Kris Rehm
1. One of your papers, “Hospitalization for Suicide Ideation or Attempt: 2008–2015,” was published in Pediatrics in May 2018. Over the study period, the proportion of emergency room and hospital encounters for suicide-related diagnoses almost tripled. While many hospitalists care for these children while they are medically stabilized or while waiting for an inpatient psychiatric bed, it often seems like little is done to impact the patient during that time. How can we as pediatric hospitalists have an impact on the startling statistics shown in the study?
Thank you for mentioning this paper, and the important work that Greg Plemmons led our group to discover. We had noticed a large swing in patients awaiting transfer to inpatient treatment facilities, with a lull in the summer and other times of school holiday. This led us to compare our experiences with other Children’s Hospitals and the results were staggering. It is a struggle for us in acute care children’s hospitals across the US to provide both safe as well as therapeutic settings for these children and we are constantly evaluating what we can do to impact their well-being while here with us in Nashville. We have begun considering ways to implement trauma informed care, using Mental Health Specialists in lieu of sitters, applying behavioral modification techniques when able and trying to keep children safe while in our setting. It’s important to remember that most of our facilities are not licensed mental health care settings, and thus what we can do is limited but incredibly important in helping children.
I do think that we as a society need to have more impact in the outpatient setting, and we need to advocate keeping kids safe at school and while using electronics. We have to serve as advocates for children, and writing this paper was one step that we thought we could call attention to the growing needs of children today.
2. As a runner, you have competed at Ohio University, were named the Ohio runner of the year, and finished second overall in the 2013 Nashville Women’s Half Marathon. Why is running so important to you and how does it impact your career as a hospitalist?
Running has been therapeutic for me, and is a HUGE part of who I am! I started running in middle school and I really haven’t stopped. It helps me relax and connect with friends—many of whom are female physicians as well----it’s my fitness time and my social time super early every morning! I would encourage all of you to do something that is physically challenging every single day! For a long time in my early 30’s, I ran just a few miles a day to stay somewhat fit, but as I entered my 40’s, I started to compete again and to race for a local running store--Nashville Running Company. This challenges me to try new races and push myself a bit more again now that my children are a little older, and I can honestly say that so many of life’s lessons for me were learned as part of a team----leading the team on rounds is similar to leading my track team in daily warm ups or races!
3. You are the prior head of the Division of Hospital Medicine at Vanderbilt University School of Medicine. How do all of the new national developments in pediatric hospital medicine in the last year change the direction for the section?
Yes, I led the Division of Hospital Medicine from 2009-2018, and now Dr Derek Williams is in charge!I’m so excited to see where the Division will go over the next few years!Derek is an accomplished academic hospitalist, and I believe that with his leadership we will develop a nationally recognized hospital medicine fellowship and will grow the academic arm of our incredible group!
4. As first author on the paper “Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study,” you found that twenty-five percent of hospitalized children reported a post-discharge issue, including difficulty obtaining follow-up appointments and difficulty filling prescriptions. What can or should we be doing in the hospital to mitigate this?
This paper, in collaboration with Boston Children’s Hospital, the University of North Carolina, and the University of Colorado was important to help us recognize that we have a lot of work to do to improve the discharge process. We were able to show that using a variety of methods to contact families, all 4 institutions had similar results---our families have difficulties when they leave our facilities—most often with prescriptions and follow up appointments. The more we can do to help smooth the processes the better it will be for families. Who else should lead the way in this important work? Hospital medicine teams!
5. You were a co-author of the Pediatric Medicine Core Competencies, which emphasizes training learners in leadership, communication, quality improvement, patient safety, and cost-effective care. With increasing administrative duties and limited face-time with learners, how best can these subjects be passed on effectively to learners?
I do believe that there is most certainly an art and a science in teaching our learners to have life long careers in Hospital Medicine. The core competencies highlight some very important factors like leadership, communication, QI, patient safety and cost-effective care and through modeling and discussion on rounds all of these can be taught to our learners today. At Vanderbilt, I feel like this is the way that we practice every single day---I think the greatest gift in my career has been to be able to model efficient team work because we all win! Our patients win, our learners win---when we can be at our best as a team—I hope that the students and residents that I have worked with can say that all of these factors are touched upon every time we round!
