Vol 26, Issue 12
David Hemsey, MD Division Chief, Hospital Medicine¶
Inside this issue:¶
| View from the Ninth | 1-2 |
|---|---|
| Floor | |
| MDUUpdates | 3 |
| Hillsborough Updates | 4 |
UNC Division of Hospital Medicine¶
Hospitalist Happenings¶
VIEW FROM THE NINTH FLOOR¶
View from the Ninth Floor December 16, 2024¶
Decembers are always action-packed at home with holiday gatherings, fun family activities and important traditions. In the office, it means that Lamba's cleaning out his junk drawer for the White Elephant, recruiting, planning and budgeting seasons are upon us and we have enough information from FY25 to talk about how we are doing.
You have all received your productivity report cards for the 1 st quarter from Saranya in the recent weeks and I encourage you to review them. They include our new productivity metrics recognizing the challenges of our direct care time and throughput. I have also posted a graphic of how the division measured on these metrics in FY24 in SharePoint (we will do the same for FY25 after the 2 nd quarter data are available). This bubble graph shows each provider with an anonymous number in terms of how they compare to peers in terms of Direct care total encounters x MDH/X cFTE, Direct care encounters/day and Discharge fraction. If you would like to know your number to see your personal baseline, please text me or ask me when you're in the office.
In the next quarter, we will begin reporting our individual Quality and group Differentiated Service metrics. If you need more details on these metrics, please review the video and slides from our faculty meeting October 9th. The Quality metrics will include Discharge Summaries within 24 hours which we have used previously and will add use of the recommended Hospital Medicine H&P template for all admissions that our team created last year that measurably improved our billing and coding documentation. Our compliance rates are high so you need to pay attention to these if you would like to maximize your incentive.
The other new addition will be the Differentiated Service group metrics. The DOM is asking all divisions to focus their incentive on the things they do best. So we are targeting a specific goal from the DHM mission -Improvement of capacity and flow throughout UNC Hospitals. As we all know, inpatient capacity at the Medical Center remains the key bottleneck that limits us. We have more patient demand for beds than there are beds and providers to safely care for them. It is also true that once a patient is referred for inpatient admission, trying to figure out a safe alternative at the Medical Center (when it exists) that still meets the patient's needs is difficult and requires extra time and effort. It makes sense to reward this work and to improve capacity by increasing the rates of our team finding solutions that provide care in alternative settings. To this end, we have chosen three separate measures:
Hospitalist Happenings¶
- Referrals to the Acute Care @ Home program from patients referred/admitted to DHM
- Discharges from the ER for patients referred for admission requiring DHM evaluation including from the MCAT team
- Admissions to MDX/CARES at the Hillsborough campus for patients originating at the Medical Center, both from ER or inpatient teams
We are still validating our data for ER discharges but I wanted to show our baselines for AC@H referrals and HBR transfers. We have seen significant increases in both metrics in the first half of the year from previous, but there remain significant opportunities to improve, especially when we compare our AC@H referrals to the teaching teams. There will be a new order "Inpatient Consult to Advanced Care at Home Hospitalist" which will make it easier to complete and know if the referral has already been made. Stay tuned for more details on the roll out of this order.
Speaking of incentive, there are openings for the UNC Health Hospital Medicine Grand Rounds speaker series for the coming year. If you have a topic that you have interest in giving or know of potential speakers, please reach out to me or Jon Heath.
On behalf of the entire DHM leadership team, I want to thank each of you for your continued dedication to the DHM mission of providing the very best clinical care, teaching and systems-thinking every day, despite the challenges of the healthcare environment in which we work. I hope the New Year brings you peace, joy and fulfillment. Happy Holidays and look forward to continued improvement and success in 2025!
General Medicine Unit on 7NSH¶
The current timeline for 8BT to move to 7NSH is February 2025 and it will be the 'General Medicine Unit'. Although we started 'walk throughs' with everyone back in Spring 2024, the final approval for MDU and MDW workrooms on 7NSH took a long, long time so the workrooms will NOT be ready for the move date. The anticipated completion date for the team workrooms will be sometime in the summer. The 8BT/MDU/ MDW team is working on interval solutions. However, in the long run, if all goes as planned, then MDU and MDW should have adequate space on the new unit sometime in 2025.
