From the Director
![DUKE.RESEARCH.NIGHT.03 (1)](http://news.medicine.duke.edu/wp-content/uploads/2013/06/DUKE.RESEARCH.NIGHT_.03-1.jpg)
VA Jets Recruit Early!
![Hostler](http://news.medicine.duke.edu/wp-content/uploads/2014/01/Hostler.jpeg)
What Did I Read This Week?
"Submitted by Krish Patel, MD."
Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of a Resident Handoff Bundle. JAMA.2013;310(21):2262-2270. Dec 4 2013 [/box]
Why I read this: It’s been really amazing to reflect on the increasing awareness and focus on quality improvement that has taken place in the program since my intern year. Through the tremendous efforts of our program leadership and Jon Bae’s undying enthusiasm (yes Jon I promise I did all my QI modules!!!) thinking about and finding opportunities for QI has really become an integral aspect of our day-to-day experiences. Handoffs are a great example of such a QI opportunity. As work hour changes have shaped changes in our care models, we have all been increasingly aware that the numbers of patient handoffs and potential adverse events related to handoffs have increased. The AHRQ (Agency for Healthcare Research and Quality) and ACGME have both identified improving handoffs as an important national effort and the ACGME now requires residency programs to provide formal handoff instruction. This issue of improving handoffs is not unique to our program and as we navigate the challenges posed by increasing numbers of handoffs I’ve been wondering what other institutions have been doing to meet the challenge. To date, there have been a number of different strategies assessed in the literature to improve handoff processes but the data from prior studies have been mixed and ultimately the impact of these strategies on actual patient outcomes is at best unclear. This study was recently published in JAMA and is a bit more robust in terms of study design and outcomes reported than some of the![Krish Patel, MD](http://news.medicine.duke.edu/wp-content/uploads/2013/08/KRISH.PATEL_.1.jpg)
![K Patel WDIRTW](http://news.medicine.duke.edu/wp-content/uploads/2014/01/K-Patel-WDIRTW.png)
QI Corner (submitted by Joel Boggan)
![boggan_1](http://news.medicine.duke.edu/wp-content/uploads/2013/08/boggan_1.jpg)
From the Chief Residents
SAR Talks
SAR Talks: January 30, 2014 Tyler Black and Jodel GiraudGrand Rounds
January 31, 2013: Dr Craig Brater – Visiting Professor Topic: Diuretic ResistanceNoon Conference
Date | Topic | Lecturer | Time | Vendor |
1/27 | MKSAP Mondays | 12:00 | Pita Pit | |
1/28 | MED PEDS SAR TALK (Balasubramanian/Sudan) | 12:00 | Chick-Fil-A | |
1/29 | IM-EM Combined QI Patient Safety Noon Conference | Cheely | 12:00 | Cosmic Cantina |
1/30 | SAR talks | Tyler Black / Jodel Giraud | 12:00 | Sushi |
1/31 | Research Conference | 12:00 | Panera |
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From the Residency Office
SAR Class Pictures
Please mark your calendars for Friday, February 14th immediately after Grand Rounds. The group picture will be taken at 9:15am in the Duke Cancer Institute healing path (the lobby). Thankful to capture such a remarkable class!! ErinAttendance At DoM Grand Rounds
As you may have noticed, there are changes underway as to how we record attendance at DoM Grand Rounds. For the past 4 yrs we have captured attendance with a bar code scanner. The data that we capture is uploaded to MedHub, and for faculty who wish to have CME credit, is uploaded to the CME office database. Effective February 1, 2014, this system is being replaced with a new record keeping system called Ethos. Internal Medicine will be using this new system to track residents’ attendance at Medicine Grand Rounds. In addition, other services will also be using Ethos to track conference attendance, so it is very important that you take the time to register, per the instructions below, ASAP. We will continue to use the card scanning method for Noon Conferences for the immediate future. Many thanks in advance for taking the time to register for this new system at your earliest convenience! How to register with Ethos- Go to the Duke Continuing Medical Education home page.
- In the upper right corner, click Join. The Account Information page opens.
- Complete the fields on the screen. A field with an asterisk is required.
