#jhmchat Transcript

Healthcare social media transcript of the #jhmchat hashtag.
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Charlie M. Wray @WrayCharles
RT @JHospMedicine: T-1 hour to #PedsHM #JHMChat with @DrJenChen4kids and colleagues! If you didn't have time to read the article, this #vis
Jennifer K. Chen, MD FAAP @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
J 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
J 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!
J 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
Jennifer K. Chen, MD FAAP @DrJenChen4kids
Here we go! #JHMChat
Kate Kyler, MD, MSc @kedkyler
Kate Kyler here, 3rd #PedsHM fellow at @ChildrensMercy in Kansas City. #JHMChat
John @jmomdphd
We’re ready!
J 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 TG @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 @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 @WrayCharles
RT @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 que…
Anika Kumar, MD @freckledpedidoc
@JHospMedicine Anika Kumar here. I’m a Pediatric Hospitalist in Cleveland. #JHMChat
Mona Krouss @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 MD MPH 🏳️‍🌈 @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
J Hospital Medicine @JHospMedicine
@kroussMD Thanks for joining #JHMChat!
Sonya TG @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, MSc @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
J 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 @jenreadlynn
@JHospMedicine @DrJenChen4kids @radychildrens Jen Readlynn. Hospitalist in Rochester, NY. #jhmchat
J Hospital Medicine @JHospMedicine
@jenreadlynn @DrJenChen4kids @radychildrens Welcome to #JHMChat!
J Hospital Medicine @JHospMedicine
RT @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 que…
J Hospital Medicine @JHospMedicine
We can even make this a quick poll: Do you think DCBN is a good idea? #JHMChat
Mona Krouss @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 @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, MSc @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
J Hospital Medicine @JHospMedicine
Agreed - I was once told discharge prep should begin at time of admission! #JHMChat
Anika Kumar, MD @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 @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 @bmcgillen26
@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
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@JHospMedicine A1: I think it's an admirable goal, but it doesn't serve the purpose the C-suite thinks it does. "Discharge times" in a hotel serve to allow time for cleaning and turnover before a comparable "admission time." Hosp/ED patients come at any hour. #JHMChat
J Hospital Medicine @JHospMedicine
@bmcgillen26 Welcome to #JHMChat!
Charlie M. Wray @WrayCharles
RT @DrGaellon: @JHospMedicine A1: I think it's an admirable goal, but it doesn't serve the purpose the C-suite thinks it does. "Discharge t…
Vinny Arora MD MAPP @FutureDocs
RT @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 que…
Kate Kyler, MD, MSc @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
J Hospital Medicine @JHospMedicine
Good point: not sure how often adult #hospitalists see patients that can be discharged the same day #JHMChat
Vinny Arora MD MAPP @FutureDocs
Joining #JHMChat late due to bedtime but better late than never - look forward to the discussion !
Anika Kumar, MD @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
Hyung (Harry) Cho, MD @HyungChoMD
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: It also depends on the patient. In #PedsHM we have high turnover-It’s one thing to discharge a patient I know well befor…
Randy Goldberg MD MPH 🏳️‍🌈 @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 @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
J Hospital Medicine @JHospMedicine
@FutureDocs Glad you could make it to #JHMChat!
Sonya TG @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 @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
Vinny Arora MD MAPP @FutureDocs
RT @kroussMD: A1: DCBN is a good goal to strive for, as improves hospital throughput and can improve LOS as in this manuscript. However, th…
Mona Krouss @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
Subha Airan-Javia, MD FAMIA @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 @WrayCharles
@DrGaellon @jenreadlynn @JHospMedicine The Law of Unintended Consequences at its best #JHMChat
J Hospital Medicine @JHospMedicine
@DrGaellon @jenreadlynn Yes, that's one of the concerns for people trying to "game the system" to hit DCBN metrics #JHMChat
J Hospital Medicine @JHospMedicine
Lots of good discussion already, and we've barely gotten started! #JHMChat Q2 coming up shortly...
