Medicine 2014-2015 Annual Report: A Year in Transition by ChristianaCare

A Year in 2014-2015 Transition Medicine â&#x20AC;&#x201D;

Acute Medicine Service Line and Department of Medicine

A Year in 2014-2015 Transition Medicine â&#x20AC;&#x201D;

Featuring key facts and figures from the Acute Medicine Service Line and the Department of Medicine for the year 2014-2015 with selected honors and accomplishments, publications and presentations. A Message from the Acute Medicine Service Line Leaders Facts & Figures Clinical Transformation Research and Scholarly Activity Education

Section Highlights Honors, Awards & Kudos Selected Publications Selected Abstracts, Posters & Presentations Welcome New Physicians Best Wishes to Our Retired Physicians

A Message from the Acute Medicine Service Line Leaders 2014-2015 was a year in transition as our entire health system began to unify around service lines, with commonalities in processes, practices, conditions and pathways of care. Integration and collaboration are the new drivers of change at Christiana Care toward a more patient-centric, population-focused model of care. Nine interdisciplinary service lines have been established with leadership from multiple departments. The Acute Medicine Service Line (AMSL) has responsibility for the clinical care and outcomes for acutely ill medicine patients from the ED through discharge from inpatient, stepdown, and critical care units. It includes nurses, physicians and other providers from the Departments of Medicine and Emergency Medicine. Under the new service line model, individual departments are responsible for education (undergraduate, graduate, and continuing), research, credentialing and privileging, peer review, faculty development, and specialty specific professional standards. Importantly, departments also have responsibilities for physician engagement and for promoting activities that remind us all of the joys associated with being physicians.

Virginia U. Collier, M.D., MACP Acute Medicine Service Line Physician Lead, Hugh R. Sharp Chair of Medicine

This year, as we transition to the interdepartmental service line model, our report begins the conversation around Service Line goals and activities. This transitional departmental annual report also continues to outline the services offered within the Department of Emergency Medicine and the Department of Medicine including activities related to Education and Research.In future years we plan for our report to be a compendium of services from both the Department of Medicine and the Department of Emergency Medicine as well as activities within our Acute Medicine Service Line. Several important projects already underway illustrate the power of the new service line model, which enhances collaboration between the Departments of Emergency Medicine and Medicine. Our Palliative Medicine team, working with Julie Cooper, M.D.

Charles L. Reese, IV, M.D., FACEP Acute Medicine Service Line Associate Physician Lead Chair, Department of Emergency Medicine

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and other interested emergency medicine physicians, is improving early access in the Emergency Department to counseling and palliative care services for applicable patients. Critical Care and Emergency Medicine inter-disciplinary teams are casting an ever-widening safety net over at-risk patients by expanding our award winning sepsis alert and sepsis trigger protocols. Led by Paul Sierzenski, M.D. from the Emergency Department, service line teams are developing new strategies to optimize the use of antimicrobial medications in both the emergency room and on inpatient units as part of a critical initiative to stem overuse and misuse of antibiotics. Congratulations to all of the Department of Medicine teaching and research award winners and Focus on Excellence Award winners, and all those who have represented the Departments of Medicine, Emergency Medicine, and the Acute Medicine Service Line with distinction on both local and national levels of leadership and service. As always, heartfelt thanks to the many physicians and nursing colleagues in the Departments of Medicine and Emergency Medicine and the Acute Medicine Service Line who have contributed countless hours of service to Christiana Care in support of our mission. Thanks also to the interdepartmental services on which we rely as we partner to construct the care models of the future.

Virginia U. Collier, M.D., MACP Acute Medicine Service Line Physician Lead Hugh R. Sharp Chair of Medicine

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Charles L. Reese, IV, M.D., FACEP Acute Medicine Service Line Associate Physician Lead Chair, Department of Emergency Medicine

Acute Medicine Service Line Report Facts and Figures The Acute Medicine Service Line cares for patients at Wilmington and Christiana Hospitals and the Middletown Emergency Department. Our patients present with a wide range of acute medical conditions, and we care for them across the spectrum: ED to ICU to Inpatient Unit, transitioning to postacute care settings. There are 476 active physicians credentialed through the Department of Medicine and 57 active physicians credentialed through Emergency Services. Collectively, they diagnose and treat a broad spectrum of diseases, as well as tertiary care medical conditions not routinely encountered in smaller hospital settings. With more than 185,000 ED visits and 28,000 inpatient admissions annually, our service line represents significant patient populations from across the system.

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Clinical Transformation Restructuring Along Service Lines The new service line structure positions the AMSL to achieve the Christiana Care Annual Operating Plan (AOP) goals for Optimal Health, Exceptional Patient Experience, and Organizational Vitality. By eliminating siloes of clinical care, we can reduce unnecessary variation, better coordinate care across the continuum, and continue to improve the quality, safety and value of the care we provide. In short, we can better deliver on the promise of The Christiana Care Way. Acute Medicine is one of nine service lines, each represented by an Executive Team (see page 5). The AMSL is led by an interdisciplinary strategic leadership team comprised of physician, nursing and operations leaders. There is also an operational team which is responsible for achieving the metrics in support of the CCHS AOP goals (see page 5). The AMSL service line executive division (SLED) team helps to coordinate and integrate system change initiatives and quality and safety efforts and collaborates closely with the Christiana Care Medical Group and Christiana Care Quality Partners (CCQP). Service lines are supported by the many essential services operating throughout Christiana Care and across service line structures.

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AMSL Strategic and Operations Leaders Executive Team Physician Leader: Virginia Collier, M.D., MACP Associate Physician Leader: Charlie Reese, IV, M.D., FACEP Operational Lead: Kate Rudolph, MS (Interim) Nursing Lead: Linda Laskowski-Jones, MS, RN Nursing Lead: Joanne McAuliffe, DNP, RN/MSN, OCN, NEA-BC, CCQP Lead: John Powell, M.D., FAAEM IT Liaison: Bid Schreppler Medical Group Lead: LeRoi Hicks, M.D., MPH

Operational Team Physician Operational Lead: LeRoi Hicks, M.D., MPH Physician Operational Lead: Tom Sweeney, M.D. Associate Physician Operational Lead: Vinay Maheshwari, M.D. Associate Physician Operational Lead: Paul Sierzenski, M.D. Nurse Operational Lead: Suzanne Heath, MS, BSN, RN-BC Nurse Operational Lead: Mike Knorr, BSN, RN, PCCN Nurse Operational Lead: Karen Toulson, MSN, MBA, RN, CEN, NE-BC Operational Lead: Kate Rudolph, MS Operational Lead: Fran Gott, III, MBA, RRT Medical Group Operational Lead: Roger Kerzner, M.D. Patient Advisor: Christine Chastain-Warheit IT Liaison: Tim Shiuh, M.D. Key Performance Improvement/Data support: John Emberger, BS, RRT-ACCS, FAARC, Adrian Fedyk, Wayne Stephens, and Lisa Clayton, BSN, RN, MBA

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AMSL Performance Metrics Interdisciplinary collaboration and teamwork provide the framework for Acute Medicineâ&#x20AC;&#x2122;s transformation toward value. The AMSL performance metrics are focused on preventing harm, reducing mortality, improving patient flow and access to care, increasing evidence-based guideline compliance, improving efficiency and enhancing the overall patient experience. Acute Medicine Value Report Cards highlight priority areas for achieving long-term strategic goals and serve as an important management tool to monitor outcomes, identify areas for improvement, and communicate/reinforce institutional values. The report cards track mortality, falls, 30-day hospital readmission rates, length-of-stay, health care associated infections and other metrics. Report card metrics drive service line initiatives and transformative projects undertaken by our UnitBased Clinical Leadership and Value Improvement Teams.

Highlighted on the next few pages, are just a few of the many projects that demonstrate the innovation, creativity and flexibility essential to our mission.

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Service Line Collaborations Multidisciplinary Palliative Medicine/Emergency Medicine Initiatives Palliative Medicine is collaborating with the Emergency Department on a number of key initiatives. Examples include contributing to the educational development of a Palliative Care Resource Nursing role in the Emergency Department. This is an important extension of the necessary work of the palliative nurse ambassadors who help improve patient access to needed palliative care services; and collaborating on the development of an innovative palliative care screening tool for all emergency patients so that ED case management can gain better insight into interventions needed among this vulnerable patient population. Participation and integration of an ED physician in the Palliative Physician Champion group is designed to align initiatives initiated in the ED so that there is continuity of the patient experience. Similar to the Palliative Medicine team effort, an ED bereavement program has been initiated to support the staff as well as the grieving family. In addition, Palliative Medicine has led IT initiatives around advanced care planning and goals of care, aligned and vetted with input from ED providers.

Sepsis Prevention Christiana Care’s award winning Sepsis Alert protocol has successfully reduced the mortality rate from sepsis throughout the health system. An interdisciplinary team from Emergency Medicine, Hospital Medicine and Critical Care continues to cast an ever-widening safety net, designed to capture patients at-risk for developing sepsis. The team initiated a sepsis trigger system — an electronic alert that utilizes a patient’s vital signs and information from his or her electronic medical record and other sepsis-related outcome data to alert caregivers when sepsis indicators are present. The team continues to pilot this system on multiple units at Christiana Hospital.

Clinical Decision Support for Antibiotic Use The Acute Medicine Service Line team is coordinating strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs. Studies have shown that clinical information that includes signs and symptoms, entered electronically can be effective in reducing inappropriate antibiotic prescribing. The team is mapping out steps toward implementation of a computer assisted decision support strategy to reduce overuse of antibiotics in the Emergency Department on medical units in the hospital.

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A statistical reduction in the use of Levofloxacin (p < 0.002) and increase in Doxycycline (p < 0.002), preferable to Levofloxacin, for all patients admitted with pneumonia occurred following the integration of a forced function Emergency Department Pneumonia Clinical Decision Support tool (ED PNA CDS). Smoothing patient flow: The AMSL leadership team is working closely with other service line leaders to coordinate, standardize and ultimately to enhance patient flow from admission to discharge. The team is designing a model which is potentially adaptable institution-wide to raise the bar for safe and efficient unit-to-unit transfers and goal directed, discharge focused plans of care for our patients. An essential element for success is the continued evolution of our team-based care model. Interdisciplinary teams provide care for patients in the ED and on Medicine inpatient units. Using Team STEPPS methodology and rapid cycle testing, these teams continue to self-actualize as high performance groups to improve patient outcomes, enable effective communication and care coordination and reduce hospital length of stay. Discharge redesign: The AMSL is committed to designing a more efficient and effective discharge process, in which the entire health care team — doctors, nurses, case managers, social workers, pharmacists and pharmacy technicians — work together throughout the patient’s stay to prepare the patient for discharge. The new model includes emphasis on interdisciplinary rounding and ongoing medication reconciliation that starts in the ED at the time of admission and continues throughout the patient’s hospital stay. 8

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An electronic module for case managers in the ED with the patient’s expected length of stay will help to establish benchmarks for discharge. Goals include reduced length of stay, more efficient discharge planning and recommendations for high-risk patients, improved efficiency throughout the hospital stay and increased patient and provider satisfaction with the discharge process. Metrics for these goals are under development.

