Discover and read the best of Twitter Threads about #hospitalist
Most recents (16)
“If you could have anything, what would you want right now?”
“Doc, I know it’s counterintuitive, since it’s what got me here... *long pause* but I haven’t had a drink in over 13 years.”
“What’s your drink of choice?”
7:45AM: I left the hospital and crossed the street.
“Doc, I know it’s counterintuitive, since it’s what got me here... *long pause* but I haven’t had a drink in over 13 years.”
“What’s your drink of choice?”
7:45AM: I left the hospital and crossed the street.
He wanted a glass of wine. A red. But not just any red. A Cabernet Sauvignon, dry but not too dry.
Fortunately we have similar tastes. I picked out a familiar label.
Fortunately we have similar tastes. I picked out a familiar label.
For good measure, I sauntered over to the kitchenware aisle and picked up a set of 4 long stemmed, round bowl-shaped glasses. I checked out and wrapped the wine in enough bags to obscure the shape and label. I crossed back to the hospital parking lot and returned to his room.
#Apologies can be steps towards assisting in #healing #medical #trauma. When my daughter was in @SanfordHealth for 2 months, virtually #secluded bc of accusations by #hospital administration that she causes her diabetic crisis a #hospitalist & #diabetic counselor accused 1
her of ‘stashing’ #Insulin in room. All visitors searched. No items in room unless searched - camera in room 24/7 YET she is accused of injecting #Insulin. My daughter again attempted to educate on post #TPAIT. After additional days, the #Diabetic #Counselor came back & 2
#apologized acknowledging how hard it was to control her #diabetes. It’s hard control when she is at #Baseline but if she is sick nightmare. That #apology meant the world 🌎 to my daughter. She continued to work w this #counselor throughout stay & after. YET #PatientRelations 3
It's time for new job signing by final-year residents. A non-compete is one of the important discussion points
It should be totally removed from Hospital-based physicians. It's a big win-win for health systems and physicians.
Why? read this thread.
#MedTwitter #healthcare
It should be totally removed from Hospital-based physicians. It's a big win-win for health systems and physicians.
Why? read this thread.
#MedTwitter #healthcare
Non-compete agreement --> it is meant to prevent physicians to compete with their old employers.
#hospitalist
#intensivist
#ER Docs
#Neurologists based at hospitals & others
These specialties don't compete or take patients with them once they leave their current job.
Why?
#hospitalist
#intensivist
#ER Docs
#Neurologists based at hospitals & others
These specialties don't compete or take patients with them once they leave their current job.
Why?
How patients chose ED/Hospitals in an emergency?
- Most of the time it is chosen for patients.
- Based on critical illness, location, a nearby hospital, capabilities of that hospital, and related factors
- ED room is not chosen based on ED doc or hospitalist or ICU doc.
- Most of the time it is chosen for patients.
- Based on critical illness, location, a nearby hospital, capabilities of that hospital, and related factors
- ED room is not chosen based on ED doc or hospitalist or ICU doc.
Trying to retain your hospitalist???
Many #Hospitals and health systems struggling to retain hospitalists, why new thinking is needed?
I have made it easy for you.
@ACHEConnect @PhysiciansLead @BeckersHR @TodaysHospital
Many #Hospitals and health systems struggling to retain hospitalists, why new thinking is needed?
I have made it easy for you.
@ACHEConnect @PhysiciansLead @BeckersHR @TodaysHospital
Why retain a #hospitalist?
- cost 50 to 100 k in lost productivity, recruitment of new hire
- extra cost of having #Locums and #PRNs
- Quality of care may be affected
- LOS increases by .5 days or more as per data
-takes from 6 to 12 months to get the replacement
- unstable team
- cost 50 to 100 k in lost productivity, recruitment of new hire
- extra cost of having #Locums and #PRNs
- Quality of care may be affected
- LOS increases by .5 days or more as per data
-takes from 6 to 12 months to get the replacement
- unstable team
What to do: I believe follows a simple process.
1. Listening/Feedback Session:
Listen to individual hospitalists:
- #surveymonkey is not okay here
- Set up a 1:1 #listening session and act on the feedback
-feel to be heard and problems acted upon
1. Listening/Feedback Session:
Listen to individual hospitalists:
- #surveymonkey is not okay here
- Set up a 1:1 #listening session and act on the feedback
-feel to be heard and problems acted upon
Searching for a #hospitalist Job? I have made it easy for you. Too many options to choose from.