Mona Krouss @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 @freckledpedidoc
@jmomdphd Valid point. However, it can be done with appropriate staffing and multidisciplinary cooperation #JHMChat
J 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 @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 @subhaairan
@FutureDocs I have 100% seen that happen. How do we prevent that? #JHMChat
J 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
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
RT @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 que…
Jen Readlynn, MD @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
Jennifer K. Chen, MD FAAP @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 @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 @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 shorte…
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you thin…
Charlie M. Wray @WrayCharles
RT @JHospMedicine: Q2: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you thin…
Mona Krouss @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 @subhaairan
@WrayCharles Yes that would be fascinating! #JHMchat
J Hospital Medicine @JHospMedicine
Hm, how many others still make late discharge decisions (like after 3-4 PM)? #JHMChat
Anika Kumar, MD @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 TG @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 @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
Jennifer K. Chen, MD FAAP @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 @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
Sumant Ranji @sumantranji
@JHospMedicine Patient flow is too complex an issue to be assessed by a single metric. All aspects of flow throughout the hospital are interrelated, so DBN can't be assessed without also looking at balancing metrics like LOS as well as ED, ICU, and OR flow measures. #JHMChat
Kate Kyler, MD, MSc @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 MD MPH 🏳️‍🌈 @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: Do you think discharge before noon (DCBN) is a good goal? Why or why not? Don't forget to use #JHMChat and the que…
J Hospital Medicine @JHospMedicine
@DrWobyn @DrJenChen4kids @radychildrens More #PedsHM participants, yay! Welcome to #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @sumantranji: @JHospMedicine Patient flow is too complex an issue to be assessed by a single metric. All aspects of flow throughout the…
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…
Anika Kumar, MD @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 TG @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…
Charlie M. Wray @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.
J 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 @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 TG @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 @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 @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 @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
J 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
Mike Platt, MD @MikePlattMD
I feel like this happens a lot in children’s hospitals. Ensuring a kid is tolerating PO or receives necessary teaching. #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 @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 TG @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 @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, MSc @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 @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: One of the findings was DCBN was associated with decreased LOS in medical but not surgical patients. Why do you thin…
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: 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 TG @STangGirdwood
@jmomdphd S/o to @AStatile and @NdidiUnaka who have worked on this as medical directors. And pretty much our entire @CincyPHM division. #JHMChat
J 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
J Hospital Medicine @JHospMedicine
Clearly, a lot of you agree that #dischargebeforenoon is not the best metric. Stay tuned for #JHMChat Q3!
J 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
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@JHospMedicine I generally only see same-day discharges when they're already pre-identified and placed in observation... we get penalized for same-day discharges from admitted status. #jhmchat
Mona Krouss @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
J 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 TG @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 @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
J 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.
J 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 @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 @freckledpedidoc
@FutureDocs @WrayCharles In Peds, most kids go home so we don’t always have the disposition delays #JHMChat
Charlie M. Wray @WrayCharles
RT @JHospMedicine: #JHMChat Q3: What alternatives might you propose as more valid measures of discharge efficiency or quality? I'm sure man…
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: #JHMChat Q3: What alternatives might you propose as more valid measures of discharge efficiency or quality? I'm sure man…
Randy Goldberg MD MPH 🏳️‍🌈 @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 @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: https://t.co/4vLxPQmvUU #JHMChat
J Hospital Medicine @JHospMedicine
Yes, and not all surgical patients have #PedsHM/#hospitalist co-management (which could be a whole separate discussion!) #JHMChat
Mona Krouss @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 TG @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
Jennifer K. Chen, MD FAAP @DrJenChen4kids
Me trying to keep up with moderating #JHMChat 😅 https://t.co/tt4VZnZNVk
Kate Kyler, MD, MSc @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, MSc @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
J 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 TG @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 @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
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@kroussMD @JHospMedicine "Description in lay terms" - I've asked dozens of colleagues if DC summaries are for patients to understand what happened to them, or doctor-to-doctor communications. It splits about 25/75 - most don't think lay language is needed. #jhmchat
Jamee Walters, MD @jamee_walters
@JHospMedicine A3: pcp appointment scheduled, scrips filled and in hand. Able to teach back anticipatory guidance. #JHMchat
Sonya TG @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 @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
Grace Farris MD @gracefarris
Coming in late to discuss my least fav metric! #JHMChat https://t.co/RUR9tnenPb
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 ou…
J 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
Society of Hospital Medicine @SocietyHospMed
RT @gracefarris: Coming in late to discuss my least fav metric! #JHMChat https://t.co/RUR9tnenPb
J Hospital Medicine @JHospMedicine
@gracefarris Glad you could make it to #JHMChat!
