#jhmchat Transcript
Healthcare social media transcript of the #jhmchat hashtag.
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See #jhmchat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: T-1 hour to #PedsHM #JHMChat with @DrJenChen4kids and colleagues! If you didn't have time to read the article, this #visualabstract @WrayCharles has the main takeaway points @SHMLive @FutureDocs @Haileyjms @SamirShahMD https://t.co/6KIAJdutNA |
 | Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC factoid: Since we’re in different time zones, we founders always discuss what beverages we’re having during the chat. For tonight’s #JHMChat, this tea seemed appropriate 😔 (no COI) @STangGirdwood @jmomdphd @kedkyler https://t.co/yG87UEtBbr |
 | Journal of Hospital Medicine @JHospMedicine Whether this is your first #JHMChat of you're an experienced #tweetiatrician/#twitternist, don't forget you can get CME credit! https://t.co/0wO2swHPgz |
| Journal of Hospital Medicine @JHospMedicine Welcome to #JHMChat! I am your guest moderator @DrJenChen4kids, currently a #PedsHM fellow @radychildrens in San Diego. Please introduce yourself and try to remember the hashtag for every response! |
| Journal of Hospital Medicine @JHospMedicine While @Haileyjms et al focused on a #PedsHM population, the idea of discharge before noon (#DCBN) came from adult #hospitalists, so we welcome all participants in tonight's discussion including #nursetwitter and trainees! #JHMChat T1 coming up |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Here we go! #JHMChat |
 | Kate Kyler, MD @kedkyler Kate Kyler here, 3rd #PedsHM fellow at @ChildrensMercy in Kansas City. #JHMChat |
 | John @jmomdphd We’re ready! |
| Journal of Hospital Medicine @JHospMedicine Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine @DrJenChen4kids @radychildrens Sonya, #PedsHM fellow from Cincy and @PHMFELLOWJC co-founder along with @DrJenChen4kids, @kedkyler and @jmomdphd. So excited for Dr Chen to be moderating a #PedsHM themed #JHMChat! #PHMFellowJC |
| John @jmomdphd John here, 2nd-year #PedsHM fellow @JHACHPHM @AllChildrens in St. Petersburg, FL #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles Excited to join in the discussion tonight w/ @DrJenChen4kids at the helm. Adult hospitalist in SF, interested in hearing how others approach DC by noon #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: Q1: Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
 | Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine Anika Kumar here. I’m a Pediatric Hospitalist in Cleveland. #JHMChat |
 | Mona Krouss MD @kroussMD Mona Krouss here, hospitalist at Mount Sinai in New York #jhmchat |
| John @jmomdphd A1: I personally try to discharge patients before noon when it is safe to do so and when it makes sense. I’ll admit I don’t always know how long it actually takes for the patient to leave the institution though #JHMChat |
 | Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine @DrJenChen4kids @radychildrens Randy Goldberg, adult hospitalist @WestchesterMed / @nymedcollege in Valhalla NY, where I also chair the DOM QA committee and the hospital Ethics committee. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @kroussMD Thanks for joining #JHMChat! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine #JHMChat: I think in high census when patients are in the ED waiting for a bed, it helps with opening rooms and patient flow. I’ve been messaged by leadership during rounds to try to discharge patients who are medical ready when beds are tight |
| Kate Kyler, MD @kedkyler I think DCBN is something to aspire to for those you KNOW can go before noon. But to try and push people out before they're ready... seems like you'd have to skimp on some aspect of care, and it'd probably be time spent with the patient/family #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @DrGaellon @DrJenChen4kids @radychildrens @WestchesterMed @nymedcollege Thanks for joining #JHMChat! I know you were particularly interested in this topic from our discussion earlier this week |
 | Society of Hospital Medicine @SocietyHospMed #JHMChat is live! Join the discussion on if #dischargebeforenoon is an appropriate efficiency metric. Don't forget to use the hashtag in each tweet to make sure you're a part of the conversation! |
 | Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine @DrJenChen4kids @radychildrens Jen Readlynn. Hospitalist in Rochester, NY. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine @jenreadlynn @DrJenChen4kids @radychildrens Welcome to #JHMChat! |
| Journal of Hospital Medicine @JHospMedicine RT @JHospMedicine: Q1: Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
| Journal of Hospital Medicine @JHospMedicine We can even make this a quick poll: Do you think DCBN is a good idea? #JHMChat |
| Mona Krouss MD @kroussMD A1: DCBN is a good goal to strive for, as improves hospital throughput and can improve LOS as in this manuscript. However, this is only a good goal if discharge is adequately planned for the day before. Many DCBN lead to rushed and unsafe discharges #jhmchat |
| John @jmomdphd @kedkyler Agreed! |
| Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine Yes and No, and it depends on your perspective. I can see how/why hospitals want to achieve this metric, but from a patient perspective it can be difficult to comprehend, etc #JHMChat |
| Kate Kyler, MD @kedkyler @STangGirdwood @JHospMedicine Same at our hospital. There is 1) an email and 2) a reminder at the 2 morning huddles we attend. #JHMChat |
 | Bartho Caponi III @bartho_caponi @JHospMedicine Yes with an If, no with a but #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Agreed - I was once told discharge prep should begin at time of admission! #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine A1. I think DCBN is a good goal if it falls into your institution’s throughput goals. I worked at an institution where we made it our goal to decrease boarding times in the ED by implementing LEAN metrics and increasing our Discharges before noon. #JHMChat https://t.co/0KdWba36eE |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine I think it's a good goal but I wouldn't want to discourage later in the day discharges. Trying to open up beds is important but so is managing the patient in front of us. #JHMchat |
 | Brian McGillen, MD @BMcGillenMD @JHospMedicine Also, hi...I’m Brian from PennState in Hershey, PA! #JHMChat |
| John @jmomdphd A1: It also depends on the patient. In #PedsHM we have high turnover-It’s one thing to discharge a patient I know well before noon-It’s another when I’m just meeting the family that morning and have to decide quickly if it’s safe and appropriate to discharge before noon #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @bmcgillen26 Welcome to #JHMChat! |
 | Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Q1: Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
| Kate Kyler, MD @kedkyler @kroussMD Agreed! I also think we providers can anticipate patients who may be read to DCBN the day before, and could even prep patients/families for that possibility so everyone is on the same page #JHMChat |
| John @jmomdphd @freckledpedidoc @JHospMedicine A1: Efforts to DCBN have helped during bed crunches with our ED as well. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Good point: not sure how often adult #hospitalists see patients that can be discharged the same day #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @WrayCharles @JHospMedicine I totally agree with you! I think if you are going to implement a policy there has to be clear communication amongst all stakeholders, and the most important stakeholder is the patient #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Joining #JHMChat late due to bedtime but better late than never - look forward to the discussion ! |