Top Factors to look for in the job.
#MedTwitter, @BeckersHR @NY_Hospital_Job @TodaysHospital @acphospitalist @ahahospitals
Top Factors to look for in the job.
#MedTwitter, @BeckersHR @NY_Hospital_Job @TodaysHospital @acphospitalist @ahahospitals
Not every hospitalist's job is the same.
#patient Volume:
- in 12-hour shifts, 15-18 encounters are common
- above 18, difficult to provide quality of care and high risk for errors and burnout risk
-it's okay to have a few days with a high census, but not with every day.
#patient Volume:
- in 12-hour shifts, 15-18 encounters are common
- above 18, difficult to provide quality of care and high risk for errors and burnout risk
-it's okay to have a few days with a high census, but not with every day.
Night Shifts - Nocturnist
- Does the program have a dedicated nocturnist team?
- or rotation with all team members
- In 12 hr, shift 10 new admissions are doable
- Cross-Coverage: If a hospital is small (<150 beds), it's manageable, beyond it is difficult.
- Does the program have a dedicated nocturnist team?
- or rotation with all team members
- In 12 hr, shift 10 new admissions are doable
- Cross-Coverage: If a hospital is small (<150 beds), it's manageable, beyond it is difficult.
1/ FRESH OFF THE PRESS: we looked at language barriers and postoperative opioid prescription use after total knee arthroplasty in @ERCSPjournal and found lower fill rates for pts with limited English proficiency tinyurl.com/tka2022. See thread🧵 below...
2/ Total knee arthroplasty is a common surgery to address advanced osteoarthritis. Racial minorities are less likely to undergo TKA and have higher complication/readmission rates
3/ We were interested in how limited English proficiency (LEP) was associated with TKA outcomes and specifically, pain management. Identifying disparities in medication utilization after TKA provides insight into barriers faced by vulnerable patient populations
Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx
🔽👇🔽🔽👇
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Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx
🔽👇🔽🔽👇
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Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to ⬇️ failures & avoid underRx.
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There is growing evidence to support for shorter courses. It is important for prescribers to be up to date with best practices. Duration of therapy plays a pivotal role in antimicrobial stewardship programme within the global effort to optimize antibiotic use &⬇️resistance.
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4-chloro-N-(2-furyl-methyl)-5-sulfamoyl-anthranilic acid, member of the sulfa’s. Potent natriuretic drug, inhibits Na+-K+-2Cl− cotransporter in the ascending limb of the loop of Henle.
Direct Vd effects results in its therapeutic effectiveness in the Rx of acute pulm edema.
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Direct Vd effects results in its therapeutic effectiveness in the Rx of acute pulm edema.
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Vasodilation leads to reduced responsiveness to vasoconstrictors, such as angiotensin II and noradrenaline, and decreased production of endogenous natriuretic hormones with vasoconstricting properties.
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Angioedema:
Edema of the deep dermis & subcutaneous tissues.
Etiology, types and treatments👇👇👇👇⬇️⬇️⬇️⬇️👇👇👇👇
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#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
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Edema of the deep dermis & subcutaneous tissues.
Etiology, types and treatments👇👇👇👇⬇️⬇️⬇️⬇️👇👇👇👇
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#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
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Mast cell–derived mediators tend to affect layers superficial to subcutaneous tissue, including the dermal-epidermal junction. These mediators cause urticaria & pruritus.
In bradykinin-mediated angioedema, the dermis is usually spared, so urticaria & pruritus are absent.
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In bradykinin-mediated angioedema, the dermis is usually spared, so urticaria & pruritus are absent.
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Pseudomonas aeruginosa (PA):
Gram-negative bacillus found widely in nature, in soil and water.
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#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX
Gram-negative bacillus found widely in nature, in soil and water.
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#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX
The genus Pseudomonas >140 species,> saprophytic & >25 species are associated with humans. Most known to cause disease in humans are associated with opportunistic infections.
⬆️ MR : ⬇️ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
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⬆️ MR : ⬇️ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
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Often found in water in sinks & can contaminate respiratory equipment, which can serve as an environmental reservoir, especially in ICUs. Is the most serious pathogen causing ventilator-associated pneumonia & remains the most important pathogen in patients with CF.
