thequalitypostGreetings from Cat, Saj, Ari and Jenica Welcome to the 120th edition of The Quality Post! In this issue, we describe how our words matter in our clinical notes and unlearning stigmatizing language, introduce and orient you to the Discharge Milestones tool in APeX, provide a Provider Dashboard Tip of the Month, and share our True North Metric performance for FY21. inthisissue
Our Words Matter: Unlearning Stigmatizing Language
Build Resilience by Turning to Your Network
Introducing Discharge Milestones
Provider Dashboard Tip of the Month
FY21 DHM True North Metric Performance Our Words Matter: Unlearning Stigmatizing Language With the rollout of Open Notes on March 31st at UCSF Health, many of us are more attuned than ever to ensuring we are using person-first language and avoiding stigmatizing terminology in our clinical notes. In addition to potentially offending our patients, we know that the use of stigmatizing language also perpetuates unconscious and conscious biases towards patients that can then affect health outcomes. In an article published in JGIM in 2018, the authors at Johns Hopkins found that the use of stigmatizing language in the medical record of a hypothetical patient with sickle cell disease was associated with significantly more negative attitudes towards the patient and less aggressive management of the patient's pain. The use of stigmatizing language and language that implies various value judgements is often learned by trainees from other medical professionals. To break this cycle of undue harm to our patients, it is important that we make a commitment to unlearn relatively common language that we have all used in our clinical practice. For instance, instead of charting that a patient "refused" a medical treatment, you can document that the patient "declined" the test. Instead of writing that the patient is "non-compliant," consider using the language "person who is non-adherent due to...". Examples of person-first language would be to document "person with housing insecurity" as opposed to "homeless." For other tips to unlearn relatively common stigmatizing language used in medicine, check out the resource below provided by our colleague Dr. Yalda Shahram who leads the Tea House Series: Striving Together To Be Antiracist. I also strongly urge to you check out The Tea House Series -- it is never to late to join this community! Build Resilience by Turning to Your Network The ability to bounce back from setbacks is often described as the difference between successful and unsuccessful people. But how do you build that resilience? Research shows that it comes down to the people in your network: You need relationships that are broad and deep enough to support you when you hit setbacks. So think about what you need in tough times. Some people need laughter, others need empathy, and others need logical perspective. Then consider your network. Identify who you go to when you're in a rut -- and ask yourself if they meet your needs. If they don't, who else might be able to help? Look to your family, your colleagues, or your loose-tie friendships. The pandemic has caused a significant amount of uncertainty and challenges for us all; the importance of building and maintaining connections has never been clearer. This tip is adapted from "The Secret to Building Resilience" by Rob Cross et al. Discharge Milestones: Improving Coordination of Multi-Disciplinary Teams in the Discharge Process Coordinating a safe and high-quality discharge for our patients is a core part of our role as hospitalists, but we can't do this alone and rely on many multi-disciplinary team members to effectively accomplish this important task. While MDR and Tee-Time Rounds certainly help with discharge planning, it has become clear that having an EHR-embedded and mostly automated discharge checklist accessible to multi-disciplinary team members can help with discharge coordination and communication throughout the day. Enter Discharge Milestones, a tool available in the Discharge Navigator and on the Daily Rounds in APeX and rolling out to 14M, 14L, 15L, and 7E/L this month. Discharge Milestones has been used in the pediatric step-down unit for two years, and their pilot resulted in sustained improvements to discharge before noon rates, decreased length of stay by 1 day, and reduced 30-day readmission rates and discharge cycle time (or the time if takes to from a discharge order being placed to when the patient discharges from the unit). Importantly, the pediatric DC Milestones pilot also resulted in multi-disciplinary providers reporting they found discharge information in APeX to be more current and reliable post-implementation. Over the past several months, Craig Johnson and Robert Schechtman from Clinical Informatics have been hard at work with a team of nurses, therapists, case managers, social workers, and physicians (including our own IM residents!) to refine and improve the DC Milestones tool for the adult patient population. They have also revamped the "IP Discharge" report based on multiple stakeholder feedback. To access the DC Milestones tool, click on the "Discharge Navigator", and you will find "Discharge Milestones" listed under "Discharge Planning" in the left-hand column. Most physician-owned milestones (discharge order, medication reconciliation) are automated based on existing workflows, although there is the option to add a Comment to any Milestone if you would like to communicate additional details to the multi-disciplinary team. Other team members, including nursing, SW/CM, and therapy services will also have their existing discharge planning workflows feed automatically into a Discharge Milestone, and some team members will be charting in the Milestones tool itself. To access the IP Discharge report from the "Patient Summary" or "Patient Lists" in APeX, type "IP Discharge UCSF" in the search bar with the magnifying glass icon at the upper right corner, click on the report, and click on the wrench icon to save this report. Our goal is to regularly use the IP Discharge report and DC Milestones during the discharge planning process, including MDR. Residents plan on using the IP Discharge Report to help with discharge communication within the team, particularly during days off and block resident coverage on weekends. If you have any questions or feedback, contact Craig Johnson, Rob Schechtman, Aline Zorian, or Cat Lau. |