- Jeffrey Grill
1. You have worked in both the hospital and a private pediatric practice. Having experienced both sides, what do you recommend for communication with a patient’s primary care provider at discharge from the hospital? Is the discharge summary enough? A phone call? Something else?
This is a challenging issue, made more so by the wide range of opinions across the hospitalist community as well as the primary care community as to what “the best” communication really is. In a perfect world, we’d all love the time and flexibility to have lots of two-way communication between primary care and inpatient care, but we all know that’s not how it works in real life. Primary care physicians are super busy with packed schedules, charts and labs to review, a million interruptions and unexpected delays. Hospitalists are similarly busy as we all know with countless responsibilities and tasks to attend to. In my group, we used to call every primary care provider at discharge, but this led to many calls that just weren’t worth the interruption and time to either party. We all know what to expect at follow-up for a patient with bronchiolitis that got better as expected! So we asked our referring community and while we were sampling a diverse group of opinions, it seemed most accepted the idea of “call when it will help patient transition.” It’s a little easier for me, having had the experience, to ask, “Would I like to have had a call about this patient if I were the primary provider?”, but it’s still a useful question to ask by any Hospitalist. So I recommend calling provider-to-provider when it is helpful, complex, or will avoid a foreseeable problem, and work hard to get timely (same day!), meaningful discharge summaries into the right hands for every patient.
2. Prior to your residency training, you served for five years on active duty in the U.S. Navy, primarily as a Submarine and Diving Medical Officer in Japan. Tell us more about this time in your life.
People who know me well have the good sense to never ask this question…..ha! Don’t ever get an old sailor going telling sea stories….
But seriously, my time in the Navy was truly an honor and a privilege. Of course, my part in defending Freedom and Democracy was tiny, but to wear the uniform and serve an idea that large was a gift, and one I remember often even though now it seems like a hundred years ago. I went into the service like many, as a way to pay for medical school, but I was also hoping for some adventure and experiences I wouldn’t get anywhere else. I was certainly not disappointed! I hoped to serve overseas and Japan proved to be one of the most incredible places I’ve ever seen. To live and share experiences with a culture I probably would have never otherwise encountered was fantastic and humbling. I also really wanted to get on board a submarine (thank you, Tom Clancy!), and after my first two-month ride I was hooked! To this day I think they are the most amazing machines humans have ever built. Part of the path to Submarine Medicine was successful completion of the Navy Diver training, to this day the hardest thing I’ve ever done. Alone I would have never made it through that, but the Navy taught me that a team, once truly formed and bonded, can do literally anything. I still believe that and my Hospitalist team would (hopefully!) tell you that our major hurdles and issues over the years have been approached, worked through, and solved as a team.
I have a hundred other stories and adventures from that time in my life I could share…if you ever see me at a meeting or an event or a bar, I dare you to ask!
3. You were the president of the Kentucky Chapter of the American Academy of Pediatrics from 2015-2017. How did you get involved? What are the benefits to being involved with your state chapter of the AAP?
So I’m one of those nerds who love organized medicine! See my comments above about the Navy and teamwork and you’ll know I firmly believe that none of us is a smart as all of us. Pretty early on in my career I had the good fortune of having some good mentors in the AAP who got me involved in a couple small projects and CME planning. I loved the passion and enthusiasm from the AAP leaders I encountered and just kept showing up and raising my hand. Really, that’s truly all it takes in many organizations. Pretty early on, I was asked to run for Chapter Vice President—against one of my favorite Pediatricians and mentor! Of course, no one else in their right mind wanted to run against this beloved pillar of the pediatric community, but I saw the need for an actual election and I was thrilled to be completely trounced by him. But the experience opened my eyes to the scope of the AAP, the Chapter, and what pediatricians can do when they get together. And while I’ve seen many times what the national AAP can do for children and pediatricians, action and passion and dedication on the local level has always amazed me. I loved working with pediatricians across the state who had absolutely incredible dedication to their patients and their communities. I couldn’t believe the lengths these professionals went to in the name of helping kids, all while working full time, balancing life, etc. It was, again, an honor to serve them. Personally, the benefits were huge. I met hundreds of new people and places, made friends in every corner of Kentucky, and had great opportunities nationally with the AAP, from hearing national pediatric leaders speak on issues I didn’t even know were issues to standing in Rand Paul’s office talking to the Senator about Medicaid for kids. I’m still involved with the KY Chapter and am grateful for all it’s added to my career as a Pediatrician.