Pain Management and Palliative Medicine The separation of these services was completed at the beginning of 2015 with Roshni Guerry, M.D. taking the lead as medical director for Palliative Medicine and John Goodill, M.D., as director for Palliative Medicine Education and Outreach. A multidisciplinary palliative care team provides expert palliative medicine consults to physicians and patients in both Wilmington and Christiana hospitals. Team members are working in a number of specialty areas such as chronic heart failure, end stage kidney disease and chronic obstructive pulmonary disease to raise the awareness of the importance of palliative care to patients with these end stage conditions. Palliative Medicine Education and Outreach provides education to both generalists and specialists to allow them to provide front-line palliative support that includes advance care planning, goals of care, and symptom management, with a specialist on the palliative medicine team to provide backup.

Nationally Acclaimed Project Engage Christiana Care’s nationally acclaimed substance abuse program, Project Engage, operates in the Emergency Departments and inpatient settings at both Christiana and Wilmington hospitals, conducting more than 2,000 patient engagements a year. A second-generation model, Project Engage Plus, introduced a peer counselor into the community to act as a recovery coach for patients initially seen in the Emergency Department or impatient settings. Project Recovery, a collaborative effort between Project Engage and Christiana Care Quality Partners, has embedded behavioral health providers at the Wilmington Health Center to improve access to substance abuse assessment and treatment for primary care patients. Roll out to other primary care sites is anticipated.

Driving System-Wide Improvements Juran Green Belt and Black Belt projects leverage “lean process” design skills to drive system-wide improvements that impact health care efficiency and affordability. The Christiana Care Value Institute’s Center for Operational Excellence has partnered with the Juran Institute to offer onsite

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training and mentorship to leaders in multiple departments and service lines. These programs teach leaders and team members how to leverage improvement science using Lean/Six Sigma methodology for rapid cycle improvements, how to work smarter and to speed up transformation.

Green Belt Projects Skilled Nursing Facility Late Discharge AMSL Champion: Marykay Ennis, Administrative Manager, Medicine Goal: Shift average discharge time to Skilled Nursing Facilities earlier by 1.5 hours to 14:30 hours, as compared to CY14 baseline. Late arrivals to SNFs make it difficult to effectively admit patients due to decreased evening staffing. In addition to operational challenges, late admissions create dissatisfaction for patients and families and do not support our vision for patient and family centered care. Reducing Length of Stay for Medicine Observation Patients AMSL Champions: Andres Moreira, Administrative Fellow and Patty McGraw, Research Nurse Supervisor Goal: Reduce the mean LOS of medicine observation patients from 44 hours to 34 hours. Having a higher LOS increases costs to CCHS and the patient, impacts patient satisfaction and safety, effects throughput, and is a key regulatory metric Improve the Turn-Around Time of Abdominal CTs Done in the Emergency Department AMSL Champions: Kate Groner, M.D. and Patty Blair, RN ACNS-BC Goal: Improve turn-around-time for completion of CT scans of the abdomen and pelvis by an average of 30 minutes off the average time of 164 minutes. Reduce Inappropriate Physical Therapy Consult Orders AMSL Champions: Kunal Bhagat, MD, IPC â&#x20AC;&#x201C; The Hospitalist Company and Carmen Pal, RN, Staff Education Specialist Goal: Reduce the number of unnecessary consults of Hospitalist patients on Christiana Hospital units 5A, B, C, & D by 50 percent (from 36% to 18%). A random sample of Hospitalist patients on these units admitted from January to October 2014 showed that 36 percent (141/390) of consults were unnecessary, which can lead to delays in treatment for other patients.

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Black Belt Projects Inter-Unit Transfers from Patient Bed Assigned to Patient Arrival on Unit AMSL Champions: Adrian Fedyk, Value Improvement Consultant, and Michelle Collins, RN, Director Nursing Development and Education Goal: Decrease the mean patient transfer time from bed assigned to patient arrival on unit from 155 to 108 minutes. This reflects a 30 percent reduction, which accounts for 101 patient days. Bed Request to Bed Ready AMSL Champions: Susan Mascioli, MS, BSN, RN, CPHQ, NEA-BC, Manager, Nursing Quality and Safety and John Emberger, BS, RRT-ACCS, FAARC, Performance Improvement Project Manager Goal: Reduce the mean time from the initial admission order to bed ready in the Christiana Emergency Department by 20 percent from 156.5 to 125.2 minutes (31.3 minutes). Delays significantly impact boarding, the ability to admit patients in a timely manner and patient safety.

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Department of Medicine Report Research and Scholarly Activity In the new service line model, much of the research is overseen by departments. The Department of Medicine recognizes that research and scholarly activity are key drivers of change and continuous improvement to the quality, safety and value of care we deliver patients. Our RSA process, under the direction of Medicine Vice Chair LeRoi Hicks, M.D., MPH, promotes a “balanced portfolio” of well-designed research projects that supports our mission and fosters the critical thinking that leads to innovation. Medicine physicians pursue a broad array of research as investigators in federal or state supported, industry sponsored, or locally initiated studies, as well as with the Christiana Care Value Institute. They work in collaboration with our clinical research nurses who are certified by the Association of Clinical Research Professionals (ACRP). The following table provides a representative snapshot of the broad research focus within the Department of Medicine.

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Central to the RSA process is the work of the Clinical Research Committee (CRC), chaired by M. James Lenhard, M.D. The multidisciplinary membership meets monthly to review resident and faculty proposals for scientific merit, validity, financial sustainability, and alignment with Medicine and Christiana Careâ&#x20AC;&#x2122;s goals and to fairly allocate available funds to the greatest number of applicants with the strongest ideas. Members offer support to investigators throughout the research process from protocol development to Internal Review Board approval through start-up and completion. Investigator initiated studies: Examples of our investigator initiated studies include several studies by Dr. Lenhard and the diabetes and metabolic diseases research team looking at autonomic neuropathy in diabetes, the interface between bone and glucose metabolism, gestational diabetes, diabetes and depression, and diabetes care delivery. This basic research is performed in collaboration with researchers from neighboring institutions, including the University of Delaware and the Delaware State University and has led to the publication of some 50 peer reviewed manuscripts and many abstracts. Other homegrown, grant supported studies include the work of Michael Vest, D.O. and Jeffery Stewart, M.D. with the Pulmonary & Critical Care Medicine research team. One such study, led by Dr. Vest, is designed to provide information on the nutritional needs of obese patients and how to optimize their nutritional care in the ICU. Obese patients now account for more than one quarter of ICU patients. Preliminary results from this work have been accepted for presentation at the American College of Chest Physicians meeting in October 2015. In a separate project, the team analyzed the discharge disposition of all mechanically ventilated ICU patients in 2013. It found that obese patients are less likely to be discharged to hospice despite similar severity of illness compared to non-obese patients. These results were presented at the 2015 American Thoracic Society meeting and were used as preliminary data in applying for 2016 Society of Critical Care Medicine Vision Grant.

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Physician investigators also serve as mentors to fellows, residents and medical students who pursue their own research interests in a variety of specialties. Many of these projects have earned national awards and have provided learners with the opportunity to present nationally. One example is the work of junior researcher, Jennifer Goldstein, M.D., assistant professor of Medicine and a Christiana Care Value Institute scholar, who is working on grant-supported studies designed to improve the patient discharge process and reduce hospital readmissions. In 2015, she received the Hamolsky Award from the Society of General Internal Medicine for her analysis of transitions of care and readmissions among patients enrolled in the Bridging the Divides program, a CMS innovation grant at Christiana Care designed to improve care transitions and longitudinal care of patients with heart disease. This award is presented to junior faculty whose abstracts are judged to be outstanding among those submitted by junior faculty members (in their first two years of a faculty appointment). Clinical trials: The Research Clinical Trials Group has brought together all the major departmental sections doing clinical trials research. These multisite, primarily pharmaceutical trials offer patients potential breakthrough treatments under the guidance of careful medical management that is backed by solid science. Participation allows research teams to network with institutions around the county and to benefit from their perspective and brings into national focus the work of Medicineâ&#x20AC;&#x2122;s physician-led investigative teams. Currently there are nine principal investigators, several recognized nationally for their work, five certified clinical research coordinators, and a program assistant who are responsible for the conduct of the trials. Neurology has championed patient recruitment efforts, particularly in the areas of multiple sclerosis and Alzheimerâ&#x20AC;&#x2122;s disease. The multiple sclerosis (MS) research program will soon begin a Phase III research study of a new molecule for the treatment of neuromyelitis optica, a disease separate but similar to MS and one without an approved therapy. Endocrinology trials include new treatment modalities for Type 1 and Type 2 diabetes with additional focus on nephropathy and cardiovascular outcomes. Infectious Disease trials are focused on C-diff, sepsis and hospital acquired infections. Pulmonary Medicine has ongoing studies of pulmonary hypertension and COPD and participation with Critical Care includes inpatient trials to prevent pneumonia. As clinical trials have become more complex, Medicine has networked successfully with other Christiana Care departments, in particular Family Medicine, Maternal Fetal Medicine and Emergency Medicine, to develop more interdisciplinary collaborations. These joint studies drive innovation and potentially contribute to the well-being of our entire community of patients.

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Education Residency Programs Christiana Care is both a clinical campus for medical students and a nationally recognized center for graduate medical training, preparing residents for leadership in the changing world of medicine. In FY 15 the Department sponsored a Categorical Internal Medicine Residency Program, along with two combined programs (Medicine-Pediatrics and Emergency Medicine-Internal Medicine), a oneyear Preliminary Medicine program, and a Transitional Year program.

Class of 2014 -2015 Program Residents Internal Medicine-Categorical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Internal Medicine-Preliminary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Medicine-Pediatrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Emergency Medicine/Internal Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Transitional Year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 TOTAL Residents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 It is Medicine’s goal to train residents to fulfill our mission to provide safe, innovative, effective, and affordable care that our patients value. One constant is that patients and their families remain at the center of our focus.

