Internal Medicine Residency News, August 24, 2015

Monday, August 24, 2015

From the Director

We had a great summer celebration on Friday night! Outstanding attendance by residents and faculty at a cool venue.  Thanks so much to Madi Smith for planning and Madi and Lynsey for helping out that night.  We even had a visit from some ‘legends’, including Aaron Mitchell and Brian Miller (Virkud :>). The class of 2014 had a mini-reunion this weekend (see photo) — #dukefamily!  Also in attendance was the newest member of the Duke family, Gabriel Bock.  Congratulations to Ashley and Chris. 

Did you miss noon conference this week?  Take a look onMedHub for the summaries of the rotation evaluations and faculty evaluations for 2014-15.  We use this information to work with the division chiefs and rotation directors to make the program better and to highlight best practices that can be incorporated into other rotations.  More details will follow at upcoming noon conferences.  Also – INTERNS – mark you calendars for SEPT 2 noon conference for a “hands-on” hand off seminar for interns, led by Transitions of Care Guru, Dr. Aubrey Jolly-Graham.  JARs and SARs, we will be having a “career planning” noon conference in room 2002 at the same time.  

Kudos this week to the VA CCU crew from Dr. Sunil Rao – Azalea Kim, Katie Qin and Bassem Matta for great work in a very sick unit, to Maggie Moses and Jennifer Kang from Brittany Dixon for being a great Gen Med team, to Kara Johnson/Wegermann for an excellent chair’s conference, to Bassem Matta and Andy Mumm from Lakshmi Krishnan for helping out with some ICU care at the VA, to John Musgrove, Winn Seay, Anubha Agarwal, Kavisha Singh, Vedran Oruc from Liz Gilbert and Ahmed Ali for caring for the Gen Med 12 patients overnight and to Marc Samsky from Lakshmi Krishnan for his support as ACR this month.  

Don’t forget to sign up for the 4th annual STEAD TREAD! Drag out those running shoes, and spend a morning getting a little exercise and helping out a great cause – the Lincoln COmmunity Health Center.  We also hope to see you at the SOCIAL ACTION COUNCIL meeting this week on Aug 26 at 6 pm!

This week’s pubmed from the program goes to Jessie Seidelman for her case report accepted to the American Journal of Medicine with co-authors Ziad Gellad, Rena Zuo and Krishna Udayakumar.  "Caught on Capsule: Iron-deficiency Anemia Due to Hookworm Infection” 

Have a great week

Aimee

What did I read this week?

Submitted by Dr. Sharon Rubin

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2015–16 Influenza Season

August 7, 2015 / 64(30);818-825

Lisa A. Grohskopf, MD1; Leslie Z. Sokolow, MSc, MPH1,2; Sonja J. Olsen, PhD1; Joseph S. Bresee, MD1; Karen R. Broder, MD3; Ruth A. Karron, MD4

Keeping with the theme of vaccines for the PEAC this month I chose the AICP recommendation for flu this 2015-2016 season. I know this seems early but the pharmacies are starting to offer flu vaccines and we need to be informed to counsel our patients correctly. AICP recommends any individual obtain the flu vaccine above the age of 6 months old and to obtain the vaccine by OCTOBER (which is why CVS is rolling this out now in August).

AICP addressed the common concern “I want to wait later in the season to get my flu vaccine.” Studies have shown there is a decline in immunity, but 6 MONTHS after the vaccine is given. “While delaying vaccination might permit greater immunity later in the season, deferral might result in missed opportunities to vaccinate, as well as difficulties in vaccinating a population within a more constrained time period. Vaccination programs should balance maximizing the likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza virus circulation begins.”

2015-2016 Influenza composition: hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus. This represents changes in the influenza A (H3N2) virus and the influenza B virus as compared with the 2014–15 season. Quadrivalent influenza vaccines will contain these vaccine viruses, and a B/Brisbane/60/2008-like (Victoria lineage) virus, which is the same Victoria lineage virus recommended for quadrivalent formulations (same as in 2013–14 and 2014–15).

