A slow, safe return

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May 29, 2020

A slow, safe return

By now you’ve probably seen the HR notice sharing the news that Emory is beginning a carefully measured resumption of research activity this week. Select staff who are essential to these activities will be returning to campus after they complete a “return to work” health assessment and safety training. This carefully planned and monitored effort is a terrific step in the right direction.

In order to safely continue making such progress, it’s imperative that we maintain the minimum necessary staffing on campus. Ensuring a low density of personnel will aid our physical distancing practices. Those team members who have been previously identified as essential to work on campus should continue to report, of course. Otherwise, please continue to work remotely unless you hear differently from your supervisor. As more of us do begin to return, we will follow rigorous protocols to ensure that we and our co-workers stay safe.

Meanwhile, until we can all be together again, I urge you to continue physical distancing, hand hygiene and to always wear your mask in public. I hope you had a relaxing and enjoyable holiday weekend, and I look forward to when we can resume a more normal work environment.

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

Jonathan S. Lewin, MD, FACR
Executive Vice President for Health Affairs, Emory University
Executive Director, Woodruff Health Sciences Center
CEO, President, and Chairman of the Board, Emory Healthcare

Quality improvement projects continue

The 2020 Emory Quality Conference has been postponed indefinitely due to COVID-19, but that doesn’t mean work in this area has stopped. Emory’s interprofessional faculty development course in quality improvement was able to continue virtually, and with it, at least 13 projects. The course is conducted in evening workshops spanning six months, allowing medical and nursing faculty to fit it into their schedules. Faculty participants must have a project and recruit a team that includes at least one trainee and at least one non-physician health professional. A poster presentation of the participant's QI project is due at the last class meeting.

“Quality improvement is an iterative process,” says Nate Spell, associate dean for education and development in the medical school. “Often your original attempts fail, but you learn from the process to improve your next attempt. This course is designed to give faculty a grounding in the basics of quality improvement so they can continue working on it in the future.”

Spell teaches the course, along with Corrine Abraham, director of the DNP program at the nursing school and Adam Webb, chief quality officer at Emory University Hospital.

Thirteen teams presented posters virtually in late April. Peter Thompson (pictured above left), who recently took over the role of quality officer for the division of plastic surgery, and his team mounted a project to reduce infection rates following implant-based breast reconstruction. At the outset, the division’s infection rate was between 7% and 10%, which often resulted in readmissions. He surveyed the surgeons and found significant variations in the protocols used by each of them. Some changed gloves before handling the implant and some did not. Some soaked the breast implant in an antibiotic solution for more than five minutes, others soaked for a shorter time, and other gave the implant a quick rinse or did not soak at all.

Thompson and his team then reviewed the literature and developed a best-practice protocol for the pre-operative, intra-operative, and post-operative phases. He started out using the new protocol himself just to make sure it was do-able. He then introduced it to the other surgeons. Using the new protocol, the division recorded three months of infection-free cases before surgeries were suspended for the COVID-19 pandemic. “Right now we are using the protocol on the Clifton Road campus only, but we plan to expand it to Midtown and Saint Joseph's,” says Thompson.

Thompson is quick to credit the course for his success. “I did not have any background in quality improvement, and the course did such a great job of giving us the tools, the organization, and the structure to succeed in these projects,” he says. “Any success we’ve had is totally due to what we were able to learn from this course.”

Bolanle Akinsola (pictured above right) used her time in the course to change the type of IV fluids given to children in the emergency room. An assistant professor in the department of pediatric emergency medicine and a physician with the Children's Healthcare of Atlanta, Akinsola faced the problem of “this is how we’ve always done it.”

For years, young children were given hypotonic maintenance IV fluids in the ED, that is, fluids more dilute than the body’s natural makeup. “There was no scientific data to back this up, just a feeling of kids are smaller, so they should do better with a weaker solution,” says Akinsola.

In late 2018, the American Academy of Pediatrics (AAP) came out with the recommendation that children aged one month to 18 years should be given isotonic maintenance IV fluids, or fluids balanced to resemble the body’s natural makeup. But getting physicians who have done things one way for years and years to make a change can be a heavy lift.