- NOTE: Please make sure you include your Duke Unique ID – even though it does not show as a required field.
- Be sure to include your mobile phone number; you will use this number to send a text message with a code supplied at each event and get credit for CME events you attend.
- At the bottom of the account information form, click Create New Account. A green feedback message near the top of the screen informs you that a confirmation has been sent to the email address you provided.
- Open the email (from dcri.cme@dm.duke.edu) and click the top link in the body of the message.
- In your browser window, enter a password of your choice in both fields and note your user name. Click Save at the bottom of the page.
- In the same window, click the Mobile settings tab in the gray menu bar at the top of the page. If you entered your mobile number when you registered, it should appear on this page. Click confirm number. You will receive a text message to that mobile number with a confirmation code from DCRI CME.
- Enter the confirmation code in the box in your browser window and click Confirm Number. A message will appear below your number saying “Your number has been confirmed.”
- Now when you attend an event for CME credit you can use your registered mobile phone to text the provided event codes and earn CME credit.
- The 6-character SMS code will be provided on a slide during your CME event.
- Begin a new text message on your registered mobile phone. Note: The provided code is only good for eight hours. You must text the code the day you attend Medicine Grand Rounds.
- In the To field, enter the Duke CME phone number: 919-213-8033. Tip: Add this number to your mobile phone contacts.
- In the message area, type the 6-character SMS code that was provided during the session (note: this code is not case sensitive).
- Press send.
- If you have set up your Ethos account, you will receive the successful confirmation text message, “Your attendance has been recorded for “[Name of Session].”
- Log into Ethos by visiting the Duke Continuing Education home page and click Log In at the top right of the page.
- Enter your username and password. Click My Account in the upper right corner.
- Navigate the gray toolbar and click My Activities.
- Click Transcript to view and search completed activities.
- Click the Courses (in progress) tab to view pending activities.
- Medicine Grand Rounds are listed at https://continuingeducation.dcri.duke.edu/medgr. Consider bookmarking this link in your browser for quick access.
MKSAP - Mid Year Opportunity
The program encourages residents to take advantage of the opportunity to obtain Medical Knowledge Self-Assessment (MKSAP) at a significantly discounted rate. How? First, you need to become a member of the ACP. Associate membership costs $109/yr https://www.acponline.org/membership/dues/new_us.htm . Please make note to record your ACP # – you will need it to complete our online request form- Which MKSAP format do you want?
- This offer is open to all Categorical, Med Peds, and Med Psych trainees who have NOT previously received a copy of MKSAP
- You are required to be a current ACP member to participate
- You have the option to request the printed or digital version. Should you want the complete set you have to cover the additional cost.
- We do not place orders randomly at different times in the year. This offer is for a limited time only – ending on February 9, 2014.
Annual Faculty Resident Research Grant applications are due on April 11, 2014.
Please find attached the forms and the link to our website below where the application instructions, forms and NIH format biosketch example can also be downloaded. http://residency.medicine.duke.edu/duke-program/resident-research/research-funding Please note that each proposal must have a Human Subjects section that describes the protections of the patients and patient data, describe the consent![Murat Arcasoy](http://news.medicine.duke.edu/wp-content/uploads/2013/09/ArcasoyMuray2010.jpg)
A new Best Practice Advisory (BPA) has been activated in Maestro Care to help prevent anticoagulant administration in patients with an epidural or regional catheter in place.
The BPA will read: “An anticoagulant and epidural have both been ordered on this patient. Check with Anesthesiology before proceeding.” A screen is included below. Purpose of the BPA: to warn providers, pharmacists and nurses of the dangerous combination of anticoagulant therapy in a patient with epidural or regional catheters. The BPA will read “An anticoagulant and epidural have both been ordered on this patient. Check with Anesthesiology before proceeding.” This BPA will fire at these points:- When an ordering provider enters an order for an anticoagulant (see list of medications below) on a patient with an active order for epidural or deep regional catheter (sciatic or lumbar plexus). The provider should select “I will discontinue order” and proceed to cancel the order with an acknowledgement reason of “Contraindicated”.