4. As one of the authors for a poster presentation “Extending the Overextended Resident: A New Role for Nurse Clinicians in the Academic Pediatric Inpatient Setting” in 2011 at Pediatric Educational Excellence Across the Continuum, what do you see as the role of nurse clinicians in the hospital? Has your view changed over the past 10 years?
Our Nurse Clinician program is one of those things that went from “a pretty good idea” in the beginning to “this is absolutely indispensable and how do we expand it!” a few years later. Our beloved nurses, as all would agree, are the heart of our hospitalist service. For those not familiar, they are not NPs, but rather bedside RNs with many years of experience in most cases who round with us every weekday, one per resident team. Residents rotate monthly, attendings rotate weekly, students rotate…well, whenever they rotate…but each Nurse Clinician sticks with their team, week after week, as the continuity and “team glue”. During rounds, they do a million things like enter orders as we discuss the care plan, prepare discharges, help educate families, and often go back after rounds to answer questions, confer and update the bedside nurses, care managers, and discharge planners, and a hundred other duties I’m forgetting. After rounds, they manage lab results that come back after patients are discharged, post-discharge phone calls to families, and another hundred duties. All this was to help off-load non-physician work from our busy residents and they certainly benefit and appreciate their efforts. I believe our Nurse Clinicians have won the resident-voted “Ancillary Staff of the Year” award three, maybe four times in the past decade. If your program needs some additional support and the skills of a Medical Assistant or Administrative Assistant aren’t quite enough, but an NP seems like overkill, call me. Have I got a plan for you!
5. You led the subcommittee that transitioned the Society of Hospital Medicine Pediatrics Committee to a Pediatric Special Interest Group. What is a SIG, and why should pediatric hospitalists get involved?
Again, organized medicine nerd here. Everything I loved and love about the AAP could be equally repeated about SHM. Great organization, great people, huge addition and enhancement to my career as a hospitalist. And again, it started by raising my hand. When I started getting involved with SHM, the focus of their pediatric efforts lived in the Pediatrics Committee, which was a great group I applied to be a part of and was accepted by the Board and another great mentor, Doug Carlson. But one of the problems with that structure was that it was a committee of 15-20 representing all of Pediatric Hospital Medicine to the massiveness of SHM. It just wasn’t enough. Family Medicine and Med-Peds were in a similar situation. So a few years ago, the SHM Board decided to change those Committees into Special Interest Groups. Some saw this as a “demotion” of these special constituencies out of the committee power structure, but I saw it as the exact opposite and exactly the right move. A SIG is huge! Or it can be, and should be. Instead of 15 or so pediatric hospitalists working on issues or projects, a SIG can tap into the entire community and get exponentially more people involved. So when Sandy Gage, the Chair of the Pediatrics Committee at the time, was looking for someone to lead the transition, I was all in. Well, that and the fact that I pretty much do whatever Sandy tells me to do… Anyway, the SIG allows any and all pediatric hospitalist SHM members get directly involved in pediatric issues, projects, concerns, or whatever. The SIG has an Executive Council which I’ve been honored to serve on for several years and that has a direct line to the Board. Great things can and have happened since the transition and so many hospitalists have been engaged, way more than would have ever happened with the committee structure. Any Pediatric Hospitalist looking for community involvement, educational planning, national exposure, etc. would do very well to join SHM, join the Pediatrics Special Interest Group, and just raise your hand when asked.
