Apparently unpopular view:

A decrease in hospital stay from 15 days to 10 days from Remdesivir is a VERY meaningful outcome and benefit.
Hospital bed capacity (or more accurately nurse/RT capacity) is limited. A decrease in the LOS and recovery time translates directly into increased capacity.

100 nurse days/15 days per patient = capacity to care for 6.6 patients

100 nurse days/10 days = 10 patients

>50% ⬆️
We know that as hospital systems get overwhelmed, excess, unnecessary mortality increases: from COVID patients who can’t get admitted because they aren’t “sick enough,” inadequate care in the hospital and for all the other patients who can’t access care.…
It’s not cheap at ~$3K for a course, but what is the alternative? Beds can magically appear but nurses can’t.…
What is the cost of 5 extra days of hospitalization?

Cost of a tent hospital?

Cost of shutdowns to flatten the curve?

Cost of lives lost due to excess mortality?

I haven’t done analysis but wouldn’t be so glib about it this. It’s not just (tami)flu.

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More from @amychomd

6 Oct
Lots of folks say “you must be brave” when they find out I work in the ER.

It’s true that I don’t (usually) get upset at the sight of blood. But there are plenty of things that scare me.

A non-exhaustive list of things this emergency physician is afraid of:

Because I’ve seen a child choke on a hot dog or grape that wasn’t cut lengthwise.
Door slamming

Because I’ve had to repair way too many fingertip amputations in little kids.
Read 20 tweets
9 Aug
As teachers go back to school, I think it's important that they learn from what we have learned in hospitals. I will share some things and hope others chime in with their best tips.

#MedTwitter #NurseTwitter #teachertwitter
First of all, if folks have any potential symptoms, they need to get tested and STAY HOME.

Common symptoms:
*Shortness of breath
*Sore throat
*Muscle aches
*Loss of taste/smell
*Nausea, vomiting, diarrhea…
Unfortunately, though, we cannot effectively screen out all of those with active infections because some don't get severe symptoms.

Some folks who are infected are:
*Minimally symptomatic

However, we believe they can still spread infection.
Read 23 tweets
17 Mar
(Author unknown)

This post is for my healthcare workers, docs, surgeons, Nurses, aids, and ems, but also support staff.

There is no emergency in a pandemic
You as a healthcare worker are a force multiplier. Your training and experience is invaluable moving into this crisis. So, you're going to be faced with some very difficult moments. You're going to have to put your needs first.
I'm speaking specifically about PPE and your safety
If you're an ICU nurse, or an ICU doc, and you become infected, not only are you out of the game for potentially weeks (or killed) But your replacements could be people without your expertise.
Read 13 tweets
13 Feb
“But in taking their cause to politicians, doctors have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with lobbyists who are merely hired guns.”

Thanks @NPR for the encouragement to keep going! Sometimes democracy does actually work. Sometimes citizens meeting with their legislators & explaining #EMTALA and the unintended consequences of certain policies to our safety net and emergency care system works.
It’s definitely not a “stealth campaign” though! One of our meetings with an aide was standing in the hall today 😂. We’ve published, done podcasts and tweeted ad nauseam since no journalists seem to care about the details or anything but lurid headlines.
Read 13 tweets
22 Dec 19
Not true @ezraklein. Doctors are not the enemy to “fight.” We aren’t a “problem.” And patients trust us because we devote 7+ years to rigorous, exhausting training and we actually take care of them. We provide invaluable services. Unlike their insurance company.
Uwe Reinhardt wrote: “If we...cut that take-home pay [of all physicians] by, say, 20%, we would reduce total national health spending by only 2% in return for a wholly demoralized medical profession to which we so often look to save our lives.”…
Uwe Reinhardt: Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.”
Read 7 tweets
10 Dec 19
I read it. It sounded familiar - like it was ghostwritten by one of the lobby groups I’ve come to know quite well. The ones that take advantage of poor understanding of the financing and business of healthcare...and EMTALA. I’ll share some different data. 1/n
I work in MN, the state with the lowest rate of OON billing. My independent practice (50years old) doesn’t balance bill charges to the <2% OON patients we see. Yet we expect the benchmark you advocate for to drive us out of business.…
A little tutorial on how private practice docs are paid:We don’t get a salary like docs in academia.We aren’t paid by hospital. Our pay is based on reimbursement - what the government/insurers/patients pay us. No patients, no pay. No paying patients, no pay.
Read 25 tweets

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