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eICU program saves lives, dollars

Tailoring care to community needs

Rollins students build lobbying skills

In brief

April 5, 2017

A new vision for nursing at Emory

Emory University Hospital charge nurse Corinne Slack (center) with student nurses (now alumnae)

Last fall, nursing leaders Linda McCauley and Sharon Pappas traveled to Washington, D.C., for the rollout of the Manatt report, a pivotal document on enhancing the role between schools of nursing and academic health centers (AHCs) across the nation.

Linda McCauley, Sharon Pappas  

Pappas had just accepted the role of chief nurse executive (CNE) at Emory Healthcare. After she arrived here three months later, she and the nursing dean began to talk seriously about how to transform nursing at Emory. While both EHC and the nursing school have a history of partnering together, the time had come to do more to serve the growing number of EHC patients in Atlanta and beyond.

The first step occurred last month when McCauley and Pappas hosted a retreat for nursing school and EHC nurse leaders. Their charge to the group: identify ways to align the school and EHC more fully around nursing education, research, and clinical practice.

Informing their discussion was the Manatt report—Advancing Healthcare Transformation: A New Era for Academic Nursing—prepared by Manatt Health for the American Association of Colleges of Nursing. Transforming health care, the report states, requires a coordinated response from academic and practice leaders across the health professions. Nursing plays an important role in such critical work. Going forward, it must find new ways to link academia and practice at AHCs like Emory.

"Nurses know how to be advocates for our patients—we've got that," McCauley said during the retreat. "But are we really partners in advancing new models of care? How can we put together new work teams to provide care differently? Do we have data in front of us to provide evidence-based care as part of a health care team? To what degree do students and new graduates understand the financial underpinnings of practice? We need to own these areas."

The Manatt report serves as a manual for ownership. It calls for nursing and other health leaders to do the following:

- Recognize academic nursing as a full partner in health care delivery (i.e., through greater participation in health system governance and workforce planning and training),
- Engage nursing faculty more in clinical practice and link clinical services more closely to nursing education,
- Build the workforce pipeline (BSN, MSN, DNP, PhD) with greater emphasis on leadership development,
- Partner more across the health professions to advance new clinical models and promote accountable care, and
- Invest more in nursing research and better integrate scientific evidence into clinical practice.

During the retreat, participants considered how to apply each recommendation at Emory, an exercise that brought several faculty and EHC nurses together for the first time.

"I'd like to see more of this type of communication," said Kristy Martyn, associate dean for graduate studies at the nursing school. "It's important to know what expertise we offer in both settings."

Martyn and others generated plenty of ideas for greater collaboration: Sharing newsletters, event calendars, and intranet and library access. Ramping up student preparation for team-based care. Preparing more clinical nurses for leadership roles. Inviting more clinical nurses to lecture in the nursing school. Inviting nursing faculty to lead workshops on informatics and research design for EHC nurses. Providing seed funding for grant writing and data support for clinical research. Forming joint research councils with faculty members and clinical nurses. Integrating McCauley and Pappas in leadership of EHC and the nursing school, respectively.

These ideas, both leaders say, will help form a blueprint for aligning the nursing school and EHC under the name "Emory Nursing." More work remains to jointly finalize a structure and details for alignment.

"One of the things that drew me to Emory was the opportunity to work across practice, education, and research," Pappas said. "Given the changes in health care delivery today, why wouldn't we merge toward a model that's more inter-professional and team-driven? Those are the type of things that I want to be part of."

"Whether you work for Emory Healthcare or the nursing school, we are all part of academic nursing because we live under the same mission—better health for patients and communities," she added. "The opportunity is to embrace it together."—Pam Auchmutey

eICU program saved lives and reduced length of stay/costs

eICU monitoring area located at Emory Saint Joseph's Hospital

A report created for the Centers for Medicare and Medicaid Services (CMS) has found that Emory's eICU program, started three years ago, reduced length of patient stays in the ICU, resulted in fewer readmissions, reduced costs by millions of dollars, and helped mitigate the shortage of intensivists (critical care physicians who work primarily in ICUs).