AICP answered one of my patients questions: can a patient under the age of 65 get the quadrivalent flu vaccine (the answer is yes, see the table and indicated age) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm#Tab )

So many different types of flu vaccine (and the acronyms are hard to remember)

“Influenza vaccination should not be delayed to procure a specific vaccine preparation if an appropriate one is already available.”

Inactivated influenza vaccine, quadrivalent (IIV4), standard dose: for pt age >3 years Fluarix, FluLaval, Fluzone (still has egg)
Inactivated influenza vaccine, trivalent (IIV3), standard dose: Fluvirin L 4 years, Fluzodne > 6 months (egg)
Inactivated influenza vaccine, cell-culture-based (ccIIV3), standard dose (egg) Flucelax > 18 years

4.Inactivated influenza vaccine, trivalent (IIV3), high dose (egg) THIS is for the > 65 year old patients;  FLUZONE high dose (egg)

Recombinant influenza vaccine, trivalent (RIV3), standard dose (NO egg but need to search to find a pharmacy that has Flublock > 18 year old)
Live attenuated influenza vaccine, quadrivalent (LAIV4) Not for Egg allergy, not for pregnant women, immunosuppressed, FluMist quadrivalent 2-49 years, allergy to flu vaccine in past, person who have taken influenza antiviral medication in previous 48 hours, persons who care for severely immunosuppressed person should NOT receive vaccine or not be in contact with person 7 days after vaccine (could spread the live virus)

Ok we are all set to help our patients. First we need to help vaccinate ourselves. Make sure you have plans for flu vaccine on and after September 17, 2015 for the Flu Blitz!

 

QI CORNER

On behalf of “big” Duke GME Patient Safety and Quality Committee, it’s time to announce the metrics for the GME QI Incentive Program this year! The Incentive Program offers a financial incentive of $200 each for four metrics, to be paid on the last paycheck of the academic year. This means a bonus of up to $800! We have had great success in the past, but it takes a concerted effort from every single resident to achieve these metrics.

The metrics are the same as last year, although some targets are even more aggressive. Here they are:

1. Median ED consult time—target: 26½ minutes

The clock starts ticking when the ED physician places a consult to Internal Medicine, Cardiology, or MICU in Maestro. It stops when the hospitalist, ACR, or night-JAR on the 1010 pager, the JAR/SAR on the Cardiology consult pager, or the JAR on the MICU pager completes the consult. The target for this year is to improve last year’s mean consult time by 5%. That means we need to achieve an average consult time of 26½ minutes. As you may be thinking, this means that it is important to electronically close out the consult as soon as you have made a clinical decision and communicated it to the ED.

2. RL6 (a.k.a. SRS) reporting—target: 2 or more per resident

RL6 is our electronic safety event reporting system. As residents, we encounter potentially unsafe situations, near misses, and adverse events almost every day, and for this incentive metric, all we have to do is take the time to report them. This is good for everybody, because it allows for interdisciplinary communication about how to prevent the same situation in the future. RL6 reports are never punitive, and are always intended to examine and improve the system. So when you see something you wish could be better, enter an RL6 report!

3. Patient satisfaction score—target: % “always” >80%

Every patient we see in the inpatient or outpatient setting receives a survey after their encounter. Three of the questions pertain to the way we physicians communicate with patients:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This metric is graded on the percent of patients who answer “always” to those questions. As of June, we were performing below target, in the 70s%. Ways to improve our scores in this area include: (1) Encourage patients to fill out the survey! Response rate is very low, so responses are really not representative of overall patients’ experiences; (2) Sit down when you go in the room! Patients perceive that you stayed longer and listened more, even if you spent the same amount of time; (3) Use teach-teachback method for making sure patients understand what you’re saying.

4. 30-day same-hospital readmissions rate—target: <20%

Here’s another one we did not cash in on last year. We are currently in the mid-20s% for 30-day same-hospital readmissions. To improve, we need a major focus on discharge coordination, cost/availability of prescribed medications (call those pharmacies!), and timely discharge summaries with thorough communication and guidance to outpatient providers. I like to make sure my patients know how call me through the hospital operator if they have any questions or problems after discharge—sometimes you can prevent them coming back by putting some time and effort in over the phone. Also, don’t schedule those PCP follow-ups too soon—patients who are just a few days out from a hospitalization can still look below their baseline and risk being sent back.