Building a “Culture of Learning” A strong academic program and nationally recognized faculty prepare residents for leadership in today’s changing world of medicine. Several faculty hold leadership roles in graduate medical education. Medicine’s innovative curriculum has become a national model for incorporating a unique scheduling algorithm for residents to focus on their outpatient rotations and ambulatory electives without competition from the demands of inpatient care. Our teaching practices also reflect our status as a Level II patient-centered medical home (PCMH) model. Residents have the opportunity to take advantage of Christiana Care’s state-of-the-art Virtual

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Education and Simulation Training (VEST) center and practice the elements of performance improvement in an award winning, quality improvement/patient safety course, a leadership track, and global health studies. The Department plans to roll out bedside ultrasound training for Medicine residents in the next year. A new program— LEED-R (Leadership Excellence Education – Residents/Fellows), is designed to offer residents and fellows the critical thinking and leadership skills they will need to work collaboratively in high-functioning teams, attain new competencies/milestones and provide value based care. The course also promotes awareness of The Christiana Care Way and the leadership principles that support it. Co-directors are Barbara A. Monegan, director, Center for Transforming Leadership, Christiana Care Learning Institute and Allen Friedland, M.D., program director of the combined Medicine-Pediatrics Residency Program.

At Christiana Care’s LEED-R program, residents and fellows developed leadership skills through problem-solving and team-building exercises.

Residency training may be combined with an MBA and other master’s degree programs in cooperation with the near-by University of Delaware. A formalized research and scholarly activity track places the clinical experience into the broader context of population health and advances the resident’s investigational interests in line with the Department’s mission and goals.

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Health Care Improvement as a Team Sport In April 2015, Achieving Competency Today (ACT) celebrated 10 years of programming that has strengthened the culture of improvement in quality and safety at Christina Care. All Medicine residents and fellows participate in the 12-week, award-winning ACT graduate level course offered by the Christiana Care Value Institute Academy. The ACT course fulfills multiple clinical learning environment (CLER) requirements for resident physicians set forth by the Accreditation Council for Graduate Medical Education (ACGME). Course format facilitates interdisciplinary teams of learners to collaborate on performance improvement projects and put what they learn immediately into practice, through rapid cycle testing; systematic application of improvement science; and inter-professional learning through diverse teamwork scenarios on topics such as patient safety, population health, clinical team effectiveness and improvement science. Evaluations by participants show that learners not only are satisfied with the course, but also experience a significant increase in confidence and skills, which they take back to their individual departments. A six-month post-course follow-up demonstrates strong retention of those skills.

Medicine Collaborators on ACT Team Projects, 2014-2015 Reflex to Urine Culture: Truncating the Time Taken to Transport the Tinkle to the Testing Tube. Xia Qiao, M.D., MPH, Internal Medicine PGY2 and Joseph Santora, D.O., Internal Medicine, PGY3, et al. Timing is Everything: Reducing Time-Sensitive Canceled Labs. Atishi Aggarwal, M.D., Internal Medicine PGY2, Shanna Berry, D.O., Internal Medicine PGY2, and Lillian Msambichaka, M.D., Medicine-Pediatrics PGY2, et al. Antibiotic Cost Awareness. Alicia Ely, D.O., Internal Medicine PGY2, Daniel Jacoby, D.O., Internal Medicine PGY2, and Rosie Musheno, Medicine-Pediatrics PGY2, et al. Get Well? Christina Rawana, D.O., Internal Medicine PGY2 and Jesse Sinanan, M.D., Internal Medicine Preliminary Year, et al. “Are We on the Same Page?” Improving the RRT Paging System. Kamleish Persad, D.O., Internal Medicine PGY2 and Jeffrey Wharton, M.D., Internal Medicine PGY3, et al.

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Is STAT the New Routine? Rethinking the Ordering of STAT EKGs. Eric Halpern, M.D., Internal Medicine PGY2 and Akash Sethi, D.O., Internal Medicine PGY3. Heart to Heart — Improving Cardiology Consult Communication. Seema Niphadkar, D.O. Internal Medicine PGY3, David Roofeh, M.D., Medicine-Pediatrics PGY2 and Alfloyd Woodard, Internal Medicine PGY2, et al.

Fellowship Opportunities Expand More than one third of Medicine residents match into competitive fellowship programs after graduation. Christiana Care’s own expanding number of accredited fellowships affords residents the opportunity to further develop the special skills and interests they plan to focus on in their professional careers. Fellowships include a Quality and Patient Safety Administrative Fellowship, a Nephrology Fellowship, General Cardiology and Interventional Cardiology Fellowships and an Advanced Heart Failure and Transplant Fellowship. A new Hospice and Palliative Care Fellowship in partnership with Nemours/A.I. duPont Hospital for Children, under the direction of Roshni Guerry, M.D., medical director, Palliative Care Education, graduated its first pediatric-focused fellow. The first adult medicine focused fellow will enter the program in July, 2016.

Salute to Our Faculty Volunteers There are 476 physicians credentialed through the Department of Medicine, and among them, as many as 100 physicians volunteer in training the next generation of clinicians and physician leaders in both inpatient and outpatient settings. Community-based teaching is an essential element to the overall resident experience. Working alongside physician preceptors in their private practices affords residents the opportunity to experience “real life” patient care in an office setting and to learn about the business of medicine. For some, the preceptor-learner experience fosters professional relationships that last a lifetime and opens up career opportunities for those seeking to enter private practice upon graduation. Thanks to the generosity and efforts of our physician preceptors residents may select a board curriculum of ambulatory primary care, a subspecialty medicine experience.

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Medical Students Clinical Campus Christiana Care is the largest teaching affiliate of the Sidney Kimmel Medical College at Thomas Jefferson University and has been designated a clinical campus since 2010. Many of Christiana Care’s 1,300-member Medical/Dental Staff hold academic appointments within the Medical College and participate in joint conferences and research projects. The Medical Student education director is Matthew Burday, D.O., who is also the associate director for the Internal Medicine Residency program. The Department of Medicine is an integral part of the Sidney Kimmel Medical College student program. Residents and interns play an important role in teaching students at all levels in both inpatient and outpatient setting. Part of that experience means working closely with the interns and residents from the Internal Medicine Residency Program as well as the Medicine-Pediatrics Residency and the Emergency Medicine-Internal Medicine Residency. Medical students continue to rate Christiana Care very highly as a place for training, and this is due in no small measure to the residents who participate in the student program and who seek out teaching opportunities on a regular basis, such as giving talks on various topics, for example. Branch Campus students become integrated into the workings of the Christiana Care Health System and in the process, come to know attendings, residents, nurses, and ancillary staff well. Most of these students live locally, and thus have a better understanding of the surrounding community as a result. Ultimately many consider staying on as residents. In FY15, 42 “Introduction to Medicine” second-year students, 73 third-year students, and 87 fourthyear students rotated through the Department. Christiana Care also hosts third-year medical students from Philadelphia College of Osteopathic Medicine who spend time rotating through Cardiology and other specialties. Undergraduate medical students from the University of Delaware are introduced to clinical medicine through the Medical Scholars Program. Students spend time on the inpatient units with residents and attendings and in private offices, observing in the outpatient setting. They are also exposed to hospital nurses, social workers, visiting nurses, laboratory personnel and others. The Internal Medicine practicum emphasizes the psychosocial aspects of patient care.

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Section Highlights Cardiology â&#x20AC;&#x201D; Directed by the Heart and Vascular Service Line Radial artery catherization rates increased from 28 percent (FY14) to 37 percent (FY15), well above national average (26.6%). Studies have shown the radial approach results in less bleeding, more rapid ambulation, increased patient comfort, and use of fewer human and hospital resources. Appropriate use compliance for Percutaneous Coronary Interventions (PCI) held at 99.5 percent compared to the national average (92.8%). PCI risk adjusted mortality is 1.65 percent versus the national average (1.8%). The Heart Failure program is the first in the region to implant the CardioMems device for remote pulmonary pressure monitoring in high-risk heart failure patients. The Heart Failure team collaborated with Palliative Care on an award-winning, one-year pilot program, using an applied risk-assessment tool to screen and provide supportive care consultations to some 600 heart failure patients at high risk for mortality.

Dermatology A new teledermatology program is expanding capabilities for triage, diagnosis and management of patients in both inpatient and outpatient settings. Dermatology now provides on-site training at Christiana Care for residents of the Sidney Kimmel Medical College of Thomas Jefferson University in collaboration with Jefferson Dermatology.

Endocrinology and Metabolic Diseases New medications on trial and available to eligible Christiana Care patients include long-lasting injectable insulin to treat Type 2 diabetes and a drug (Bococizumab) to reduce occurrence of major cardiovascular events in high-risk patients. Also on trial are new dosing strategies of a drug (Genotropin) to treat adults with growth hormone deficiency.

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Gastroenterology Ranked among the nationâ&#x20AC;&#x2122;s top performers by U.S. News & World Report, Gastroenterology provides a comprehensive array of diagnostic, therapeutic and consultative gastrointestinal services. In FY15, GI labs performed a total of 8,759 endoscopies and the latest interventional bronchoscopy procedures. The lab continued to enhance cross-departmental and collaborative team based endoscopy care, working in collaboration with Infection Prevention to routinely monitor and culture ERCP and EUS endoscopes to prevent CRE infections.

General Internal Medicine Medicineâ&#x20AC;&#x2122;s largest section, Internal Medicine, has more than 150 internists who are committed to providing excellent, coordinated, patient-focused care on our inpatient Medicine services, in our offices throughout the hospital system and in the community. Christiana Care has employed Internal Medicine practices in the Wilmington Health Center (Adult Medicine Office, Transitions Practice and

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Internal Medicine Faculty Practice), the Annex at Wilmington Hospital (HIV practice) and at various sites in the region (The Medical Group of Christiana). In addition a large number of private practicing internists are members of the Christiana Care Quality Partners integrated collaborative.

Internal Medicine’s Division of Hospital Medicine The Division of Hospital Medicine is committed to developing innovative models of patient centered care though collaboration and research. IPC Heathcare, Inc. collaborated with the Christiana Care Heart Failure program and the Visiting Nurse Association on a Remote Monitoring Program to improve outcomes for congestive heart failure patients discharged to six skilled nursing facilities. The project demonstrated that telemonitoring technology in skilled nursing facilities coupled with standardization of care processes is operationally efficient, well received by patients and results in a significant reduction in the risk of readmission among those patients with a primary or secondary heart failure diagnosis. In addition, the skilled nursing facilities that adopted a standardized diuretic protocol experienced lower rates of “in program” and 30-day, all cause readmissions among this high-risk patient population.

