/find |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood And I can’t help myself but ask again during #PHMFellowJC what the purpose of rounds is. I think one of the major part of having a shared mental model between providers and family is discharge goals and planning to prevent readmission. |
| Jacqueline Walker @jackiewalkermd @PHMFellowJC Yes! Always trust the mom (or dad), right? #PHMFellowJC |
| Sarah Marsicek MD @docmarsicek A4: I worry about how knowing a score would impact the bottom line. I feel like if we have a patient with an at-risk score for readmission and the patient was read noted, how would insurances use this to justify not reimbursing? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC Good question - a quick ED visit for something like replacing a Gtube is very different from a long ED visit that just barely avoided another admission #PHMFellowJC |
| Dan Herchline @herchd @STangGirdwood Especially as discharge goals can change numerous times over the course of an admission for a medically complex patient #PHMFellowJC |
| Sarah Marsicek MD @docmarsicek A4: Could insurances argue that we didn’t do a good enough job mitigating risk based on this score? #PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide Q4: Yes this... if not actionable/modifiable, scores/alerts/alarms are just noise #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd Yup, there's "children with medical complexity" and "children with special healthcare needs" with all sorts of variations depending on who you ask! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC Q4: w/any scoring system, we should always be careful to be considering the patient and family before us, not just the numbers that come out of the risk model. There are patients who’d score high, but whose parents are extremely savvy and have great support @ home. |
| John @jmomdphd @docmarsicek That’s a good question—not until we know we have modifiable factors that are evidence-based… #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @STangGirdwood: #PHMFellowJC Q4: #PHMFellowJC Q4: w/any scoring system, we should always be careful to be considering the patient and family before us, not just the numbers that come out of the risk model. There are patients who’d score high, but whose parents are extremely savvy and have great support @ home. |
| Sarah Marsicek MD @docmarsicek A4: What are the impacts of peer review? If I have 20% of my patients with a high risk score and all of them are readmitted, do I get penalized? On the flip side, if none of these are readmitted, do I get an incentive? #PHMFellowJC |
| Dan Herchline @herchd @docmarsicek Could also have difficulty justifying longer admissions when patients would have previously been considered ready for discharge #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC Q4: I worry that due to fears of readmissions, the LOS for patients would increase as @herchd asked. Whats’s interesting is that longer LOS had higher odds of being readmitted (perhaps marker of more severe illness?). Keeping patients likely not the right answer. |
| John @jmomdphd @STangGirdwood #PHMFellowJC Q4: I also wonder if perhaps a change in risk score should be important? Much like PASS scores in asthma…maybe it’s not one single score but a trend over time. If I have a patient that goes from 20% risk to 70% that could be a big deal. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @herchd: @STangGirdwood Especially as discharge goals can change numerous times over the course of an admission for a medically complex patient #PHMFellowJC |
| Dan Herchline @herchd RT @chris_bonafide: Q4: Q4: Yes this... if not actionable/modifiable, scores/alerts/alarms are just noise #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @docmarsicek: A4: A4: What are the impacts of peer review? If I have 20% of my patients with a high risk score and all of them are readmitted, do I get penalized? On the flip side, if none of these are readmitted, do I get an incentive? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @docmarsicek Deciding what is truly a "preventable" admission is really hard, eg no one can predict if the child w a trach/vent is going to pick up another virus and have to come back for respiratory distress just a few days after the last episode! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @chris_bonafide: Q4: Q4: Yes this... if not actionable/modifiable, scores/alerts/alarms are just noise #PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @STangGirdwood Oh man, we could have a big ol'Tweetstorm about the ~100+ competing priorities/goals that we currently pack into rounds. Probably a convo for another day but yeah we try to do way too much right now, and in the end we do noting exceptionally well #PHMFellowJC @herchd |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd Absolutely makes sense that a delta may be more meaningful than the score. Most of patients on the complex care team automatically score a 4. #PHMfellowJC |
| #PHMFellowJC @PHMFellowJC RT @STangGirdwood: @jmomdphd Absolutely makes sense that a delta may be more meaningful than the score. Most of patients on the complex care team automatically score a 4. #PHMfellowJC |
