From the Director
Brace yourselves! It’s quite a lengthy post for this week! Lots of great things happening, and we look forward to ending the week with our FIRST 2015-16 Chief’s Grand Rounds, featuring our VA Chief Resident for Quality and Safety, Dr. Lindsay Boole! Be sure to be on time Friday morning to cheer Lindsay on.
So, this week was full of accomplishments by our #Dukefamily! Representing us at the GME Innovations Celebration were Amy Jones, Anubha Agarawal, Dinushika Mohottige and Lakshmi Krishnan presenting the Duke Narrative Medicine Project, Myles Nickolich (with help from Megan Dupuis), and Rajiv Agarwal who all had Innovation Celebration posters.
Our ACLT group led by Dani Zipkin and Alex Cho went to lobby in Washington! Follow #ACLT on twitter to find out the latest! They met with representatives to talk about the opioid crisis, and also met with Dr. Dzau and Karen DeSalvo, the National Coordinator for Health Information. Can’t wait to hear this amazing group present to us what they learned!
Meg Steiner and Caroline Sloan were absolutely OUTSTANDING at Schwartz Rounds! One of the best I have ever seen.
We then had outstanding representation by our residents at the Clinical Research Symposium (David Sermer, Peter Hu, Rachel Hu, Adam Barnett, Eric Black-Maier, Ryan Orgel, Michael Dorry, Jessie Seidelman, Nick Turner, Tim Hinohara, Brian Sullivan, Div Patel, Emily Kinsey, Pascale Khairallah, Bhavana Singh, Li-Wen Huang) with Peter Hu winning Third Place in the poster competition! Outstanding work!
Following Clinical Research Night, we kicked off our second annual family weekend with our Resident Research Grand Rounds. The posters and talks were absolutely outstanding .. see the attached program for details of all the posters and mentors! Our platform speakers were (Basic Science) – Michael Goldstein, and (Clinical Research) – Pascale Khairallah, Benjamin Peterson and Nicholas Turner. Mentors were Michael Kastan, Julia Scialla, Al Sun, James Daubert, Dev Anderson and Christina Sarubbi. Congratulations to all platform speakers! Our best poster awards went to Div Patel and Dana Clifton and best QI poster went to Matt Atkins and Nick Turner. Mentors for these included Sana Al-Khatib, Lish Clark, Joel Boggan, Jon Bae, and Jane Trinh.
Our winner of Best Grand Rounds of 2015-16 went to Kevin Harrison, with nominations also to Mala Kaul and Ephraim Tsalik.
Our Greenfield Research Mentor Award was given to Katie Garman, with nominations also to Schuyler Jones, Jason Stout, Rob Mentz and Yousef Zafar.
Family weekend was fun, with a great Chair’s conference led by Megan Dupuis, a program overview by Dave Butterly, tours by our Chiefs, a weather-permitted brunch at Dr. Klotman’s and a Bulls game! It was really wonderful to meet the families and significant others who came to join us. Thanks so much to Madi Smith and Lynsey Michnowicz for planning and executing such a great weekend.
Congratulations to Caroline Sloan and Drew Eckstein on their wedding this weekend!
And congratulations to our new residency council members, elected with large numbers of the relevant precincts reporting!
SAR
Christine Bates
Lakshmi Krishnan
Bill McManigle
John Musgrove
JAR
Tanya Aylward
Ankeet Bhatt
AJ Blood
Sarah Nouri
Med-Peds
Amy Lee
Med-Psych
Liz Gilbert
This week’s Pubmed from the Program goes to all of our Faculty Resident Research Grant Recipients for 2016-17: Zach Wegermann, Jenny Van Kirk, Hari Ramalingam, Ryan Orgel, Juan Magana, Jared Lowe, Sam Lindner, Amy Lee, David Kopin, Azalea Kim, Emily Kinsey, Peter Hu, Coco Fraiche, Michael Dorry, Lauren Collins, Luke Cerbin, Ankeet Bhatt, Taylor Bazemore and Brian Andonian!
Have a great week
Aimee
What Did I Read This Week?
Denson JL, Jensen A, Saag H, Wang B, Fang Y, Horwitz L, Evans L, Sherman S. Increased Mortality Associated With Resident Handoff in A Multi-Center Cohort. Poster session presented at the American Thoracic Society International Meeting; 2016 May 16; San Francisco, CA.
http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A7568
What if I told you your patients are 20% more likely to die if their hospital stay includes a block transition?
I read this abstract from ATS because one of the authors is a CRQS and I had heard about it from him. The headline is getting a lot of attention though—it came across in one of my journal watch emails this week (http://www.medpagetoday.com/MeetingCoverage/ATS/57991). You’ll see why.