 | Harry (Hyung Jin) Cho, MD @HarryChoMD A1: I think it's a solid goal, often messaged sub-optimally. It can alleviate the ED and shorten dwell times, improving patient safety outcomes and patient experience #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @jmomdphd: A1: A1: It also depends on the patient. In #PedsHM we have high turnover-It’s one thing to discharge a patient I know well before noon-It’s another when I’m just meeting the family that morning and have to decide quickly if it’s safe and appropriate to discharge before noon #JHMChat |
| Randy Goldberg 🏳️🌈 @DrGaellon @jenreadlynn @JHospMedicine Studies in adult med have shown that incr DCBN leads to increased LOS by about half a day - theorized to be because they just hold the patient until the next morning instead of allowing the late discharge. #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @kedkyler @kroussMD Yes! One of my colleagues worked on this (identifying people the day before and having the team prep the discharge early) and it really did help reduce boarding times. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @FutureDocs Glad you could make it to #JHMChat! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jenreadlynn @JHospMedicine Absolutely! Not all patients should be d/c’d by noon. Some need to be monitored after rounds, but setting discharge goals on rounds so that families and med team are on same page can help facilitate discharges earlier. We have orders that identify discharge criteria. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @jenreadlynn @JHospMedicine Great point, Jen. While I doubt many/anyone does this, you could see how there could be a perverse incentive to not DC someone late in afternoon/evening and hold on to them for next day DCBN.... #JHMChat |
| Mona Krouss MD @kroussMD A1: Yes, agreed, @jmomdphd Much more difficult to dc before noon the same day. I rarely dc before noon unless thinking about it the day before. Too much to plan with med rec, apts, etc #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @kroussMD: A1: A1: DCBN is a good goal to strive for, as improves hospital throughput and can improve LOS as in this manuscript. However, this is only a good goal if discharge is adequately planned for the day before. Many DCBN lead to rushed and unsafe discharges #jhmchat |
 | Subha Airan-Javia MD FAMIA (she/her) @subhaairan @JHospMedicine @FutureDocs I may be coming at this the wrong way - but I feel like it is missing the forest for the trees. Seems like the goal should be safer, timely discharges. But instead I think DCBN often puts the emphasis/focus on the wrong thing - at least on the “front line” #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @DrGaellon @jenreadlynn @JHospMedicine The Law of Unintended Consequences at its best #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @DrGaellon @jenreadlynn Yes, that's one of the concerns for people trying to "game the system" to hit DCBN metrics #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Lots of good discussion already, and we've barely gotten started! #JHMChat Q2 coming up shortly... |
| Mona Krouss MD @kroussMD @jenreadlynn Yes, I am a medical director of a unit and we, along with our SW, NM, apt maker, pharmacy message teams the day before and the morning of. We then make sure RNs get out on time after dc order gets in #jhmchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @jmomdphd Valid point. However, it can be done with appropriate staffing and multidisciplinary cooperation #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @subhaairan @FutureDocs Yes, that's one of the reasons we picked this topic! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs A1 all metrics can be gamed so dc before noon is a good metric as long as folkd dont prioritize it at the expense of shorter length of stay. (keep people longer to get the am discharge) #jhmchat |
| Charlie M. Wray, DO, MS @WrayCharles Great point, Harry. Like many value/quality projects -- the troops on the ground often don't understand what the generals are actually trying to accomplish #JHMChat |
| John @jmomdphd @freckledpedidoc Couldn’t agree more. #JHMChat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @FutureDocs I have 100% seen that happen. How do we prevent that? #JHMChat |
| Randy Goldberg 🏳️🌈 @DrGaellon RT @JHospMedicine: Q1: Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
| Journal of Hospital Medicine @JHospMedicine Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you think this was so? Don't forget to use #JHMChat and the question number! https://t.co/w69HEVToaT |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @WrayCharles @JHospMedicine I notice a trend that if we haven't decided to discharge by a certain time (say 3 or 4), the team sort of "forgets" about the possible discharge and the patient stays until the next day. It takes someone being proactive or the patient asking to leave to prompt d/c. #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #JHMChat Q1: IMO, DCBN doesn't begin to capture all the complexities that go into discharge planning. When our hospital is full and there are pts waiting in ED, we get pages to "prioritize discharges" on rounds (or the charge nurses hunt us down) |
| Charlie M. Wray, DO, MS @WrayCharles Would be interested to see a study that looked at those with DCBN compared to those not, and see if 7-10 day readmissions rates were different...Could suss out the question of expediency vs. efficiency #JHMChat |
 | Tom Varghese Jr. MD, MS, MBA, FACS, MAMSE 🇺🇸 @TomVargheseJr RT @FutureDocs: A1 all metrics can be gamed so dc before noon is a good metric as long as folkd dont prioritize it at the expense of shorter length of stay. (keep people longer to get the am discharge) #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Q2: Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you think this was so? Don't forget to use #JHMChat and the question number! https://t.co/w69HEVToaT |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: Q2: Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you think this was so? Don't forget to use #JHMChat and the question number! https://t.co/w69HEVToaT |
| Mona Krouss MD @kroussMD @wraycharles @HyungChoMD yes, very difficult to explain to residents why DCBN is important. They view it as more work for them and unnecessary stress, pressure #jhmchat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @WrayCharles Yes that would be fascinating! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Hm, how many others still make late discharge decisions (like after 3-4 PM)? #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @FutureDocs It’s also important to study readmissions when concerned with decreasing LOS. However, the jury is still out on #PedsHM readmissions as a quality metric. #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jenreadlynn @WrayCharles @JHospMedicine I usually run the list with my team before signing out at 4 pm. We identify discharge criteria for patients who could still be discharged that evening and I also let the evening attending know so they’re not forgotten. #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @subhaairan @JHospMedicine @FutureDocs Completely agree. I try not to focus on the time but that everything we need for a safe discharge is completed. (PS - great to meet you today!) #JHMChat |
