DUKE SURGERY 2018 ANNUAL REPORT
CONTENTS 4
Patient Care
10
Research
14
Education
18
Citizenship & Community
22
Giving
MOVING FORWARD When J. Deryl Hart, founder of Duke Surgery, moved to the small city of Durham in the summer of 1930, he came with a vision—to establish a surgical center that was the best of its kind, not just in the region or the state, but in the nation and later the world. It is this ambitious farsightedness, a constant eye on the future horizon, that has always guided our department. Today, a palpable anticipation of surgery’s future permeates every departmental mission. Clinically, our patient volume is increasing and we are distributing those cases across a broader inpatient and ambulatory network, delivering the best care to the patients we serve in the most appropriate environments. Although the complexity of our cases is rising, the measures of case morbidity and mortality are improving, indicating a rise in both quantity and quality. The demands of this increased clinical intensity are being met both by increasingly innovative research—our research productivity is rising faster than ever in the history of the department—and by advanced education—with programs spanning from community engagement in our area primary schools to new programs for medical students, residents, and fellows.
Importantly, we continue to engage new technologies, particularly those in the data science realm, and to attract world thought leaders to Duke through events like the recent Future of Surgery Symposium held this November. The event orchestrated collaborations between surgeons, scientists, engineers, and entrepreneurs to meet the continuing demand for higher value care for our patients. We clearly have much to celebrate— from novel surgeries to high national rankings—but the advances that I am most proud of this year are those made in our culture. Highlighted by an unprecedented gathering of every member (nearly 1800!) of the Duke perioperative community in Cameron Indoor Stadium this past April, our 1 Duke Periop initiative is shining light not only on what we accomplish, but also on how we support one another in reaching our many goals. Duke Surgery has always driven toward excellence, but our future is dependent on creating an unrivaled culture of support, civility, and inclusion as we strive to improve care “for all patients.” With this in mind, I offer you a brief presentation of our past year. Let this reflection be a springboard that propels us together into 2019 and beyond. Allan D. Kirk, MD, PhD, FACS
The crowd at the 1 Duke Periop launch event. Huth Photo.
David C. Sabiston, Jr. Distinguished Professor Chairman, Department of Surgery, Duke University School of Medicine Surgeon-in-Chief, Duke University Health System
3
Speech pathologist Leda Scearce, MS (left), and Associate Professor of Surgery Seth Cohen, MD, MPH (right), meet with a patient in the Duke Voice Care Center. Jared Lazarus / Duke Photography.
PATIENT CARE
4
OPERATING ROOM VOLUME
68,137
69,146
71,499
73,456
TOTAL AND DEPARTMENTAL Patient volume continues to increase across the Duke Health system, with more than 73,000 procedures performed in FY ‘18, and more than 29,000 performed by the Department of Surgery. This continues a steady rising trend. Total outpatient visits for the department in FY ‘18 totaled 191,538.
27,032
FY ‘15
27,197
FY ‘16
28,765
FY ‘17
29,402
FY ‘18
1 DUKE PERIOP INITIATIVE On April 18, 2018, for the first time in the history of Duke Health, all members of the perioperative teams from Duke University Hospital, Duke Raleigh Hospital, and Duke Regional Hospital came together under one roof—that of Duke’s Cameron Indoor Stadium. The event marked the launch of the new Perioperative System model, which seeks to create an environment that allows team members to take better care of patients, themselves, and each other. Team building exercises and improved communication were the first improvements implemented in 2018.
pat ien t care
5
1
BUILDOUT OF AMBULATORY PROGRAM Ambulatory surgery is the fastest growing segment of surgical cases across the country, rising from 50.5% in 1990 to 65.9% in 2014. Duke Health is expanding operative capacity across the Triangle, and the department is committed to growing its procedural capabilities across all Duke Health campuses.
2
DUKE’S FIRST ABDOMINAL WALL TRANSPLANT In October 2018, a team of 25 physicians, nurses, and support staff performed a successful dual transplant of a patient’s abdominal wall and intestines. The 14-hour transplant, performed under an IRB-approved clinical trial, is the first of its kind in North Carolina and the region, and only the 21st in the nation. This innovative first comes amid growing transplant volume for all organs.