- If the ordering provider opts to not remove the order, the BPA will fire again upon order signature
- The BPA will fire again when the order reaches Pharmacy for verification. Pharmacy should verify Attending APS approval.
- The BPA will fire one final time at the point of medication administration. The nursing staff should again verify Attending APS approval.
abciximab (Reopro) | alteplase (tPa, Cathflo Activase) | anagrelide (Agrylin) |
apixaban (Eliquis) | cilostazol (Pletal) | clopidogrel (Plavix) |
dabigratan (Pradaxa) | enoxaparin (Lovenox) | eptifibatide (Integrilin) |
fondaparinux (Arixtra) | prasugrel (Effient) | reteplase (Retevase) |
rivaroxaban (Xarelto) | tenecteplase (TNKase) | ticagrelor (Brilinta) |
ticlodipine (Ticlid) | tirofiban (Aggrastat) | warfarin (Coumadin) |
Resident/Fellow Survey Instructions Now Open
Program Scheduled: Duke University Hospital Program - 1403621320 Survey Timeframe: January 13, 2014 - February 16, 2014 HOW TO ACCESS THE SURVEY: Residents that started the program off-cycle (after Aug 31 of the current academic year) will not be asked to participate in this year's implementation.- 1. Open a new window using your internet browser (Internet Explorer [8.0 or higher]; Firefox; Google Chrome; etc.)
- 2. Click the following URL, or copy and paste it into your internet window's address bar - https://www.acgme.org/Surveys/Security/LogOn
- 3. Your username for this survey is the program's 10-digit number - 1403621320
- 4. Your password for this survey is unique to you. It will consist of your date of birth, followed by the LAST TWO letters of your LAST NAME.
RESIDENTS, FELLOWS wanted to be “SUPER USERS” FOR MAESTRO CARE Go LIVE : at Duke Regional and Duke Raleigh Hospitals: OPPORTUNITY FOR TSMA (“internal moonlighting”)
The Need: To support providers going Live on Maestro Care at Duke Regional and Duke Raleigh. We are again offering “moonlighting” (TSMA) shifts for the first two weeks of the Go Live. These are nonclinical at- the-elbow support on the floor supporting other providers in the first two weeks of March, 2014. Pay is $75/hour. Most shifts are during the weekend and evening times with more limited opportunities for regular AM shifts. We are looking for more coverage the first few days of the Go Live and the need tapers off from there. Who’s eligible: Any resident/fellow (PGY2 to end of fellowship training is eligible) if they have 1. Approval from their Program or Fellowship Director, Chair, and DIO (as for any TSMA) 2: Nonclinical time to spare to complete the additional training and support and remain duty hour compliant.. Any specialty is possible, but you will be asked to support your “Base” clinical activity. For example, a radiology resident would support Radiology. Moonlighters will need to be identified into their primary specialty. What’s needed: This position requires a can-do helpful attitude, approval of your Residency or Fellowship Director and a commitment to a minimum of two shifts of service. Shifts range from 6 to 12 hours in duration Shifts needed: Check excel spreadsheet attached and let Mary Beth Magallanes mary.magallanes@dm.duke.edu know of your interest Necessary training: Super users will need to have been clinically active for at least 6 months in Maestro Care. Interested Residents/fellows should contact Mary Beth Magallanes. mary.magallanes@dm.duke.edu to “schedule” shifts. Complete the TSMA approval process. You will be notified by February 3rd of dates and times. “TSMA” forms (for approval) are on MedHub. Any other questions? Contact: jonathan.lovins@dm.duke.edu for Duke Regional or Charles.hodges@dm.duke.edu for Duke Raleigh shifts.Information/Opportunities
Frankfort IM Flyer (1-23-14)Richmond IM Flyer (Mansilla) (1-21-2014)SRMC - Internal Medicine (1-21-2014) SWVA IM Flyer (Updated January 2014)Upcoming Dates and Events
- January 31: Medicine Research Conference at 12 noon in DUH 2002.
- February 14: SAR Class Pictures
- April 18th: Charity Auction
Useful links
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- http://duke.exitcareoncall.com/.
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.