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Vol 26, Issue 2

David Hemsey, MD Division Chief, Hospital Medicine

UNC Division of Hospital Medicine

Hospitalist Happenings

VIEW FROM THE NINTH FLOOR

View from the Ninth Floor

July 25, 2025

This past Wednesday, I presented our annual State of the Division for FY25. I know you all can't wait to review the recording when you have a spare hour but figured it would be useful to mention some highlights in this space.

We were busy last year, with productivity higher in all areas without exception. At the HBR campus, we added a 2 nd team that exactly doubled MD rounding productivity and discharges from the year before with no ramp up needed! All of our admitting providers at both campuses saw more patients last year, driven by the team changes including MCAT.

I am still working through all of the data for the MCAT team but here are a few key points. We saw 1659 patients through this workflow in FY25. 236 (14%) were discharged from the ED without admission/observation orders placed, after an average of 28 hours, half of which were spent under MCAT team care. 236 (14%) were discharged from the ED without admission/observation

Inside this issue:

View from the Ninth Floor 1-3
Cross Cover Talk 3-4
Announcements 4
Hospitalist Highlight 5

orders placed, after an average of 28 hours, half of which were spent under MCAT team care. There were another 150 patients evaluated with consults provided after referral to the MAO that did not require MCAT care at all.

Of the admitted patients, 600+ were admitted to MDH/X, with 517 to General Medicine/Medicine Specialty teams including Geriatrics, 175 to MDE teams, 18 to Cardiology and 29 to the MICU. 55 were ultimately admitted to other non-DOM services. The change improved time to DOM evaluation for all patients as seen here in this bar chart which shows time in ER for DOM patients admitted Jan23-Dec24

(baseline), Jan24-Jun24 (pre-MCAT when capacity issues arose) and Jul24-Jun25 (MCAT). MCAT covered 35% of the ADT9-1 gap that was created by the capacity constraints and brought average time from arrival to DOM evaluation to < 1 hour from baseline -9.4 hrs in 2023 to 10.4 hrs in FY25.

Hospitalist Happenings

We crushed our group throughput metrics, nearly TRIPLING UNC MC ER diversions from FY24 marks: 28/mo to 80/mo. Reminder, ER diversions are referrals from UNCMC ED to the MAO team that were discharged outpatient care without admission, transferred to our HBR campus through transfers, or admitted to AC@H. Over the year, we increased from Q1&2 to Q3&4 by 33%.

We also had strong academic success. Nearly 50% of our faculty contributed to abstracts that were accepted at the Triangle SHM RIV meeting and the vast majority of those abstracts were presented at the national SHM Converge in Las Vegas in April. Last year, we had 60 invited presentations across NC and the country, on topics including POCUS and innovations related to patients 'medically -ready' for discharge and the TEC2.0 curriculum. We had 21 publications, with our original research and quality improvement work outnumbering case reports. We had 4 promotions, including Evan to Professor and Liz, Rimma and Mukhtar to Associate. We now have 3 faculty who have been promoted to Associate while working as full time nocturnists (!!!), a record of success you will be hard-pressed to find in other academic HM divisions.

Finally, we presented our division awards for FY25:

Physician of the Year: William Kwan MD

Will was recognized for his clinical excellence, dedication to both bedside education and compassionate care, and for living the mission of our division. He has been cited as a consistent example for all faculty throughout his time with Hospital Medicine and we are sad to say goodbye to him in the coming weeks. Other nominees included Ejaz Janjua, Lindsey Phillips, Courtey Detwiler, Jessica Fuller and Christina Kahl.

Advanced Practice Providers of the Year: Dana Mabry NP

Dana has always been recognized as a thoughtful and intuitive provider who takes excellent care of her patients and of the team in the office including our physicians and other APPs. This year, she has also provided exceptional leadership, helping with solutions to our short staffing, driving our recruiting efforts and onboarding and mentoring multiple providers. Other nominees included Kelly Stepanek, Stellamary Inigo and Eric Allman.

Educator of the Year: Jessica Fuller MD

Jessica has been both one of our highest rated bedside educators on our General Medicine teaching service as well as a highly regarded leader for her work in the 1 st and 2 nd year Case-Based Learning courses in the Foundation Phase and the Rapid Response simulation training for UNC Medicine residents. She has also been recognized this year with an Academy of Educators Professorship award and as core faculty for UNC Internal Medicine residency program. Other nominees included Will Kwan, Erin Finn, Christina Kahl, Jen McEntee and John Stephens.

Hospitalist Happenings

Health Systems Improvement Award: Leo Marucci MD

Leo was recognized for his long-standing service to our division, department and system in the ISD world. This year, he has helped lead initiatives to spread clinical decision-making support through the Agile Pathways@UNC, to improve billing through note templates and to pilot new technologies for the EHR including AI generated hospital summaries and the Abridge ambient scribe. Other nominees included Aaron Fried, Chris Caulfield, Mike Craig, Patrick O'Shea and Ashmita Chatterjee.

I am very grateful that I have the privilege to work with such a terrific group of providers who remain focused on our missions to provide excellent, patient-centered care while we teach our learners the skills of hospital medicine and improve care delivery and throughput across UNC Medical Center and UNC Health. I know we will continue to work hard to improve, both in the care we provide and the way we work together to provide that care through the changes that are sure to come.