6. At the PHM Conference in 2016, you presented “Analysis of Pending Laboratory Tests after Discharge from a Pediatric Hospital.” What were your conclusions? How do you prevent pending labs from getting lost/not followed up?
This is one of those dreadful issues that you never even knew was an issue until badness happens. We order tons of lab tests and studies and most of them have a result that we act on before we discharge a patient. Most. But when you start looking at the volume of lab tests that can result after discharge, you find there are a ton! For example, every single blood culture for a patient who leaves before day five. And that’s just the tip of the iceberg. So we dug into this with the help of our awesome Nurse Clinicians mentioned above. They comb the discharge summary and the EMR at every discharge and keep a running log of all tests that are still pending at the time of discharge. Every single day, they run that list and look for results of everything not accounted for. This is a huge amount of effort, about 2000 lab results per year need to be followed, and around 20% are abnormal in some way. Of course, not all of them require action that changes the care plan, about 1% of all pending labs need an action by a Hospitalist (3-5% of the abnormal lab results), but that 1% can be pretty critical, especially when you’re seeing patients sent home on antibiotics and later we find a culture result resistant to that medication, or abnormal genetic testing, etc. So, yes, a lot of work, but important to have a program like this.
7. Many large academic conferences have already been canceled for this summer including PHM20. As a co-chair of the PHM20 Planning Committee, what do you see happening with conferences moving forward in the world of COVID-19? Further, some are being held remotely—what do you think will be the role of online platforms like Zoom or WebEx?
I have to be honest here and say that this STILL hurts. The PHM20 Planning Committee was beyond incredible, and my other co-Chairs, Erin Shaughnessy and Jeremy Yardley, are like siblings to me now. All of these folks put in a ton of work before converting to a virtual format and then an even GREATER amount of work and dedication and innovation after that decision was made. To not mention them would be an injustice to planning groups everywhere! Now, on to the actual question…
The drama aside, the upheaval aside, and having just said what I just said, I think this is actually a good thing. I totally miss in-person meetings and conferences. We all know that we get way more out of those events than just some new knowledge, or clinical pathway, or new research ideas and answers. We know the heart of these events is the collaboration, the networking, the reconnecting with friends and past associates, and the mix of the community we all belong to but rarely get to bask in. I really hope that comes back and I think it will. But there is something to be said for the virtual learning. Online platforms broaden the reach to those at home “manning the ship” so the rest of us can travel. And then there’s the cost of travel. I’ve loved going to the AAP NCE and SHM’s annual meeting and PHM and regional meetings and for crying out loud I’ve never even been to PAS because I’m at all these other things! There’s a limit to what you can do financially, schedule-wise, and with some regard to your loving family. I hope these online platforms continue and I believe they will now that we have all seen the benefits for what is a relatively low cost and infrastructure needs. I’m very proud to have been closely involved with one of the first wave of meetings that went this direction, as sad as it was, but we learned a ton and will continue to do so. I’d love to have several options going forward, but really do hope in-person stays one of those options for years to come, post-COVID-19.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I’m finding it hard to believe anyone is still reading, but God love you if you are. Call me sometime.
I’ve often said that I want this on my tombstone: “Here lies Jeff Grill, the luckiest man alive.” My personal good fortune (wife who supports my craziness, great kids, friends I can’t thank enough) aside, my professional good fortune has been amazing. Standing on the bridge of a submarine, sitting in the Senate Office Building, filming the intro to Virtual PHM20 with my heroes, leading a Hospitalist group in Louisville, on and on. You get it, I’m a lucky guy. But looking at all of those events, as I’ve already mentioned a couple times, they all started with raising my hand and saying, “sure, why not?” I wish every new pediatric hospitalist would do that, just one more time than they are comfortable doing or were going to do anyway. This community is incredible. It’s young (the community, not necessarily all the members...), it’s motivated by an idea that is larger than us, and it is doing important, fantastic work. I’m not special, by any measure, but I raised my hand a few times more than I was comfortable doing, and that has made all the difference.