MDU Stewardship Rounds with CASP -Thursdays 2 pm¶
Handshake stewardship rounds with CASP and MDU have already started. The time is Thursdays at 2 pm so please attend and encourage the whole team to be in the workroom. The goal is a brief discussion regarding patients on antibiotics without a formal ID consult.
Quality Improvement -Length of Stay¶
If anyone is interested in working on a quality improvement project, one of the MDU/ MDW FY25 priorities is Length of Stay. So please reach out if you are looking to get involved or thinking about an IHQI proposal. IHQI Concept proposals due January 31, 2025.
Did you know??? Phlebotomy edition¶
· Phlebotomy workflow -draw list times¶
- Draw list is downloaded at 3 am, 5 am, 8 am and every 3 hours after that. If the order is released after those times, it does NOT appear on the worklist until the next refresh
- So, if you order labs at 6 am, phlebotomy does not even 'see' it on the draw list til 8 am.
· Unit collect to Lab collect¶
- If an order needs to be changed from Unit collect (nurse) to Lab collect (phlebotomy), the change will ONLY show on the phlebotomy side if the order is CANCELLED AND REORDERED. Editing the order does not suffice.
- So, if a central line is not drawing back and the order is modified from Unit collect to Lab collect, then phlebotomy will NEVER see it. They need a NEW order.
· Safe Reports¶
- Please continue to file Safe Reports for phlebotomy delays, it seems to be the most effective way for administration to know about this issue.
- Particularly important to file Safe Reports if phlebotomy delay impacts patient safety or delays diagnosis or delays procedures or delays discharge.
Please email Sharon Baker ([email protected]) if you would like to recognize a fellow peer, share a personal work achievement, family/coworkers photos, or submit an announcement to be featured in future newsletters.
Christina Kahl, MD, PhD Physician Service Leader,
MDU
Hospitalist Happenings¶
Operational Reminders:¶
We are consistently staying busy across our services at Hillsborough. Since starting the HBB service, we have been able to accept more outside hospital transfer, direct admissions, and admissions from the medical center. Thank you everyone for your hard work to make these services run smoothly.
As we have many people rotating at Hillsborough for the first time, here is a refresher of the basics of operations for Hillsborough:
- The total number of acute patients across HBB, HBC, and CARES is 26. On weekdays, this is distributed as 11 patients each on HBB and HBC and 4 patients on CARES.
- The total number of long term patients across HBB, HBC, and CARES is 8. There are 4 patients on CARES and 2 patients each on HBB and HBC.
- For appropriate patient numbers, please ensure that acute patients are designated as 'MDX' treatment team and long term patients as 'MED' treatment team. If you are unfamiliar with how to change the designation, you can ask the MAOs, Emily, or Keva
- Consults from surgical services and Tikosyn loads should be placed on the HBB team
- Tikosyn loads can come in close to the 7AM sign out. Nocturnists: it is most helpful that basic orders and meds are ordered as soon as possible to keep them on track for getting their first dose of Tikosyn. As these admissions are straight forward, it is ok to ask the HBB MD to write the H&P later if you are crunched for time.
- When Keva is out:
- The acute patients to be distributed back to HBB and HBC. Please ensure these patients are moved to the HBB/ HBC lists and off of the CARES lists to avoid confusion from staff on who to contact
- The long term patients will be seen by second shift. If this is a fellow, they will also need to be seen and staffed with either HBB or HBC attending and their notes co-signed.
- When Brian is out:
- New surgical patients are triaged and seen by second shift. If a patient does not require a consult, please write a treatment plan note stating the chart has been reviewed and no formal consult needed.
- Patients who need ongoing management should be placed on the HBB list
Emily Sturkie, MD Associate Chief, Clinical Operations at Hillsborough
Additional Consulting Services Coming¶
Podiatry: Podiatry will start performing outpatient surgeries in January at Hillsborough. As they hire additional staff, they will also perform inpatient consults and surgeries.
Endocrinology: We are in the process of obtaining an APP for Hillsborough to provide endocrinology consults for diabetes management. This will allow us to take more complex diabetes patients at Hillsborough.