Friday Emails Document

DHM Friday emails (text)

6/5/2026 Good afternoon, I will take some time to speak more in an upcoming faculty meeting, but it is important for me to address the email this week from Dr. Dewalt. It is no secret that it has been a difficult period for the members of the Division of Hospital Medicine at UNC. There are a lot of reasons for that truth and some of those concerns have been captured in the survey and in the many contentious conversations recently. Short staffing has had large negative impacts on workload, schedule and scheduling, the bedside environment has deteriorated, burnout is real, and solutions are slow and difficult. And because things in our control are outnumbered by those outside of it, it has also been a difficult time as a leader in our division for me and our entire leadership team. Despite the difficulties, I remain confident that SOM and DOM leadership know the issues, that efforts and investments needed to address them are happening as we speak, that compensation concerns will be addressed satisfactorily across the DHM in the coming comp plan and that there is a path to a better place than we are in currently that we will continue to work towards. There is still no place I'd rather be.

Many of you have reached out by text, email, or just dropping by to discuss the situation, and I appreciate every one of those touch points more than you know. We are a big group (and growing) of really amazing people with great ideas and different perspectives and hearing all of them is crucial to my work. For those of you who haven't come by or don't feel that you can, I wanted to reiterate that my open-door policy will not change. I want to hear your concerns. Call, text, email or come by (no Secure Chats, please). No ideas or solutions are off-limits. Fine to just complain without an answer or ask me to explain why anything is the way it is or what options we have considered or are considering.

I ask that we work together, assume good intent from and be respectful to all no matter where they fall in any hierarchy, and be true to our missions of providing excellent inpatient care, being effective and innovative educators and improving care delivery and throughput at UNC Medical Center.

Some Friday updates: Beth Ann, Christina Siems, Escher, Leo, amongst others continue to work to tackle the barracuda-sized issue that is Secure Chat volume. They have worked with CM and the new chiefs to get the Treatment Team Sticky Note workflow incorporated as what we do here for non-urgent communication. See Beth Ann's email for more details and use .passiton to help decrease your and your colleague's interruptions. Speaking of communication, Emily and others have been working through IDR and Complex Patient review improvements to try to streamline our approach to discharge planning and empower our CM/SW as the leader of the shared efforts. Look forward to upcoming pilots on the new IDR format when you attend on MDL. From Ann Marie: "Join us in a work potluck in the noon hour on Monday, June 15th to celebrate Hannah and her next adventure, becoming a Mom. I will have cards to sign. Feel free to bring a favorite children's book to share. " Also see her email about upcoming changes to Med M call structure that parallel the transient decrease in admission volume when the new interns join June 24th. As part of the Organizational Goals around quality improvements efforts at UNC MC, please see the QR code below for a ultrashort survey that enables the amazing QI work you are participating in, or training (TeamSTEPPS) you have done to be tracked and credited. See Taylor's email for all of the June deadlines - I have LMS modules on my agenda and I am grateful that the test out are available these days. Congratulations to Josh Garcia for winning the Educational Mentor/Advisor Award and Jessica Fuller for receiving the Kathleen Rad Educational Scholarship Grant at the Academy of Educators ceremony last night! Their excellence has help keep the DHM AOE award streak alive 6 years running.

Enjoy your weekend. Dave

5/30/2026 Good morning,

A busy week in the Medical Center and Hillsborough as we have ramped down our Bluebird census for its hiatus.