 | Robyn K Rogers MD, FAAP @DrWobyn @JHospMedicine @DrJenChen4kids @radychildrens Robyn Rogers, hospitalist in Tacoma WA #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids I've definitely staffed afternoon admissions or even #PedsICU transfers that could be discharged in the evening if they otherwise meet criteria (and parents often want to go home) #PedsHM #JHMChat |
| John @jmomdphd A1: Does anyone do night rounds specifically ensuring all discharge criteria are met including adequate transportation, meds in hands, etc? #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @kroussMD @HyungChoMD I'm also curious on how well we message this to patients? Is it a selling point that we're getting them out early or are we "kicking them out"...? #JHMChat |
| Kate Kyler, MD @kedkyler @JHospMedicine I know I do! Especially for the kids who arrive in the early AM hours... tough to decide before noon for most of them. #JHMChat |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine @jenreadlynn Begs the question of "what drives us?" - metrics or patient care? #jhmchat |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles issue is those that can be DCBN are going to be healthier (no placement issues or delays more likely to go home) need strong matching... #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Q1: Q1: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the question number to help keep the transcript organized! https://t.co/xDj240lgsK |
| Journal of Hospital Medicine @JHospMedicine @DrWobyn @DrJenChen4kids @radychildrens More #PedsHM participants, yay! Welcome to #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @DrJenChen4kids: I've definitely staffed afternoon admissions or even #PedsICU transfers that could be discharged in the evening if they otherwise meet criteria (and parents often want to go home) #PedsHM #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @subhaairan @WrayCharles I totally agree. In Pediatrics the jury is still out on whether we should use readmissions to counter balance and many studies don’t consider it, but I think it’s very important. #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine All the time. When I run the list, I let my residents and evening attending know who can leave if they meet certain criteria. Happens a lot with bronchiolitis who just need another feed or asthmatics who need another q4 albuterol. #JHMChat |
| John @jmomdphd RT @freckledpedidoc: @subhaairan @WrayCharles I totally agree. In Pediatrics the jury is still out on whether we should use readmissions to counter balance and many studies don’t consider it, but I think it’s very important. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @FutureDocs With a robust population and propensity matching, I bet it could be done :) #GettingInTheWeeds #JHMChat |
| Society of Hospital Medicine @SocietyHospMed Join the conversation on #JHMChat on #dischargebeforenoon! Make sure you use the hashtag to ensure your comments are a part of the discussion. |
| Journal of Hospital Medicine @JHospMedicine This would probably depend on how much work the night team already has, but would probably help move things along especially for families that can only be present in the evenings! #PedsHM #JHMChat |
| Society of Hospital Medicine @SocietyHospMed There's still time to join the conversation on the effectiveness of #dischargebynoon as a metric on #JHMChat with @JHospMedicine! @DrJenChen4kids is leading the conversation - check out the discussion by clicking on the hashtag! |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @jmomdphd No specific night rounds but with my APP service, we set up specific goals for discharge and get the process started during the day so everything is in place if they meet those criteria later. Very patient specific. #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd During 10 pm huddles between residents and night attending, we identify early discharges and ask residents to tee them up - send prescriptions, write d/c instructions - and we list them on overnight handoff form. In busy census times, resource attending sees them in AM. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine I make discharge decisions until about 6-7pm. Afterwards if families want to be discharged, I consider safety for the patient (medications, transportation) #JHMChat |
| Vinny Arora MD MAPP @FutureDocs A2 #JHMChat in a prior QI project, patients told us they want to go home in the daytime and earlier is better to get settled but they want their education to start sooner. so key is not rushing them into discharge..but planning day 24h prior |
| Mona Krouss MD @kroussMD @WrayCharles @HyungChoMD We have signs in the room saying "DC time is 8-10 AM" and usually tell them the day before, so usually we are ok on this. We defn have had patients who want to stay for lunch and we have to tell them to go which likely impacts pt satisfaction #jhmchat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @JHospMedicine @FutureDocs This is not based on evidence 😬 but seems like there is little wiggle room for surgical discharges. Many of their admissions follow an algorithmic post op plan, only changing if there is a complication - unlike medicine admits which seem to be wholly unpredictable! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine @jenreadlynn @jmomdphd Dr. Readlynn, what do you mean by APP service (in case others are unfamiliar with that particular acronym)? #JHMChat |
| Robyn K Rogers MD, FAAP @DrWobyn @JHospMedicine Just discharged 4, after 4 pm. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @JHospMedicine we call it the surprise evening hospital discharge #jhmchat- no one thinks they are going but then consult team or imaging is done and case is wrapped up at 5p |
| John @jmomdphd @JHospMedicine @hopkins_akshata championed this at our hospital and had some great results! The sustainability has been difficult due to workloads and time constraints but it was impressive when the effort was firing on all cylinders! #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @FutureDocs @WrayCharles We've at least moved to getting our placement patients out before noon because we don't get insurance approval until too late for the SNF to take them the day before. Now we know when they can go and do their discharge in advance. #JHMChat |
| John @jmomdphd @STangGirdwood That’s impressive @STangGirdwood #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrGaellon @JHospMedicine @jenreadlynn #JHMChat: one could argue that it could also be in best interest of patients to leave early. I’ve walked into rooms where everyone is dressed b/c they knew they met d/c criteria and just waiting for the attending to see patient. Parents have other kids, jobs, etc |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine @jmomdphd Advanced Practice Providers - PAs and NPs #JHMChat |
| Vinny Arora MD MAPP @FutureDocs A2 here is my theory- surgeons do operate and they are often in preop in the am dealing with the new cases . so it may not be til later that they are getting the info they need to make a discharge decision. #jhmchat |
| Kate Kyler, MD @kedkyler @subhaairan @JHospMedicine @FutureDocs I wonder how many of the surgical admissions in the analysis were for planned procedures vs emergent? Maybe that would make a difference in discharge plans #JHMChat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @jmomdphd our night floats tried this for a while. The NF would see the discharges early, and work on dc docs and Med recs. It was helpful, but I’m not sure how efficient or safe it is for someone who doesn’t know the Pt well to do the Med Rec? #JHMChat |