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Dementia
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
The criteria for delirium listed in the Diagnostic and Statistical Manual of Mental Disorders vs Confusion Assessment Method (CAM) 👇👇. CAM has a sensitivity of 94% to 100% and a specificity of 90% to 95%.
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Features:
disturbances of sleep, altered psychomotor activity, and changes in emotion (eg, anxiety, apathy, lability, irritability, or anger). Subtypes of delirium are hyperactive, hypoactive & mixed. Hypoactive form >> hyperactive form. Inattention is hallmark. 3/16
disturbances of sleep, altered psychomotor activity, and changes in emotion (eg, anxiety, apathy, lability, irritability, or anger). Subtypes of delirium are hyperactive, hypoactive & mixed. Hypoactive form >> hyperactive form. Inattention is hallmark. 3/16
The HPA Axis and Adrenal Fxn.
Typical excretion of cortisol ➡️diurnal pattern with peaking in the a.m, ⬇️toward the afternoon, & ⬆️ in the early p.m. The basal adrenal production of cortisol is 10-15 mg daily. #MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Typical excretion of cortisol ➡️diurnal pattern with peaking in the a.m, ⬇️toward the afternoon, & ⬆️ in the early p.m. The basal adrenal production of cortisol is 10-15 mg daily. #MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Physiologic & psychological stress can boost daily production of cortisol to 3 or more times typical levels.
Adrenal insufficiency: caused by a disease involving the adrenal gland itself (primary AI) or one altering its regulation by the hypothalamus and pituitary (secondary AI)
Adrenal insufficiency: caused by a disease involving the adrenal gland itself (primary AI) or one altering its regulation by the hypothalamus and pituitary (secondary AI)
Primary AI results from destruction or replacement of the adrenal cortex. Addison’s disease (autoimmune destruction of the adrenal cortex) accounts for 80% to 90% of primary AI.
So these are my thoughts. First, I am not a parent, so I have no stake in that side of this debate. However, I AM an extremely overstretched #hospitalist doctor who has seen both hospitals in #AnnArbor balloon to unmanageable patients levels three times now, with...
patients being housed in simulation centers, in team/break rooms, in ED hallways. And that is without schools being open locally, but we cover a large catchment area, and schools never closed in other counties.
I think we could maybe have made elementary schools work with in class instruction. These young kids are the ones most needing the structure of in person, and all kids are in one classroom with one teacher, so could control the flow.
Yep - definitely tougher this morning...
@SickKidsCCM @mac_picu peeps - looks like we’re closing in on a consensus
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VENOUS STASIS LEG ULCERS!!!
A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread
Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
VENOUS STASIS LEG ULCERS!!!
A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread
Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
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Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!
While some say they aren't painful, many of my patients would disagree....
Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!
While some say they aren't painful, many of my patients would disagree....
3/
Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
Bit of a different #tweetorial today, on:
CONSULT ETIQUETTE!
- TIPS for the PRIMARY TEAM calling the consult.
Caveat: Some examples are a little #dermconsult specific, but can be extrapolated to others!
#medthread #dermtwitter #medtwitter #meded #FOAMEd #tipsfornewdocs
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CONSULT ETIQUETTE!
- TIPS for the PRIMARY TEAM calling the consult.
Caveat: Some examples are a little #dermconsult specific, but can be extrapolated to others!
#medthread #dermtwitter #medtwitter #meded #FOAMEd #tipsfornewdocs
1/
As both a #dermatologist & a #hospitalist, I have the pleasure of being on both ends of the #consult game.
So, your team has decided to call a consult, and you are the intern or student who has been tasked with contacting the team. Don't be nervous! Try these tips!👇👇👇
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So, your team has decided to call a consult, and you are the intern or student who has been tasked with contacting the team. Don't be nervous! Try these tips!👇👇👇
2/
First of all:
1)Have a consult question
Asking a consultant to see a pt w/o a ? is like having a pt see you w/o a chief complaint! The ? helps the consultant frame the note in a way that is most helpful for you & your team. Otherwise, I'm guessing at what you want to know.
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1)Have a consult question
Asking a consultant to see a pt w/o a ? is like having a pt see you w/o a chief complaint! The ? helps the consultant frame the note in a way that is most helpful for you & your team. Otherwise, I'm guessing at what you want to know.
3/