Let’s start working toward these 4 metrics with our eye on the cash prize! Look forward to periodic updates from me on our progress throughout the year.

 

CLINIC CORNER

 

Submitted by:  Dr. Sonal Patel

Hi everyone,

I wanted to spend a minute and share some greetings and farewells with all of you in PRIME clinic. 

Greetings to:

Dr. Sophia Califano who will be joining the PRIME attending team.  She will be taking over for Dr. Karen Goldstein on team H.

Christina Winn who will be training for Carol’s replacement  as Carol’s retirement approaches.

Quinnton Holloway is working with us temporarily and will be helping in the waiting room welcoming patients, assisting with check-in and assisting with notifying patients of delays. 

Farewells to:

Madge McDonald who will be leaving PRIME clinic  to be closer to friends and family September 11th.

Beth Schnitker who will be leaving PRIME clinic to cross the Atlantic to live in Germany  September 17th  

Carol Rivenburgh who will be retiring in October. 

Renee Shopshire who has already moved to be closer to family.

Dr. Karen Goldstein who is pursuing research opportunities in Women’s health. 

Also for all of the positions that we are hiring for (RN, LPN, PA/NP)  please let me know if you know someone that would be a good fit for our PRIME family.  Looking forward to another great year of PRIME clinic where we all learn and grow together.

Regarding this upcoming year.

  • Please let your nurse know if you are falling behind in clinic so that the staff can alert your patients to the time delay.  This is a great practice just so patients can notified and expectations can be set about the time that they will be seen.
  • Please meet with your PRIME team (residents and attending) and alert your team when you are on busy rotations or away on vacation. 
  • Everyone should have PIV badge access to PRIME clinic, if yours is not working please stop by Police to get your badge activated to the “1D clinic”
  • Please obtain VA home access, if you are having trouble please let me know.

Enjoy getting to know our veterans and your clinical experience at the VA. 

Sonal Patel, MD

PRIME  Clinic Director

Durham VA Medical Center

 

From the Chief Residents

 

Grand Rounds

Friday, August 28- Endocrine, Dr. Jennifer Green

Noon Conference

Date Topic Lecturer Time Vendor
8/24/15 SAR Emergency Series: Oral Anticoagulants: Indications, Management, Complications

Andrea Sitlinger

12:00 Domino's
8/25/15 SAR Emergency Series: ETOH/Narcotic Withdrawal Management

Amy Newhouse

12:00 Chick-Fil-A
8/26/15 SAR Emergency Series: Rheumatologic Emergencies

Ryan Jessee

12:00/2002 Cosmic Cantina
8/27/15 SAR Emergency Series: Acute Liver Failure - Recognition & Management

Paul St. Romain

12:00 Firehouse Subs
8/28/15 Chair's Conference Chiefs 12:00 Nosh

From the Residency Office

 

Global Health-Internal Medicine Residency Program Recruiting Eligible Candidates

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply for the Duke Global Health Residency, an extended residency that leads to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site.

Please visit our website for an in-depth description of the core curriculum including rotations, global health competencies, and program requirements as well as application instructions:www.dukeglobalhealth.org

Watch current global health resident John Stanifer, MD, discuss his decision to pursue global health training at Duke:

https://youtu.be/mE5wdtqP3_s

Send all application materials electronically to sarah.brittingham@duke.edu.

Applications accepted on a rolling basis until October 1, 2015.  Offers will be made in November.