Some weekend updates: Reminder: Routine GI consults (including Biliary, Hepatology) should be obtained through placement of the Epic order prefentially - like VIR. We have heard from their team that some people have reverted back to calling for routine.  This step should not be necessary, nor more efficient so we encourage everyone to use this workflow. This is especially good for our night folks who can place the order at admission and have it acted on first thing in the morning. On June 7th, there will be an Epic upgrade. The ER will be piloting a new communication tool for Critical Labs with a closed loop Secure Chat workflow. This workflow will be active for patients admitted to our services who remain in the ER but will not be used for our usual floor patient. In the new workflow, the signed-in primary team will get a Secure Chat with closed-loop feedback that you can more easily acknowledge with one click.  If there is no response in 15 minutes, this will be followed by a page.  This notification will not go to consulting teams (i.e. MCAT). See slides attached. I strongly recommend you use the Timely Follow Up workflow that Lindsey shared in an email and I have reattached here. People have used it with excellent results and turn around. There are a few steps to get it to be active as a saved workflow which make doing this very easy when you need to, so I suggest you go through those steps before you are on service next. CT contrast is on nationwide shortage and our allotment at UNC was lower than expected in recent weeks. Please be thoughtful about your use of IV contrasted studies. Reminder: Insulin pumps were part of a care redesign project that went live last October.  The insulin pump order itself was simplified, and any clinician can place the order to continue the patients' home pump settings, an Endocrinology consult is not required.   This is a positive change to prevent unneeded delays in patient care. This is most appropriate for patients with well controlled diabetes who are competent and able to manage their usual pump settings. An educational sheet is attached. Our Endocrine colleagues welcome any consults on these patients if you do have questions about their care or settings. Please see Taylor's email yesterday for updates on our compensation discussions. We remain confident that the majority of concerns expressed during our recent conversations will be reasonably addressed this fiscal year, finalized this summer with changes retroactive to July. As soon as we have firm specfics we will share them.

Have.a nice weekend, Dave

5/22/2026 Good afternoon and Happy Memorial Day!

Sadly, it seems like it won't be beach weather this weekend but suspect our lawns and gardens will appreciate the overdue rain.

Some Friday updates; Reminder: Med H Coverage moonlighting is now available for picking up. If you are scheduled for this role, you may put it up in the swap pool to see if it gets picked up. If it does not, you are responsible to cover but will receive moonlighting pay for the role. We have sent this information out to our moonlighting pool and hopefully will have some uptake in the weeks to come. Reminder: if Cedar APP (when present) does not have MDH coverage responsibility Sa-Mo, Stella will pick up additional patients to help with the MD census.

The Secure Chat improvement pilot enters its next phase on Tuesday May 26 with 4ONC joining 7BT and 7GMU in using the Pass It On template for non-urgent communication. See the attached infographic for more details. We are hoping to move more of our communication either to page/in-person for Urgent or the Treatment Team Sticky Note for Non-Urgent issues. TLDR: use the .passiton phrase in the Treatment Team Sticky Note and review this note in the morning and prior to sign out to catch up with communication with RN or CM/SW for your patients on these units.

The July-September preliminary schedule should be published later today, as Andy and Angela finish final touches. See Angela's email for details. July and August are heavier for our current folks like previously due to vacations and the slow roll of onboarding but gets lighter as the quarter moves on. We are trialing grouping of Back Up shifts to try to minimize the spread of the burden of this requirement for our team, improve opportunities for continuity for our patients and allow for easier moonlighting. Andy will share more details on the Back Up adjustments in a separate email.

Thank you for your patience with the scheduling process. We are going to immediately start work on the next quarter, which will allow us to release more in line with our usual cadence. We are hopeful that the improved staffing will allow for more rapid turnaround.

Speaking of schedule, we are excited about all of the new faces coming to join DHM as we grow to improve capacity and decrease workload on our busy MDH teams. See next week's newsletter for quick blurbs about all of the new people joining the DHM team this summer and fall.

There is current significant shortage of ECHO techs at the Medical Center which our Cardiology team is working to mitigate. Be thoughtful about the patient's need for an inpatient study and expect delays from the usual turn-around times.

As part of our Throughput efforts, Care Management is partnering with UNC Homecare at both the Medical Center and HBR to improve the delivery times for DME. They are using PT notes and preliminary recommendations to start the process ahead of a signed order. Please be a good partner with your CM/SW and sign DME orders and document appropriately when suggested to help speed this process.