They did a retrospective cohort study using data from 10 academic VAs, and they had access to the block schedules at each. The “exposure” was being admitted before a block transition and then discharged within 7 days after a block transition. They had data from 230,701 discharges, gleaned from the VA’s huge Clinical Data Warehouse.
30-day mortality was 20% higher in patients whose intern had changed over within 7 days prior to their discharge, controlling for age, sex, race, ethnicity, length of stay, calendar month, and comorbidity index. It was 15% higher in patients whose resident had changed over, and 10% higher when both intern and resident had changed over (p values all very significant). The risk persisted to 90-day mortality, with 17%, 14%, and 9% higher mortality, respectively.
Interesting that the intern handoff has the strongest effect, stronger even than the intern+resident handoff. Maybe block-to-block handoff is a skill that improves with training; or maybe JARs/SARs know enough to be afraid and just exercise more caution when making one of these transitions. (Do you think you worried more about these handoffs the farther along you got? I did.)
But 20%! If there were a biological exposure or behavior that we knew raised 30-day mortality by 20%, we’d be aggressively treating or eliminating that exposure. (We anticoagulate in afib for a heck of a lot less, right Jenn?) But residents gotta rotate… So what to do?
Some institutions are setting the expectation of a “warm handoff” to transfer information. That’s something that only works in a x+y scheduling system: the oncoming intern/resident comes in the Sunday afternoon or evening before they start the block and get bedside handoff from their offgoing counterpart. Some of you probably already do this. It makes sense—and we may see a future study from these authors determining whether it helps.
QI CORNER
Please complete your Culture of Safety survey! (Look for emails from safeandreliablecare.) We know you are experiencing a bit of Survey Storm, and we appreciate you working your way through these. This one gives us and Duke leadership really important information about how well we're achieving a culture of safety in our program, and what our levels of resiliency look like. ...Plus, the sooner you do it the sooner you'll stop getting those twice-weekly email reminders. The survey ends on Memorial Day Monday, so get it done this week!
Clinic Corner
PRIME family,
May 30 brings Memorial Day which honors those Americans who have died serving our country in wars. Did you know it started as Decoration Day in 1868 after the Civil War, to honor both the fallen Union and Confederate soldiers? We appreciate what our residents are doing to take care of our Veterans’ medical and psychosocial needs following their military service.
We are getting ready to trial some changes you requested at the recent Town Hall meeting. ROS sheets are at the print shop right now and we will get those rolling soon, along with the nurses giving patients their med lists to review before you see the patient. E&M coding tip sheets and ICD10/SNOMED cheat sheets are now posted in each exam room.
New green routing sheets will soon be ready and will include how to send your patient to Audiology for routine hearing screening, possibly even same day, without a consult – we are the pilot clinic for this at the DVAMC and are excited to offer this service to our Veterans.
COMP spreadsheets have been updated by John Yeatts and once the data is migrated to the new version, you can use those for your team’s next round of chronic narcotic refills. More on that before next month.
SARs plus Jordan Pomeroy, mark your calendar to join us for lunch in your honor on Friday, June 10, 12:00 p.m. so the PRIME staff can celebrate your accomplishments and hard work!
Thanks you for all you!
PRIME
From the Chief Residents
Grand Rounds
Friday, May 27 - VA/CRQS: Dr. Lindsay Boole
Noon Conference
| Date | Topic | Lecturer | Time | Vendor | |
| 5/23/16 |
Anti-Fungals |
Aimee Zaas |
12:00 | Dominos | |
| 5/24/16 |
Outside Hospital Transfers |
Adia Ross |
Bullocks |
||
| 5/25/16 |
TBD |
Scott Sanoff | 12:00 | Cosmic | |
| 5/26/16 |
CXRs for the Night Resident |
Armando Bedoya | 12:00 | Chick Fil A | |
| 5/27/16 |
Chair's Conference |
12:00 | Panera |
From the Residency Office
PECOS Enrollment - ACTION REQUIRED
Dear Residents and Fellows:
A new requirement has arisen that requires each one of you to be enrolled in PECOS (Medicare Provider Enrollment, Chain, and Ownership System) as prescribers. Most of you are likely already registered, but we need confirmation of your enrollment by June 1. Unfortunately, there is no report that we can generate to check this, and each trainee must confirm enrollment individually using your personal information.
A number of trainees have already completed the process, and it takes less than 5 minutes to complete. Please download and use this instruction pdf to confirm your enrollment, and give a copy of your enrollment page to your Program Coordinator.