Internal Medicine’s Division of Addiction Medicine The nationally recognized model, Project Engage, continues to improve access to care for patients addicted to drugs or alcohol. Project Engage conducts more than 2,000 patient engagements a year in the Emergency Departments and inpatient settings of both Christiana and Wilmington Hospitals. A poster presentation illustrating project impact on 30-day hospital readmissions received the American Society of Addiction Medicine‘s Program Planning Committee Award at their annual conference in April 2015. Addiction Medicine is working with the University of Pittsburgh Medical Center to develop and implement Project Engage at three of their hospitals.

Medicine — 2014-2015

Staff and patients celebrate successes at a Project Engage Recovery Roundtable.

The Mother and Child Project was launched in May to improve the care of opiate-dependent pregnant women and their children in partnership with Obstetrics and Pediatrics. Further collaborations with the Behavioral Health Service Line will launch pathways to improve the care of illicit opiate-dependent patients throughout Christiana Care continuum. Resident training in addiction and early engagement methods continues in partnership with the Department of Family Medicine. In June, the Division hosted the Third Annual Addiction Medicine Symposium titled “Understanding Substance Abuse in Teens and Young Adults.” Organized in partnership with Delaware’s Division of Substance Abuse and Mental Health, and the National Institutes on Drug Abuse, Clinical Trials Network, the all-day symposium, held at the Christiana Care John H. Ammon Medical Education Center featured a number of internationally renowned experts as well Rita Landgraf, the Secretary of Health and Social Services.

Geriatric Medicine This is the third consecutive win for the WISH (We Improve Senior Health) Program at Christiana Care, earning Exemplar status for care of the elderly. Christiana Care is the only hospital in Delaware to achieve the award and among only a small number nationwide. Denise Lyons, RN, presents the 2011 WISH Champion Award to Colleen McGhie, RN, of unit 4E at Christiana Hospital. Christiana Care’s We Improve Senior Health Program celebrated 10 years of providing bestpractice care to seniors in the hospital.

Collectively, ACE (Acute Care of the Elderly) units at Christiana and Wilmington hospitals provide top-notch care: • 6 A (Christiana Hospital) reduced acquired pressure ulcer rates by 42 percent and falls by 18 percent. Length-of-stay is 4.87 days, the lowest in the Medicine Service Line. • 6A achieved the highest GetWell Network medication education utilization rate in the system in May and June 2015. The rate for June was 66 percent. • Project Dream Team is underway to improve bedtime routines and to avoid/reduce sleep medication.

Medicine — 2014-2015

Independence at Home, a project spearheaded by geriatricians in Family Medicine, meets all CMS Quality Measures:

CCHS PY1 Quality Measure Performance Quality Measure Follow â&#x20AC;&#x201C; up contacts within 48 hours of Hospital Admissions, Hospital Discharges, and Emergency Department Visits Medica on Reconcilia on in the Home within 48 hours of Hospital Discharges and Emergency Department Visits Annual Documenta on of Pa ent Preferences All-Cause Hospital Readmissions within 30 Days (Ra o of Observed to Expected) Hospital Admissions for Ambulatory Care Sensi ve Condi ons (Ra o of Observed to Expected) Emergency Department Visits for Ambulatory Care Sensi ve Condi ons (Ra o of Observed to Expected)

Practice Score

Measure Met?

65%

Yes

58%

Yes

98%

Yes

0.7

Yes

0.5

Yes

0.3

Yes

Threshold

50% or higher 80% or higher 1.0 or lower

Case Management and Palliative Care (CMAP) reached out to high-risk, home-visit patients to lower 30-day readmissions and discuss advance directives and goals of care. The Swank Memory Care Center celebrated four years by serving more patients, with a 17 percent increase over last year. Proceeds from the 2014 Junior Board Medicine Ball have funded programs for caregiver support/ education, community education, respite care and expansion of the resource library.

Hematology Hematology supports an active clinical trials program, expanding treatment options for patients with many hematological diseases. Studies are comparing new with standard combinations for first line therapy of follicular lymphomas, chronic lymphocytic leukemia, and multiple myeloma. A Phase II, non-randomized trial of reduced-intensity donor blood or marrow stem cell transplants is underway to treat conditions that occur when blood-forming cells in the bone marrow are damaged. Our FACT-accredited Blood and Marrow Stem Cell Transplant program has grown dramatically and is on track to perform nearly double the number of transplants over the previous average.

Medicine â&#x20AC;&#x201D; 2014-2015

Infectious Diseases The introduction of Verigene technology in the Microbiology Lab has dramatically reduced the time required to identify clinically significant, harmful bacteria in positive blood cultures. Verigene can also identify some of the resistant markers to commonly prescribed antibiotics. Christiana Care’s HIV program continues to be the major provider of HIV medical services in Delaware, serving 1,631 HIV-positive individuals at eight clinical sites with a 97 percent level of retention in care. Among active patients, 94 percent are on HAART (anti-retroviral therapy) and 81 percent have undetectable HIV RNA levels. The program also includes office-based opioid treatment and referral services and treatment for Hepatitis C and mono-infected HIV patients.

Medical Oncology — Directed by the Oncology Service Line A collaborative effort among physicians with Pharmacy, Nursing, and Quality Improvement has introduced a new chemotherapy delivery process on inpatient units, which aims to cut the time in half from writing in the order to delivery. Oncology has one of the largest research programs in the country among community-based hospitals with more than 100 active clinical trials and patient participation well above the national average at 14 percent. Top trials include a new antibody drug conjugate trial for epithelial cancer; a lung cancer trial using molecular markers to identify patients for targeted adjuvant therapies; and a new platinum-based chemotherapy trial for triplenegative breast cancer combined with targeted anti-cancer agents.

Neurology Our American Academy of Sleep Medicine accredited Sleep Disorders Center has established a home sleep study program. If appropriate, a polysomnography (sleep study) may be ordered toassess breathing and eye movements in the patient’s familiar sleeping environment. Christiana Care earned Comprehensive Stroke Center Certification from the Joint Commission and the American Heart/American Stroke Association in 2014, joining fewer than 80 hospitals nationwide that have this designation. In FY15, the program improved the average door-to-needle time for alteplase drug treatment of acute ischemic stroke down from 60 minutes to less than 45 minutes. The stroke team responded to more than 600 stroke alerts in the Emergency Department and administered tPA to 217 ED patients, more than double last year’s number.

Medicine — 2014-2015

System wide there were more than 2,080 hospital admissions for ischemic and hemorrhagic stokes and more than 400 Stroke clinic patient visits. Electroencephalography (EEG) earned a second five-year accreditation by the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET), the national credentialing board for EEG technologists. In the last year, the lab performed a total of 4,131 EEG procedures at Christiana and Wilmington hospitals.

Palliative Medicine Section physicians are working to improve care across transitions. One example is partnership with the Dartmouth Medical School Working Group project to develop an ICU trigger checklist and early integration of palliative care. Palliative Care Physician Champions, inaugurated in February 2015, brainstorm new projects and promote self-study and advancement in palliative care. Currently represented are the Christiana Hospital MICU and Emergency Department, Nephrology, Family Medicine faculty, and the hospitalist practices. The Palliative Nurse Ambassador program includes 55 registered nurses representing patient care units at both Christiana and Wilmington hospitals.

Diane Meier, M.D., FACP, spoke at the Value Institute Symposium on End-of-Life Care in America about the value palliative care can bring to patients and their families.

Medicine â&#x20AC;&#x201D; 2014-2015

Members of the Section are active in medical education and advocacy on behalf of patients and the specialty, and contributed to successful passage and implementation of legislation on DMOST (Delaware Orders for Scope of Treatment) form, to help align medical care in the final phase of life with a personâ&#x20AC;&#x2122;s wishes/preferences.

Pulmonary and Critical Care Medicine As part of an ongoing commitment to preventive care, Pulmonary Medicine is collaborating to provide lung cancer screening with low-dose computed tomography for patients with a history of heavy smoking in line with the U.S. Preventive Services Task Force recommendations. Respiratory Care services increased by 28 percent in FY15. Recognized for quality by the American Association of Respiratory Care, the team performed 634,560 procedures, serving both Christiana and Wilmington hospitals and the Middletown Emergency Department. A tracheostomy protocol developed in collaboration with Speech Therapy effected a 10 percent reduction in hospital length-of-stay among treated patients. The Cystic Fibrosis Clinic at the Wilmington Health Care Center is the primary practice for young adults with cystic fibrosis who are transitioning from pediatric care. Working with colleagues from Temple University, eligible cystic fibrosis patients may benefit from the latest therapies targeting specific gene defects, which could lead to dramatic improvement in their symptoms including increased lung function, weight gain and a decrease in pulmonary exacerbations. Intensive care units at Wilmington and Christiana hospitals achieved a four percent increase in off-shift extubations, in their push to wean patients off mechanical ventilation when they are ready, “round the clock.” Extubating when the patient is ready is a well-studied key factor in reducing ventilator days, length of stay, and delirium while credited with increasing mobility. The eCare nursing team offers the benefit of their experience on a regularly scheduled national webinar series for e-ICU nurses across the nation. Christiana Care’s telemedicine model is unique in the presence of this core nursing team who work round the clock and in collaboration with telemedicine privileged physicians at Advocate Health System, who cover the ICU beds from 7 pm to 7 am.

Renal & Hypertensive Diseases Christiana Care nephrologists are rated among the nation’s top performers by U.S. News and World Report. The section provides hemodialysis for patients with chronic and acute kidney disease at two Joint Commission accredited labs. In FY15, 10,870 dialysis treatments (includes CAPD and SLEDD) were performed at two labs located at both Christiana and Wilmington hospitals.

Medicine — 2014-2015

Honors, Awards & Kudos Celebrating the selected accomplishments of our physicians, nurses and other health care professionals.

Sidney Kimmel Medical College at Thomas Jefferson University Teaching Appointments Michael Benninghoff, D.O., Clinical Assistant Professor in the Clinician Educator Track Meenakshi A Bhalla, M.D., Clinical Assistant Professor in the Clinician Educator Track Robert Dressler, M.D., Professor in the Clinical & Educational Scholarship Track Kathleen Eldridge, M.D., Clinical Assistant Professor in the Clinician Educator Track Jennifer Neuman Goldstein, M.D., Assistant Professor in the Clinical & Educational Scholarship Track Roshni Therese Guerry, M.D., Clinical Assistant Professor in the Clinician Educator Track Michael Kostal, M.D., Clinical Assistant Professor in the Clinician Educator Track Erin Myer, D.O., Clinical Assistant Professor in the Clinician Educator Track Jenny Petkova, M.D., Clinical Assistant Professor in the Clinician Educator Track Paul Sierzenski, M.D., Professor of Emergency Medicine Jeffrey Stewart, M.D., Clinical Assistant Professor in the Clinician Educator Track Karla Anna Testa, M.D., Clinical Assistant Professor in the Clinician Educator Track Pan Wu, Ph.D., Research Assistant Professor in the Research Non-Tenure Track.

