Dustin Monroe, MD, MBA

It’s Sepsis Awareness Month! Are you looking for peer inspiration to get started on improving Sepsis practices? Check out our 2023 Sepsis Honor Roll hospital journey posterboards, compiled in this Excellence in Practice Hospital Journey virtual booklet. https://hubs.ly/Q02MWxGn0 #SepsisAwarenessMonth

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Healio had the pleasure of speaking with Clyde Yancy, one of the most prominent KOLs in #cardiology, on a variety of topics at the American College of Physicians Internal Medicine Meeting. Check out a summary of what he told us below, at the bottom of which there are links to six videos that he shot with us. Northwestern University - The Feinberg School of Medicine The topics he discussed include: ❤️ Cardio-kidney-metabolic syndrome ❤️ Social determinants of health ❤️ The heart-related benefits of the newer weight-loss drugs ❤️ The promise of small interfering RNA technology in heart care ❤️ Using incidental calcification findings to assess heart disease risk ❤️ The benefits of following the American Heart Association's Life Essential 8 lifestyle parameters https://lnkd.in/egv_RtGp

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The Mobility S.T.E.P. (Safely Transitioning Every Patient) protocol integrates the ICU Liberation bundle and the BMAT 2.0 mobility assessment into one Nurse driven protocol. Early mobilization starts in the ICU, the 5 step protocol continues until patient is discharged! The protocol supports ICU aquired weakness prevention strategy!

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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"Implementation of DAX Copilot at Montefiore will Automate Documentation and Streamline Clinical Tasks, Giving Time Back to Clinicians and Enabling Them to Dedicate More Time to Patient Care."

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Do you want to see who knows what we need to do and what is most important to fix health care? Listen to Sue Veer addressing this Committee. Hear from those who have a heart for serving most Americans most behind and are willing to sacrifice to address the next generation always ignored - and then we wonder why outcomes get worse. She was discussing 340B in about them most balanced and informative way possible. She noted how the CHC used 340 B "supports health care services that would otherwise be unavailable in many of the communities that we serve... the one that is near and dear to my heart are those early childhood services that are otherwise unfunded because we are building the health of the future generation" - Early Childhood Services - Sue Veer - More than a Hero - A leader for our nation and absolutely on target with her heart and her service and her testimony $600,000 margin lost and 0.6 FTE of labor to comply with 340 B - loss of nearly $700,000 in delivery capacity for those most in need! Did you hear this Congress, CMS, and others how you cut the lifeblood and distract the delivery team members time and time again over the past 40 years of design changes. Stop killing hospitals, practices, and delivery team members where most Americans are most behind. Start paying attention to Sue Veer and many others like her who can teach you how your designs fail and how they can work - for future generations. You do not fun health care where needed. You have forced a patchwork. Please don't kill the patches and pieces before you actually implement a plan for sufficient basic health access for 95% of the nation, not just 50 - 60%. Listen to the heart of health care delivery. Listen to those that you must fully fund who are the only ones that can be most and best for most Americans most behind.

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How to Maximize Reactions Phase of Debriefing Healthcare Simulation https://lnkd.in/gvUmQtym

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I'm curious what health policy makers in Florida had in mind when they wrote recently approved legislation that allows OBs to perform #cesareans outside a hospital? Unlike most surgeries performed in ambulatory surgery centers, a C-section involves cutting into the uterus, which receives up to 1.5 liters of blood flow each minute. When hemorrhage occurs, hospital resources (embolization, blood, other clinicians) are needed immediately and there isn't time to transfer a patient to a real hospital. (Contrast that to a colonoscopy: if something goes wrong and the patient needs to be transferred to a hospital, they won't be happy but they won't be dead.) Excessive bleeding during C-section isn't super rare: I don't know an obstetrician who hasn't had to treat an unanticipated C-section hemorrhage at some point in their career. Florida already has a higher maternal mortality rate than most states, so this seems like a step in the wrong direction. Does anyone understand this?

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"How to Live Longer" - reflecting on a fascinating discussion about the future of healthcare at the #newyorkerfest between Dr. Atul Gawande and Dr. Dhruv Khullar: A few key insights worth sharing: 💡 The future of medicine isn't just about living longer—it's about living better. We're finally recognizing that healthcare should align with patients' life priorities and values, not just survival metrics. 🔍 While maximum lifespan remains stubborn (~120 years), we're getting better at helping more people reach their 80s and 90s with quality of life. Countries like Japan and Korea are leading the way with 85-year average life expectancies. 📊 The power of accessible healthcare is striking: Thailand reduced deaths before age 50 from 60% to just 35% in 20 years by building strong primary care infrastructure and deploying community health volunteers. That's the difference good healthcare systems can make. 🌡️ Climate change is emerging as a major health crisis. From heat-related illnesses to changing disease patterns, our healthcare systems need to adapt quickly. ⚖️ The biggest challenge ahead? Healthcare equity. When our top 1% live to 89 while others barely reach 72, we have work to do. Countries succeeding in this space prioritize accessible primary care and community health workers. One measure Dr. Gawande uses in his work at USAID is % of people dying under the age of 50. This is what this measure looks like in different parts of the world: - Japan 2% - Europe -5%  - USA - 10%  - Africa - 65% #Healthcare #FutureOfMedicine #PublicHealth #HealthEquity #ClimateHealth

