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August 20, 2019

Celebrating a partnership in pediatrics

As we approach the first anniversary of the launch of the Emory + Children's Pediatric Institute, we have much to celebrate. By combining the human, intellectual, social, and financial resources of both of our world-class institutions through a collaborative model, we have been able to accomplish much: We have been able to recruit and retain the most talented physicians, researchers, and students; conduct cutting-edge pediatric research; and, most important, improve outcomes for the children and families we serve.

Our relationship with Children's is so important--not only to each of the partners, but also to the ultimate bottom line--the health of children here in Atlanta, across the region, and indeed around the world. Collectively, our two organizations understand and appreciate that investments in education and research lead to improved clinical care--and therefore to better health for our kids. Together, we've raised the bar, making Georgia a major player on the national stage in pediatric innovation.

So much of the work we do has a broad and long-term impact on the health and well-being of children, and that's a direct result of our two institutions coming together to advance the greater good--because we know that together we can do so much more than either of us could do alone.

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

New council addresses issues of opioid safety

Christy Norman, Noreen Peyatt, and Penny Castellano

In 2017, more than 47,000 people in the U.S. died from drug overdoses involving prescriptive opioids, according to the CDC. Of those deaths, 568 occurred in Georgia.

Such statistics weigh on the minds of Emory Healthcare (EHC) providers like Christy Norman, VP for pharmacy services. Last year, Norman co-led formation of the EHC Opioid Stewardship Council to address an epidemic that claims 130 lives in the U.S. every day.

The council spans care settings, service lines, and clinical and nonclinical roles throughout EHC. It coalesces grassroots efforts begun by emergency departments and ambulatory surgery sites to prescribe opioids more responsibly to prevent harm to patients.

"There was a lot of duplication of efforts, and we weren't collaborating and sharing expertise across the system to come up with solutions to use opioids more wisely to safely manage pain," says Norman. "The council helps ensure that providers across the system use the same protocols, resources, and tools based on national guidelines and best practices."

In March 2018, EHC adopted the National Quality Partners Playbook: Opioid Stewardship as the framework for establishing the new council. Norman and Noreen Peyatt, a clinical nurse specialist and pain expert at Emory University Hospital, used the playbook as a guide to set five council objectives:
  • Educate staff on the risks of opioid use and alternative strategies for managing pain.
  • Measure ordering and prescribing behaviors with the goal of decreasing the amount of morphine milligram equivalents/day that are prescribed, by provider and across the organization.
  • Modify provider behavior to improve standardization and reduce patient harm as measured through a reduction in adverse events related to opioid use (hospital admissions and emergency room visits).
  • Educate and effectively manage patients who have opioid and substance use disorders.
  • Reduce the operational burden on providers who prescribe opioids and manage patients who require them. Steps include e-prescribing (to curb unlawful duplication of written prescriptions) and full compliance with Georgia's Prescription Drug Monitoring Program (PDMP), which tracks controlled substance prescriptions statewide.
To help meet these objectives, the council established a repository of opioid-related initiatives, including one pertaining to dosing recommendations for post-operative pain that was developed at Johns Hopkins. Penny Castellano, chief medical officer for Emory Clinic and a council co-leader, is leading this effort with a pilot project in general surgery, orthopaedics, and gynecology/obstetrics.

"As part of this initiative, we've developed a dashboard and shared it with the council's MD champions, who serve as liaisons to physicians in their respective divisions, to evaluate alignment with the Johns Hopkins recommendations for select procedures," says Castellano. "Each division receives a report at the physician level. The pilot initiative has prompted conversations in these departments and will become a quality improvement project goal for residents in general surgery."

The council is making progress in other areas as well. Under state law, for instance, patients treated for pain must sign an agreement that requires them to use and store prescriptions responsibly. Patients who violate the agreement risk being discharged from a pain clinic or a physician's care. "We had 10 versions of a pain agreement previously," says Norman. "Now we have it down to one."

Providers now can use the electronic medical record to access the state PDMP portal more easily. E-prescribing directly to retail pharmacies is being piloted in oncology, palliative care, and psychiatry to improve tracking of prescriptions for opioids. The PDMP can detect when a provider is overprescribing or a patient is filling the same prescription at several locations.

For years, clinicians have relied on a traditional number scale that asks patients to rate pain from one (low) to 10 (high). To better assess pain, EHC's pain management committee has endorsed use of a functional pain scale systemwide. The scale rates pain based on behaviors (i.e., is the patient in good spirits and sleeping well versus acting out and crying). The functional pain scale is being piloted at Emory Johns Creek Hospital.