Bluebird flies the coop for a 3-week period starting next Saturday, May 30th. We appreciate our Hillsborough team's flexibility and help in covering the gap, see Emily's recent email for more details on specific capacity adjustment plans.

The suggestion box has been used!!  We were already working on updating our SharePoint documents for the next academic year and will add one for MDM at Hillsborough (per the suggestion). We are also partnering with Vanderbilt in an effort, led by Danielle and Mike N., to have DHM-specific information including onboarding documents and recent email updates accessible through a LLM chatbot.

Ashmita will share DHM survey results next week during the faculty meeting on Wednesday, May 27.  Our Educational meeting has been re-scheduled to allow timely follow up on the survey. Please join us.

I hope you all enjoy a nice holiday weekend, Dave

5/15/2026 Good afternoon,

There is a lot going on as we approach the end of year so please read.

Good news! As a short term measure to address the workload challenges of the MDH teams while we await reinforcements this summer and an expected transition back to 2nd shift hours in October, the DOM will support the return of the MDH coverage moonlighting structure, starting Monday May 18th until the end of the 1st quarter FY27. What this means: Starting Monday, Med H Coverage will be transitioned to a moonlighting opportunity 4-7 pm 7 days a week and anyone eligible to moonlight, including approved residents, fellows, APPs and faculty, can pick up the role. To avoid any gaps, MDH Tree attendings scheduled in that role will be designated to cover if not picked up by someone else but would be paid for the shift.

ACTION NEEDED: If you want to give up shifts that you are assigned, you must put up Med H Coverage shifts in the Swap Pool.

The payment structure will be the same as in FY25. For faculty and SOM fellows/chiefs, the rate is $450 per shift.  It is compatible with the daytime rounding shifts, including MDU, MDL, Consult, Procedure and MCAT, but you will need to be available in office by 4 pm for this work and we expect that extra time may be required to complete the work of both roles if covering.  It cannot be done on the same day as Hillsborough MD day shifts, Swing, UM or MAP roles. For GME residents/fellows, it is $300/shift. For APPs, it is unfortunately also the same pay structure as in FY25 at this time - $600 for coverage of 3 shifts. We are still looking into options to improve the APP pay structure from last time, so will update when we have more information. The accounting for this work will be different than our usual quarterly shift accounting, and will be submitted and paid separately on a quarterly basis. On Saturday, Sunday and Mondays that are covered by moonlighters, Stella will cover additional patients in the Cedar APP role up to 10 which should help lower censuses for our weekend rounders. If the MDH coverage is not picked up, she will cover her usual census and provide the afternoon coverage starting at 4 pm.

DOM Team Names are changing Monday May 18th!  Nothing needs to be done but the names will now follow a standard convention: Primary - I admit to this team. Consult - I can order a consult from this team.  Follow Up (like MCAT) - I don't admit to or order a consult from but this team assigns itself when it follows.  Examples:

OLD NAMES	NEW NAMES
UNCH - General Medicine Consult Service	UNCMC - Adult - Medicine Consult - General Medicine
UNCH - General Medicine Floor Team MED L - Bell	UNCMC - Adult - Medicine Primary - Med L Bell
UNCH - General Medicine Floor Team MED L - Tower	UNCMC - Adult - Medicine Primary - Med L Tower
UNCH - General Medicine Floor Team (MED U - Bell)	UNCMC - Adult - Medicine Primary - Med U Bell
UNCH - General Medicine Floor Team (MED U - Tower)	UNCMC - Adult - Medicine Primary - Med U Tower
UNCH - IM SWEEPER	UNCMC - Adult - Medicine Follow Up- Sweeper
UNCH - Medicine Care Advancement Team (MCAT)	UNCMC - Adult - Medicine Follow Up - Medicine Care Advancement Team (MCAT)

The Early Team Leadership pilot started this week on MDU and MDL and will run until the new interns join June 23rd. See attached faculty guide for those of you on these services during this time.