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Bridging Gaps in Renal Care with the PAR Method #Renal care systems are failing patients, with fragmented care pathways that leave individuals to navigate the journey on their own. From late #CKD diagnoses to inadequate transitions into dialysis or transplants, these "gaps in care" result in preventable suffering and inequities. Kidney Watch Consulting is here to bridge those gaps with our PAR Method: Prevention, Access, Reform, an approach designed to build seamless, equitable care pathways. The gaps in renal care often begin with missed opportunities for prevention. Studies show that over 50% of patients crash into #dialysis, meaning they begin treatment without prior education or preparation. Early detection is vital, yet 90% of CKD cases remain undiagnosed until it's too late. These statistics reflect more than patient challenges—they’re failures of the system itself. When patients do seek care, access becomes the next obstacle. Rural populations, low-income families, and racial minorities face significant barriers to receiving timely nephrology referrals, home dialysis options, or transplant opportunities. Black patients, for example, make up 35% of dialysis patients but receive only 14% of kidney transplants. These disparities cannot be ignored if we hope to build an equitable healthcare system. Finally, care pathways often lack the reform necessary to align all stakeholders. Patients are frequently shuffled between specialists who don’t communicate, leaving them stuck in a fragmented system that delays treatment and increases costs. These inefficiencies disproportionately harm vulnerable communities and exacerbate healthcare inequities. The PAR Method is Kidney Watch Consulting’s solution to these systemic failures: 🌟 Prevention: Advocating for mandatory CKD screenings, community education campaigns, and early interventions to catch kidney disease in its earliest stages. ⚖️ Access: Developing equity-driven strategies that expand home dialysis, telemedicine, and transplant outreach to underserved communities. 🔄 Reform: Streamlining care pathways by fostering collaboration between nephrologists, primary care providers, and policymakers to create prevention-first systems. With PAR, we’re not just addressing the symptoms of a broken system—we’re fixing the root causes. By focusing on prevention, access, and reform, we can ensure patients receive the care they need without being lost in the chaos of whiplash care models. Why It Matters Gaps in care aren’t just inefficiencies—they’re life-threatening failures. Patients deserve a system that works for them, not against them. At Kidney Watch Consulting, we are committed to building collaborative, prevention-first systems that eliminate disparities and create a pathway to equitable renal care for all. #RenalCareReform #PreventionAccessReform #KidneyHealthEquity #EndDialysisCrashes #KidneyWatchImpact

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The U.S. healthcare system, once a beacon of innovation, is collapsing under its own weight, failing both patients and providers. Americans pay nearly double what citizens of other developed nations do for healthcare, yet rank last among wealthy countries in access, equity, and outcomes. Over 46% of U.S. adults struggle to afford care, and medical debt affects more than 20 million people, often leading to bankruptcy. Meanwhile, administrative costs account for 25% of healthcare spending—far higher than any other country—forcing physicians to spend nearly two hours on paperwork for every hour of patient care. I won’t even begin to speak about the exponential growth of the corporate and C- Suite component of medicine. Programs like Medicare Advantage highlight the system’s dysfunction. Marketed as affordable, these privatized plans restrict access to care with narrow networks and preauthorization hurdles. Insurers exploit inflated risk scores to collect billions in overpayments from taxpayers, prioritizing profits over patient outcomes. For physicians, burnout rates exceed 50%, with many leaving the profession entirely due to relentless administrative burdens, shrinking autonomy, and moral injury from being unable to provide the care their patients need. This system isunsustainable. Patients are sicker, poorer, and underserved, while healthcare workers are demoralized and overworked. Without reform to reduce administrative waste, improve access, and refocus on care quality over profit, the U.S. healthcare system risks collapse—leaving millions without the care they deserve.

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Amazing insights on #womenshealth and focused ultrasound! Did you know 70-80% of women will have #fibroids The Fibroid Foundation and yet few know that non-invasive technology exists to shrink and treat them AND can go right back to work the next day? It also is used in treating #cancer and many conditions differently, disproportionately and/or solely impact the #health of #women. Some 170+ applications for women and men - this is the current and future of medicine! Society for Women's Health Research (SWHR) Women's Health Access Matters Women's Digital Health Network Medical Imaging for Biomedical Professionals, A technical training Black Women's Health Imperative HealthyWomen Hispanic Professional Women’s Association Alliance for Women's Health & Prevention