3
NATIONAL RANKINGS IN U.S. NEWS & WORLD REPORT On the honor roll of best hospitals for 2018– 2019, Duke University Hospital placed 19th in national rankings and 1st in North Carolina, and was nationally ranked in 11 adult specialties and 9 pediatric specialties.
6
BETTER CARE FOR PATIENTS
FURTHER EXPANSION OF ECMO PROGRAM
4
The Extracorporeal Membrane Oxygenation (ECMO) program treats patients with life-threatening heart or lung problems, using a system to bypass the lungs and oxygenate blood. The program began in 1990 with treatment of 6 patients, but now treats over 250 patients per year. It is recognized as one of the top programs worldwide, earning an Excellence in Life Support Award from the Extracorporeal Life Support Organization.
LAUNCH OF BLACK BOX ÂŽ INITIATIVE
5
The Black BoxÂŽ platform, which captures clinical data and analytics using specialized hardware and custom software, was integrated in October 2018. Over the next several years, the health system will use this data to inform clinical quality improvement, patient safety, research, and education.
ROLLOUT OF iQUEUE SYSTEM
6
iQueue for Operating Rooms objectively optimizes OR block scheduling, matching supply with demand. The system uses machine learning, staffing insights, and untapped data resources to better allocate blocks, which improves both staff satisfaction ratings and overall revenue. It is set to launch in January 2019. pat ien t care
7
RECORDS IN TRANSPLANT Duke surgeons performed transplants in record numbers in 2017. The Organ Procurement and Transplantation Network reports 461 total operations performed from January to December, including more than 100 liver transplants and more than 100 lung transplants.
Transplants in Kidney Liver Kidney & Pancreas Heart Lung Heart & Lung Intestine
8
2017 168 102 11 73 104 2 1
total to date
2822 1448 350 1297 1888 39 42
Associate Professor of Surgery Matthew Hartwig, MD, examines a lung held in cold storage prior to transplant. Shawn Rocco / Duke Health.
THE PATIENT EXPERIENCE The Department’s Balanced Scorecard continues to monitor the status of patient and physician satisfaction, reporting data from patient and clinician surveys, including the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CAHPS® and CG-CAHPS) and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The snapshot data presented here from the end of FY ‘18 show on-target results for several factors of the patient experience.
Scheduling phone calls not answered
2.86
<6.00
Patient access to care at 3 months
84.5
79.8
Physician communication
93.5
93.0
Overall rating of hospital by physician
78.7
78.2
Phone calls answered within 30 seconds
86.5
70.0
PECTED
AR
AS
EXE MPL
EX
PECTED AS
NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM
AS
Target %
The American College of Surgeons recognized Duke University Hospital as achieving meritorious outcomes for surgical patient care for the second year in a row. Eight criteria relating to quality of care are listed below, measured across all cases.
NSQIP REPORT
EX
Actual %
EX
PECTED
Y
EX
PECTED
EX
PECTED
Y
Y
VENOUS THROMBOEMBOLISM
PNEUMONIA
EXE MPL AR
AR
AS
EXE MPL
RENAL FAILURE
AS
SEPSIS
MORTALITY
UNPLANNED INTUBATION
VENTILATOR > 48 HOURS
CARDIAC
pat ien t care
9
Vice Chair of Research and Professor of Surgery Shelley Hwang, MD, MPH, has received a $10.8 million grant from the NCI to develop a Breast Pre-Cancer Atlas, an active repository on breast tumors open to the scientific community for further research. Shawn Rocco / Duke Health.
RESEARCH
10
BLUE RIDGE INSTITUTE FOR MEDICAL RESEARCH RANKING OF NIH FUNDING INSTITUTION
Duke Surgery has remained in the top five surgical departments in funding for the last 10 fiscal years, with receipt of over $205 million in funding. Researchers often rely on smaller donations to lay groundwork needed to begin the process of applying for grants from the NIH. Faculty are supported by the Surgery Research Development team, who provide guidance in development, editing, and submission of grant proposals.
2 0 1 7
The Blue Ridge Institute for Medical Research measures funding from the National Institutes of Health (NIH).