6. In January, you were named the vice chair of Outreach Activities at Vanderbilt. Why do you think it’s important for hospitalists to apply for leadership roles among their institution? What biases have you encountered as a pediatric hospitalist in a leadership position and how do you overcome these?
I truly believe that Pediatric Hospitalists are in prime positions for leadership roles in their Departments, Schools of Medicine and Hospitals. We are so in tune with the Educational, Clinical, Operational, and Quality endeavors in our institutions, and with that expertise we can lead our institutions in any arena. I would encourage us to consider additional training opportunities in leadership at PHM in July, or with the SHM Leadership course in Vancouver in October as well as the APA Scholars programs. But my best advice is to consider any opportunities that come your way in regards to leadership. Often, we think we should have a plan to pursue a career in a particular domain, but I believe most successful leaders would say that an interesting opportunity presented itself and he or she went for it. Don’t be afraid to put yourself out on a limb---you will continue to open more doors for a lifetime of success.
7. You have 2 sets of twin boys, which is impressive and intimidating to many of us. How do you juggle everything in your work and personal life?
You know what, life is full of ups and downs—of feeling more and less “balanced” and at the end of the day, I try to say, “did I make the most of today?” Was the time I spent at work and at home as efficient and as effective as I would like? It all evens out in the end—some days I have to work a long shift and some other days I sneak out early to watch soccer or eat lunch at school with my boys----my time with them is so important to me that I have to block it out on my calendar---no one knows exactly where I should be anytime---my husband and my calendars have invites to dinner or teacher conferences or shifts in the Hospital so that we can stay on the same page! Just take time to do the things that matter most---having gone through my own health care journeys about 5 years ago helped me see that I don’t want to put off living once things calm down at home or work. It’s important to live today.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
To be honest, you have captured my thoughts as a Pediatric Hospitalist and as a working mother of 4 so nicely in your questions.I am so grateful for the opportunities I have had to explore Hospital Medicine, and I can’t wait to see where the next few years take us---Board Certification, subspecialty status, so much exciting adventures on the horizon. Always be true to yourself and keep your options open---sometimes it may not seem to be the perfect time, but when an opportunity is there don’t be afraid to give it a try.
Thank you for mentioning this paper, and the important work that Greg Plemmons led our group to discover. We had noticed a large swing in patients awaiting transfer to inpatient treatment facilities, with a lull in the summer and other times of school holiday. This led us to compare our experiences with other Children’s Hospitals and the results were staggering. It is a struggle for us in acute care children’s hospitals across the US to provide both safe as well as therapeutic settings for these children and we are constantly evaluating what we can do to impact their well-being while here with us in Nashville. We have begun considering ways to implement trauma informed care, using Mental Health Specialists in lieu of sitters, applying behavioral modification techniques when able and trying to keep children safe while in our setting. It’s important to remember that most of our facilities are not licensed mental health care settings, and thus what we can do is limited but incredibly important in helping children.
I do think that we as a society need to have more impact in the outpatient setting, and we need to advocate keeping kids safe at school and while using electronics. We have to serve as advocates for children, and writing this paper was one step that we thought we could call attention to the growing needs of children today.
2. As a runner, you have competed at Ohio University, were named the Ohio runner of the year, and finished second overall in the 2013 Nashville Women’s Half Marathon. Why is running so important to you and how does it impact your career as a hospitalist?
Running has been therapeutic for me, and is a HUGE part of who I am! I started running in middle school and I really haven’t stopped. It helps me relax and connect with friends—many of whom are female physicians as well----it’s my fitness time and my social time super early every morning! I would encourage all of you to do something that is physically challenging every single day! For a long time in my early 30’s, I ran just a few miles a day to stay somewhat fit, but as I entered my 40’s, I started to compete again and to race for a local running store--Nashville Running Company. This challenges me to try new races and push myself a bit more again now that my children are a little older, and I can honestly say that so many of life’s lessons for me were learned as part of a team----leading the team on rounds is similar to leading my track team in daily warm ups or races!