| Sarah Marsicek MD @docmarsicek @STangGirdwood @STangGirdwood Ironically, this question is something we have been talking a lot about in our group. Why do we round? And the answer is, everyone rounds with different motivators and goals. Your goals as a medical student vastly differ from your goals as a fellow. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @docmarsicek: @STangGirdwood @STangGirdwood Ironically, this question is something we have been talking a lot about in our group. Why do we round? And the answer is, everyone rounds with different motivators and goals. Your goals as a medical student vastly differ from your goals as a fellow. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @jmomdphd Would make more sense then if the risk score included things like "new technology" - obviously a patient with a new trach or central line is going to have higher/different risks than they did prior #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #truth #tweetstorm #purposeofrounds #questionwillnevergetold #PHMFellowJC @jmomdphd |
| Dan Herchline @herchd We could always use a score to help counsel families and make decision more patient-centered? Some families may be willing to risk readmission to go home while others would feel less comfortable. #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @DrJenChen4kids: @STangGirdwood @jmomdphd Would make more sense then if the risk score included things like "new technology" - obviously a patient with a new trach or central line is going to have higher/different risks than they did prior #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @herchd #patientcenteredness #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC #PHMFellowJC How might families react to being told the risk of their children being readmitted? |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd True for non-complex kids too, e.g. watching a baby w #bronchiolitis off O2 for 4 hours (technically meets our discharge criteria) but parents still uncomfortable w feeding or suctioning needs #PHMFellowJC |
| Dan Herchline @herchd @chris_bonafide @STangGirdwood Often feel rounds could use a trimming down! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @STangGirdwood @jmomdphd Let’s storm @PHMConf! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @herchd @chris_bonafide No one likes long rounds but I think everyone does want thorough rounds so questions (families and providers) are answered. Everyday I hope for efficient but thorough rounds. #PHMfellowJC #finebalance |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC I had a really complex Friday evening discharge where I flat out told the mom I was worried about them having to come back within 48 hours...she totally agreed with me, but for her, it was worth the risk to get home even for a night #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @PHMFellowJC: @STangGirdwood @jmomdphd Let’s storm @PHMConf! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC @STangGirdwood @jmomdphd @PHMConf Maybe that can be the #tweetup topic? =P #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @PHMFellowJC @jmomdphd @PHMConf I am so there! #PHMFellowJC https://t.co/xoctNWWhey |
| #PHMFellowJC @PHMFellowJC Thank you everyone for making this an awesome #PHMFellowJC discussion tonight! What last thoughts do you have about the topic? What is the biggest learning point you will take away from tonight's chat? How would you summarize the chat for your colleagues? |
| #PHMFellowJC @PHMFellowJC @DrJenChen4kids I would imagine most families of children with medical complexity know their child is at-risk for readmission…#PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide @STangGirdwood @herchd Are you luring me into a #tweetstorm @STangGirdwood? #PHMfellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood I love this @docmarsicek! Mind sharing what 5 techniques you used with us? #PHMfellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @chris_bonafide @herchd Maybe... #PHMFellowJC https://t.co/gKurSFxPQz |
| John @jmomdphd @chris_bonafide @STangGirdwood @herchd That’s what I’m hearing…#PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Thank you to all of our #PHMFellowJC participants tonight! It was a great discussion! It’s time for #PHMFellowJC co-founding moderators @DrJenChen4kids @kedkyler and @jmomdphd to graduate from their respective @PHMFellowships! |
| #PHMFellowJC @PHMFellowJC Please join #PHMFellowJC in welcoming @joylynnsolano and @herchd as new co-moderators! They will be joining @STangGirdwood and are excited to continue the #PHMFellowJC journey! Thank you to everyone for taking this #MedEd journey with us! https://t.co/filisgWKri |
| Dan Herchline @herchd Don't know if I'm making huge changes to my practice yet, but definitely thinking about risk of readmissions a lot more and will be reflecting on readmissions for complex patients much more thoughtfully going forward! #PHMFellowJC |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide I love this - daily rounding PDSA cycles. Keep at it @docmarsicek #PHMfellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC - Discharges are hard, complex discharges even more so! - #PedsHM needs more research on potentially modifiable factors to help prevent readmissions - WIDE variation of how institutions handle discharge prep (#QI opportunities?) |