Cross Cover Talk: 4-7pm and Night 2 coverage

Using Paul Ossman as our 'gold standard' for partnership between Admitter shifts and Cross Cover shifts, his reflections provide clear guidelines:

  • -I feel a sense of ownership over my admissions until I leave.
  • -I expect Night 2 to add me to chats for patients I have admitted that shift.
  • -I go to the rapid responses for patients I have admitted that shift.
  • -I touch base with Night 2 prior to leaving, specifically signing out sick patients.
  • -I encourage questions from Night 2 about challenging crossover.
  • -If added to a chat about patients that I did not admit, I feel that I am added in an advisory role rather than as a primary responder.
  • -I generally do not know about new admissions from MCAT, so expect Night 2 to cross-cover MCAT admissions.
  • -I do not go to any rapid responses on patients that I have not admitted that day unless my presence is requested by Night 2.

Beth Ann Brubaker, MD Physician Service Leader, Direct Care Svcs Chapel Hill

These guidelines may be extrapolated to the MCAT admitter in relation to 4-7pm cross cover provider.

Housekeeping requests/considerations, on behalf of Cross Cover providers:

  • -Set expectation for family updates to occur during daytime hours and only by primary team.
  • -If you place pain med dosing restrictions on a patient, please provide a clear POC in your notes and ideally discuss directly with nursing staff the rationale for the restrictions.
  • -Provide thorough PRN orders for constipation, nausea, sleep, etc. on every patient.

Hospitalist Happenings

When leaving for the day, please avoid Offline chat status. DND is acceptable alternative that does not require additional work by cross cover provider to make you aware of non-urgent issues communicated during primary provider off-hours.

MCAT providers - upon AM arrival please be sure to take over coverage of Hospitalist New Admit pager!

As service line leader, I will be meeting regularly with nurse managers on DHM regionalized units. Please reach out to me with patterns of issues/difficulties that you wish to escalate. Ideas/opinions for solutions are always welcome too.

Request for input: Please contact me if you are interested in helping create guidelines on epic chat communications during cross cover hours. The goal of this work will be to reduce non-urgent message volume to cross cover providers and to choose an appropriate place in chart/sticky notes for nurses to communicate non-urgent issues directly to primary team.

Announcements

Physicians, APPs, & Executives: Upcoming Headshot Photo Sessions

The UNC Health Marketing and Communications team is offering multiple photo sessions for physicians, APPs and executives Wednesday, Sept. 17 Friday, Sept. 19.

Chapel Hill (N.C. Basnight Cancer Hospital Conference Room 4)

  • Wednesday, Sept.17: 8 a.m. - noon

Raleigh (Rex Women's Center Classroom 100B)

  • Thursday, Sept.18: 8 a.m. - noon

Morrisville (5221 Paramount Pkwy, Bldg 3, 1st Floor, Bell Tower Leadership)

  • Friday, Sept. 19: 8 -10 a.m.

Upcoming DHM Faculty Meetings

Noon -1:00 | PECR3 & Webex August 13th: Agile Pathways w/ Shah Farooq & Sepsis Order Set w/ Dave Hemsey

August 20th: Journal Club w/ Christina Kahl August 27th: Opportunities for AI w/ Michael Neuss

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.

Ann Marie Kumfer -Aug. 6th Patrick O'SheaAug. 11th Danicela Younce -Aug. 12th

Hospitalist Happenings

Hospitalist Highlight

Cherie Ann Somera

'As a child my strongest passions were in music and art, but familial pressure from a young age led to me doublemajoring in Biochemistry and Biology with the intent of attending medical school. What I realized from hospital

volunteering, taking an EMT course, and navigating my mom's experience with breast cancer, was that I identified more strongly with the role of a nurse. Because it was too late for me to change majors at Loyola University Chicago, I finished my science degrees and matriculated into an accelerated nursing program at Massachusetts College of Pharmacy and Health Sciences. As a nurse I learned invaluable skills and entered the lives of people that were experiencing their worst days. I realized how unique a position we are in as healthcare professionals to have the opportunity to help people, and I don't take that responsibility lightly. After 5 years of working as a critical care nurse in the MICU, I felt a calling to switch my role and became a nurse practitioner. It is because of my now husband (Bryan Quach) that I ended up in North Carolina. We have 2 children, Aidan (6) and Lily (7 months!).'

Hobby/Hobbies:

'I tend to 'collect' hobbies (to my husband's great disdain at times) and fully immerse myself into things. Some hobbies that I enjoy: family time in any shape and form, crocheting, intricate alcohol marker coloring, video games, gardening, traveling, reading, paper crafts, cooking/baking, listening to music, playing my violin (when I can find the time), and DIY nail dipping.'

What is a fun or interesting fact about your hometown:

'I immigrated from the Philippines as an infant to the Southside of Chicago, then moved to the suburb Lake in the Hills. I consider Lake in the Hills my hometown, but I don't think there's any interesting facts about it. But for Chicago there is! The Chicago River is unique in that it was engineered to flow backwards. Chicago is also where the first open-heart surgery happened. It's the birthplace of the skyscraper, the Ferris wheel, and the Twinkie. And to Chicagoans the Sears T ower will always be known as the Sears T ower, not Willis T ower.'

What is a fun fact about your life, your past, your future?

'1) I can't swim. You can try to teach me, but you will likely fail. 2) I used to own an Etsy Shop selling amigurumi crochet figures and handmade cards. 3) I dream of being a standup comedian (think Ali Wong). 4) I LOVE finding a good deal when shopping/thrifting.'