Tim Buchman, Cheryl Hiddleson  

Emory was one of 10 institutions to receive a Health Care Innovation Award from CMS in 2012. The $10.7 million award was used to launch and evaluate Emory's plan of a network supporting ICUs remotely in North Georgia.

Emory's eICU program included two components: (1) establishing a critical care residency training program for affiliate providers and (2) providing continuous, 24/7 monitoring of critical care patients and access to intensivist physicians and other support staff on night and weekend shifts, when physicians are infrequently present in ICUs.

"Emory leads the nation in the training and use of advanced practice providers [APPs] in the critical care setting," says Tim Buchman, director of the Emory Critical Care Center. "This program was set up to train APPs working alongside critical care nurses at the bedside and to provide support by experienced Emory intensivists and Emory critical care nurses around the clock from a remote location."

The eICU program began in 2014 in critical care units at Emory University Hospital, EUH Midtown, and Emory Saint Joseph's Hospital. Later, it expanded to Emory Johns Creek Hospital and East Georgia Regional Medical Center in Statesboro.

"The goal was to improve quality of care, shorten ICU lengths of stay, and discharge patients in a better state of recovery, potentially reducing Medicare spending," says Cheryl Hiddleson, director of the Emory eICU Center.

During the evaluation period (from April 1, 2014, to June 30, 2015)  8,019 patients were cared for by the Emory eICU. More than 60% were federal beneficiaries. The report shows a reduction of $1,486 in Medicare spending per patient stay, saving $4.6 million during the 15-month evaluation time.

"We attribute those savings to standardizing our care delivery and offering more immediate access to intensivist-led interventions," says Hiddleson. "Our patients are being discharged more frequently to home settings instead of long-term care or rehab because they have more consistent care in the hospital."

The program's remote monitoring of patients was credited for numerous "saves" when problems were brought to the attention of bedside staff that might have otherwise gone undetected. ICU staff reported that the most important benefit of the eICU was the timeliness of emergent interventions during the night and the rapid attention to patients' needs.

Other program benefits that are difficult to measure include reducing physician burnout, improving adherence to standardized clinical guidelines, and enhancing communication and critical care knowledge of entire care teams, according to Buchman.

"As the nation ages and chronic illnesses accumulate, the need for timely and effective critical care continues to grow," says Hiddleson. "The Emory eICU innovation offers patients, families, hospitals, and payers a high-quality, cost-effective strategy to ensure that critical care can be provided when and where needed." Read more.

Tailoring mental health care to community needs

Grayson Norquist  

In 2004, Grayson Norquist left a 14-year stint at the National Institute of Mental Health, where he directed clinical and health services research, to return to his home state to chair the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. One day, when he was discussing the programs he planned to implement to some local community health care providers, a woman interrupted him with, "Bless your heart, but. . ."

She explained why his approach would fall flat in their community.

"I had come in with the 30,000-foot view of what mental health care should look like," says Norquist, who has both MD and MSPH degrees. "But as soon as I heard that 'bless your heart,' I knew it was going to have to be different on the ground. I've learned that you really have to look at mental health care from the perspective of the people in the community and address the greater problems there."

Norquist brought that sensibility with him when he joined Grady Memorial Hospital as chief of psychiatry in January 2015. In this position, he oversees mental health services at Grady Health System, including inpatient and outpatient services for some of the state's most marginalized citizens. Though the community he is serving has switched from the rural Mississippi Delta to urban Atlanta, the need to listen to local patients and providers is the same.

He has heard many things. He heard the need to bring care to where the patients are. Grady has long sent community treatment teams out to meet patients who can't or won't come in to the clinic, but it was inefficient to send psychiatrists out with each team. Borrowing an idea he had already implemented with success in Mississippi, Norquist incorporated telehealth technology, which case workers in the field now use regularly to consult with psychiatrists at Grady.

He heard the need for improved psychiatric services in the emergency department. Grady, like many hospitals across the country, had a big problem with wait times for psychiatric patients in the ER. Implementing a plan that had already been approved, Norquist oversaw the addition of a 12-bed dedicated psychiatric ER unit. Currently, an attending psychiatrist is on duty from 8 a.m. to midnight seven days a week. Once two more psychiatrists are hired, an attending will be on hand 24/7, and Grady will be the only hospital in metro Atlanta offering this level of service for emergency psychiatric needs.