Medicine â&#x20AC;&#x201D; 2014-2015

Teaching Awards Jordan Assadi, M.D., Dan Jacoby, M.D., Amit Patel, M.D., David Roofeh, M.D., and Vishal Patel, M.D., were recognized as outstanding teachers by the medical students from the Sidney Kimmel Medical College. David Chen, M.D., Vishal Patel, M.D., and David Roofeh, M.D., earned the Sidney Kimmel Medical College Clinical Campus Award. Marci Drees, M.D., was named a Distinguished Educator Mentor by the Learning Institute of Christiana Care. John Donnelly, M.D., is the Department of Medicine 2015 Teacher of the Year, voted by medical students. Larry Edelsohn, M.D., received the Blockley-Osler Award for Excellence in Teaching from the Sidney Kimmel Medical College. The award is presented each year to an affiliate faculty member who exemplifies the ideals of teaching excellence in the tradition of Sir William Osler. Allen Friedland, M.D., received the 2014 Transforming Leadership Award and the 2014 Distinguished Mentor Award from the Christiana Care Learning Institute. Anthony Gannon, M.D., is the 2015 Joel David Klein Faculty Teacher of the Year and a 2014 Educator of the Month at Nemours/A.I. du Pont Hospital for Children. LeRoi Hicks, M.D., was named a Distinguished Research Mentor by the Learning Institute of Christiana Care. Erin Meyer, D.O., is the 2015 Department of Medicine, Leonard Lang Teacher of the Year Award, voted by house staff in recognition of her exceptional contributions to medical education. Jason Stankiewicz, M.D., earned the Resident Teaching Award.

Medicine â&#x20AC;&#x201D; 2014-2015

More Awards Alfred Bacon, III, M.D., FACP, received the “Laureate of the Delaware Chapter” award from the American College of Physicians in February 2015. The award honors fellows who have demonstrated an abiding commitment to excellence in medical care, education or research and in service to the community and their Chapter. Diane Bohner, M.D., FACP, is a winner of the Wilmington Awards for Health, presented by the mayor to those who have made outstanding contributions to the city. Nina Bennett, MS, HIV educator, received the 2014 Sister Dolores Macklin Guardian Angel Red Ribbon Award from the Delaware HIV Consortium. Kunal Bhagat, M.D., FACP, received the 2014 IPC Healthcare Hospitalist of the Year Award and was recognized by the Delaware Chapter of the American College of Physicians for Excellence in Hospital Medicine. David Chen, M.D., received the 2015 John W. Maroney Award for Excellence in Ambulatory Care. Himani Divatia, D.O., received the 2015 Herman Rosenblum Award for Excellence in Delivering Pediatric Care. Mary Gant, RN, and Michael Lankiewicz, M.D., received a Christiana Care Performance Improvement Award for developing a patient-specific treatment plan for each hemophilia patient. Jennifer N. Goldstein, M.D., MSc, is winner of the 2015 Milton W. Hamolsky Award from the Society of General Internal Medicine. Victoria Hammond, RN, (6C/STAR) and Michelle Ellana, PCT (6A/ACE) at Christiana Hospital are the 2015 WISH Champions of the Year. Julie Holmon, M.D., is the 2015 recipient of American College of Physicians Delaware Chapter Hospitalist Award. Stephanie Guarino, M.D., is the winner of the 2014 American Academy of Pediatrics (AAP) Leadership Conference Scholarship from the Delaware AAP.

Medicine — 2014-2015

Heart Failure Team earned the American Heart Association’s Gold Plus Performance Award and the Mission Lifeline 2015 Bronze Award for Improving STEMI and Cardiac Resuscitation Systems of Care. Terry Horton, M.D., Claudine Jurkovitz, M.D., MPH, Bailey Ingraham-Lopresto, MS, Elizabeth Ivey, and Beverly Wilson, MA, earned the top research award at the 46th Annual Meeting of the American Society of Addiction Medicine. Denise Lyons, MSN, GCNS-BC, became a Fellow of the National Gerontological Nursing Association (NGNA). Respiratory Care earned recognition from the AARC for Quality Respiratory Care in 2015, for the thirteenth year in a row. Albert Rizzo, M.D., received the 2015 Will Ross Medal from the American Lung Association, the highest award bestowed on a volunteer for significant contributions to prevention and control of lung disease. Akash Sethi, M.D., is the 2015 recipient of the Mark Maxwell Award, voted by house staff for the resident who best exemplifies devotion to patients, extraordinary enthusiasm, compassion and humility. Linda Sydnor, MSN, GCNS-BC, ANP, and Patricia Curtin, M.D., FACP, CMD, received the Alzheimer’s Association Corporate Appreciation and Recognition Award, for raising awareness and participation in the Walk to End Alzheimer’s in May 2015 for the second year in a row. Giovanna L. Uzelac, M.D., Akash N. Sethi, D.O., Xian Qiao, M.D., and Nirmol Philip, M.D., are 2015 American College of Physicians “Young Achievers.”

Medicine — 2014-2015

Focus on Excellence Awards These awards represent the work of Medicine in its broadest sense, recognizing the accomplishments of the Acute Medicine Service Line, the Department of Medicine Residency Programs and Medicine colleagues. Medicine had the lion’s share of entries in this year’s competition, 55 of 144 submissions. President’s Award The Brown Battle Reduction of WICU Acquired Clostridium Difficile Rates Team: Wilmington Intensive Care Unit Value Improvement Team Value Award Gold Is that Chest Radiograph Really Needed? Let’s Choose More Wisely Team: Christiana Care Pulmonary Associates medical intensivists Value Award Silver The Impact of Performing Active Surveillance on Know MRSA+ Patients Admitted to CHR Team: Interdisciplinary membership from Infection Prevention, Value Institute, Christiana Care Quality Partners and Medicine faculty Clinical Excellence Gold Christiana Care Cardiology Consultants Transitional Care Program Team: Christiana Care Cardiology Consultants Transitional Care Committee Clinical Excellence Silver Impact of Multidisciplinary Team Approach on Cardiac Care Unit Patient Outcomes Team: Interdisciplinary membership from Christiana Care Pulmonary Associates medical intensivists, Christiana Care Cardiology Consultants, Cardiology fellows and CVCC nursing staff Clinical Excellence Bronze Let’s Get Rid of Those Bugs. Organizing a VIT to Improve Outcomes Related to Sepsis Team: Sepsis Value Improvement Team including membership from Critical Care, ED, Nursing, Pharmacy and Data Acquisitions & Measurement Clinical Excellence Honorable Mention Chronic Obstructive Pulmonary Disease (COPD) Care Improvement Team: Interdisciplinary membership from Medicine, Respiratory Care, Social Work, Case Management, Christiana Care Hospitalist Partners, IPC-Healthcare, Inc and the 3D staff

Medicine — 2014-2015

Safety First Silver Implementation of an Electronic Sepsis Advisory Trigger Team: Interdisciplinary membership from Critical Care, Value Institute, Data Acquisition & Measurement, 2C, 3D, 5A, 5B, 6B and eCare Think of Yourself as Patient Silver Communication Innovation! Patient-Centered Bedside Shift Report Team: 4 North Medical Nursing Nursing Excellence – Empirical Outcomes Possible Side Effects Include Patient Satisfaction and Knowledge Team: 4E Cardiac Stepdown Nursing Nursing Excellence – Exemplary Professional Practice Gold Successful Integration of Palliative Care and Heart Failure Teams Team: Interdisciplinary membership from Heart Failure leadership, Pain & Palliative Care Program and the Supportive Care Pilot Committee Nursing Excellence – Transformational Leadership Bronze Changing the Culture of Restraining Patients Team: Critical Care Clinical Nurse Specialists, Nurse Managers and Value Improvement Teams Excellence in Community Health Gold Integration of Behavioral Health in Primary Care Team: Interdisciplinary membership from the Wilmington Health Center, Medicine Adult Medicine Office and Behavioral Health Resident’s Award Embracing the Huddle in a Resident Teaching Clinic Team: Medicine’s Adult Medicine Office including Medicine chiefs, preceptors, residents and staff

Medicine — 2014-2015

American College of Physicians (ACP) Delaware Chapter Poster Competition Winners The Department of Medicine’s 2014-2015 winners of the American College of Physicians (ACP) Delaware Chapter Poster Competition will present their posters at both the Delaware and national ACP meetings. Akash Sethi, D.O., is this year’s grand prize winner with mentor Badrish Patel, M.D. Dr. Sethi presented his clinical vignette, “It Will Take Your Breath Away – A Case of Rapidly Progressing Pulmonary Tumor Thrombotic Microangiopathy,” at the Delaware Chapter meeting and will present a poster at the national ACP meeting in April in Boston. High Value, Cost-Conscious Care Category 1st Place: “Reflex to Urine Culture: Truncating the Time Taken to Transport the Tinkle to the Testing Tube.” Xian Qiao, M.D., with co-authors: Joseph Santora, D.O., Gealina Dun, BS MS3, Alicia Edelblute, PA-C, Nora Protokowicz, MSN, RN, Allison Steuber, MSN, RN, CEN, Loretta Consiglio-Ward, MSN, and John Powell, M.D. 2nd Place: “Got Status? DNR Status in RRT’s.” Benjamin Silverman, M.D., and Christopher Batchelor, M.D. Quality Improvement/Patient Safety Category 1st Place: “Super-Size This! Improving Resident Communication about Obesity in the Outpatient Clinic.” Pearl Philip, M.D., with co-authors: Tara Edwards-Booker, D.O., Matthew Lunser, D.O., Jung Kim, RN, Evalyne Mwangi, RN, Dennis Shaw, PA-C, and Edward Ewen, M.D.

Resident Abstract Competition Winners 1st Place: “More Than Meets the Eye: A Challenging Case of Bilateral Optic Neuritis.” Joseph Santora, D.O. 2nd Place: “Recurrent Upper GI Bleeding in the Elderly: A Multi-disciplinary Etiology.” David Roofeh, M.D., Shaun Hanson, M.D., and Kristen Facciolo, D.O. 3rd Place: “Fool Me Twice: Unexpected Findings in a Patient with Hemophagocytic Lymphohistiocytosis.” Shaun Hanson, M.D.