Charlie M. Wray @WrayCharles
@FutureDocs @JHospMedicine Yeah, a "same day discharge" is pretty much heralded as a home run in the adult world... #JHMChat
Jen Readlynn, MD @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
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
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@kroussMD @JHospMedicine I've had after-the-fact, unappealable denials from commercial insurance. #jhmchat
Romil Chadha @romilchadha
@JHospMedicine #JHMchat #DischargeSummary quality could also be a metric. https://t.co/rfgbY08TCt
Mona Krouss @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 @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 TG @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 @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
J 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 @WrayCharles
I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat
Brian McGillen, MD @bmcgillen26
@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 @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
Ichhya Pant @3rdcultureme
RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat https://t.co/E7dA5TCMyJ
Sonya TG @STangGirdwood
@jmomdphd Both. For asthma, usually meds in hand. For others, family preference. #JHMchat
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@freckledpedidoc @JHospMedicine @WrayCharles @FutureDocs @bmcgillen26 7-10d readmit is a better metric than 30d readmit for discharge quality. By 30d, you're usually seeing the effect of noncompliance more than poor discharge quality. #jhmchat
John @jmomdphd
RT @DrGaellon: @freckledpedidoc @JHospMedicine @WrayCharles @FutureDocs @bmcgillen26 7-10d readmit is a better metric than 30d readmit for…
J 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...
Grace Farris MD @gracefarris
@bmcgillen26 @freckledpedidoc @JHospMedicine @WrayCharles @FutureDocs Aren’t most of the 30 day readmits in the first week anyway? #JHMChat this is my recollection of the adult data
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
J 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
J 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 readmi…
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
Subha Airan-Javia, MD FAMIA @subhaairan
@FutureDocs @ETSshow 😂me too! I kept refreshing thinking I missed it #theartoftweeting #jhmchat
Grace Farris MD @gracefarris
@subhaairan @FutureDocs @ETSshow Me too! #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 v…
Brian McGillen, MD @bmcgillen26
@ETSshow @FutureDocs Betting on no change in dc time, with widened delta between order time and dc time? #JHMChat
Sonya TG @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
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
Jorge A Rodriguez MD @translatedmed
@JHospMedicine Not to mention discharge instructions in the patient's preferred language.... #jhmchat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat https://t.co/E7dA5TCMyJ
Grace Farris MD @gracefarris
@ETSshow @FutureDocs From your mouth to gods ears 👂 lol! #JHMChat
J 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 @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: How is your institution trying to improve discharge efficiency? What barriers have you encountered? https:/…
Sonya TG @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 @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
J 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 TG @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
Romil Chadha @romilchadha
RT @DrGaellon: @kroussMD @JHospMedicine "Description in lay terms" - I've asked dozens of colleagues if DC summaries are for patients to un…
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Another good question for our adult #hospitalist colleagues: do you have as much trouble getting meds filled especially…
Jamee Walters, MD @jamee_walters
@JHospMedicine Yes! Compounding meds can be such a hassle on weekends. So many pharmacies won’t do it. #jhmchat
J Hospital Medicine @JHospMedicine
Yes, wonder how much extra time translation takes for our #ESL families #JHMChat
Mark Shapiro MD @ETSshow
@FutureDocs Throughput #JHMchat
Grace Farris MD @gracefarris
One last thought... #JHMChat https://t.co/mT7O9ueuXi
Jen Readlynn, MD @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: How is your institution trying to improve discharge efficiency? What barriers have you encountered? https:/…
Sonya TG @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
J Hospital Medicine @JHospMedicine
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Charlie M. Wray @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 MD MPH 🏳️‍🌈 @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 TG @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…
J 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
John P Erwin III MD✭ @HeartOTXHeartMD
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Anika Kumar, MD @freckledpedidoc
@gracefarris My favorite quote! My trainees roll their eyes EVERY time I say it! #JHMChat
Charlie M. Wray @WrayCharles
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
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 MD MPH 🏳️‍🌈 @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 TG @STangGirdwood
RT @jmomdphd: @STangGirdwood @romilchadha @JHospMedicine Is there a QI Cincy hasn’t done? #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
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✭ @HeartOTXHeartMD
RT @JHospMedicine: Yes, wonder how much extra time translation takes for our #ESL families #JHMChat https://t.co/iPCqlOEtzE
Brian McGillen, MD @bmcgillen26
@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, MSc @kedkyler
@MikePlattMD @DrJenChen4kids Ummm u bet there is! #JHMChat https://t.co/GVJPW0ei8t