This is a challenging issue, made more so by the wide range of opinions across the hospitalist community as well as the primary care community as to what “the best” communication really is. In a perfect world, we’d all love the time and flexibility to have lots of two-way communication between primary care and inpatient care, but we all know that’s not how it works in real life. Primary care physicians are super busy with packed schedules, charts and labs to review, a million interruptions and unexpected delays. Hospitalists are similarly busy as we all know with countless responsibilities and tasks to attend to. In my group, we used to call every primary care provider at discharge, but this led to many calls that just weren’t worth the interruption and time to either party. We all know what to expect at follow-up for a patient with bronchiolitis that got better as expected! So we asked our referring community and while we were sampling a diverse group of opinions, it seemed most accepted the idea of “call when it will help patient transition.” It’s a little easier for me, having had the experience, to ask, “Would I like to have had a call about this patient if I were the primary provider?”, but it’s still a useful question to ask by any Hospitalist. So I recommend calling provider-to-provider when it is helpful, complex, or will avoid a foreseeable problem, and work hard to get timely (same day!), meaningful discharge summaries into the right hands for every patient.
2. Prior to your residency training, you served for five years on active duty in the U.S. Navy, primarily as a Submarine and Diving Medical Officer in Japan. Tell us more about this time in your life.
People who know me well have the good sense to never ask this question…..ha! Don’t ever get an old sailor going telling sea stories….
But seriously, my time in the Navy was truly an honor and a privilege. Of course, my part in defending Freedom and Democracy was tiny, but to wear the uniform and serve an idea that large was a gift, and one I remember often even though now it seems like a hundred years ago. I went into the service like many, as a way to pay for medical school, but I was also hoping for some adventure and experiences I wouldn’t get anywhere else. I was certainly not disappointed! I hoped to serve overseas and Japan proved to be one of the most incredible places I’ve ever seen. To live and share experiences with a culture I probably would have never otherwise encountered was fantastic and humbling. I also really wanted to get on board a submarine (thank you, Tom Clancy!), and after my first two-month ride I was hooked! To this day I think they are the most amazing machines humans have ever built. Part of the path to Submarine Medicine was successful completion of the Navy Diver training, to this day the hardest thing I’ve ever done. Alone I would have never made it through that, but the Navy taught me that a team, once truly formed and bonded, can do literally anything. I still believe that and my Hospitalist team would (hopefully!) tell you that our major hurdles and issues over the years have been approached, worked through, and solved as a team.
I have a hundred other stories and adventures from that time in my life I could share…if you ever see me at a meeting or an event or a bar, I dare you to ask!
3. You were the president of the Kentucky Chapter of the American Academy of Pediatrics from 2015-2017. How did you get involved? What are the benefits to being involved with your state chapter of the AAP?
So I’m one of those nerds who love organized medicine! See my comments above about the Navy and teamwork and you’ll know I firmly believe that none of us is a smart as all of us. Pretty early on in my career I had the good fortune of having some good mentors in the AAP who got me involved in a couple small projects and CME planning. I loved the passion and enthusiasm from the AAP leaders I encountered and just kept showing up and raising my hand. Really, that’s truly all it takes in many organizations. Pretty early on, I was asked to run for Chapter Vice President—against one of my favorite Pediatricians and mentor! Of course, no one else in their right mind wanted to run against this beloved pillar of the pediatric community, but I saw the need for an actual election and I was thrilled to be completely trounced by him. But the experience opened my eyes to the scope of the AAP, the Chapter, and what pediatricians can do when they get together. And while I’ve seen many times what the national AAP can do for children and pediatricians, action and passion and dedication on the local level has always amazed me. I loved working with pediatricians across the state who had absolutely incredible dedication to their patients and their communities. I couldn’t believe the lengths these professionals went to in the name of helping kids, all while working full time, balancing life, etc. It was, again, an honor to serve them. Personally, the benefits were huge. I met hundreds of new people and places, made friends in every corner of Kentucky, and had great opportunities nationally with the AAP, from hearing national pediatric leaders speak on issues I didn’t even know were issues to standing in Rand Paul’s office talking to the Senator about Medicaid for kids. I’m still involved with the KY Chapter and am grateful for all it’s added to my career as a Pediatrician.