Medicine — 2014-2015

Medical Student Abstract Winners “Recognizing Anti-synthetase Syndrome.” David Maniscalco, Sidney Kimmel Medical College at Thomas Jefferson University 1st Place: “The Way to a Man’s Lungs is through His Nails: Defining Yellow Nail Syndrome.” Anita Modi, Sidney Kimmel Medical College at Thomas Jefferson University 2nd Place: “Wernicke Encephalopathy in a Non-Alcoholic Patient.” Susan Joan Chinnery, Second Lieutenant, United States Air Force, DesMoines University 3rd Place: “Consideration of Age in the Treatment of Acute Promyelocytic Leukemia.” Rino Sato, Sidney Kimmel Medical College at Thomas Jefferson University Honorable Mention: “Arterial Thrombosis Presenting As Renal Colic.” Jeffrey Muenzer, Sidney Kimmel Medical College at Thomas Jefferson University

Medicine — 2014-2015

Selected Publications AMSL authors share lessons learned in this selected list of published articles and book chapters, followed by abstracts, and poster presentations. Bradley JD, Paulus R, Komaki R, Masters G… Koprowski C, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomized, two-by-two factorial phase 3 study. Lancet Oncol. 2015 Feb; 16 (2):187-99. Burke PA, Vest MT, Kher H, Deutsch J, Daya S. Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study. Journal of the American Osteopathic Association. July 2015; 7 (115). Condamine T…Hockstein N, Witt R, Masters G, Bauer T, Gabrilovich DI. ER stress regulates myeloid-derived suppressor cell fate through TRAIL-R-mediated apoptosis. J Clin Invest. 124:2626. PMCID: PMC4038578. Dressler R, Dryer MM, Coletti C, Mahoney D, Doorey AJ. Altering Overuse of Cardiac Telemetry in Non–Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines. JAMA Internal Medicine. Published online September 22, 2014. Davis J, Riesenberg L, Mardis M, Donnelly J, Benningfield B, Youngstrom M, Vetter I. Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review. Journal of Graduate Medical Education. June 2015; 2 (7)174-180. Dressler R, Consiglio-Ward L, Maxwell L, Moore CK, Jasani N. Driving quality and safety with residents and faculty. Quality Matters, Qmentum for better health. Spring 2015; 1(8):7-15. Elliott DJ, Young RS, Brice J, Aguiar R, and Kolm P. The Impact of Hospitalist Workload on the Quality and Efficiency of Care. JAMA Internal Medicine. May 2014; 174 (5):786-793. Fanari Z, Choudhry UI, Reddy VK, Eze-Nliam C, Kolm P, Weintraub WS, Marshall, ES. The Value of Quality Improvement Process in the Detection and Correction of Common Errors in Echocardiographic Hemodynamic Parameters in a Busy Echocardiography Laboratory. J Am Soc Echo. 2015; 28 (6):B 61.

Medicine — 2014-2015

Goldsetin J, Ibrahim SA, Frankel ES, Mao JJ. Race, Pain and Beliefs Associated with Interest in Complementary and Alternative Medicine Among Inner City Verterans. Pain Med. 2015 August; 16 (8):1467-74. Epub 2015 June 10. Goldstein JN, Long JA, Arevalo D, Ibrahim SA, Mao JJ. US veterans use vitamins and supplements as substitutes for prescription medication. Med Care. 2014 Dec; 52 (12 Suppl 5):S65-9. Gupta M, Msambichaka L, Ballas SK, Gupta K. Morphine for the treatment of pain in sickle cell disease. Scientific World Journal. Jan 2015. Jalal SI, Hanna N, Zon R, Masters GA, et al. Phase I Study of Amrubicin and Cyclophosphamide in Patients with Advanced Solid Organ Malignancies HOG LUN -7-130. Am J Clin Oncol. 2014 Dec 10; doi: 10.1097/COC.0000000000000160. Kansara P, Jackson K, Dressler R, Weiner H, Kerzner R, Weintraub WS, Doorey A. The Potential to Miss Life Threatening Arrhythmias after Limiting the Use of Cardiac Telemetry. JAMA Internal Medicine, accepted for publication, April 2015. Khan OA, Donnelly J, Prater C, Testa K, Merriam A. Developing and sustaining residency tracks in global health at an independent academic medical center. Annals of Global Health. May, 2014; 80 (3):166. Khan O, Derman R ,Testa K. Why We Should Care About Global Health. Delaware Medical Journal. Feb 2014; 86 (2):49-51. LaSorda MW and Marcotte GV. Angioedema of the tongue with an unfamiliar final diagnosis. Ann Allergy Asthma Immunol. 2015; (114): 269-272. Lyons, D. Implementing a comprehensive functional model of care in hospitalized older adults. MEDSURG Nursing. 2014; 23 (6): 379 â&#x20AC;&#x201C; 385. Marbach JA, Thapa J, Goldenberg E, Duffy Danielle. Pharmacogenetics in the Development of Lipid Lowering Medications: Lomitapide and Mipomersen in Clinical Practice. Delaware Medical Journal. In press. Maser RE, Lenhard MJ, Pohlig R. Vitamin D insufficiency is associated with reduced parasympathetic nerve fiber function in type 2 diabetes. Endocrine Practice. In press.

Medicine â&#x20AC;&#x201D; 2014-2015

Maser RE, Lenhard, MJ, Sneider,MB. Osteoprotegrin trumps osteocalcin in association with arterial calcification in diabetes. Endocrine Practice. In press. Maser RE and Lenhard MJ. Autonomic modulation in gestational diabetes mellitus. Journal of Diabetes and Its Complications. In press. Maser RE, Lenhard MJ, Kolm P, Hausman SP, Nowakowski-Grier L. Diabetes resource nurse model: any effect in length of stay for patients? Diabetes 2015; 64, Suppl 1, A 194. Maser RE, Lenhard MJ, Pohlig R. Osteopontin: A potential determinant of cardiovascular autonomic nerve function in type 2 diabetes. Diabetes 2015; 64, Suppl 1, A. Masters G, et al . Clinical Cancer Advances 2015: Annual Report on Progress Against Cancer from the American Society of Clinical Oncology. Journal of Clinical Oncology. 2015; 7 (33):786-809. Melby MK, Loh LC, Evert J, Prater C, Lin H, Khan OA. Beyond ‘medical missions’ to impact-driven short-term experiences in global health (STEGH): ethical principles to optimize community benefit and learner experience. Academic Medicine (accepted). Michalec B, Reinbold N, Dressler R, Laskowski-Jones L, Adarve L, Elliott DJ. Barriers to and Facilitators of Interprofessional-Interdepartmental Interventions: Unearthing Departmental Culture. American Journal of Medical Quality, published online January 2014. Neuman MD, Goldstein JN, Cirullo MA, Schwartz JS. Durability of class I American College of Cardiology/American Heart Association clinical practice guideline recommendations. JAMA. 2014 May; 311(20):2092-100. Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom M, Masters GA, et al. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol. 2015 May 20; 15 (33): 1660-1665. St Germain D… Grubbs SS, GO R. Use of the National Cancer Institute Community Cancer Centers Program Screening and Accrual Log to Address Cancer Clinical Trial Accrual. Journal of Oncology Practice. In press. Sarotub AN, Ocean A, Shah MA, Guarino MJ, et al. First-in-Human Trial of a Novel Anti-Trop-2 Antibody-SN-38 conjugate, Sacituzumab Govitecan, for the Treatment of Diverse Metastatic Solid Tumors. Clinical Cancer Research. In press. 38

Medicine — 2014-2015

Sawyer AM, King TS, Sawyer DA, Rizzo A. Is Inconsistent Pre-Treatment Bedtime Related to CPAP Non-Adherence? Research in Nursing & Health 12/2014; 37(6). DOI:10.1002/nur.21631. O’Toole JK, Friedland AR, Gonzaga AMR, Hartig JR, Holliday D, Lukela M, Moutsios SA, Kolarik R. The Practice Patterns of Recently Graduated Internal Medicine–Pediatric Hospitalists. Hospital Pediatrics (ISSN Numbers: Print, 2154 - 1663; Online, 2154 - 1671). Vest M. Case Report An Unusual Cause of Pulmonary Nodules in a Patient with Relapsing Polychondritis. Respiratory Care. Dec 9, 2014. Vest M. Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study. Journal of the American Osteopathic Association. July 2015; (115)7.

Book chapters: Moffa C. Heart Failure Chapter. Textbook: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 10th Ed, Lewis. June 2015.

Medicine — 2014-2015

Selected Abstracts, Posters & Presentations Aggarwal A, Donnelly J, Raman T. “The Problem of Persistent, Progressive Pneumonia,” poster presented at the American College of Physicians Delaware Annual Scientific Meeting, February 2015. Beardell F. “Ask the Adult Transplant Experts,” presented at the Blood Cancer Conference of the Leukemia & Lymphoma Society, Delaware Chapter, September 2015. Burke P, Vest M, Deutsch J, Daya S, Kher H. “Improving performance of resident lead rapid response teams: results of a performance improvement project,” presented at the Society of Hospital Medicine Annual Meeting, March 29- April 1, National Harbor, MD. Bhamidipati S, Consiglio-Ward L, Moore C, Dressler R. “MBA Improving interdisciplinary team effectiveness by team training,” presented at the Alliance of Independent Academic Medical Centers (AIAMC), March 26-28, 2015, in New Orleans, LA. Bhamidipati S, Sonnad S, Elliott DJ, Hicks LS, Jordan J, McGraw P, Ingraham-Lopresto B, Ivey E, Robinson E. “Physician-Patient communication and outcomes: A mixed methods study,” and “Interdisciplinary Admissions and Rounding to Improve Patient Outcomes,” presented at the Society of General Internal Medicine, April 22-25, 2015, in Toronto, ON, CA. Bhamidipati S, Sonnad S, Elliott DJ, Jordan J, McGraw P, Ingraham-Lopresto B, Greer D, Ivey E, Robinson E. “Interdisciplinary Admissions and Rounding to Improve Patient Outcomes,” presented at the Society of Hospital Medicine Annual Meeting, March 29- April 1, National Harbor, MD. Bhamidipati S, Elliott DJ, Justice E, Belleh E, Sonnad S, Robinson E. “Structure and Outcomes of Inter-Disciplinary Rounds in Hospitalized Medicine Patients: A Systematic Review,” presented at the Society of Hospital Medicine Annual Meeting, March 29- April 1, National Harbor, MD. Bhattacharya S. “Impact on Haemophilus Influenzae Type b Vaccine in Children and Their Families Affected By HIV,” presented at the Indian Institute of Technology, Kharagpur AAP Section of International Child Health Abstract Symposium, 2015. Bley B. “Use of Ultrasound in Musculoskeletal Medicine,” presented at the Delaware Academy of Family Physicians Sports Medicine Symposium, February 2015.