FUNDING
1
University of Michigan
$19,526,316
2
Washington University
$18,020,515
3
University of California, SF
$16,261,894
4
Duke University
5
University of Pittsburgh
$16,040,032 $16,023,975
INCREASING OUR EFFICIENCY Efficiency of laboratory space must increase with our growing research portfolio. Comparing expenditures per square foot of research space over the last several years reveals a continued upward trend.
$600 $500 $400 $300
1’ Modified total direct cost $ per sq. ft.
$100
Indirect $ per sq. ft. FY ’14
FY ’15
FY ’16
1’
Direct $ per sq. ft.
$200
$
FY ’17
research
11
2,270 total 600
616 573
1,161 total
TOTAL NUMBER OF PATIENTS
481
Clinical trial enrollment continues to increase. FY ‘18 saw a twofold increase in patients compared to 2017.
434
Researchers in the department are supported by the Surgery Office of Clinical Research, Substrate Services Core and Research Support, the Surgical Center for Outcomes Research, and a newly developed task force providing assistance with data management.
279 248
605 total 171 172
200
2016
2017
A LEAD ENROLLER IN NATIONAL TRIALS The department’s portfolio currently includes over 400 active studies. The Surgery Office of Clinical Research, one of several teams that support department research, reports that more than 9,000 patients were screened for participation in trials in FY ‘18. Duke Surgery is currently the lead enrolling site for several notable national trials. 12 12
Q4
Q3
Q2
Q1
Q4
Q3
Q2
Q1
Q4
Q3
122
Q2
Q1
140
CLINICAL TRIAL ENROLLMENT BY FISCAL YEAR
2018
Heart Mate III
Multi-Center Study of MagLev Technology in Patients Undergoing MCS Therapy with HeartMate 3™
Heartware DT & DT2
A Prospective, Randomized, Controlled, Un-blinded, MultiCenter Clinical Trial to Evaluate the HeartWare® Ventricular Assist System (VAS) for Destination Therapy of Advanced Heart Failure
EXPAND Heart Clinical Trial
Test of the Portable Organ Care System™ (OCS) Heart for Preserving and Assessing Expanded Criteria Donor Hearts
OrganOx
A Multicenter Randomized Controlled Trial to Compare the Efficacy of Ex-vivo Normothermic Machine Perfusion With Static Cold Storage in Human Liver Transplantation
TOTAL DEPARTMENTAL RESEARCH AWARDS BY YEAR 2013 – 2018 Total external funding in FY ‘18 totaled over $61 million, combining federal and nonfederal dollars.
$60m
$40m
Federal Dollars
$20m
Non-Federal Dollars
$0m FY ‘13
FY ‘14
FY ‘16
FY ‘17
FY ‘18
SPONSORED FUNDING
Other 28%
A DIVERSIFIED PORTFOLIO
DoD 20% NIH 26%
Foundation 14%
FY ‘15
Industry 12%
The department receives funding from a variety of resources. A breakdown of data from FY ‘18 shows that the largest percentage of funding comes from subcontracts with other collaborating institutions, and local and state funding. This diversification makes the department much more fiscally stable and increases the sustainability of the research mission.
research
13
School of Medicine graduating and third-year medical students receive training in the Surgical Technique and Review Course (STAR) in the Trent Semans Center Duke Human Simulation and Patient Safety Center. Shawn Rocco / Duke Health.
EDUCATION
14
NATIONAL RANKINGS Through its 9 residency programs and 12 fellowship programs, trainees are offered opportunities for advanced training and research.
5 TH
6 TH
AEI
U.S. NEWS & WORLD REPORT MEDICAL SCHOOL RANKINGS
DOXIMITY RESIDENCY RANKINGS
AMERICAN COLLEGE OF SURGEONS ACCREDITED EDUCATION INSTITUTES
5th in surgery based on reputation and statistical data regarding the quality of the school’s research, faculty, and students.
6th based on current resident and alumni satisfaction, reputation data, and research output.
Re-accreditation of the surgery education and training program after a site visit in March 2018 by the ACS.