Today, about half of the people who come to the Grady ER with a psychiatric problem are discharged after being assessed and treated in the ER. The other half go to a crisis intervention service—an observation arm of the ER—for another 24 to 36 hours. About half of those are discharged, and the remaining are admitted to an inpatient psychiatric hospital. "That's a huge improvement," says Norquist. "Patients used to go straight from the ER to a psychiatric hospital. Now they are able to be stabilized and then get the care they need in the community."

Another thing that Norquist heard from those on the ground was the need for more specialized care. Psychiatry has lagged behind other branches of medicine in establishing specialized teams to treat specific disorders. Norquist is working to catch up. He has plans to group Grady's psychiatric practice into three areas—psychotic, mood spectrum, and trauma/personality disorders—and create teams (psychiatrist, psychologist, social worker, and case worker) specializing in each area, beginning with psychosis. "For each patient, we want to be able to determine what intervention is best at their particular stage of illness," says Norquist.

In addition to his Grady post, Norquist chairs the Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI), which was founded to help providers make better treatment decisions based on evidence from outcomes research. "I can't think of a better place than Grady to understand firsthand the types of health care decisions providers struggle with every day and how we can ensure that what we know works is implemented in practice," he says.—Martha McKenzie

Rollins students learn lobbying skills

On a bright, unseasonably warm late February afternoon, dozens of Rollins students passed up the opportunity to sit in the sun or share a laugh with friends. Instead, they gathered in a classroom to listen to a representative from the Georgia legislature give tips about how to lobby effectively. 

"I feel like it's important for me to learn how to advocate for issues that are important to me," says Anna Shao 18MPH, who attended the event.

Tina Mensa-Kwao  

The seminar, "Lobbying 101," was the second event in the student-led Rollins Advocacy Series. After being approached several times by students looking for opportunities to learn advocacy skills, Rollins Student Government Association president Tina Mensa-Kwao MPH18 reached out to the leaders of the other Rollins student organizations. Together, they cobbled together the series, which kicked off in mid February with a seminar titled "What Is Advocacy?"

Several other events are scheduled, each organized by a different student organization. Topics include environmental justice, advocacy in public health emergencies, and the local legislative process. The series also includes an effort every Thursday during lunch called "Tabling for Change." A table is manned by a student who encourages fellow students to call their representatives. Sample scripts on various topics related to public health are available, along with a list of all state representatives and their phone numbers.

"I am thrilled the students are organizing these workshops," says Karen Andes, assistant professor of global health, who spoke at the first seminar. "They are asking the same questions that many of us are right now—what can we do?" 

The series will run through the end of the semester, and then Mensa-Kwao and other student leaders will see if there is demand to continue it.—Martha McKenzie

From the Executive VP

Finding our true north

Jonathan S. Lewin

"Efforts and courage are not enough without purpose and direction."—John F. Kennedy

Across the breadth of the health sciences at Emory, we share a common purpose—to make people healthy and to keep them that way. To help guide the Woodruff Health Sciences Center (WHSC) toward that true north, we are currently developing a WHSC Strategic Plan for FY18-FY22. The plan will cross all units of WHSC and will address research, education, and patient care, as well as the places where the three missions intersect.

We have been soliciting broad stakeholder input from the WHSC units, trustees, emerging leaders, patient and family advisers, and others. These groups have shared their perspectives on the future direction of WHSC, and through their input, we are identifying key priority areas, or themes. Beginning this spring, a series of subject matter expert teams will begin developing strategies for each theme, which will form the basis of our WHSC Strategic Plan.

We will continue to seek broad stakeholder input throughout the process, and I will continue to update you as the plan takes shape. Meanwhile, thanks for all that you do to help us reach our true north.

Please direct questions and comments to evphafeedback@emory.edu.

In Brief

Match Day 2017

The medical school's class of 2017 included 131 students in the National Residency Match Program. Of the 44 students remaining in Georgia, 40 will train at Emory. Other schools where students will go for training include Hopkins, Brown, Duke, Harvard, U Mass, NYU, and University of Washington. The students' most popular chosen specialties include internal medicine, pediatrics, surgery, emergency medicine, and family medicine. Read more.