3. You are the prior head of the Division of Hospital Medicine at Vanderbilt University School of Medicine. How do all of the new national developments in pediatric hospital medicine in the last year change the direction for the section?
Yes, I led the Division of Hospital Medicine from 2009-2018, and now Dr Derek Williams is in charge!I’m so excited to see where the Division will go over the next few years!Derek is an accomplished academic hospitalist, and I believe that with his leadership we will develop a nationally recognized hospital medicine fellowship and will grow the academic arm of our incredible group!
4. As first author on the paper “Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study,” you found that twenty-five percent of hospitalized children reported a post-discharge issue, including difficulty obtaining follow-up appointments and difficulty filling prescriptions. What can or should we be doing in the hospital to mitigate this?
This paper, in collaboration with Boston Children’s Hospital, the University of North Carolina, and the University of Colorado was important to help us recognize that we have a lot of work to do to improve the discharge process. We were able to show that using a variety of methods to contact families, all 4 institutions had similar results---our families have difficulties when they leave our facilities—most often with prescriptions and follow up appointments. The more we can do to help smooth the processes the better it will be for families. Who else should lead the way in this important work? Hospital medicine teams!
5. You were a co-author of the Pediatric Medicine Core Competencies, which emphasizes training learners in leadership, communication, quality improvement, patient safety, and cost-effective care. With increasing administrative duties and limited face-time with learners, how best can these subjects be passed on effectively to learners?
I do believe that there is most certainly an art and a science in teaching our learners to have life long careers in Hospital Medicine. The core competencies highlight some very important factors like leadership, communication, QI, patient safety and cost-effective care and through modeling and discussion on rounds all of these can be taught to our learners today. At Vanderbilt, I feel like this is the way that we practice every single day---I think the greatest gift in my career has been to be able to model efficient team work because we all win! Our patients win, our learners win---when we can be at our best as a team—I hope that the students and residents that I have worked with can say that all of these factors are touched upon every time we round!
6. In January, you were named the vice chair of Outreach Activities at Vanderbilt. Why do you think it’s important for hospitalists to apply for leadership roles among their institution? What biases have you encountered as a pediatric hospitalist in a leadership position and how do you overcome these?
I truly believe that Pediatric Hospitalists are in prime positions for leadership roles in their Departments, Schools of Medicine and Hospitals. We are so in tune with the Educational, Clinical, Operational, and Quality endeavors in our institutions, and with that expertise we can lead our institutions in any arena. I would encourage us to consider additional training opportunities in leadership at PHM in July, or with the SHM Leadership course in Vancouver in October as well as the APA Scholars programs. But my best advice is to consider any opportunities that come your way in regards to leadership. Often, we think we should have a plan to pursue a career in a particular domain, but I believe most successful leaders would say that an interesting opportunity presented itself and he or she went for it. Don’t be afraid to put yourself out on a limb---you will continue to open more doors for a lifetime of success.
7. You have 2 sets of twin boys, which is impressive and intimidating to many of us. How do you juggle everything in your work and personal life?
You know what, life is full of ups and downs—of feeling more and less “balanced” and at the end of the day, I try to say, “did I make the most of today?” Was the time I spent at work and at home as efficient and as effective as I would like? It all evens out in the end—some days I have to work a long shift and some other days I sneak out early to watch soccer or eat lunch at school with my boys----my time with them is so important to me that I have to block it out on my calendar---no one knows exactly where I should be anytime---my husband and my calendars have invites to dinner or teacher conferences or shifts in the Hospital so that we can stay on the same page! Just take time to do the things that matter most---having gone through my own health care journeys about 5 years ago helped me see that I don’t want to put off living once things calm down at home or work. It’s important to live today.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
To be honest, you have captured my thoughts as a Pediatric Hospitalist and as a working mother of 4 so nicely in your questions.I am so grateful for the opportunities I have had to explore Hospital Medicine, and I can’t wait to see where the next few years take us---Board Certification, subspecialty status, so much exciting adventures on the horizon. Always be true to yourself and keep your options open---sometimes it may not seem to be the perfect time, but when an opportunity is there don’t be afraid to give it a try.