Medicine — 2014-2015

Bley B. “Musculoskeletal Ultrasound and Management of Chronic Tendinopathy,” presented at ATI Physical Therapy Educational Seminar, January 2015. Bonis K. “Does Suctioning During HFOV Effect the Airway Pressure and Flow? A Bench Evaluation,” presented at the American Association of Respiratory Care Congress 2014. Bradley G… Guarino M, Hoon D, Karakousis G, Mitra N, Nicholas J. Petrelli, et al. “Targeted, massively parallel sequencing identifies novel genetic subsets of cutaneous melanoma.” AACR Abstract # 4668,2015 Burday M, Slack D, Hess J, Deutsch J, Donnelly J, Aboff B. “Intern Orientation – A New Beginning,” presented at the Association of Program Directors in Internal Medicine Spring Meeting, April 2015. Chen D, “Ebola, Measles, and Gun Violence: Epidemiology, Ethics, and Redefining Public Health,” presented at the Global Health Series, March 2015. Chen D and Denn M. “Growing Up in a Violent Neighborhood,” presented at the Medical Society of Delaware’s It’s Obvious Campaign, Feb 2015. Comer D, Elliott DJ, Harris D. “Policy Implications of Linked Pharmacy Claims to Improve Electronic Health Record Interoperability,” presented at Academy Health 201, San Diego, CA. Comer D, Couto J, Aguiar R, Wu P, Elliott, DJ. “A New Frontier: Using Pharmacy Claims within the EHR to Conduct Medication Reconciliation in Primary Care Practice,” presented at ISPOR Annual Meeting 2014. Donnelly J, Noronha C, Suddarth K, Clemmon J. “Scheduling in an X+Y Schedule. Avoiding Roadblocks and Maximizing the Resident Experience,” presented at the Alliance of Academic Internal Medicine APDIM Spring Meeting. Chief Conference 2015. Donnelly J, Aboff B, Deustch J, Burday M. “Identifying & Coaching Emotional Intelligence to Improve Teamwork,” presented at the Alliance of Academic Internal Medicine Academic Internal Medicine Week National Meeting 2014. Donnelly J and Jordan, J. “Synchronized Admissions as a Tool for Multi-disciplinary Team Leading and Direct Observation,” presented at the Association of Program Directors Spring Meeting, 2014, Nashville, TN.

Medicine — 2014-2015

Drees M, et al. “Optimization of PEEP as a Strategy to Reduce Ventilator-Associated Events,” presented at IDWeek 2014TM, October 8-12, in Philadelphia. Elliott DJ, Fanari Z, Kolm P, Weintraub WS. “Predicting Readmission Risk Following Coronary Revascularization,” presented at AHA Quality of Care and Outcomes Research, June 2014, Baltimore, MD. Elliott DJ, Williams KD, Wu P, Kher HV, Michalec B, Colletti CM, Reinbold N, Dressler RM. “A Novel Intervention Improving Patient Transitions from the Emergency Department to the Medical Intensive Care Unit,” presented at the Academy Health Annual Meeting, June 2014. Emberger J, Mixell J, Brown K, Bonis K, Locke R. “Rate of Unplanned Extubation and Associated Outcomes in the Neonatal Intensive Care Unit,” presented at the American Association of Respiratory Care Congress 2014. Emberger J, Mixell J, Brown K, Bonis K, Maheshwari V. “Unplanned Extubation Rate and outcomes in the adult Intensive Care Population,” presented at the American Association of Respiratory Care Congress 2014. Emberger J, Brown K, Bonis K. “Does Endotracheal Tube Clamping maintain Airway Pressure? A Bench Evaluation,” presented at the American Association of Respiratory Care Congress 2014. Ewen E, LeComte J, Lopresto B, Schenck S. “The Impact of Chronic Opioid Therapy for Non-Cancer Related Pain on the Delivery of Preventive Services and Chronic Disease Management in Primary Care Practices,” presented at the Society of General Internal Medicine Annual Meeting 2015. Ewen E, LeComte J, Lopresto B, Schenck S. “The Impact of and Interaction between Chronic Opioid Therapy and Behavioral Health Co-Morbidities on Hospital, Emergency Department, and Primary Care Utilization in a Large Integrated Health System,” presented at the Society of General Internal Medicine (SGIM) Annual Meeting 2015. Ewen, E, Schenck, S, Donnelly, J. “Embracing the Huddle in a Resident Clinic,” presented at the National SGIM Meeting 2014, San Diego, CA. Fanari Z, Choudhry UI, Reddy VK, Eze-Nliam C, Kolm P, Weintraub WS, Marshall ES. “The Value of Quality Improvement Process in the Detection and Correction of Common Errors in Echocardiographic Hemodynamic Parameters in a Busy Echocardiography Laboratory,” presented at the American College of Cardiology 64th Annual Scientific Session, San Diego, CA 2015.

Medicine — 2014-2015

Fanari Z, Choudhry UI, Reddy VK, Hammami S, Weintraub WS, Marshall ES. “The role of quality improvement approach on reducing systematic errors in echocardiographic hemodynamic parameters assessment. Eur Heart J 2015; (36)35. Fanari Z, Barmpouletos D, Reddy VK, Eze-Nliam C, Hammami S, Weintraub WS, Marshall ES. “The impact of age on the outcomes of low flow versus normal flow severe aortic stenosis with preserved left ventricular function.” J Am Soc Echo 2015; (28)6:B76-77. Fanari Z, Barmpouletos D, Hammami S, Hammami B, Weintraub WS, Marshall ES. “The Role of Aortic Valve Velocity and Stroke Volume Index in Predicting the Outcomes of Severe Aortic Stenosis with Preserved Ejection Fraction in Elderly.” Eur Heart J 2015; (36)35 and J Am Soc Echo 2015; (28)6:B76. Glasgow J (IM-2), Deutsch J, Divatia H. “Evaluation of Inpatient Teaching Rounds,” presented at the Society of Hospital Medicine Annual Conference poster/abstract presentations, March 2015, National Harbor, MD. Guarino M. “A Phase I/II Study of IMMU-132 (hRS7-SN38 Antibody Drug Conjugate) in Patients with Epithelial Cancer (Immunomedics 132-01),” presented at the American Society of Clinical Oncology Annual Meeting, May-June 2015, Chicago. Himelstein A, et al. “CALGB 70604 (Alliance): A randomized phase III study of standard dosing vs. longer interval dosing of zoledronic acid in metastatic cancer,” presented at the American Society of Clinical Oncology Annual Meeting, May-June 2015, Chicago. Horton T, Jurkovitz C, Ingraham-Lopresto B, Ivy E, Woody G. “Hospital-based Peer Counseling Reduces 30-Day Readmission of Alcohol Abusing Medical Inpatients,” ASAM Annual Conference Program Planning Committee Award. American Society of Addiction Medicine Annual Conference, Austin, Texas, April 2015. Horton T. “Medical Marijuana, an Internist’s Perspective,” presented at the American College of Physicians Delaware Chapter annual meeting, Feb. 14, 2015. Horton T. “Using Peer Counselors in the Hospital,” presented at the Steering Committee Symposium, Clinical Trials Network, National Institute on Drug Abuse, Gaithersburg, Maryland, April 15, 2015. Horton T. “Addiction Overview for the Primary Care Physician,” presented at the Eastern Shore Medical Symposium, Rehoboth, Delaware, June 26, 2015.

Medicine — 2014-2015

Khan O, Donnelly J, Prater C, Testa K, Merriam, A. “Developing and sustaining residency tracks in global health at an independent academic medical center.” Annals of Global Health Journal. September 2014. Khan OA, Rosenthal MP, O’Neill E, Sharif I, Geisler P, Passarella J, Rogers S, Rahmer B, Fagan HB. “Integrating Community Engagement & Outreach across the Delaware Clinical & Translational Research Program (ACCEL),” presented at the Annual Conference of the Association for Clinical & Translational Science, Washington, D.C., April 2015. LeComte J. “Best Practices in Transition Care for Young Adults with Special Health Care Needs,” presented at Autism Delaware, June 2014. Loh L, Evert J, Khan O, Melby M, Prater C, Lin H. “Evolution of ‘medical missions’ into short-term experiential education in global health: Implications for learners and practitioners,” presented at the American Public Health Association Annual Meeting, New Orleans LA, Nov. 2014. Lyons D. “CCHS Exemplar Experience” and with Shearon EB. “Reducing Falls using Another Pair of Eyes,” presented at the NICHE Exemplar Panel, 18th Annual NICHE Conference, Orlando, FLA, April 15, 2015. Margolese R…Wozniak T, et al. “NRG / NSABP B-35: A Clinical trial comparing anastrozole with tamoxifen in postmenopausal patients (pts) with ductal carcinoma in situ (DCIS) undergoing lumpectomy with radiotherapy (RT),” published online at ASCO University 2015. Maser RE, Lenhard MJ, Kolm P, Hausman SP, Nowakowski-Grier L. “Diabetes resource nurse model: any effect in length of stay for patients?” poster presented at the 75th Scientific Sessions of the American Diabetes Association, Boston, MA. Maser RE, Lenhard MJ, Pohlig R. “Osteopontin: A potential determinant of cardiovascular autonomic nerve function in type 2 diabetes,” poster presented at the 75th Scientific Sessions of the American Diabetes Association, Boston, MA. Meyer E, “Wilderness Medicine. The Specialty You Didn’t Know You Practiced,” presented at the Wilmington New Castle Pediatric Association Annual Meeting 2015. Meyer E, Cipolle M, Pirrung J. “Improving trauma patient care through trauma surgery and hospitalist co-management,” presented at the Society of Hospital Medicine Annual Meeting, March 29- April 1, National Harbor, MD.

