Posts by Vineet Arora

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…

Next on #JHMChat: Ideas from Residents to Root Out Routine Labs

While the saying goes, “you can’t teach an old dog new tricks”, I think we all assume you can teach a new dog new tricks… or at least all of us in medical education believe this! However, new research in the Journal of Hospital Medicine highlights that maybe the old dog is the key to the puzzle after all. In the case of routine labs, a practice that has already been called into question by the Society of Hospital Medicine’s Choosing Wisely list, the majority of medicine and surgery residents at University of Pennsylvania admitted that they engaged in unnecessary ordering of inpatient labs, with over a third of them occurring on a daily basis! Why is this so hard to change? Not surprisingly, one of the key culprits was it was hard-to-break habit. However, several of the top reasons were also related to the “old dog”, also known as…

Time to #TurnTheTide: No Doctor Should Be Excited about Prescribing Opioids

As a resident, I still remember the day I was so excited that I could prescribe narcotics on my own. I had taken my USMLE part 3 and paid for my DEA number so that I could moonlight at a local community hospital. As an added bonus, I was no longer reliant on an attending to write narcotics scripts. While this may sound trivial, word spread through our residency like wildfire. That week, I got paged daily by an intern whose attending physician had left for the day, and they had patients to discharge on narcotics. After all, it was not uncommon to send patients home with narcotics because they were “having pain” and they needed pain medications to give them the edge they needed to stay out of the hospital. I did not think much of this until 5 years ago, I saw a patient “RC” acutely suffering from…

Taking CME to the Next Level on Twitter with #JHMChat

What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… until now! On Monday, July 11th, the Journal of Hospital Medicine will be hosting its 3rd Tweetchat. For those new to Twitter or to “tweetchats”, it is a block of time (typically an hour) on Twitter during which tweeters use a hashtag to engage in a dialogue about an issue. #JHMChat uses its one hour to engage in a dialogue about a particular article in the Journal of Hospital Medicine. We often choose an article that has implications for Costs of Care or Choosing Wisely and most importantly, could be practice-changing for hospitalists. While we…