| Robyn K Rogers MD, FAAP @DrWobyn @jmomdphd @STangGirdwood @JHospMedicine One of our RTs 👇🏼 #JHMChat https://t.co/zTzLy8bL1J |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Q2: Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you think this was so? Don't forget to use #JHMChat and the question number! https://t.co/w69HEVToaT |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: We can even make this a quick poll: We can even make this a quick poll: Do you think DCBN is a good idea? #JHMChat |
| John @jmomdphd @kroussMD @WrayCharles @HyungChoMD I like the idea of a sign and setting expectations…who initiates the time conversation? Nurses? Residents? Attendings? Everyone? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd S/o to @AStatile and @NdidiUnaka who have worked on this as medical directors. And pretty much our entire @CincyPHM division. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @MikePlattMD Welcome to #JHMChat! Yes, that's exactly what I discussed in my blog post |
 | Jamee Walters, MD @jamee_walters @JHospMedicine Yup. Did this afternoon when I ran the list. No reason to only make these decisions during certain hours. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Clearly, a lot of you agree that #dischargebeforenoon is not the best metric. Stay tuned for #JHMChat Q3! |
| Journal of Hospital Medicine @JHospMedicine Believe it or not, SNF placement comes up in #PedsHM too (or inpatient rehab sometimes). Psychiatric placement is much harder to predict #JHMChat |
| Mona Krouss MD @kroussMD @jmomdphd @WrayCharles @HyungChoMD In my experience, it needs to be said by multiple providers and reinforced.Certainly a team effort and takes A LOT of coordination to get them out on time! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Yes, it's probably to everyone's benefit to get patients and families back to their regular lives as soon as possible! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles i feel an outcomes research workshop tweetorial coming #jhmchat https://t.co/3oRSbQxCnH |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd @kroussMD @WrayCharles @HyungChoMD We set d/c critieria in our EHR orders. When nurses see criteria have been met, they hit the med ready discharge button so we all can see it. We had intense QI periods to have nurses hit the button but it’s dropped off in last couple of years but we’re working on it. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine A2. This is multifactorial. I co-manage surgical pts and many times families aren’t ready bc they don’t have clear expectations. The patient is the most important stakeholder; if they aren’t included in DC planning, then challenges can arise #JHMChat |
| Journal of Hospital Medicine @JHospMedicine #JHMChat Q3: What alternatives might you propose as more valid measures of discharge efficiency or quality? I'm sure many of you have ideas... https://t.co/WO5hFcCBoD |
| Society of Hospital Medicine @SocietyHospMed Do you agree that #dischargebeforenoon isn't a solid metric? Join #JHMChat and voice your opinion! Still plenty of time! |
 | Romil Chadha @romilchadha @JHospMedicine #JHMchat #DCBN needs to be titrated to #PPI #PatientPerspectiveOfIllness and resources. At @UKHospitalists practice half of our patients are from across the state. Traveling hundreds of miles in difficult terrain. So #DCBN is a necessity but we are not good at it. |
| Journal of Hospital Medicine @JHospMedicine Anyone else get penalized for same-day admit/discharge? It happens all the time in #PedsHM (e.g. the kid with anaphylaxis or croup who just needs extra 6-12 hours of monitoring) #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine @MikePlattMD Here's a link: https://t.co/4vLxPQmvUU #JHMChat |
| John @jmomdphd A2: I worked closely with our surgical team as a #PedsHM fellow and learned that their workflow was entirely different than our workflow. And yet, most of our patient flow initiatives really only focus on the medical teams. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @FutureDocs @WrayCharles In Peds, most kids go home so we don’t always have the disposition delays #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: #JHMChat Q3: #JHMChat Q3: What alternatives might you propose as more valid measures of discharge efficiency or quality? I'm sure many of you have ideas... https://t.co/WO5hFcCBoD |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: #JHMChat Q3: #JHMChat Q3: What alternatives might you propose as more valid measures of discharge efficiency or quality? I'm sure many of you have ideas... https://t.co/WO5hFcCBoD |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine I do 20-30% of the time. Late test result clears the patient. Late consult approves a discharge plan. Insurance authorization for rehab comes in at 330pm. ALL. THE. TIME. #jhmchat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @HyungChoMD @WrayCharles Yes that is certainly how it is often being messaged. Which in my mind triggers the exact opposite of pt safety. FWIW I have been on planning & pt flow cmtes advocating for this so I get the drive. But on the floors, it can feel like we are focusing on the wrong thing #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @WrayCharles: @JHospMedicine @MikePlattMD Here's a link: @JHospMedicine @MikePlattMD Here's a link: https://t.co/4vLxPQmvUU #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Yes, and not all surgical patients have #PedsHM/#hospitalist co-management (which could be a whole separate discussion!) #JHMChat |
| Mona Krouss MD @kroussMD @JHospMedicine A3: Definitely having close follow up within 7 days, accurate med rec, PCP handoff, personalized discharge instructions with description in lay terms of what happened #jhmchat |
| Society of Hospital Medicine @SocietyHospMed #JHMChat in full swing! Q3 up now! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine I don’t know about penalized but I do remember this time I discharged a patient within 3 hours of seeing them because they were already 6 hours post racemic. Put in discharge instructions before even writing H&P. Sometimes, an ED Obs unit would help. #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Me trying to keep up with moderating #JHMChat 😅 https://t.co/tt4VZnZNVk |
| Kate Kyler, MD @kedkyler A few ideas: clinic/ED re-visits within 7 days? Nursing line phone calls? In terms of quality of discharge: maybe surveying patients about the reason for admission and discharge care plan? #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @JHospMedicine i gotta admit i have no idea what you are talking about #jhmchat not #pedshm |
| Romil Chadha @romilchadha @JHospMedicine #JHMchat #DischargeEfficiency is a way cooler metric https://t.co/faxY40lLUB @TodaysHospital |
| Kate Kyler, MD @kedkyler @STangGirdwood @JHospMedicine We had an obs unit attached to the ED where I did residency. It was wonderful for patients with croup, gastro/dehydration who just needed some tanking up, etc. Loved it! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Some starting ideas for more specific measures of discharge quality #JHMChat |
 | Mark Shapiro, MD @ETSshow @FutureDocs Mark Shapiro here Joining late, sorry Forgive if already covered, are we talking dc order bf noon or physically out of building by noon? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @SHMLive Ask families what they prefer? Family satisfaction is often cited as a key metric. I’ve been pleasantly surprised by number of families willing to leave as late as 11 pm. And there are others who just need a little more time and reassurance, and that’s totally OK too! #JHMChat |
| Mona Krouss MD @kroussMD @JHospMedicine This happens in adult patients for medicare who require at least 2 day stay. Wouldn't say penalized, but we do have to state they got better earlier than expected. Most of the time,could have been observation pt #jhmchat |