4. As one of the authors for a poster presentation “Extending the Overextended Resident: A New Role for Nurse Clinicians in the Academic Pediatric Inpatient Setting” in 2011 at Pediatric Educational Excellence Across the Continuum, what do you see as the role of nurse clinicians in the hospital? Has your view changed over the past 10 years?
Our Nurse Clinician program is one of those things that went from “a pretty good idea” in the beginning to “this is absolutely indispensable and how do we expand it!” a few years later. Our beloved nurses, as all would agree, are the heart of our hospitalist service. For those not familiar, they are not NPs, but rather bedside RNs with many years of experience in most cases who round with us every weekday, one per resident team. Residents rotate monthly, attendings rotate weekly, students rotate…well, whenever they rotate…but each Nurse Clinician sticks with their team, week after week, as the continuity and “team glue”. During rounds, they do a million things like enter orders as we discuss the care plan, prepare discharges, help educate families, and often go back after rounds to answer questions, confer and update the bedside nurses, care managers, and discharge planners, and a hundred other duties I’m forgetting. After rounds, they manage lab results that come back after patients are discharged, post-discharge phone calls to families, and another hundred duties. All this was to help off-load non-physician work from our busy residents and they certainly benefit and appreciate their efforts. I believe our Nurse Clinicians have won the resident-voted “Ancillary Staff of the Year” award three, maybe four times in the past decade. If your program needs some additional support and the skills of a Medical Assistant or Administrative Assistant aren’t quite enough, but an NP seems like overkill, call me. Have I got a plan for you!
5. You led the subcommittee that transitioned the Society of Hospital Medicine Pediatrics Committee to a Pediatric Special Interest Group. What is a SIG, and why should pediatric hospitalists get involved?
Again, organized medicine nerd here. Everything I loved and love about the AAP could be equally repeated about SHM. Great organization, great people, huge addition and enhancement to my career as a hospitalist. And again, it started by raising my hand. When I started getting involved with SHM, the focus of their pediatric efforts lived in the Pediatrics Committee, which was a great group I applied to be a part of and was accepted by the Board and another great mentor, Doug Carlson. But one of the problems with that structure was that it was a committee of 15-20 representing all of Pediatric Hospital Medicine to the massiveness of SHM. It just wasn’t enough. Family Medicine and Med-Peds were in a similar situation. So a few years ago, the SHM Board decided to change those Committees into Special Interest Groups. Some saw this as a “demotion” of these special constituencies out of the committee power structure, but I saw it as the exact opposite and exactly the right move. A SIG is huge! Or it can be, and should be. Instead of 15 or so pediatric hospitalists working on issues or projects, a SIG can tap into the entire community and get exponentially more people involved. So when Sandy Gage, the Chair of the Pediatrics Committee at the time, was looking for someone to lead the transition, I was all in. Well, that and the fact that I pretty much do whatever Sandy tells me to do… Anyway, the SIG allows any and all pediatric hospitalist SHM members get directly involved in pediatric issues, projects, concerns, or whatever. The SIG has an Executive Council which I’ve been honored to serve on for several years and that has a direct line to the Board. Great things can and have happened since the transition and so many hospitalists have been engaged, way more than would have ever happened with the committee structure. Any Pediatric Hospitalist looking for community involvement, educational planning, national exposure, etc. would do very well to join SHM, join the Pediatrics Special Interest Group, and just raise your hand when asked.