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@JHospMedicine See my reply to Jen - estimates are rarely accurate. #jhmchat
J Hospital Medicine @JHospMedicine
Any #Orthopedics or other #Surgery folks out there who would like to discuss this further? #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Mona Krouss @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
J 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 MD MPH 🏳️‍🌈 @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 @jenreadlynn
@bmcgillen26 @jmomdphd When it's visible, our PT/OT use it to prioritize visits. #jhmchat
Anika Kumar, MD @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 TG @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
Jan Elizabeth Bell @SwearyPaed
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
J Hospital Medicine @JHospMedicine
As with many things in the hospital, interdisciplinary planning (including the patient/family) is key! #TeamworkMakesTheDreamWork #JHMChat
Emily Fridenmaker @emily_fri
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Any #Orthopedics or other #Surgery folks out there who would like to discuss this further? #JHMChat https://t.co/vAJAEkW…
Anika Kumar, MD @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! #TeamworkMakesThe
Jennifer K. Chen, MD FAAP @DrJenChen4kids
@STangGirdwood @ETSshow @JHospMedicine Prior auth: the bane of physicians everywhere... #JHMChat
Randy Goldberg MD MPH 🏳️‍🌈 @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 @subhaairan
RT @WrayCharles: I think @JHospMedicine has it's new series -- MWDFNR (Metrics We Do For No Reason)... #JHMChat https://t.co/E7dA5TCMyJ
J 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 TG @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: https://t.co/trxWMhmFjU. It's as simple as logging in wit…
Jennifer K. Chen, MD FAAP @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 @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 TG @STangGirdwood
@JHospMedicine Great job @DrJenChen4kids in picking a #PedsHM article that fostered great discussion among #tweetiatricians and #twinternists! #JHMchat
John P Erwin III MD✭ @HeartOTXHeartMD
RT @JHospMedicine: As with many things in the hospital, interdisciplinary planning (including the patient/family) is key! #TeamworkMakesThe
Vinny Arora MD MAPP @FutureDocs
Amazing job @DrJenChen4kids moderating #jhmchat ! so interesting to hear from our #pedshm colleagues on this ubiquitous topic
Randy Goldberg MD MPH 🏳️‍🌈 @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?
Kelsey Murray @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
Jennifer K. Chen, MD FAAP @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!
Jennifer K. Chen, MD FAAP @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!…
J 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…
Jennifer K. Chen, MD FAAP @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…
#PHMFellowJC @PHMFellowJC
RT @DrJenChen4kids: @WrayCharles @FutureDocs @SamirShahMD @JHospMedicine @SHMLive @PHMFellowJC We might be talking about #readmissions, but…
J Hospital Medicine @JHospMedicine
A pretty good summary of tonight's #JHMChat discussion!
Kelsey Murray @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 @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...
Kyle @KyleTMueller
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Randy Goldberg MD MPH 🏳️‍🌈 @DrGaellon
@ETSshow @JHospMedicine @ETSshow has a talent for good #summaries. :) #jhmchat
Kelsey Murray @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 @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! https://t.co/H4UPYK4sBE
Rebecca Jaffe @RJmdphilly
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Charlie M. Wray @WrayCharles
RT @DrJenChen4kids: As we wrap up #JHMChat, I want to thank @WrayCharles, @FutureDocs @SamirShahMD and everyone @JHospMedicine @SHMLive for…
Rebecca Jaffe @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 @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 @RealRahatNoor
#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 @RJmdphilly
RT @ETSshow: @FutureDocs Throughout is so complex, pegging all HM patient movement to a single variable (dc order time) is barely a proxy f…
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…
bujaj49 @bujaj49
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @DrJenChen4kids
@melsdunlop @JHospMedicine A very good question - unfortunately I don't think anyone has a straightforward answer! #JHMChat
Jennifer K. Chen, MD FAAP @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
Jorge Ganem, MD @jfganem
RT @freckledpedidoc: This 👇🏽. Incredibly important when addressing healthcare disparities with our ESL or non-English speaking patients/fam…
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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 https://t.co/E7dA5TCMyJ
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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 https://t.co/E7dA5TCMyJ
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
Jennifer K. Chen, MD FAAP @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
OjO_MedNews @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
Jennifer K. Chen, MD FAAP @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 https://t.co/E7dA5TCMyJ
BMM on Health and Tech @datadrivencare
RT @DrJenChen4kids: Yes, I've had a couple attendings tell me they stopped trying to "push" too hard for discharge if family was uncomforta…
#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
Med Peds Hospitalist @medpedshosp
RT @gracefarris: One last thought... #JHMChat https://t.co/mT7O9ueuXi
Jennifer K. Chen, MD FAAP @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
Jennifer K. Chen, MD FAAP @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.