| Vinny Arora MD MAPP @FutureDocs @ETSshow this is the eternal question #JHMChat |
| John @jmomdphd A3: What about a readmission that requires an escalation of care (whatever that means)? It’s one thing to be readmitted—it’s another to readmitted in a worse condition than when you were discharged #JHMChat |
| Jamee Walters, MD @jamee_walters @JHospMedicine A3: pcp appointment scheduled, scrips filled and in hand. Able to teach back anticipatory guidance. #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @kedkyler @JHospMedicine I think it would also help those admissions where ED providers felt they could be discharged but families just wanted extra set of eyes thru the night. #JHMchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @JHospMedicine I would like to ask my colleagues who care for adults, how good of a metric do you feel 7-10 day readmissions are for measuring discharge quality? #JHMChat @WrayCharles @FutureDocs @bmcgillen26 |
| Vinny Arora MD MAPP @FutureDocs RT @ETSshow: @FutureDocs Mark Shapiro here Joining late, sorry Forgive if already covered, are we talking dc order bf noon or physically out of building by noon? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @ETSshow @FutureDocs Welcome to #JHMChat! I think it's something in-between, like at least out of the room so it can get cleaned for the next patient |
| Journal of Hospital Medicine @JHospMedicine @gracefarris Glad you could make it to #JHMChat! |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine A3: 7d readmission rate, meds filled, close follow-up appt scheduled - need to set the patient up for success outside the hospital #jhmchat |
| Charlie M. Wray, DO, MS @WrayCharles @FutureDocs @JHospMedicine Yeah, a "same day discharge" is pretty much heralded as a home run in the adult world... #JHMChat |
| John @jmomdphd A3: For those of you saying meds filled—do you mean meds in hand or confirmation that Rx filled at external pharmacy (or either)? #JHMChat |
| Romil Chadha @romilchadha @JHospMedicine #JHMchat #DischargeSummary quality could also be a metric. https://t.co/rfgbY08TCt |
| Randy Goldberg 🏳️🌈 @DrGaellon @kroussMD @JHospMedicine I've had after-the-fact, unappealable denials from commercial insurance. #jhmchat |
| Mona Krouss MD @kroussMD @freckledpedidoc @JHospMedicine @WrayCharles @FutureDocs @bmcgillen26 We've studied this at our hospital. Most of 7 day readmits were related to original admission, so I do feel like it is a reflection of dc quality #jhmchat |
| Charlie M. Wray, DO, MS @WrayCharles @DrJenChen4kids I like the duck metaphor -- calm and cool on top, chaos below water. #JHMChat @FutureDocs |
| Mark Shapiro, MD @ETSshow @FutureDocs Just so My shop: dc order bf 11, out door by 2pm As HM got really good at order bf 11 (exceeded target 4 months in a row) any guess impact on target out the door? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @SHMLive Have you had families who were re-admitted & said they felt they were pushed out too soon? Having a convo about goals up front could prevent that. I often need to tell my residents, I’d rather keep a patient longer than family not sleep or come back to ED that night. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @WrayCharles @FutureDocs @JHospMedicine I think of it as a home run in #PedsHM. It’s generally observation patients because many hospitals don’t have Peds observation units #JHMChat |
| Journal of Hospital Medicine @JHospMedicine How many other #PedsHM or #PEM divisions have an "observation" unit? So many of our #pediatric patients could fit this category! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @freckledpedidoc @JHospMedicine @WrayCharles @bmcgillen26 depends on goal fo discharge - sometimes you discharge someone to give them a shot to going home before escalating to placement. Lots of times family not ready for SNF, pt refused rehab so they ask to give it a try. #jhmchat |
| John @jmomdphd A3: Had a few ICU attendings tell me “You’re not extubating enough if you never have to reintubate”. Are we not discharging enough if we never have readmissions? Is there a level of readmissions that are acceptable? #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @ETSshow not its worse and out by 3p? #jhmchat |
| Charlie M. Wray, DO, MS @WrayCharles I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| Brian McGillen, MD @BMcGillenMD @freckledpedidoc @JHospMedicine @WrayCharles @FutureDocs @freckledpedidoc it’s a better metric than 30-day! I do agree with the notion that 7-day readmits inherently have flaws with index stay (dc too early, not well coordinated, wrong dc dispo), so think there is a better chance to improve practice with 7 vs. 30. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @FutureDocs @JHospMedicine @WrayCharles @bmcgillen26 Interesting. In #PedsHM we don’t have the same disposition challenges with rehab/SNFs. Most kids are discharged home with their legal guardians. #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd Both. For asthma, usually meds in hand. For others, family preference. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Now that we've brainstormed a lot of ideas for better measures, #JHMChat Q4 coming up in a few minutes to discuss what various hospitals already have in the works... |
| John @jmomdphd @STangGirdwood We can only get meds in hand M-F during business hours…completely changes the DCBN dynamic on the weekends #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @ETSshow im waiting in suspense...#jhmchat |
| Journal of Hospital Medicine @JHospMedicine #DischargeInstructions and #healthliteracy could also be a whole separate discussion - we did a little of this during the December 2018 #PHMfellowJC |
| Romil Chadha @romilchadha @JHospMedicine #JHMchat Because the #Wifi connection was bad. https://t.co/oM5VreE5VY |
| Mark Shapiro, MD @ETSshow @FutureDocs Zero impact. Needle didn’t budge at all! Order is false flag & IMO poor metric. Need whole dc bundle to be tracked (scripts, orders etc) #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @freckledpedidoc: @JHospMedicine I would like to ask my colleagues who care for adults, how good of a metric do you feel 7-10 day readmissions are for measuring discharge quality? #JHMChat @WrayCharles @FutureDocs @bmcgillen26 |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @FutureDocs @ETSshow 😂me too! I kept refreshing thinking I missed it #theartoftweeting #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Now that we've brainstormed a lot of ideas for better measures, #JHMChat Q4 coming up in a few minutes to discuss what various hospitals already have in the works... |
| Brian McGillen, MD @BMcGillenMD @ETSshow @FutureDocs Betting on no change in dc time, with widened delta between order time and dc time? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd Our pharmacy is opened until 8 pm on weekdays, 2 pm on Weekends. We remind residents and families of this so they can get meds in hand. Most times we know what meds they are going home on the day b4 discharge. #JHMchat |
 | Jorge A Rodriguez MD @translatedmed @JHospMedicine Not to mention discharge instructions in the patient's preferred language.... #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @ETSshow totally agree. so everyone was still dc at 2p? we have been exploring "batching" of work and why it leads to bottlenecks #jhmchat |