CONTINUAL IMPROVEMENT IN ABSITE ® SCORES The American Board of Surgery offers an Annual In-Training Examination (ABSITE®), a multiple-choice exam measuring residents’ progress in knowledge of applied science and management of clinical problems related to surgery. Duke general surgery residents’ average scaled scores have increased on the exam for the last 5 years.
60.48
2014
63.85
2015
65.62
2016
71.60
2017
74.00
2018 edu cation
15
1992 16
2003
ENDOWED PROFESSORSHIPS Professorships allow the department to recruit, retain, and reward exceptional faculty members by offering resources, recognition, and prestige, while providing the support that will allow the completion of cutting-edge research, provision of excellent patient care, and mentorship of surgical residents and fellows. Duke Surgery currently holds 11 endowed professorships and relies on donor support to fund the program. PROFESSORSHIP
HONOREE
David C. Sabiston, Jr., Professor of Surgery
Allan D. Kirk, MD, PhD
Mary and Deryl Hart Professor of Surgery
Stuart Knechtle, MD Peter Kent Smith, MD
James F. Glenn, MD, Professor of Urology
Glenn Michael Preminger, MD
Joseph W. and Dorothy W. Beard Professor of Experimental Surgery
Bruce Alan Sullenger, PhD Kent James Weinhold, PhD
George Barth Geller Professor
Herbert Kim Lyerly, MD
Paul H. Sherman, MD, Associate Professor of Surgery
Jonathan Charles Routh, MD
Gary Hock Professor of Surgery
Thomas Anthony Dâ&#x20AC;&#x2122;Amico, MD
James H. Semans, MD, Professor of Urologic Surgery
Judd Wendell Moul, MD
The Duke Surgical Innovation Professorship
Theodore N. Pappas, MD
Margaret Harris and David Silverman Professor of Neuro-Oncology Research
Francis Ali-Osman, DSc
Cary N. Robertson, MD, Assistant Professor
2 0Brant 1 Allen 4 Inman, MD edu cation
17
Associate Professor of Surgery Linda Cendales, MD, offers hands-on training to students from the Durham Nativity School during the Academic Success through Surgical Education and Training (ASSET) program. Shawn Rocco / Duke Health.
CITIZENSHIP & COMMUNITY 18
NEW LEADERSHIP HOWARD W. FRANCIS, MD, MBA, FACS
Chief, Head and Neck Surgery & Communication Sciences
Dr. Francis joined the department from Johns Hopkins University, where he served as professor and vice director of the Department of Otolaryngology-Head and Neck Surgery and director of the Johns Hopkins Listening Center. In his new role, Dr. Francis will grow the clinical enterprise to serve the growing population of the Triangle, and will work to enhance and nurture the research program by building new collaborations across the institution.
SURESH K. AGARWAL JR., MD Chief, Trauma and Critical Care Surgery
Dr. Agarwal comes to Duke from the University of Wisconsin School of Medicine and Public Health where he served as Chief of the Division of Trauma and Acute Care Surgery and Chief of Trauma Services. Dr. Agarwal is board certified in General Surgery and Surgery Critical Care, and serves as principal investigator on several grants funded by the National Institutes of Health, the National Trauma Institute, and the Department of Defense.
PETER J. ALLEN, MD
Chief, Surgical Oncology
Dr. Allen comes to Duke from the Memorial Sloan Kettering Cancer Center, where he served as the Chair in Surgery and Vice Chair of Surgical Services. Dr. Allen is board certified in surgery and specializes in treating cancerous and precancerous conditions of the pancreas, liver, bile duct, and stomach. His research focuses on developing nonsurgical methods for diagnosing pancreatic cancer, including the identification of novel biomarkers and imaging modalities for patients with precancerous conditions. c i ti z e nshi p & c ommu n ity
19
2018 COMMUNITY EVENTS FEBRUARY 28
APRIL 13â&#x20AC;&#x201C;14
Consortium for Inflammatory Breast Cancer The inaugural annual meeting of Dukeâ&#x20AC;&#x2122;s Consortium for Inflammatory Breast Cancer rose community awareness for this highly lethal form of cancer, and began partnerships to promote research and engagement. Mayor of Durham Steve Schewel gave opening remarks at the event.