In response to the reality of our staffing challenges, HB Bluebird will be flying the coop from May 30th until June 18th. Our capacity for general medicine patients at HBR will be decreased during this time and see Emily's email for more specific details on the ramp down plan and coverage expectations of our MDM attending. While this news has been spread far and wide, I suspect there will be complaints when the time comes, and we do not have space to admit ER patients. Please refer them to Emily or me. If anyone is looking for moonlighting opportunities to pick up Bluebird time either at the beginning or end of the time, please let me know.

After multiple recent discussions with Leo and the system Hospital Medicine group, Escher, in her role leading the Hospital Follow-Up clinic, the residency program and our outpatient GIM colleagues, it has become clear that the Division would benefit from an inpatient faculty member who wants to develop an academic focus on best practices in Discharge Summaries in the DHM/DOM. If you are looking for an academic niche and this is of interest, please reach out to me for more discussion. While I do not currently have financial or time support for this work, the DOM does have senior faculty who have worked on previous efforts and literature reviews that would provide mentorship and a head start. This can be an excellent path to scholarship and promotion!

Angela, Saranya, and Andy have been working hard with the Lightning Bolt team to get the July-September schedule constructed and expect it to be available next week. We will immediately start to work on the next quarter so starting to think about and put in requests for October to December can be helpful.

Thank you for the discussion during Wednesday's meeting about the Secure Chat pilot and sincere gratitude to Beth Ann, Escher, Leo and Christina Siems (who will be joining us this summer) for leading this important work. We continue to pilot the use of the Pass It On dotphrase for 7BT and 7GMU and will be spreading to 4ONC on Tuesday May 26th. Please use this tool for non-urgent asynchronous communication with other members of the care team. See this week's newsletter for more details.

Congratulations to Amy Tierney, who became our 4th (!!) full time nocturnist to be promoted to Associate Professor over the last decade!  We have a whole bunch of promotions in progress to both Associate and Full level. I look forward to discussing how we progress you towards the next rank during 1:1s this summer.

Please reach out with questions. Stay well, Dave

4/15/2026 Good afternoon,

In response to the faculty survey and leadership discussion this week, DHM leadership is going to bring back the Friday DHM updates as a regular feature to increase and improve communication about all of the action going on in and around the Division. For those of you not here in 2020, these emails were an almost daily occurrence during the pandemic and helped keep everyone up to speed on the rapid fire changes. Over time, the pace slowed to weekly and have more recently been more ad hoc. If you have information that you would like to share in this forum, please send them to me during the week.