| Journal of Hospital Medicine @JHospMedicine #JHMChat Q4: How is your institution trying to improve discharge efficiency? What barriers have you encountered? https://t.co/k7vFLEzaz7 |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @jmomdphd @STangGirdwood Our pharmacy recently changed to being open 24/7! Game changer. It was a huge barrier for patients on weekends. #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: #JHMChat Q4: #JHMChat Q4: How is your institution trying to improve discharge efficiency? What barriers have you encountered? https://t.co/k7vFLEzaz7 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine We’ve had various QI studies trying to make early discharges actually early - identifying in EMR, stopping fluids during prerounds, transitioning to enteral abx early. When it takes more than 2 hours between medically ready and discharge, we’ve looked @ failure reasons. #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc This 👇🏽. Incredibly important when addressing healthcare disparities with our ESL or non-English speaking patients/families! #JHMChat |
| Romil Chadha @romilchadha @JHospMedicine #JHMchat Uncertainty of rounding time for Sub-Specialists and procedure times |
| Journal of Hospital Medicine @JHospMedicine Another good question for our adult #hospitalist colleagues: do you have as much trouble getting meds filled especially on weekends? #PedsHM has the extra issue with compounding liquid meds for kids too young (or developmentally delayed) to swallow pills...#JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jenreadlynn @jmomdphd #JHMchat https://t.co/6hZ3vxgffw |
| Mark Shapiro, MD @ETSshow @FutureDocs Throughout is so complex, pegging all HM patient movement to a single variable (dc order time) is barely a proxy for process, certainly not a driver of process #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Another good question for our adult #hospitalist colleagues: Another good question for our adult #hospitalist colleagues: do you have as much trouble getting meds filled especially on weekends? #PedsHM has the extra issue with compounding liquid meds for kids too young (or developmentally delayed) to swallow pills...#JHMChat |
| Jamee Walters, MD @jamee_walters @JHospMedicine Yes! Compounding meds can be such a hassle on weekends. So many pharmacies won’t do it. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Yes, wonder how much extra time translation takes for our #ESL families #JHMChat |
| Mark Shapiro, MD @ETSshow @FutureDocs Throughput #JHMchat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine There's a movement for us to identify estimated discharge date within 24h of admission so the team knows what we're shooting for. It's hard to get people to commit. #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: #JHMChat Q4: #JHMChat Q4: How is your institution trying to improve discharge efficiency? What barriers have you encountered? https://t.co/k7vFLEzaz7 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @freckledpedidoc Yes! @AChoeMD has been helping to improve this at our hospital. We now have Spanish dc instructions for common diagnoses, and efforts to improve turnaround period for customized dc instructions or non-Spanish language. #JHMchat |
| Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine We certainly don't have the liquid med issue, but yes --getting meds filled is a frequent barrier. Have worked at facilities that DC patient from room to await meds in pharmacy. Works for some patients, but not all #JHMChat |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine At my hospital, we have NO mechanism for meds-in-hand, so it's irrelevant. :-p (and don't ask what that does to discharge planning for uninsured/underinsured) #jhmchat |
| John @jmomdphd A4: We have an order in the computer called “Anticipated Discharge Date” that that includes date and suspected timeframe for discharge. This populates into patients lists for both medical and case management teams #JHMChat |
| Jorge A Rodriguez MD @translatedmed @JHospMedicine Time is one challenge, availability of translators is another, especially given the time constraints of the discharge period. Not to mention the challenge of delivering discharge information when there is provider-patient language discordance. #jhmchat |
| Mark Shapiro, MD @ETSshow @gracefarris Just bravo! #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @romilchadha @JHospMedicine Consults can definitely be a barrier to discharge. We had a QI study trying to get consultants to commit to a time when they’d see patients and give recs. #JHMchat |
| Romil Chadha @romilchadha RT @SHMLive: #JHMChat is live! Join the discussion on if #dischargebeforenoon is an appropriate efficiency metric. Don't forget to use the hashtag in each tweet to make sure you're a part of the conversation! |
| Journal of Hospital Medicine @JHospMedicine Has anyone else found "Estimated discharge date" to be helpful for planning? #JHMChat |
| John @jmomdphd @STangGirdwood @romilchadha @JHospMedicine Is there a QI Cincy hasn’t done? #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @gracefarris My favorite quote! My trainees roll their eyes EVERY time I say it! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs A4 we have not tried this but I have been enamored with the idea of a "discharge brunch" which has worked well in post op ortho patients https://t.co/bqtIyBl4sc #jhmchat |
| Randy Goldberg 🏳️🌈 @DrGaellon @jenreadlynn @JHospMedicine We have it right in the admit order: "<3 days, 3-5 days, 5-10 days, >10 days" We did a QI project and found the estimate was right <20% of the time. #jhmchat |
| Romil Chadha @romilchadha RT @jmomdphd: @STangGirdwood @romilchadha @JHospMedicine Is there a QI Cincy hasn’t done? #JHMChat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @jmomdphd: @STangGirdwood @romilchadha @JHospMedicine Is there a QI Cincy hasn’t done? #JHMChat |
| Mark Shapiro, MD @ETSshow @JHospMedicine TY for this question! HM operations are 24-7-365 Dc services (Internal & external) are 9-5 M-F HUGE BARRIER! #JHMchat |
 | John P Erwin III MD FACC @HeartOTXHeartMD RT @JHospMedicine: Yes, wonder how much extra time translation takes for our #ESL families #JHMChat |
| Brian McGillen, MD @BMcGillenMD @jmomdphd Same at PennState. Hard to get but-in on order use, though. Order lacks functionality. At my previous institution, order resulted in auto-prioritized studies, PT/OT evals, labs. #JHMChat |
| Kate Kyler, MD @kedkyler @MikePlattMD @DrJenChen4kids Ummm u bet there is! #JHMChat https://t.co/GVJPW0ei8t |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine See my reply to Jen - estimates are rarely accurate. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Any #Orthopedics or other #Surgery folks out there who would like to discuss this further? #JHMChat |
| Mona Krouss MD @kroussMD @JHospMedicine We have an order in computer that we place for anticipated dc within 48 hours.Patients get a paper notice of dc planning. This also prompts pharmacy to review med rec, apts scheduled, etc. only works if interdisciplinary team acts on it and patient knows about it #jhmchat |
| Journal of Hospital Medicine @JHospMedicine @DrGaellon @jenreadlynn Next QI project: trying to improve the estimate accuracy? #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles @DrJenChen4kids can this be my life motto #jhmchat |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine I'd love to see a QI project comparing LOS to the Milliman Guideline LOS and see how accurate THAT is. #jhmchat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @bmcgillen26 @jmomdphd When it's visible, our PT/OT use it to prioritize visits. #jhmchat |