"Pain is subjective and often difficult to quantify," says Peyatt. "Effective management of pain remains an important indicator of the quality of care provided to patients. Focusing on function rather than a number provides patients and clinicians with a multidimensional means for assessing pain. We are changing our focus to how pain impacts a person's function."

Other projects include standardizing prescribing and protocols for patient-controlled analgesia devices and creating an electronic dashboard to track prescriber habits at the provider and patient level. Physicians in orthopaedics, gynecology/obstetrics, and general surgery are piloting the color-coded dashboard, which allows them to see prescribing patterns over time to determine discrepancies in practice and when a patient requires more of a drug than others typically use.

Patient education is paramount. The Opioid Stewardship Council wants every patient to know what to expect regarding pain and how to manage it safely. It seeks to standardize protocols for pain management, including limiting the number of opioids prescribed (a few days' supply instead of a month's worth), and using multimodal pain management (nonopioid medications, exercise, acupuncture, and massage). It also looks at policies and practices to monitor opioid usage and waste and how best to assist an employee who has a substance use disorder.

These steps and more are aimed at preventing patient continued use of prescriptive opioids 90 days or more after major or minor surgery, which happens in 6% of cases, according to a New England Journal of Medicine study. "That's a lot when you look at the number of patients across our system," says Norman.

In late April, EHC joined with 125 organizations in support of the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic. Its purpose parallels that of the Opioid Stewardship Council.

As Norman wrote in a statement of support for the NAM collaborative, EHC will contribute and share solutions "through clinical practice, research, and education in an effort to combat the opioid epidemic for our patients, families, health care professionals, and the communities we serve."--Pam Auchmutey

Woodruff Scholar Early Independence Award recipients focus on pain research

Daniel Harper, Jinbing Bai

Daniel Harper (dual appointment in anesthesiology and physiology) is the 2018 recipient of the Woodruff Scholar Early Independence Award, given by the Woodruff Health Sciences Center (WHSC) to individuals who have been identified as rising stars, with outstanding early-career accomplishments and strong potential to become future leaders at Emory. The award comes with $50,000 to support the recipient's research and career development.

Harper's research focuses on sensation and pain. His contributions include insights into the mechanisms by which pain and other sensory signals are modulated differently in chronic pain patients. His work also sheds light on how pain signals interact with other somatosensory signals, including tactile and thermal signals. Dr. Harper is the recipient of a K99 NIH award that is transitioning to a three-year R00 award.

Funding from this WHSC award will enable Harper to continue his current research and establish new collaborations with faculty across the health sciences and university, including in medicine, neurology, psychiatry, psychology, oral and maxillofacial surgery, radiology, and physiology, according to Andrew Jenkins, division chief for anesthesiology and pharmacology research. "This award will help cement Dr. Harper's position at Emory as an emerging leader in pain medicine," he says. Read more.

Jinbing Bai (nursing) is the 2019 recipient of the Woodruff Scholar Early Independence Award. Bai's research provides evidence on how to address cancer treatment toxicities and symptoms and has led to testing and development of the Parent Caring Response Coding Systems for pain management in cancer treatment-related procedures in children, which has received considerable attention from nurses around the world.

"Dr. Bai is incredibly deserving of this recognition," says nursing dean Linda McCauley. "The ability to reward junior faculty of his caliber allows us to truly celebrate the value of nurse scientists and the work they do every day to elevate the science and practice of nursing."

Dr. Bai has received numerous awards, including the Young Investigator Award from the American Pain Society, the Jean Guveyan Scholarship awarded by the American Society of Pain Management Nursing, and an NIH Pathway to Independence Award (K99/R00) that he is using to study the biological mechanism of children's suffering from pain, fatigue, anxiety, depression, and cognitive dysfunction across cancer therapies. Read more.

In brief
WHEA teaching fellowship applications due Sept. 15

Applications for the 2020 Woodruff Health Educators Academy Teaching Fellowship are due Sept. 15. The 12-month program for health sciences educators who want to advance their teaching skills includes monthly two-hour workshops and online intersession discussion groups. All sessions are organized around three domains: Designing and Planning Learning, Teaching and Facilitating Learning, and Assessment of Learning. On completion, fellows will be awarded a Certificate of Distinction in Teaching and will have the opportunity to teach workshops to future fellowship cohorts. Participants will be notified Sept. 30, and the program begins next March.