PUBLICATIONS & COMMUNICATIONS UPDATE
Improving external and internal communication continues to be vital to our expansion and development. With more than 800 faculty and staff, the department has worked to ensure consistency in voice, with a focus on creating high-quality publications and materials.
20
World Voice Day The 12th annual World Voice Day celebration, sponsored by the Duke Voice Care Center, shared principles of vocal health, voice anatomy, and tips for vocal success. The Voice Care Center remembers Patrick D. Kenan, MD, a Duke otolaryngologist for 40 years, with an annual award for Vocal Health and Wellness in his honor.
The Office of Publications & Communications supports all faculty and staff in the Department of Surgery. The office completed over 200 projects in 2018, including medical illustration, news reporting, graphic design, and publications.
SEPTEMBER 22
NOVEMBER 3
“What’s Best for Breasts?” A Conversation with Duke Clinicians
Future of Surgery Symposium
The breast cancer community symposium included question and answer panels, interactive information sessions, risk assessments, and tours of the breast imaging department.
The Department of Surgery website reaches potential residents, patients, the medical community, and the general public. In 2018, the site saw a 28% increase in total website users, and 22% increase in page views.
Featuring leaders of surgery from across the nation, the symposium’s sessions on data, interfaces, training, and therapeutics shed light on coming advances and the steps surgeons can take to prepare for them today.
The department’s Twitter has an academic audience of alumni and other medical professionals, and gained a 72% larger audience in 2018. @DukeSurgery on Twitter
On Facebook, the department reaches a patient audience and the general public, with a 22% audience increase in 2018. Facebook.com/DukeSurgery
surgery.duke.edu c i ti z e nshi p & c ommu n ity
21
DONOR SPOTLIGHT New Endowment Honors Former Chief Ramon Esclamado Head and Neck Surgery & Communication Sciences is pleased to announce the creation of the Ramon M. Esclamado, MD, Leadership Legacy Fund. This new endowment was established with a very generous gift from Mac and Wendy McCorkle to honor Dr. Esclamado’s legacy as a servant–leader by supporting leadership development training for faculty, trainees, and staff with the ultimate goal of improving patient care. The McCorkles were motivated to make this gift to honor Dr. Esclamado’s legacy as an excellent surgeon, leader, mentor, and teacher. This investment in the leadership development of the division’s faculty, trainees, and staff will have a lasting impact and is a fitting tribute to Dr. Esclamado, who led the division for 11 years.
Thank you to our donors, who in FY ‘18 supported us with $2,799,247 in new gifts.
22
GIVING TO DUKE SURGERY A gift to the Department of Surgery is a gift of knowledge, discovery, and life. The continued success of Duke Surgery is highly dependent upon the generous support of its alumni and friends. Your gifts benefit the department’s tripartite mission of providing world-class patient care, training the world’s best and brightest surgeons to serve future generations, and discovering new techniques, technology, and treatments to improve the health of all through creative innovation and cutting-edge research. Your gift to the Department of Surgery will support: • Novel Advances in Patient Care • Endowed Professorships • Resident and Fellow Education • Cutting-Edge Research
Your gift, no matter the size, will make an immediate difference.
TO DONATE OR FOR MORE INFORMATION, CONTACT: Marcy Romary Executive Director of Development Department of Surgery 710 W. Main St., Suite 200 Durham, NC 27701 919-385-0051 marcia.romary@duke.edu givin g
23
Non-profit Org. U.S. Postage PA ID Durham, NC Permit No. 60
Department of Surgery DUMC 3704 Durham, NC 27710 4017669
MISSION
VISION
Through sustainable, multidisciplinary teams we:
1
Provide insight regarding the fundamental nature of patient health and disease
EDITORIAL STAFF
2
Duke Surgery: United, for All Patients
Empower all patients, trainees, and colleagues with knowledge
3
Provide safe and high-quality care based on an advanced understanding of and respect for our patientsâ&#x20AC;&#x2122; needs and guided by best practices
CREATOR
COVER ARTIST
EDITOR
DIRECTOR
Scott Behm
Lauren Halligan
Ashley Morgan
Jill White