Lewin meets with legislators

On March 22, EVPHA Jon Lewin, along with Paul Rothman from Johns Hopkins and Alan Kaplan from University of Wisconsin Health, met with House Speaker Paul Ryan and other legislators to discuss possible impact of the proposed American Health Care Act on patient care, education, and research.

Nursing ranked fourth in US News

The nursing school was ranked fourth in the nation according to US News & World Report's 2018 America's Best Graduate Schools. The ranking is a jump from eighth last year. The school's Family Nurse Practitioner program also increased from 10th to eighth in the list. Read more.

Emory named official care provider for Atlanta Braves

Emory Healthcare is now the official team health care provider for the Atlanta Braves. The recently announced partnership between the two entities gives the Braves priority access for all medical needs to Emory's facilities, equipment, and specialists, including sports science research and performance measurement expertise at the new Emory Sports Medicine Complex, which opens in Executive Park this fall. Read more.

Hospital tower timeline update

Due to some unexpected construction delays, which often occur with large, complex projects such as this one, the new Emory University Hospital tower timeline has been revised to ensure that the new building meets the needs of patients, staff, and physicians. "While this affects the move and transition dates," says EUH CEO Bryce Gartland, "it also provides our transition teams with additional time to plan and prepare. We will continue working to expedite key projects that impact staff, physicians, patients, and visitors, such as completion of the bridges and valet drop-off area." The public spaces of Levels 1-3 are set to open July 29, followed by the inpatient care units of Levels 5-9 August 26 - October 29.


The American College of Oral and Maxillofacial Surgeon gave Shelly Abramowicz the inaugural Elaine A. Stuebner Scholar Award, an essay-based honor giving the recipient opportunities in education and mentoring to advance their knowledge and skills.

Hicham Drissi has been named vice chair for research in orthopaedics in the medical school. Read more.

Cardiothoracic surgeon Robert Guyton received the 2017 Presidential Citation from the American College of Cardiology 66th Annual Scientific Session. Read more.

CEPAR director Alex Isakov (emergency medicine) is one of 10 experts selected to engage the nation’s EMS community in creating a vision for the future of the nation’s EMS system. Read more.

Cardiologist Douglas Morris, professor of medicine, director of Emory Medicine Professional Leadership Enrichment and Development Program, and former director of the Emory Clinic, will receive the Lifetime Achievement Award from the Georgia Hospital Association in November. Read bio.

Oluseun Olufade (orthopaedics) is the new president of the Johns Creek Healthcare Association. Read more.


CEO forums:
April 6: 3:00-4:00 p.m., ESJH auditorium*
April 10, 9:00-10:00 a.m., EJCH, classroom A
April 13, 1:00-2:00 p.m. EUH auditorium*
April 27,
1:00-2:00 p.m., Decatur Plaza, Room 131
*View via live webcast.

April 7: Advances in Active Treatment and Palliative Care for Persons with Neurodegenerative Disorders. Miller-Ward Alumni House. 7:30 a.m. to 2:45 p.m.

April 13: Healthcare Innovation Symposium XIX. Featuring Joe Selby, Exec. Director, PCORI. Noon to 2:00 p.m. More info.

April 14: Interprofessional Team Training Day, 8:00 a.m. to noon. WHSCAB and other campus locations. RSVP. More info.

April 25: 2017 State of the WHSC Address by EVPHA Jon Lewin. 4:30 p.m., WHSCAB auditorium. Reception to follow. RSVP.

May 10: Emerging Concepts in Health Services Research, 4th Annual Health Services Research Day, 8:30 am. to 5 p.m. RSPH CNR bldg auditorium. More info.

May 10: Eighth Annual Academic & Industry Intersection Conference. Georgia Tech Research Institute Conference Center.

May 19: Regenerative Engineering and Medicine Workshop. 9:00 a.m. to 1:45 p.m. UGA Regenerative Bioscience Center, Athens.

June 1: 10th Emory Quality Conference. Posters and workshops 1 to 4 p.m. Speakers 4:30 to 7 p.m. More details soon.


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