| Anika Kumar, MD (she/her) @freckledpedidoc @STangGirdwood @romilchadha @JHospMedicine In our study we informed our consultants the day prior to discharge that the patient was being discharged the following day. Many times our consultants would come early to help with expediting discharges. #JHMChat |
| Romil Chadha @romilchadha @gracefarris @JHospMedicine #Osler did not encounter #MetricFailure in his career #JHMchat |
| Mark Shapiro, MD @ETSshow @JHospMedicine BEST CHAT EVER! That is exactly what we are pressing hard! EDD seems very promising & helps pt sat too. Interesting to observe how hard to get DDocs to try. Fear of failure? #JHMchat |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @ETSshow @JHospMedicine Don’t forget prior auths!! I’ve started to learn what meds might end up needing them and ask residents to send those meds as early as possible. Teaching about the system is as important as clinical knowledge. Learned that early in my #PedsHm fellowship. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine As with many things in the hospital, interdisciplinary planning (including the patient/family) is key! #TeamworkMakesTheDreamWork #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Any #Orthopedics or other #Surgery folks out there who would like to discuss this further? #JHMChat |
| Anika Kumar, MD (she/her) @freckledpedidoc @FutureDocs We do something similar for our newborn nursery discharges. We have new parent classes. #JHMChat |
| Mark Shapiro, MD @ETSshow @STangGirdwood @romilchadha @JHospMedicine TFW can’t get echo read on dc pending pt >>> TFW consultant rounds late on dc pending pt >>>>TFW consultant says “you can go” W/o asking you #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: As with many things in the hospital, interdisciplinary planning (including the patient/family) is key! #TeamworkMakesTheDreamWork #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @ETSshow @JHospMedicine Prior auth: the bane of physicians everywhere... #JHMChat |
| Randy Goldberg 🏳️🌈 @DrGaellon @bmcgillen26 @JHospMedicine sorry, O:E? #jhmchat |
| Mark Shapiro, MD @ETSshow @STangGirdwood @JHospMedicine I have prior auth fear Don’t say basaglar insulin around me out loud please #JHMChat |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| Journal of Hospital Medicine @JHospMedicine We have just a few minutes left in #JHMChat - final thoughts? |
| Society of Hospital Medicine @SocietyHospMed You'll have 2 hours to claim your #CME from tonight's #JHMChat here: https://t.co/trxWMhmFjU. It's as simple as logging in with your SHM username and password! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @DrJenChen4kids @ETSshow @JHospMedicine Agreed. #JHMchat https://t.co/zEoB49Rg9R |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: You'll have 2 hours to claim your #CME from tonight's #JHMChat here: You'll have 2 hours to claim your #CME from tonight's #JHMChat here: https://t.co/trxWMhmFjU. It's as simple as logging in with your SHM username and password! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids We're asked to put in EDD at admission (with pre-filled options like 2-3 days for #bronchiolitis pathway), then can easily change if things don't go as expected...it's more to help the case managers with discharge planning #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles A big shout out to @DrJenChen4kids as our guest moderator for the first ever #pediatrics-based #JHMChat. Fantastic job, Jennifer! @FutureDocs @SamirShahMD https://t.co/L5VOwRXoVl |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @JHospMedicine Great job @DrJenChen4kids in picking a #PedsHM article that fostered great discussion among #tweetiatricians and #twinternists! #JHMchat |
| John P Erwin III MD FACC @HeartOTXHeartMD RT @JHospMedicine: As with many things in the hospital, interdisciplinary planning (including the patient/family) is key! #TeamworkMakesTheDreamWork #JHMChat |
| Vinny Arora MD MAPP @FutureDocs Amazing job @DrJenChen4kids moderating #jhmchat ! so interesting to hear from our #pedshm colleagues on this ubiquitous topic |
| Randy Goldberg 🏳️🌈 @DrGaellon @JHospMedicine Metrics are the lifeblood of the business side of medicine - but often detrimental to the human connections that make being a doctor a calling. #jhmchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: We have just a few minutes left in #JHMChat - final thoughts? |
 | The Ghostwriting Physician 👻⌨️ @doctorakelso21 @sumantranji @JHospMedicine Also when services and imaging stop after 4-5 and on weekends it often limits what you can do #JHMChat love the conditional discharge if option too |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids As we wrap up #JHMChat, I want to thank @WrayCharles, @FutureDocs @SamirShahMD and everyone @JHospMedicine @SHMLive for this opportunity! If you enjoyed this chat, look out for the next #PHMFellowJC in May (follow @PHMFellowJC for updates)! |
| Society of Hospital Medicine @SocietyHospMed Seconded! Thank you, @DrJenChen4kids for really sparking some fantastic conversation on this #JHMChat! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Clearly #PedsHM and adult #hospitalists have a lot in common...maybe we can work together on many of these issues too! #FutureResearchIdeas #JHMChat |
| Mark Shapiro, MD @ETSshow @JHospMedicine These chats are awesome!! Discharge is complex, control what you can, help others do same Set table for d/c at admission Prepare early for weekends & holidays! Patient 1st! Don’t ever give into institutional pressure if you don’t feel or ready to go or dispo isn’t safe #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @DrJenChen4kids: Clearly #PedsHM and adult #hospitalists have a lot in common...maybe we can work together on many of these issues too! #FutureResearchIdeas #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Thanks everyone for participating in a lively #JHMChat! Don't forget to claim CME and see you next time! https://t.co/0wO2swZq87 |
| Vinny Arora MD MAPP @FutureDocs RT @DrJenChen4kids: As we wrap up #JHMChat, I want to thank @WrayCharles, @FutureDocs @SamirShahMD and everyone @JHospMedicine @SHMLive for this opportunity! If you enjoyed this chat, look out for the next #PHMFellowJC in May (follow @PHMFellowJC for updates)! |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @WrayCharles @FutureDocs @SamirShahMD @JHospMedicine @SHMLive @PHMFellowJC We might be talking about #readmissions, but I won't steal @jmomdphd's thunder ;-) #JHMChat #PHMfellowJC |
 | #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: As we wrap up #JHMChat, I want to thank @WrayCharles, @FutureDocs @SamirShahMD and everyone @JHospMedicine @SHMLive for this opportunity! If you enjoyed this chat, look out for the next #PHMFellowJC in May (follow @PHMFellowJC for updates)! |
| #PHMFellowJC @PHMFellowJC RT @DrJenChen4kids: @WrayCharles @FutureDocs @SamirShahMD @JHospMedicine @SHMLive @PHMFellowJC We might be talking about #readmissions, but I won't steal @jmomdphd's thunder ;-) #JHMChat #PHMfellowJC |
| Journal of Hospital Medicine @JHospMedicine A pretty good summary of tonight's #JHMChat discussion! |
| The Ghostwriting Physician 👻⌨️ @doctorakelso21 @sumantranji @JHospMedicine Also this encourages earlier rounding which no one likes (no one sane that is). Can’t we all round at 9/10 with patients? Forget this 530 am wake up prerounds #JHMChat #attendinglife maybe? |
| Subha Airan-Javia MD FAMIA (she/her) @subhaairan @DrJenChen4kids @STangGirdwood @ETSshow @JHospMedicine Yes another example of how we are asked to warp and mold our care of patients to another groups needs (EHR design is one as well) #JHMchat Sorry to be cynical... |
| Randy Goldberg 🏳️🌈 @DrGaellon @ETSshow @JHospMedicine @ETSshow has a talent for good #summaries. :) #jhmchat |