Speaking of the survey, Ashmita is working through results and plans to present a summary of results and next steps at our next DHM faculty meeting on May 13th. This meeting will also include an update on the next part of the Secure Chat communication improvement initiative being led by Beth Ann and others, so don’t miss it. There is a new initiative starting to address inconsistencies in triage decisions between acute and intermediate care. I will forward a more in-depth summary from Aaron, who is working with the resident SLTs and a multidisciplinary group to standardize decision-making and minimize  conflicts. They are looking for feedback from direct care providers about the existing acute care inclusion/exclusion criteria (if you even knew they existed!) and any feedback. This is your chance to reimagine the process completely! Click the link here to provide your feedback.  Acute/intermediate care criteria survey Information about the upcoming pilot of Early Team Leadership (ETL) running from 5/12 to 6/23 Many of you have heard about our Early Team Leadership (ETL) pilot (you may have heard it called “Intern Only Teams”) on Med U and Med L at the end of this academic year. During this pilot period, these services will be staffed by two categorical interns and one preliminary intern, and the categorical interns will spend one week each functioning as the team's senior resident. The goal of this change is to give our rising PGY-2s the opportunity to develop their workflow and logistical skills as team leaders with experienced interns before they officially assume a team leadership role with an inexperienced team. By refining these skills ahead of time, our new PGY2s will have more bandwidth to support new interns in providing safe and effective patient care at the start of the year. Our rising PGY2s have learned a tremendous amount over the last year and have our full confidence. As is the case at the start of the academic year, our interns may need additional support when functioning as the team resident. As above, we hope that their growth during this period will lessen their need for intensive support when brand new interns arrive. If you have questions or want to learn more details about the pilot, please feel free to reach out to Aaron Fried ([email protected]) and/or Ryan Bonner ([email protected]). UNC Hospitals Epic team names are changing to follow a standard format across the Departments. I have discussed this previously, but as a reminder, all names will follow the following schema:  Location – Adult or Pediatric – Department or Division – Primary/Consult/Follow up – Specifiers.  DOM is tentatively planned to roll out May 18th. For our teams, the changes will be subtle. The Trees/Birds will look like this: UNCMC – Adult – Hospital Medicine Primary – Dogwood MD (or APP). Teaching teams: UNCMC – Adult – Medicine Primary – Med U Tower (or Bell).  This will allow easier searching and identification of which teams are Primary and should used for ADT-1 Orders and which teams are Consults and therefore an appropriate target for a Consult Order as we try to move to a standard order process for routine consults. See slide below for more details about the designations. Thanks to Leo for helping support this effort. Infectious Disease would like to be consulted for patients with HIV admitted to the hospital “for optimization of management” even if the disease is not an active issue and there is not a specific question – they are hoping to try to ensure access to medications and good follow-up. They are working on a more automated system to identify these patients which is still in process. There is a system-wide UNC Hospital Medicine virtual retreat scheduled next Thursday organized by the system hospital medicine specialty program. Angela forwarded the invitation yesterday and the agenda is listed. Join the times that you are able and interested. We have ongoing meetings (including next week) with FP and DOM leadership in regards the compensation concerns discussed over the last 2 weeks and I will provide more details when I have them.

The length of this email suggests this is a good idea, hopefully they will be shorter as we get back into the routine. Feel free to reach out with questions.

Enjoy your weekend, Dave

4/17/2026 Good afternoon and happy Friday,

I wanted to personally thank you all for the engagement with the conversations with the DOM and FP leadership last week and last night. I hope they brought some clarity to the plans for compensation and helped show how these changes are good news for the division and represent an overdue effort to more appropriately recognize the value we bring. There was a lot of thoughtful and important advocacy expressed last night for our division and our patients and it reinforced my belief about the strength of our division and our steadfastness to our mission. As we learn more over the next couple weeks, we will share it.

I also want to emphasize that improved compensation is not the only target that the DHM, DOM and Medical Center are working towards - we continue daily to fight to improve the day-to-day work of hospital medicine and that the growth we are working to get to is a step in that direction.

Some brief Friday updates: The UA with culture reflex order is returning to UNC Hospitals inpatient space.  See the attached guidance but the TLDR: if you think UTI in most patients, order UA + reflex. If you think UTI in patient with catheter > 14 days, send UA alone first. If pyuria, change catheter then send culture. If neutropenia, send both UA and culture because culture is needed even without pyuria. 6 Medicine Specialty Unit has obtained portable stools that can used on rounds to sit with your patients during your visit. There is one in the Hospital Medicine workroom as well as in the resident workrooms. Patients really like this general practice if you don't typically do it and adequate seating options can be hard to find in some rooms. There is ongoing work to address issues with discharges of patients with out of network insurance (OON). Please continue to send examples of how this phenomenon is hindering patient care so that we can fully address concerns.

In the recent meetings, there have been questions about how to address concerns. There are many things we are working on, some we have made progress and others where we lag - we discuss these in our huddles, meetings and newsletters. There are multiple forums to bring new concerns and/or ideas: Our suggestion box online is still up and very lonely - see QR code. Monday DOM operational huddles are open for discussion and feel free to send agenda topics to Andy ahead of time. The service leaders (Beth Ann, Christina, Ann Marie, Aaron, Ashmita) all regularly attend a DOM/nursing/CM huddle on Fridays where concerns can be raised to that level so you can discuss with them. There are SOM Town Halls with senior leadership - next on Monday 4/27. My office door is usually open and always happy to talk things through, especially if you have something you're not sure where to bring your issue.