Medicine — 2014-2015

Moffa C. “Decreasing Readmissions in the HF Population: A Task Shared Across the Continuum,” poster presented at the American Association of Heart Failure Nurses (AAHFN) conference, June 2014. Moffa C. “Integration of the Palliative Care and Heart Failure Teams,” presented at AAHFN, June 2015. Moore C, Consiglio-Ward L, Bhamidipati S. “A team of experts is not an expert team: Optimizing Interdisciplinary Rounds Communication,” workshop presented at Team STEPPS National Conference, June 16-18, 2015, in Denver, CO. Patel V and Elliott D. “Multidisciplinary Approaches to Identify Causes for Readmission Following Revascularization,” presented at the Society of General Internal Medicine Annual Meeting 2015. Patel V and Elliott D. “Factors Contributing to Readmissions for Patients with Ischemic Heart Disease,” presented at the Society of General Internal Medicine regional meeting, 2014. Patel V, Weintraub WS, Robinson EJ, Kerzner R, Salam T, Elliott DJ. “Factors Contributing to Readmissions for Patients with Ischemic Heart Disease,” presented at the Society of General Internal Medicine Annual Meeting 2014. Pendergast L, Cannatelli K, Khan O, Rahmer B. “Effectiveness of MarketPlace Guides (MPGs) in promoting health access through the Affordable Care Act,” presented at the American Public Health Association Annual Meeting, New Orleans, LA, Nov. 2014. Rizzo A. “Lung Cancer in Women,” presented at the COPD Foundation’s Board Meeting, Austin, Texas, 2014. Rizzo A. “The importance of clinical research in lung disease—Asthma, COPD, Lung Cancer—and the leveraging of funds,” presented at the National Board Meeting of the American Lung Association, Chicago, June 2015. Roofeh D, Uzelac G, Donnelly, J. “Dialing Down Chest Pain: A Case of ‘Atypical Chest Pain and Shortness of Breath,’” poster presented at the Society of General Internal Medicine Annual Meeting, April 2015.

Medicine — 2014-2015

Roofeh D, et al. “Recurrent Upper GI Bleeding in the Elderly: A Multidisciplinary Etiology,” poster presented at the Delaware American College of Physicians, February 2015. Second Place Clinical Vignette Sapra M, Lucas A, Hulsey E, Shanahan A, Parham K, Wilson B, Horton T. ‘Use of Peer Navigators in Engaging Consumers Suffering from Co-Occurring Substance Use Disorders,” 168th APA Annual Meeting in Toronto, Canada, May 16-20, 2015. Shalaby M, Yaich S, Donnelly J, Chippendale R, DeOliviera, Noronha C. “X + Y Scheduling Models for Internal Medicine Programs- A Look Back and a Look Forward.” Journal Graduate Medical Education. Dec 2014; 639-642. Siegel S. “The Scars You Can’t See Are the Hardest to Heal: Facing Emotional Challenges After Transplant,” presented at the Blood Cancer Conference of the Leukemia & Lymphoma Society, Delaware Chapter, September 2015. Silverman B, et al. “Got Status. DNR Status in RRT’s” poster presented at the Delaware American College of Physicians, February 2015. Second Place winner Silverman B, et al. “Improving DNR Status Communication; A Quality Improvement Project at Christiana Care Health System,” presented at the Mid Atlantic Society of General Internal Medicine, 2014. Simmons R, Plumb J, Donnelly J, Martin P, Brody C, Todd T. “Experiential Global Health Education for the Health Professions: Lessons Learned from Experience-Based Learning for Students, Residents and Healthcare and Population Health Professionals,” presented at the Consortium of Universities for Global Health National Meeting, Washington, D.C., 2014. Stewart J. “Switch from Bosentan to Macitentan in Patients with Pulmonary Arterial Hypertension.” CHEST 2015 abstract accepted. Stewart J. “Impact of Average Volume Assured Pressure Support (AVAPS) on Hospital Admissions in Patients with Acute on Chronic Hypercapnic Respiratory Failure.” CHEST 2015 abstract accepted. Szabo S, Preininger L, Ewen E, James C, Singh-Patel S, Cantwell-McNelis K, Miner S. “The Influence of HIV Infection on Non-Infectious Co-morbidities in an Aging Cohort,” presented at the 5th International Workshop on HIV & Aging, October 2014, Baltimore, MD.

Medicine — 2014-2015

Taylor D, Bradley E. Goldenberg E. Million Hearts Delaware: A First State Coalition to Prevent Heart Attack and Stroke. Journal of Cardiovascular Nursing. Winning abstract at the Preventive Cardiovascular Nurses Association Annual Symposium, April 2015. Taylor D, Bradley E. Goldenberg E. “RD’s Manage a Statewide Coalition to Prevent Heart Attack and Stroke - Million Hearts Delaware, “ accepted for poster presentation at The Academy of Nutrition and Dietetics’ Food & Nutrition Conference and Exhibition, October 2015 and for publication in the Journal of The Academy of Nutrition and Dietetics, September 2015. Testa K. “Developing Global Health Tracks through a Shared Global Health Curriculum. The Experience from Christiana Care Health System” and “How do I find a Residency Which Prepares Me for Global Health,” presented at the Delaware Health Science Alliance, June 2014. Upchurch CN, Mascarenhas SJ, Noor SA,D., Moncrief J. “Changing of the Guard-Christiana Care Health System Pulmonary Stepdown,” presented at the Society of Hospital Medicine Annual Meeting, March 29- April 1, National Harbor, MD. Uzelac G. “A Case of Ehrlichiosis: Going on a History and a Hunch,” presented at the American College of Physicians National Poster Competition, 2015. Vest M. Outcomes and Discharge Disposition of Obese and Non-Obese Critically Ill Patients in a Community Based Medical Intensive Care Unit. Am J Respir Criti Care Med. 2015; 191: A1610. Vest M. In a Community Setting, Can Co-Morbid Conditions Identify MICU Admission as Low Benefit? Am J Respir Crit Care Med. 2015; 191: A5226. Vest M. “ACCEL Grant Nutrition Project,” presented at the American Association for Clinical and Translational Science Meeting in April, Washington, DC. Third place winner at Accelerate Clinical and Translational Research (ACCEL) Annual Meeting, Charleston, SC, February 2015.

Vest M, Trabulis J, Slennon-Edwards S, McGraw P, Shapiro M, Halbert J, Kolm P, Jurkovitz C. “Weight Based prediction equations result in hypocaloric feeding of obese patients,” accepted for presentation by the American College of Clinical Pharmacy.

Medicine — 2014-2015

Welcome New Physicians We welcomed 46 new physicians to the department in FY15 (through June 30, 2015).

Cardiology Meenakshi A. Bhalla, M.D. Christiana Care Cardiology Consultants

Lionel J. Malebranche, M.D. Heart & Vascular Clinic

Kevin A. Copeland, D.O. Cardiology Physicians, PA

Brian J. Pahlow, D.O. Christiana Care Cardiology Consultants

Antony L. Innasimuthu, M.D. Heart & Vascular Clinic

Leon Shao, M.D. Christiana Care Cardiology Consultants

Anand S. Kenia, M.D. Christiana Care Cardiology Consultants

Dermatology Courtney B. Guerrieri, M.D. Jefferson Dermatology Associates

Jason B. Lee, M.D. Jefferson Dermatology Associates

Matthew S. Keller, M.D. Jefferson Dermatology Associates

Endocrinology Anthony W. Gannon, M.D. Christiana Care Endocrinology Specialists

Lalitha Gudipaty, M.D., PhD Christiana Care Endocrinology Specialists

Gastroenterology Dinu Cherian, M.D. Gastroenterology Associates

Medicine â&#x20AC;&#x201D; 2014-2015

Jesse M. Civan, M.D. Jefferson Hepatology Clinic

Hematology Jenny H. Petkova, M.D. Delaware Clinical Lab Physicians

Internal Medicine Justin E. Devotta, D.O. CCHP, Christiana Care Hospitalist Partners

Muhammad O. Khokhar, MBBS IPC – Healthcare, Inc.

Meghana V. Dhamdhere, MBBS IPC – Healthcare, Inc

Poonam Maru, D.O. The Medical Group

Lauren N. Douglas, MD. CCHP, Christiana Care Hospitalist Partners

Tresa R. Mascarenhas, MBBS IPC – Healthcare,Inc.

Michael A. Giunta, M.D. CCHP, Christiana Care Hospitalist Partners

Anuja Mohla, D.O. CCHP, Christiana Care Hospitalist Partners

Jennifer N. Goldstein, M.D. CCHP, Christiana Care Hospitalist Partners

Tea Ramishvili, M.D. CCHP, Christiana Care Hospitalist Partners

LeRoi S. Hicks, M.D., MPH Department of Medicine

Carmen Tirlea, M.D. CCHP Christiana Care Hospitalist Partners

George J. Kargul, M.D. IPC – Healthcare, Inc.

Carlo R. Valencia, M.D. United Medical Clinic of DE

Neelambari B. Kerkar, M.D. IPC – Healthcare, Inc.

Maria Ana V. Valencia, M.D. United Medical Clinic of DE

Medicine — 2014-2015

Medicine-Pediatrics Sneha S. Daya, M.D. CCHP, Christiana Care Hospitalist Partners

Himani R. Divatia, D.O. CCHP, Christiana Care Hospitalist Partners

Neurology Richard K. Choi, D.O. Christiana Care Neurology Specialists

Yadira Velazquez-Rodriguez, M.D. Christiana Care Neurology Specialists

Jessica C. Stirpe, M.D. Christiana Care Neurology Specialists

Physical Medicine & Rehabilitation Margaret A. Guest, D.O. Christiana Care Medical Group

Christopher S. Karam, M.D. Christiana Care Medical Group

Pulmonary & Critical Care Medicine Jeffrey I. Stewart, M.D. Christiana Care Pulmonary Associates

Pulmonary & Critical Care Medicine â&#x20AC;&#x201C; Telemedicine Ismail Al-Ani, M.D. Advocate Health Care

Bharati Prasad, MBBS Advocate Health Care

Grace H. Chang, M.D. Advocate Health Care

Rajive Tandon, M.D. Advocate Health Care

Vijayakumar S. Nair, M.D. Advocate Health Care

Renal & Hypertensive Diseases Romilkumar R. Patel, M.D. Nephrology Consultants, PA

Medicine â&#x20AC;&#x201D; 2014-2015

Best Wishes to Our Retired Six physicians retired from the Department in FY15. These physicians collectively have performed several hundred years of service to their patients, to Christiana Care, and to the community. We wish them well in their retirement and thank them for living the Christiana Care Way.

Gastroenterology Ira F. Lobis, M.D. Retired June 30, 2015 Parviz Sorouri, M.D. Retired November 30, 2014

Infectious Disease Marshall T. Williams, M.D. Retired December 31, 2014

Medical Oncology Barbara A. Neilan, M.D. Retired December 31, 2014

Neurology Sung Ho Bae, M.D. Retired June 30, 2015

Pulmonary & Critical Care Medicine John Chabalko, M.D. Retired December 31, 2014

Medicine â&#x20AC;&#x201D; 2014-2015