| The Ghostwriting Physician 👻⌨️ @doctorakelso21 @freckledpedidoc @JHospMedicine Especially key if tolerating PO challenge prior to dc which may not happen until at LEAST lunch along with BMs too #JHMChat |
| Mark Shapiro, MD @ETSshow @subhaairan @JHospMedicine Paging @numberphile #JHMchat |
 | Rebecca Jaffe, MD @RJmdphilly @subhaairan @ETSshow @JHospMedicine Haha - this is funny and accurate #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: A pretty good summary of tonight's #JHMChat discussion! |
| Charlie M. Wray, DO, MS @WrayCharles RT @DrJenChen4kids: As we wrap up #JHMChat, I want to thank @WrayCharles, @FutureDocs @SamirShahMD and everyone @JHospMedicine @SHMLive for this opportunity! If you enjoyed this chat, look out for the next #PHMFellowJC in May (follow @PHMFellowJC for updates)! |
| Rebecca Jaffe, MD @RJmdphilly Complex adaptive #systems don’t do well with oversimplification #jhmchat |
| Mark Shapiro, MD @ETSshow @FutureDocs @DrJenChen4kids Thank you so much @DrJenChen4kids! A superb forum, thanks for facilitating! #JHMchat |
 | Paneez Khoury, MD (she/her) @KhouryMD @JHospMedicine Discharge date "range" seems more realistic...how can you commit when you just admitted the patient and there's alot going on? #JHMChat |
 | Rahat Noor, MD, FACP, FHM @RahatNoorMD #MWDFNR I love it! |
| Mark Shapiro, MD @ETSshow @subhaairan @JHospMedicine @numberphile I LOVE @numberphile Was intimidated by math & gen chem in HS & college, survive & advance! Circling back to embrace &learn in a fun way. @numberphile is great! @rabihmgeha Re: chem, excited for @TeachMePOD w/ @ChemistryCayk #JHMchat (bc why not!) |
| Rebecca Jaffe, MD @RJmdphilly RT @ETSshow: @FutureDocs Throughout is so complex, pegging all HM patient movement to a single variable (dc order time) is barely a proxy for process, certainly not a driver of process #JHMChat |
 | PedsICU_tweets @PedsICU_tweets RT @DrJenChen4kids: I've definitely staffed afternoon admissions or even #PedsICU transfers that could be discharged in the evening if they otherwise meet criteria (and parents often want to go home) #PedsHM #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @doctorakelso21 @sumantranji @JHospMedicine I usually start rounds 7:30-8:30 AM. There are morning conferences that end at varying times, and our trainees have to also get to subspecialty rounds by a certain time so the post-call person can present all the new admits (when possible) #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @melsdunlop @JHospMedicine A very good question - unfortunately I don't think anyone has a straightforward answer! #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd Agreed - we have a huge cachement area so sometimes patients have to wait hours just for a ride home, especially if parents can't come until after work or something #JHMchat |
 | Brendan McCorkle @McCorkley @subhaairan @FutureDocs #JHMChat Both sides of the equation have to have aligned incentives or the behavior will always surprise you and/or pull away from the "goal" metric |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Considering so many #PedsHM patients only need admission for 1-2 days, why isn't this more common? #PEM folks, your thoughts too? #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids Yes, I've had a couple attendings tell me they stopped trying to "push" too hard for discharge if family was uncomfortable even though kid met all discharge criteria. Hard to balance #PatientExperience with knowing that they might be taking up a bed someone else needs #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @FS_Southwick @JHospMedicine In residency, we started having case managers with us on #familycenteredrounds, which made my job as team senior so much easier than it had been for my predecessors! The hard part is finding qualified people to take on that (not very easy) job #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @subhaairan @ETSshow @JHospMedicine @subhaairan that does sound like a great program - our hospital outpt pharmacy does a lot of that too, but problem is we have some pts who can’t use our pharmacy for insurance reasons plus it’s closed on Sunday/holidays #JHMChat |
 | Robert Trevino, MD, PhD @trevy13 RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids On the flip side, I’ve also been occasionally consulted by various surgical services with something like “We think this kid is ok to go but then (s)he started coughing...pls see ASAP to decide if can still d/c, thnx” 🙃 #PedsHM #JHMChat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @MShoaibAfridi @JHospMedicine That might be appropriate in some circumstances (eg we have an EMR reminder to bring up smoking cessation if screening question was positive) but probably not for everyone #JHMChat |
| Mark Shapiro, MD @ETSshow Is there a Twitter widget that will go off whenever @gracefarris or @mike_natter posts new art? (This one is gem Mint BTW) |
| Mark Shapiro, MD @ETSshow @WrayCharles @JHospMedicine I’ve never seen study that dc time improves outcomes, thus I don’t care abt specific time (10:50=11:06) I care a great deal about throughput: impacts key metrics & incredibly complex! Which is aspirational & motivating? Which is the one we emphasize & incentivize? Oy #JHMchat |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @KhouryMD @JHospMedicine #PedsHM we have a lot of (relatively)straightforward admissions eg asthma, bronchiolitis, etc where we know our average LOS is 2-3 days. More complex kids, I start with EDD ~1 week but we’re also supposed to update it as things change #JHMChat |
 | Med Peds Hospitalist @medpedshosp RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| Mark Shapiro, MD @ETSshow @WrayCharles @JHospMedicine Finally: dc metrics shift all risk into HM. We control PART of process, not all. Throughput looks at organizational approach, which is much more effective. DC order by a certain time isn’t just valueless, it puts onus on HM & absolves other stakeholders. #jhmchat @FutureDocs |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @romilchadha @JHospMedicine I often joke with my trainees that if the patients are well enough to throw toys/food at you or try to run/toddle out of the room, they probably* don’t need to stay in the hospital 😂 #PedsHM #JHMChat *With exceptions, obviously |
 | Dr. Diana @OMednews I did that today and it never occurred to me to just plug into google for translation. I was copy/paste accents . Took me forever but I wanted them to have access to their DC summary without having to ask their 5 yr old to translate and explain it to them |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jamee_walters @WrayCharles @JHospMedicine Vitamin D supplement? 😋 #JHMChat #PedsHM |
 | Daniel Cabrera 🦔🦊🤖 @CabreraERDR RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat |
| #PHMFellowJC @PHMFellowJC @JHospMedicine A (partial) transcript from that #PHMFellowJC chat on improving discharge instructions (full one available via Symplur if anyone really wants it) #JHMChat https://t.co/2FGsh6W30a |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @jmomdphd For our kids w #asthma, we send the inhaler(s) + spacer/mask they've been using in the hospital home with them (both albuterol and controller if applicable), otherwise they'd just get thrown out #JHMChat #ReduceMedicalWaste |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @jmomdphd So hard to predict progression of illness (or new illness) sometimes especially during respiratory season in #PedsHM. I once discharged a baby with #bronchiolitis who came back less than a week later with #influenza and was definitely sicker the second time! #JHMchat |
#jhmchat content from Twitter.