Stay well, Dave

2/27/2026 Good afternoon and Happy Friday,

Willow is gone and our ERs has settled back to its daily state of chronically too full with patients waiting for inpatient space, with MCAT engaged in helping progress care. We are now in the process of operationalizing our growth plans for next year to try to address these long standing capacity issues.

Our recruiting efforts have made significant progress this month towards these plans for next year. We now have 8 new faculty signed to join us summer/fall, with 1 more expected soon behind: Wagma Mirzoy (Tulane), Haley Stone (UNC & Palliative Care), Calvin Gross (UNC alum & Palliative Care), Eleanor Saunders (UNC & ID), Christina Siems (UNC Chief Resident), Nidhi Agrawal (NYU), Feerozeh Jahanshahi (experienced HM from Duke), Cameron Burgess (Nevada-Reno). We have a few positions left to fill to be able to grow our services as planned so please continue to help Angela fill the interview days. Since we now have the needed complement to do so, we are going to start working on our Jul-Sep schedule in the next weeks.

Some important Friday updates:

At Medicine Grand Rounds next Thursday March 5th, the Medical Staff office will recognize our own Jon Heath, who won the MPSEC Award for Physician Excellence in Clinical Care, an honor recognizing physicians across the entire medical staff for unwavering commitment to compassionate, high-quality patient care, leadership in clinical education, and dedication to service across the UNC Health system and beyond. Please come celebrate this incredible achievement in person! Based on the success of silent Code Blues, there is going to be a proof-of-concept pilot of Silent Rapid Response Calls to the MPCU (ONLY) starting March 9th. RRTs in the MPCU will be paged like usual but not called overheard. All of our teams are on the page list and our providers will need to be alert to these pages. All other RRTs will continue to be paged and called overhead. The goal is to have primary team presence or response by Vocera to the primary nurse within 5 minutes. This pilot has 2 ways in its design to avoid safety events - 1. The MICU team is alerted and expected to report to RRTs in the MPCU, 2. If the primary team does not respond, an overhead call will be made at 5 minutes. There will be debriefs and weekly evaluations of the data to ensure safety and efficacy of this pilot. See attached educational sheet for more details and please  reach out if you have questions or concerns. Lower GI Surgery and Surgical Oncology are finalizing their workflow to join the Epic order consult pilot. Very soon (date still to be determined), you will be able to place routine consults to these services through an Epic order, just like we are doing for Neurology and GI now.  The target teams are below. UNCH Colorectal/Lower GI Surgery Consult - New Consult (SRG) UNCH- Surgical Oncology Consult - New Consult (SRA) After some lively discussion about ways to be get more ideas and input from our faculty, we are going to tie our underutilized Suggestion Box more closely to our Monday Operations Huddle, now open to all. We will review suggestions in the box weekly and have planned follow up to let you know how progress is going. If you have a good idea but do not feel comfortable bringing it up directly to leadership or the huddle , use the link here to put it in the suggestion box.  Tell us how to improve UNC Division of Hospital Medicine Angela will sending out information on ordering DHM gear very soon. We will be ordering with the new School of Medicine logo branding with Division of Hospital Medicine underneath. If you would like the UNC Health logo instead, there is an online store you can order directly but would not include the bulk discount. In order to get the discount we need a minimum of 6 orders per item, so we have tried to pare down the options to hit that total. I will pay the upfront cost and collect from those ordering individually. We have some upcoming moonlighting opportunities available, including weekend APP shifts, so if you're looking for Spring Break vacation money, look no further!

Stay well and have a nice weekend, Dave