Archive for July 2011

The July Effect: “Don’t Get Sick In July” Is Not An Answer

“Don’t get sick in July!” We’ve all heard patients and family members say this – part declaration, part wishful thinking – in reference to the perceived summertime risks of teaching hospitals. When I hear it, I usually respond with comforting bromides like “robust supervision” and “cream of the crop.” But deep down, if I had the choice of entering a teaching hospital in July and April, I’d choose the latter. This preference comes partly from my recollections of my own training experience. The day before I began my residency at UCSF, my entire intern class gathered to meet our new bosses. We were on pins and needles – laughing at jokes that weren’t really funny, suspiciously eyeing our colleagues, whose admission to the program (unlike our own) could not be explained by clerical error. The chief of service, Greg Fitz, a brilliant gastroenterologist with a disarming “aw shucks” manner and…

Care transitions “coach” effectively reduces readmissions

In this quasi-experimental trial of medicare beneficiaries, patients that received Care Transitions "coaching" had significantly lower 30 day readmission rates than those that did not (13% versus 20%). The coaching involved a visit near hospital discharge, a home visit within a few days, and 2 follow up phone calls before 30 days. The 4 pillars of coaching focused on medications, health conditions, follow up plans, and "red flags" requiring health care contact. This Care Transitions Intervention plan is effective in real-world settings in reducing 30 day readmission rates in a variety of disease conditions (abstract)

Two On Transitions

Today's Archives of Internal Medicine has two interesting and instructive studies on readmission prevention. (more…)

Last Day and one more Gem

Found this at the bottom of my "in-box", also from the Levinson Institute, things to remember that help us connect to the people we work with: The Universal Sources Of Stress 1. We all feel inadequate - the self image never meets up to the ego ideal 2. We all age - and with aging comes increasing rigidity 3. The Unconscious Conspiracy - throwing resources at a problem doesn't fix it 4. The World of Expanding Complexities 5. Isolation - DONT BE ISOLATED , maintain connections 6. Stand on your Values - your values are your anchors, not your behaviors 7. Pair Up those last two aren't sources of stress, I don't know how they got on the list, but I like them.