| #PHMFellowJC @PHMFellowJC Stay tuned for more information on the next #PHMFellowJC featuring @joylynnsolano, @herchd, and @STangGirdwood coming in July! Good night! |
| Dan Herchline @herchd #goals for next service week @chris_bonafide ?? #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids It's been a steep learning curve building up #PHMFellowJC from scratch, but so excited to see where it will go next with @joylynnsolano and @herchd joining @STangGirdwood! |
| Chris Bonafide, MD, MSCE (he/him) @chris_bonafide RT @PHMFellowJC: Please join #PHMFellowJC in welcoming @joylynnsolano and @herchd as new co-moderators! They will be joining @STangGirdwood and are excited to continue the #PHMFellowJC journey! Thank you to everyone for taking this #MedEd journey with us! https://t.co/filisgWKri |
| #PHMFellowJC @PHMFellowJC #PHMFellowJC leading to changes in practice! |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: It's been a steep learning curve building up #PHMFellowJC from scratch, but so excited to see where it will go next with @joylynnsolano and @herchd joining @STangGirdwood! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood What a pleasure and honor it has been to have launched and coordinated #PHMFellowJC with @jmomdphd, @DrJenChen4kids and @kedkyler this past year. Never would have imagined it becoming so successful when I tweet messaged you with this crazy idea! Happy graduation #peermentors!! |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: #PHMFellowJC - Discharges are hard, complex discharges even more so! - #PedsHM needs more research on potentially modifiable factors to help prevent readmissions - WIDE variation of how institutions handle discharge prep (#QI opportunities?) |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood Beyond thrilled to work with @herchd and @joylynnsolano who are going to take this to the next level in the area of #Meded. Future of #PHMFellowJC! |
| #PHMFellowJC @PHMFellowJC RT @herchd: Don't know if I'm making huge changes to my practice yet, but definitely thinking about risk of readmissions a lot more and will be reflecting on readmissions for complex patients much more thoughtfully going forward! #PHMFellowJC |
| Dan Herchline @herchd Can't wait! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @chris_bonafide @herchd Let us know how it goes! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @PHMFellowJC: Stay tuned for more information on the next #PHMFellowJC featuring @joylynnsolano, @herchd, and @STangGirdwood coming in July! Good night! |
| #PHMFellowJC @PHMFellowJC RT @STangGirdwood: What a pleasure and honor it has been to have launched and coordinated #PHMFellowJC with @jmomdphd, @DrJenChen4kids and @kedkyler this past year. Never would have imagined it becoming so successful when I tweet messaged you with this crazy idea! Happy graduation #peermentors!! |
| Dan Herchline @herchd @STangGirdwood @joylynnsolano Could not be more excited and feel so privileged to get to follow in the footsteps of @jmomdphd @kedkyler and @DrJenChen4kids. Looking forward to a wonderful year! #PHMFellowJC |
| John @jmomdphd To think #PHMFellowJC all started with an idea and a vision…it has been such an honor working with @DrJenChen4kids @kedkyler and @STangGirdwood. Can’t wait to see where @herchd and @joylynnsolano take #PHMFellowJC with the guidance of @STangGirdwood! |
| #PHMFellowJC @PHMFellowJC #PHMFellowJC This sounds excellent! |
| Jacqueline Walker @jackiewalkermd @STangGirdwood @jmomdphd @DrJenChen4kids @kedkyler Kudos to the founders on launching a truly innovative platform for discussing best practices in PHM! #PHMFellowJC 👏🏻 |
| #PHMFellowJC @PHMFellowJC RT @jackiewalkermd: @STangGirdwood @jmomdphd @DrJenChen4kids @kedkyler Kudos to the founders on launching a truly innovative platform for discussing best practices in PHM! #PHMFellowJC 👏🏻 |
| Jacqueline Walker @jackiewalkermd @STangGirdwood @herchd @joylynnsolano Look out for some Ed theory and conceptual frameworks up in here! Another great crew of leaders for next year! 👍🏻 #PHMFellowJC |
| John @jmomdphd RT @jackiewalkermd: @STangGirdwood @herchd @joylynnsolano Look out for some Ed theory and conceptual frameworks up in here! Another great crew of leaders for next year! 👍🏻 #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @jackiewalkermd: @STangGirdwood @herchd @joylynnsolano Look out for some Ed theory and conceptual frameworks up in here! Another great crew of leaders for next year! 👍🏻 #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jackiewalkermd @STangGirdwood @jmomdphd @kedkyler Thanks for joining us! Hopefully we can build up even more #PedsHM presence among #tweetiatricians #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @jackiewalkermd: @STangGirdwood @herchd @joylynnsolano Look out for some Ed theory and conceptual frameworks up in here! Another great crew of leaders for next year! 👍🏻 #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @jmomdphd: To think #PHMFellowJC all started with an idea and a vision…it has been such an honor working with @DrJenChen4kids @kedkyler and @STangGirdwood. Can’t wait to see where @herchd and @joylynnsolano take #PHMFellowJC with the guidance of @STangGirdwood! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd @kedkyler and I will still be around to participate in future #PHMFellowJC chats! 😉 |
#PHMFellowJC content from Twitter.