If you are not yet enrolled, there may be additional steps not outlined in the instructions. Please complete these steps to complete your enrollment. If you encounter any problems with the registration/enrollment/confirmation process, please contact Tonya Cuffie in the PRMO (681-4918 or tonya.cuffie@duke.edu). If you have any other questions or concerns, please email David Turner (david.turner@duke.edu)
Thank you,
David A. Turner, MD
Associate Director, Graduate Medical Education
Duke University Hospital and Health System
Associate Professor, Department of Pediatrics
Division of Pediatric Critical Care
Duke Children’s Hospital
Medical Improv Workshop
I’m writing to invite you to take part in a new learning offering for members of the Duke and UNC Health Sciences. It’s one of the first Medical Improv Workshop being offered in the Triangle area. And it’s free!
Medical Improv is quickly gaining popularity as an innovative approach to teaching principles that are at the heart of patient centered care: Deep listening, collaboration and seeing things from other’s point of view. Medical Improv can help teach skills that will make you more present and aware during high stakes conversations with patients and colleagues. If you find yourself feeling overwhelmed by everything that’s coming at you during your time with patients, these skills can help things slow down a little so you can prioritize what’s most important and make better decisions.
This 3 hour pilot workshop is free to all Triangle health professions students and clinicians on a first-come-first-served basis. The workshop will be capped at 15 students for more individualized attention. No observers will be allowed in these sessions. Everyone will be expected to participate. The sessions will not be recorded in any way and no grades will be given. The goal is to create a safe environment where people can play and speak freely.
These sessions will be led by Dan Sipp, a trainer for the Clinical Skills Program at Duke Medical School. Dan has taught improvisation in Chicago and the Triangle for over 20 years. He’s trained with the creator of Medical Improv, Katie Watson of Northwestern University’s Feinberg School of Medicine*, and they have collaborated on projects for the University of Indiana School of Nursing. Dan is very excited to bring these sessions to medical learners in the Triangle. Duke Faculty members from the School of Medicine, Graduate Medical Education, The School of Physical Therapy and The Physician Assistant Program will be co-facilitating these and upcoming sessions.
You’re invited to register this free workshop!
Saturday, June 11th 10 a.m. to 1 p.m. @ Trent Semans Center for Health Education, 6th floor
To reserve your spot in the next Medical Improv Workshop please email Dan. Once he receives your email he’ll follow up with a confirmation of your spot, directions to the site and more information about the day.
Remember space is limited to 15 participants per session. We want to see you there. So sign up soon! You are also free to forward this email onto friends or colleagues who you feel might be interested in this innovative training session.
Sincerely,
Dan Sipp
919-681-8681
Attention DOC Residents and Prelim Interns
I’m very excited to share information about our expanded behavioral health services at DOC. In addition to having Jan onsite to provide targeted counseling, we have hired 2 Master’s-level behavioral health consultants who are available to see patients immediately after your visit or by appointment. All 3 can see patients up to 6 times and are true behavioral health generalists helping with issues such as depression, anxiety, PTSD, substance abuse, bereavement, etc. They can also help patients with wellness behaviors such as exercising consistently, taking meds, eating better, improving sleep etc. Joy Long and Ashley Cyr are our new folks and Jan Dillard remains enthusiastic about serving our patients. Please take 5-10 minutes and look at the attached PowerPoint slide deck entitled “Resident Info PPT” (attached as a PDF at the end of this post) put together by Krupa, the grad student who has been helping with our project. There is no cost to the patient for any of these services. Our behavioral health team will communicate with you directly and in Maestro.
In addition, we have begun screening all patients for depression and will soon expand the range of social and behavioral issues for which we screen.
Larry Greenblatt
Office Hours for Dr. Zaas
Dr. Zaas will have the following office hours. Please feel free to stop by during these times and of course always feel free to reach out to her office to set up a meeting outside of these times if needed!
Monday - 3:00 p.m. to 4:00 p.m.
Thursday 10:00 a.m. to 11:00 a.m.
LiveSafe Mobile App
Duke is introducing a new mobile app called LiveSafe to put a powerful safety tool in the hands of the Duke community.
The app, available as a free download from Apple and Android app stores, enables smartphone users to submit real-time tips to Duke Police, virtually “SafeWalk” friends and family while traveling, place emergency calls, and access important resources for support.
You can find more information, including instructions on how to download the free app, on the DukeALERT website: http://emergency.duke.edu/notified/livesafe.
Opportunities for Wellness
Feeling down? Need to talk to someone?
All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE.
https://www.hr.duke.edu/pas/
Upcoming Dates and Events
May 31 - Rising JAR Retreat
June 1 - Rising SAR Retreat
June 4 - SAR Dinner
June 5th, 11am - First Annual Spike and Swim
Useful links
GME Mistreatment Reporting Site
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
https://www.phs.wakehealth.edu/public/edu.cfm
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx