D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 4, Issue 4: Oct. 2015
Highlight on the Critical Care Medicine Team by Dr. Niva Misra The Medical ICU is the unit in the hospital where some of the sickest patients stay. The course of the patients’ stay may be uncertain at times. However, thanks to the critical care attending physicians, no patient goes without having the best and most dedicated care possible. These attendings not only care for the sickest of the sick but take time out of their day to teach residents how to be the best they can possibly be. Daily rounds in the medical critical care unit are very comprehensive. The attendings listen to the presentations of the residents and what interventions have thus far taken place. They help the residents think about what has been done and then educate them in treatments to consider. These physicians help teach the residents early in their careers how to value the nursing staff in the ICU and involve pharmacists and respiratory therapists for complete care of the patient. Although a very ill patient may be in the room next to the team, these attendings somehow manage to care for the patient while instructing residents in a kind and enduring way. These attendings are also some of the best physicians when it comes to speaking with families. They are truly compassionate and treat families as if they are their own. Their emotions may be so strong that they are brought to tears. In the most delicate of social situations, our attendings exhibit class, patience, and understanding. Through all of their training and stress, these physicians have not lost the empathy that we in the medical field should all exemplify.
To further show the dedication and hard work of our attendings, the pulmonary department was ranked nationally in the US New and World Report. This report is an objective evaluation of hospitals and has recognized the critical care team as outstanding. Education is clearly important to this team. The attendings are now dedicating their time to expanding the pulmonary fellowship to become a pulmonary/critical care fellowship. This would bring in more fellows to give better care to patients, assist in teaching residents, and expand the institution’s continued on page 2 research on medical critical care.
Points of View
Recent meetings have helped me to gain valuable insights into the changes in our health care system. First, there is increasing emphasis on integrating care for patients after discharge from the hospital, whether at home, in post-acute care settings, nursing homes, skilled nursing facilities, or in palliative or hospice care Rajiv Dhand, MD, Chair settings. These measures are aimed at providing a seamless transition of care for patients, with better communication between various providers, to reduce the frequency of hospital readmissions. Second, the provision of effective and more efficient care has been the focus of “patient-centered” care for several years, but 1
the Affordable Care Act has added the objective of reducing the costs of health care. There are formidable challenges in simultaneously achieving all these goals. To meet these challenges, greater standardization of care by adopting clinical pathways and minimizing waste due to unnecessary care, inefficiently delivered care, and administrative inefficiencies in insurance paperwork and electronic documentation are needed. Moreover, there is a shift from “volume-based” care, where providers are paid on a “fee-for-service” basis to “valuebased” care, which assesses the performance of care providers based on outcomes and cost. This redesign engenders a conceptual shift from treating “illness” to promoting “wellness” among the population. Thus, the quality of care will not be assessed by the number of interventions or the number of doctor or hospital visits. Instead, quality of health care delivery will be assessed at a system level by whether desired outcomes are achieved and at what cost. continued on page 3
We’re Growing! Clinic Expansion and New Conference Room by Annette Mendola, PhD July is a month for changes in an academic medical center. In addition to welcoming our new residents, there were two exciting developments for the Department of Medicine in the month of July. The first was the inaugural of the new conference room in the Graduate School of Medicine building, with seating for 60 and two AV screens. It will serve as a centralized place for departmental events such as Quarterly Department Meetings, Grand Rounds, and noon lectures. The second was the expansion of the outpatient clinic, which opened for use on July 6. The clinic, which serves both the Medicine and the OB/GYN Departments, gained 10 exam rooms, a third consult area, and a nurses’ station. Administrative Director Penny Reagan, RN, says the number of office visits has been growing, so the clinic expansion has been timely. She expects to see visits continue to increase. The clinic expansion has facilitated the addition of the REACT clinic on Monday and Wednesday mornings. REACT (Rapid Evaluation and Care Transition), an initiative of our CMO, Dr. Jack Lacey, is designed to bridge gaps in care that can occur after an inpatient stay. REACT patients receive a phone call within two business days of discharge and have an appointment at the clinic within 7-14 days. Drs. Carol Ellis and John Pierce supervise the REACT clinic. Clinic Director Dr. Juli Williams says, “The clinic expansion has allowed us to implement the REACT clinic and to staff the continuity clinic two extra mornings each week. As a result, we expect to see fewer readmissions and better outcomes for patients.” With the growth of our resident complement, it has been an important goal of the department to expand our facilities so that we may enhance the learning experience we provide. The new conference room is spacious and comfortable, with improved audiovisuals, and the clinic expansion provides an improved environment for both teaching and learning. We have been very pleased with the accomplishment of these goals.
Sim Center: Changing the Culture of Medical Education by Annette Mendola, PhD In the past, medical procedures were learned by the process “see one, do one, teach one.” Since the Simulation Center opened at UTMCK in 2007, the process includes practicing in a supervised, risk-free environment before performing procedures on patients. “Medical education is changing from an ‘apprentice’ model of learning to a competency-based model,” says Dr. Leonard Hines, co-director of the Simulation Center. Simulation is used for both teaching and evaluation. For example, OSCEs (objective structured clinical exams) afford learners a chance to practice their skills and then review a video of the encounter with faculty and peers. “We see a huge improvement in the second OSCE over the first,” says Dr. Janet Purkey, clerkship director. “The Sim Center is such an amazing place.” Internal medicine residents and students on their internal medicine rotation use the Sim Center to practice procedures, such as “gowning and gloving,” ultrasound-guided central line placement, lumbar puncture, thoracentesis, paracentesis, and arthrocentesis. They also participate in code scenarios. Melinda Klar, RN, administrative director for the Sim Center notes that the Sim Center is a faculty-driven resource. As long as a faculty member or their designee is available to provide instruction, the Sim Center can often accommodate learners on short notice. “We gained accreditation in 2012,” said Dr. Hines. “There has been a good team effort between the hospital and the GSM to make the Sim Center available across disciplines.” It also accommodates learners at all levels, from medical students to practicing specialists. The Sim Center is a comprehensive, state-of-the-art center for hands-on learning.
Highlight on the Critical Care Medicine Team
continued from page 1
The residents are able to confirm the dedication of these attendings. “So far, this experience has been overwhelming but outstanding, thanks to the critical care team,” said Hannah Byland, an anesthesia intern rotating in the MICU. Josh Hayes, a third year medicine resident stated, “Throughout the last two years, I have learned many great things in MCC because of the attendings. I have felt a sense of calmness, gained a wide range of clinical knowledge, and witnessed attendings becoming very emotionally involved in patient care.” To close, it is important to recognize the commitment and enthusiasm of this group of physicians. We thank you for staying at the hospital late at night and coming in early to care for patients. We thank you for being patient with teaching the residents and helping them build confidence. We thank you for talking to families with such grace. Most of all, we thank you for your unwavering dedication to patients, no matter what the situation. 2
Resident Highlight: Brandon Sammons, DO “Research projects are important to help develop new ideas for the betterment of medicine,” said Brandon Sammons, the winner of the first annual Department of Medicine Research Day. With the help of Dr. Rasnake and Dr. Eric Heidel, Brandon began his research project featuring central venous line catheter infections in early August 2014 during his intern year. When he began the project, he never imagined he would win the research competition. “I feel so fortunate to have won the research day! All of the entries were great, and I am so humbled that the audience would pick me,” he stated. Brandon’s project is a case control study involving the incidence of central venous line catheter infections (CLABSIs). “Many of these infections in the hospital were actually linked to patients with a history of IV drug abuse. Finding that some of these infections were caused by atypical microorganisms was evidence that certain patients may have been manipulating their own central lines,” Brandon stated. Brandon is now going on to present his project at a national conference, the Infectious Diseases Society of America in San Diego, CA. He has also been working on adding new data to his project by performing a retrospective study to involve more patients. Brandon hopes to publish his data in a journal before finishing residency. While he was in medical school, he was involved in two recently published projects being done by the cardiology department and graduate students at UT involving sexism and racism in regards to decisions for cardiac treatments. In addition to his interest in research, Brandon enjoys spending time with his wife, family, and friends, playing in a Tuesday night basketball league, riding his bike, and taking spin classes.
New Members of the In Touch Editorial Board The In Touch editorial staff wishes to thank past Editor-in-Chief Dr. Ron Lands for his fine contributions to our newsletter. His gift for writing, compassion, and insight greatly benefited our publication. We also greatly appreciated the excellent work of our resident contributor Dr. Christen Fleming, who completed our program in June. We are very excited to announce new Editor-in-Chief Annette Mendola, PhD. Dr. Mendola is an Assistant Professor in the Department of Medicine and is Director of Clinical Ethics for University Health System. She actively publishes and presents on ethics topics. Niva Misra, MD, is our new resident contributor to the newsletter. Dr. Misra Is a PGY-3 resident with a special interest in writing. We are very pleased to have these two talented individuals on our staff.
1st Annual DOM Research Contest The Department of Medicine held its first Annual Residents’ and Fellows’ Research Contest at the Medicine Grand Rounds on June 9, 2015. The event was lively and informative with excellent presentations, and the audience enjoyed participating by voting for the winners. Brandon Sammons won first place for his presentation, “Illicit Injection Drug Use as a Risk Factor for Hospital Onset Central Line Associated Bloodstream Infection.” Several inpatients have been suspected of manipulating central lines to inject illicit drugs and have subsequently developed CLABSI. Dr. Sammons sought to determine the impact of this practice on the medical center’s hospital onset CLABSI. Dr. Charlie Allderdice won second place for “The Impact of a Heart Failure Pathway Implementation: An Institutional Review,” and Dr. Aimee Wehber won third place for her presentation, “Bilateral Rectus Sheath Hematomas Presenting as Symptomatic Anemia: A Case Study (CR #3).” Dr. Rafael Alba Yunen gave an excellent presentation on “An Unusual Case of Brain Abscess Complicating Foreign Body Aspiration in an Adult.” The faculty, residents, and fellows enjoyed the event and found the information relevant to their practice. We look forward the second annual contest next year.
International Research Scholar The Department of Medicine welcomes visiting scholar Dr. Hua Wang, who practices as an intensivist at Zhujiang Hospital in Guangzhou, China. Dr. Wang will be assisting Dr. Rajiv Dhand with clinical trials and bench testing. We are pleased to have the opportunity to collaborate with Dr. Wang.
Points of View continued from page 1 Third, the redesign of the health care system shifts the focus from the current paradigm of hospital-based care to a network of primary care providers caring for a population of patients. In fact, performance metrics will assess the ability to “prevent” hospital admissions among this population. There is a saying that “When change is the only thing, the choice is the only option.” However, for providers in the redesigned health care system, choices are being driven by insurers and governmental agencies. Reimbursement for services and payor contracts are increasingly linked to the ability of health care systems to provide safe and efficient patient care with superior patient experiences at a lower cost. These goals may appear to be difficult or even impossible to achieve, but physicians must be actively engaged in meeting these challenges. 3
AWARDS AND HONORS Dr. Jack Lacey received a 2015 Graduate School of Medicine Alumni Award for Outstanding Achievements. Dr. Lacey has been a dedicated and effective leader here at the UT Medical Center and has accomplished much in developing the quality of care here as Chief Medical Officer. He has been very active in the community, serving as a board member of the Knoxville Academy of Medicine and the Knox County Board of Public Health. He also serves as Medical Director of Knoxville Area Project Access. Dr. Lacey has won numerous awards for his community service over the years. We are delighted
that he has been recognized by the graduate school for his distinguished career. Three Department of Medicine faculty members have been recognized by the Greater Knoxville Business Journal as “Health Care Heroes.” Dr. Robert Overholt and Dr. Wahid Hanna received recognition in the area of “Community Outreach”, and Dr. Jonathan Wall in the category of “Innovation”. We fully concur with the journal’s choices of these highly accomplished department faculty members.
Volume 4, Issue 4: October 2015 Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean Editor Annette Mendola, PhD Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Niva Misra, MD Jane Obenour
New Faculty We are pleased to welcome these excellent new faculty members to the Divisions of Cardiology and Neurology.
In Touch
Benjamin Shepple, Cardiology
Matt Chua, Cardiology
Muhammad Masud, Neurohospitalist
Li Hua, Neurohospitalist
Grand Rounds Guest Speakers 07/14/15 John C. Ruckdeschel, MD, “It’s Not Your Father’s Lung Cancer Anymore”
08/25/15 Toufic Kachaamy, MD, “Cancer Palliation Endoscopic Challenges”
08/11/15 Lane M. Cook, MD, “Transcranial Magnetic Stimulation in Depression and Anxiety”
09/22/15 Robert F. Browning Jr., MD, “Relevance of Military Service in Lung Cancer: Risk, Outcomes and Care”
Presentations, Publications, Awards Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.
Thank You For Your Support For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.
Stay In Touch! Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you! 4
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