6. At the PHM Conference in 2016, you presented “Analysis of Pending Laboratory Tests after Discharge from a Pediatric Hospital.” What were your conclusions? How do you prevent pending labs from getting lost/not followed up?
This is one of those dreadful issues that you never even knew was an issue until badness happens. We order tons of lab tests and studies and most of them have a result that we act on before we discharge a patient. Most. But when you start looking at the volume of lab tests that can result after discharge, you find there are a ton! For example, every single blood culture for a patient who leaves before day five. And that’s just the tip of the iceberg. So we dug into this with the help of our awesome Nurse Clinicians mentioned above. They comb the discharge summary and the EMR at every discharge and keep a running log of all tests that are still pending at the time of discharge. Every single day, they run that list and look for results of everything not accounted for. This is a huge amount of effort, about 2000 lab results per year need to be followed, and around 20% are abnormal in some way. Of course, not all of them require action that changes the care plan, about 1% of all pending labs need an action by a Hospitalist (3-5% of the abnormal lab results), but that 1% can be pretty critical, especially when you’re seeing patients sent home on antibiotics and later we find a culture result resistant to that medication, or abnormal genetic testing, etc. So, yes, a lot of work, but important to have a program like this.
7. Many large academic conferences have already been canceled for this summer including PHM20. As a co-chair of the PHM20 Planning Committee, what do you see happening with conferences moving forward in the world of COVID-19? Further, some are being held remotely—what do you think will be the role of online platforms like Zoom or WebEx?
I have to be honest here and say that this STILL hurts. The PHM20 Planning Committee was beyond incredible, and my other co-Chairs, Erin Shaughnessy and Jeremy Yardley, are like siblings to me now. All of these folks put in a ton of work before converting to a virtual format and then an even GREATER amount of work and dedication and innovation after that decision was made. To not mention them would be an injustice to planning groups everywhere! Now, on to the actual question…
The drama aside, the upheaval aside, and having just said what I just said, I think this is actually a good thing. I totally miss in-person meetings and conferences. We all know that we get way more out of those events than just some new knowledge, or clinical pathway, or new research ideas and answers. We know the heart of these events is the collaboration, the networking, the reconnecting with friends and past associates, and the mix of the community we all belong to but rarely get to bask in. I really hope that comes back and I think it will. But there is something to be said for the virtual learning. Online platforms broaden the reach to those at home “manning the ship” so the rest of us can travel. And then there’s the cost of travel. I’ve loved going to the AAP NCE and SHM’s annual meeting and PHM and regional meetings and for crying out loud I’ve never even been to PAS because I’m at all these other things! There’s a limit to what you can do financially, schedule-wise, and with some regard to your loving family. I hope these online platforms continue and I believe they will now that we have all seen the benefits for what is a relatively low cost and infrastructure needs. I’m very proud to have been closely involved with one of the first wave of meetings that went this direction, as sad as it was, but we learned a ton and will continue to do so. I’d love to have several options going forward, but really do hope in-person stays one of those options for years to come, post-COVID-19.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I’m finding it hard to believe anyone is still reading, but God love you if you are. Call me sometime.
I’ve often said that I want this on my tombstone: “Here lies Jeff Grill, the luckiest man alive.” My personal good fortune (wife who supports my craziness, great kids, friends I can’t thank enough) aside, my professional good fortune has been amazing. Standing on the bridge of a submarine, sitting in the Senate Office Building, filming the intro to Virtual PHM20 with my heroes, leading a Hospitalist group in Louisville, on and on. You get it, I’m a lucky guy. But looking at all of those events, as I’ve already mentioned a couple times, they all started with raising my hand and saying, “sure, why not?” I wish every new pediatric hospitalist would do that, just one more time than they are comfortable doing or were going to do anyway. This community is incredible. It’s young (the community, not necessarily all the members...), it’s motivated by an idea that is larger than us, and it is doing important, fantastic work. I’m not special, by any measure, but I raised my hand a few times more than I was comfortable doing, and that has made all the difference.