First Akinsola and her team mounted an education campaign with data to back up AAP’s recommendation. They made some changes in the electronic medical records system that made ordering isotonic IV fluids easier than ordering hypotonic fluids. And they followed up with a practice review, giving individual feedback to outlier physicians.

When Akinsola and her team started her intervention, use of isotonic IV fluids in the Children's Healthcare of Atlanta EDs was less than 20%. The goal was to raise maintenance IV fluid use to 80%, which they achieved in September 2019. By the first of the year, use of isotonic fluids had reached over 90%.

You can see all 13 posters here. Applications for the next session of Faculty Development in Quality Improvement will occur later this summer.—Martha McKenzie

Health Care Heroes

Emory was well represented in this year’s Health Care Heroes Awards from the Atlanta Business Chronicle. David Reznik, chief of dental medicine for the Grady Health System and adjunct professor in the medical school, received the Lifetime Achievement Award. Justine Welsh, director of Addiction Services for Emory Healthcare and assistant professor in the medical school, won the Rising Star Award. Colleen Kraft, associate chief medical officer of Emory University Hospital, received the Physician Award. Kate Pettorini, unit nurse and educator with Emory University Hospital/Emory Healthcare won the Nurse Award. And the Health-Care Innovator/Researcher Award went to Brian Vickery, director of Emory and Children’s Food Allergy Center and associate professor of pediatrics.

Michelle Goodin, clinical dietician and coordinator of the Dietetic Internship Program at Emory University Hospital, and William Sharp, associate professor of pediatrics, were finalists in the Allied Health category. Three people affiliated with the nursing school were finalists for the Community Outreach Award.  Twilla Haynes 80N, instructor, and her two daughters, Angela Haynes Ferere 91MPH 08N 09N, assistant professor, and Hope Haynes Bussenius 93N were honored for founding Eternal Hope in Haiti to provide basic nutrition, health care, and education for thousands of Haitian children.

In brief
Coopersmith named director of the Emory Critical Care Center

Craig Coopersmith has been named director of the Emory Critical Care Center (ECCC) following his service as interim director since 2018. Coopersmith is also professor of surgery and vice chair of research in the Department of Surgery, program director of the Emory Surgical Critical Care Fellowship and director of the Surgical/Transplant Intensive Care Unit at Emory University Hospital.

The ECCC is a national leader in designing, testing and implementing innovations in critical care. The center was created in 2009 to ensure the highest quality critical care for patients in intensive care units throughout the Emory Healthcare system, and to integrate patient- and family-centered care with research, education and training across the health sciences. Read more here.

COVID-19 wellness guide

Psychiatry and Behavioral Sciences has created Caring Communities, an interprofessional group of mental health experts from Emory, Grady and Morehouse College of Medicine. The group has created a variety of wellness guides with tips and resources to help healthcare workers, families and people with health concerns cope with the COVID-19 pandemic. The guides reflect the consensus ideas and recommendations of the interprofessional group and are aimed at helping people use effective coping strategies and be as resilient as possible during this pandemic.

New director of Distinction in Medical Education

Jennifer Spicer, assistant professor in the Division of Infectious Diseases, has been selected as the new director for the Distinction in Medical Education for the J. Willis Hurst Internal Medicine Residency Program.

First established in 2007, the distinction programs serve as educational opportunities that enable residents to pursue additional expertise in specific areas of interest. The Distinction in Medical Education is one of the most popular distinctions in the residency program.

Sidewalk closure

As part of the R. Randall Rollins Building construction project, a section of sidewalk along Clifton Road will be closed from Monday May 25 through May 2022. The bus stop at this location will be removed during the sidewalk closure. View construction updates here.

Joanna Bonsall (hospital medicine) received the 2020 Evangeline Papageorge Distinguished Teaching Award.

Victor Corces (human genetics) was elected to the National Academy of Sciences (NAS).

Aparna Kesarwala has received an MRA Young Investigator Award from the Melanoma Research Alliance.

Janice Lea (renal medicine) has been selected for the 2020 Best of Atlanta Award in the Physicians category by the Atlanta Award Program.

Robert B. Smith III (professor emeritus of vascular surgery) received the Lifetime Achievement Award by the Society of Vascular Surgeons.

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