SCHWARTZ ROUNDS

Schwartz Center Rounds

Title:  "I'm Gonna Die Young Anyway So Why Bother"

Panelists:

Prithvi Mruthyunjaya, MD

Ocular Oncology and Vitreoretinal Surgery

Associate Professor of Ophthalmology and Radiation Oncology

Medical Director, Duke Eye Center

Director, Duke Center for Ophthalmic Oncology

Director, Medical Education

 

Renee Halberg, MSW, LCSW

Clinical Social Worker

Department Case Management, Duke Eye Center

Friday, August 28 , 2015,  Noon - 1 p.m., Duke North Lecture Hall 2001

About Schwartz Center Rounds:

All members of the Duke Medicine community are invited to attend an ongoing series of discussions called the Schwartz Center Rounds about the human side of patient care.  Schwartz Center Rounds is a monthly interdisciplinary conference that offers all of us from no matter which discipline as well as non-clinicians who work closely with our patients a regularly scheduled time....  We are excited to have brought this program here to Duke and hope many of you will be able to join us on a regular basis.

 

Please contact, Lynn Bowlby, MD (lynn.bowlby@duke.edu), Nathan Gray, MD (nathan.gray@dm.duke.edu) or Bill Taub (arthur.taub@dm.duke.edu) with questions. There is no need to RSVP, but we do recommend that you arrive early as food and seats are at a premium!

 

STEAD TREAD 2015!

Wanted to take a second to invite you all to come support the Stead Tread, the Kempner Stead Society's annual charity event, which benefits Lincoln. It was a blast this year, and since we're due for some good weather this year, I'm sure it will be even better this time around.

Some additional information:

Please access the Stead Tread 2015 website (http://www.steadtread.org) for additional information, to securely register ($25), or make a donation
Race date/time: Saturday, September 12th, 2015 at 10:00AM (registration from 8:45-9:45)
Race location: American Tobacco Trail, starting at Solite Park on Fayetteville Road in Durham (https://www.google.com/maps/place/Solite+Park/)
Race beneficiary: Lincoln Community Health Center (and all Lincoln patients walk/run for free)
Your $25 registration fee includes an official Stead Tread 2015 T-shirt – shirts are going fast, so register ASAP to reserve your size!
Participants are welcome to run or walk, and strollers are permitted - kids under 12 walk/run for free (but should be registered by their parent/guardian)
In case you cannot make the race this year, donations can be made securely through our website

Thank you for considering supporting the Stead Tread – we really hope to see you there this year. For any questions, please contact us through our website (http://www.steadtread.org), via e-mail at steadtread5K@gmail.com, or by replying directly to me (Matt Crowley, M.D. <matthew.crowley@dm.duke.edu>).

 

SARs

Please know there is an excellent opportunity to hone your interviewing skills.  Dr. Kathryn Pollak who is a communication coach and faculty member in the SoM will provide 4  1-hour sessions from which you can choose. In the session, Dr. Pollak will cover tips to finesse interviewing skills as well and give some a chance to role play.  She also will be available for practice for their interviews in September and October.

The four sessions will be held the following dates and times:

Tuesday, August 18th: 4:00 to 5:00pm

Wednesday, August 26th: 12:00 to 12:00pm

Thursday, August 27th: 4:00 to 5:00pm

Each session will be 10 people or less, that way it’s more personalized. Please let me know as soon as possible which session you would like to sign up for. This is a very valuable tool being offered!

 

Book Club

Every few months, the Department of Internal Medicine Book Club joins together residents, fellows, and attendings to discuss the humanistic side of medicine through reading.  Please join us for our first event of this academic year on Tuesday, September 8th from 5:30 - 7:30 pm in the Faculty Lounge! This time we're reading Changing the Culture of Academic Medicine by Linda Pololi, which tackles the changing roles of women and minorities in medicine and what ground is still left to cover. 

The best news:  all are welcome to attend, and thanks to help from the Program for Women in Internal Medicine and the Trent Memorial Foundation, this year books are free to ALL participants who RSVP (while supplies last)!   Food and drinks will be provided. 

For more questions or to RSVP, please email laura.caputo@duke.edu to reserve a spot now!  We're looking forward to seeing you all there!

Thank you!

Laura M. Caputo, MD

Hospital Medicine, Durham VA Medical Center

 

Upcoming Dates and Events

September 12 - Stead Tread

December 12 - DOM Holiday Party

 

Useful links

https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response

 

Opportunities

http://www.ad001.info/blasts/CKS/CKS15_05431/CKS15_05431.html