Injury prevention center re-funded and re-established

The CDC awarded $4.2 million over five years to fund the Injury Prevention Research Center at Emory (IPRCE), designed to reduce the top causes of injury and injury death in Georgia and the Southeast. IPRCE is one of nine centers in the U.S. being funded by the CDC. Formerly known as the Emory Center for Injury Control, the IPRCE has existed since 1993 and previously received CDC funding from 2009 to 2013. IPRCE is part of Emory's Department of Emergency Medicine and is the only center of its kind in Georgia. Jonathan Rupp is principal investigator of the IPRCE. Read more.

Winship receives major NCI lung cancer grant
Winship received a five-year, $9.7 million Specialized Program of Research Excellence (SPORE) grant from the NCI to study new approaches for lung cancer treatment, one of only four SPORE grants in the U.S. dedicated to lung cancer. Led by Haian Fu and Suresh Ramalingam, this program will support a team of investigators in immunology, pharmacology, medical oncology, radiation oncology, surgical oncology, and pathology. Read more.
EHC hospitals move up in rankings

For the eighth year in a row, U.S. News & World Report ranked Emory University Hospital the No. 1 hospital in Georgia and metro Atlanta in its 2019-2020 Best Hospitals Guide. Emory Saint Joseph's Hospital ranked No. 2 in Georgia and metro Atlanta, while Emory University Hospital Midtown ranked No. 5 in Georgia (3-way tie) and No. 4 in metro Atlanta (3-way tie). Read more. For an updated list of other rankings in health sciences, see website.

Jennifer Adamski (nursing) was elected to the board of the American Association of Critical Care Nurses.

Frank Brown (psychiatry) was named chief medical officer and chief quality officer for Emory Decatur Hospital, Emory Hillandale Hospital, and Emory Long-Term Acute Care.

Sheryl Gabram-Mendola (surgery) was named the Ada Lee Correll Chair.

Maura George (medicine) received the Vulcan Teaching Excellence Award.

Robert Guyton (cardiothoracic surgery) received the Arnall Patz Lifetime Achievement Award from the Emory Medical Alumni Association.

Jill Hamilton (nursing) was named distinguished alumna by UNC School of Nursing.

Omar Lattouf (cardiothoracic surgery) received the Award of Honor from the Emory Medical Alumni Association.

Viraj Master (Winship) was named director of integrative oncology and survivorship at Winship.

Lauren McCullough (public health) received the 2019 Brian MacMahon Early Career Award from the Society for Epidemiologic Research.

Mary (Mimi) Newell (Winship) was named president of the Georgia Radiological Society.

Neil Pfister (Winship) received the 2019 Young Investigator Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology.

Suresh Ramalingam (Winship) was named a fellow of the American Society of Clinical Oncology.

Steven Roser (oral surgery) received the Distinguished Service Award from the International Association of Oral and Maxillofacial Surgeons and a Nexus Research Award from the medical school.

Ignacio Sanz (rheumatology) received the 2019 Lupus Insight Prize.

Rein Saral (hematology) received the Distinguished Medical Alumnus Award from Johns Hopkins School of Medicine.

Nate Spell (medicine), who leads continuing medical education in the medical school, was recently notified that this office received accreditation with commendation from the Accreditation Council for Continuing Medical Education.

Shanthi Srinivasan (gastroenterology) was named director of Digestive Diseases.

Adam Webb (neurosurgery) was named chief quality officer for Emory University Hospital (EUH), Emory University Orthopaedics & Spine Hospital, and EUH at Wesley Woods.

Not pictured: The following nursing faculty and/or Emory Healthcare nursing staff were recently named fellows in the American Academy of Nursing: Jinbing Bai, Rasheeta Chandler, Carolyn Reilly, Patricia Moreland, Theresa Gillespie, Eve Byrd, Deena Gilland, and Mary Zellinger. Read more.


Sept 11: Educators Salon: Real Life Educational Research: If We Can Do it so Can You. Presented by the Woodruff Health Educators Academy. 5:00-7:00 p.m., WHSCAB plaza. RSVP.

Nov 14-15: 3rd Interprofessional Simulation Conference. Day 1: 8:00 a.m. to 6 p.m., Marriott Century Center, Atlanta. Day 2: 9:00 a.m. to 1:00 p.m., ExCEL Simulation Center. Register. More info.

Oct 5: Winship Win the Fight 5K: 8:00 a.m., Quadrangle, Emory University campus. Nicki Collen, head coach of the WNBA's Atlanta Dream, will serve as Grand Marshall of the event. Register. 
Nov 14-15: Innovating with Existing Drugs and Nutraceuticals Conference (sponsored by the Center for Affordable Medical Innovation). Emory Conference Center Hotel. Register.

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