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Very important points about hospital consolidation. ⏺ Has led to the majority of physicians now being employed by a system. ⏺ A hospital system may have different priorities than physicians (in private practice). ⏺A system in which physicians have very little leverage to negotiate or change factors important to patients and clinical care. The real reason highlighted around 2 minutes 50 seconds. Short interview with beneficial insight. ⏺Physicians have joined unions not for wage negotiation but to focus on changes that affect clinical care. We as physicians do not have a unified voice. We have not organized ourselves well to create a unified voice. I am not sure that a union is the right path, but uniting to have a common voice, leverage, and negotiation power is needed. At 9 minutes Kevin Schulman highlights how this could be done without creation of a union (we need a system clinical strategy, not a market strategy) based on thoughts by @atul gawande. #UsingWhatWeHaveBetter https://lnkd.in/g5YTjFbD

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In this piece I’m quoted about multiple aspects of #COVID19, especially its manageability in the current era https://lnkd.in/gA_eKahH

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This is from Becker's Healthcare. It shows how many MD/DO's and the highest caseloads in each. If I were running a Locums firm, I would find the highest number of patients per Physician and then look for the fewest number of active Doctors.... this means supply/demand in the coming years. Then, target those specialties knowing that the likelihood of you being able to place that specialty is higher, on average. Simply put....plan and create your own supply of hard to find MD's then have your BD team "sell them to facilities"...surprisingly, not many Locums firms are doing this. They wait for the client to tell them what they need....only. Not a good sales strategy... https://lnkd.in/gg63Ns7s

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🌟 **Improving Blood Transfusion Practices in NICUs! 🌟** New research reveals that while many very low birth weight (VLBW) infants in the NICU often need blood transfusions, current practices may vary widely and can sometimes be harmful. Studies show that a significant number of preterm babies receive red blood cells, platelets, and plasma during their NICU stay, often as a precaution rather than in response to active bleeding. 🚼 Key Points: - **High Incidence**: In infants <27 weeks gestation, 70% receive RBCs, 34% platelets, and 24% plasma. - **Emerging Concerns**: Evidence suggests some practices, like platelet transfusions, could be harmful. - **Prophylactic Approach**: Most transfusions are given based on blood count values rather than active bleeding. A modified Delphi method was used to develop new, evidence-based transfusion guidelines across a 19-hospital neonatal network. The aim? To optimize patient outcomes and minimize unnecessary risks. 🔬 **Highlights**: - **Lower Platelet Thresholds**: Studies suggest transfusing at lower thresholds (~25,000/μL) reduces risks. - **RBC Transfusions**: Liberal vs. restrictive thresholds show no significant difference in many outcomes, supporting restrictive thresholds. - **Plasma Transfusions**: Often used without clear benefit, with emerging evidence suggesting potential harm. The new guidelines focus on more restrictive transfusion thresholds and continuous evaluation of practices to ensure the best care for our tiniest patients. If you're interested in more details, here is the article: https://lnkd.in/ehZKgGw6 #NICU #BloodTransfusion #NeonatalCare #HealthcareInnovation #PatientSafety

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Dear fellow family medicine doctors: If you want to know how statins really affect your patients you have to learn to read between the lines. I just had to take a test on a statin research paper to keep my board certification. The paper is called “Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease” [link below] and it’s a great example of the kind of unethical data presentation I see all too often. The study compares the effects of two levels of statin drug dosages. One called “high intensity” meaning patients got maximum doses of their statin (20 of Crestor or 40 of lovastatin), and one called “treat to target” meaning people were given the amount of statin required to get their LDL between 50 and 70 mg/dl. People in the treat-to-target group generally took lower doses of statins and their LDL levels were a little higher. People in the high-intensity group generally took higher doses and had slightly lower LDL levels. What did that slight difference in LDL do to their health? The people with lower LDL levels (in the “high intensity” statin group) did worse. They died significantly more often than the people with higher LDL levels in the less aggressive treatment group. This difference had a p-value of <0.001 meaning it was statistically significant. This suggests having a lower LDL is WORSE than having a higher LDL. It also suggests more drug equals more death. So how do they report this finding that goes counter to everything we hear about how dangerous cholesterol is and how safe statin drugs are? The study authors don’t tell you what I just told you. They don’t want you to know the truth. So they use doublespeak. They say the “treating to target strategy is “noninferior” to treating with “high intensity” statin doses.” They spin a negative into a neutral. That’s fraud. But unless you have your cynical hat on, you will be fooled. This is just one example of how doctors get fooled. I’ve covered others in previous posts, most notably here: However, a much bigger fraud centers on the very notion that saturated fat is bad for us. I just spent 4 years writing a book called Dark Calories, which I hope will open eyes to how a medical organization pulled off the deadliest deception ever perpetrated on humanity. JAMA article here: https://lnkd.in/eE7Wz7mP To learn about Dark Calories visit https://lnkd.in/eRnWG-q7 #cholesterol #preventativemedicine #familymedicine #hearthealth #statins Ken Berry, MD Jeffry Gerber, MD, FAAFP The Florida Academy of Family Physicians (FAFP) Laurence Bauer Joseph Scherger

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