January 2013 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


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Surgery flying high with safety checklist

OR nurse filling out surgical checklist.

Pilots and flight crews use them. Project engineers depend on them. Checklists keep multiple pairs of eyes on potential problems and confirm that critical steps are not missed.

Modeled after the World Health Organization Surgical Safety Checklist and modified to reflect Emory Healthcare-specific needs and interests such as the standards of care of the Surgical Care Improvement Project (SCIP), the surgical checklist in use at Emory University Hospital and Emory University Orthopaedics & Spine Hospital is a simple and inexpensive way to provide additional safety to patients. The list is also undergoing implementation at Emory University Hospital Midtown.

Fitting on a single color-coded page, the checklist uses the familiar language of the profession. By design, it is intended to encourage better communication and collaboration between all surgical participants, be they members of the anesthesia team, nurses, or surgeons. According to Joanna Kobylivker, MPH, project manager of surgical services, "Someone's name or title shouldn't prohibit him or her from speaking openly."

One stage in the checklist calls for all OR personnel to introduce themselves, creating a group cohesion that fosters interaction. "This type of basic exercise paves the way for people to feel able to speak up if something unsafe is happening and to call attention to us missing straightforward things we should get right," says Dr. John Sweeney, interim chair of the Department of Surgery and director of its clinical quality and patient safety program.

Divided into three sections, the list covers procedures, confirmations, and communications before induction of anesthesia, prior to excision, and during the debriefing that occurs before the surgeon leaves the OR. The latter component is a new concept that requires either the attending surgeon or a designee such as a surgical resident to lead a brief discussion that evaluates the performance of the case. Any comments that have been written on the checklist are also reviewed at this time. "It may be recorded that a piece of equipment was not working," says Ms. Kobylivker. "We will then reach out to the appropriate parties to quickly replace or fix that item."

Quantification of retrospective data and comparison of outcomes indicates a clear connection between use of the checklists and reduction in surgical errors. "The data shows decreased mortality and decreased morbidity for our patients. That's the most important thing," adds Dr. Sweeney.

The culture of safety and quality is extending beyond the operating room. Residents and medical students are introduced to the concept of the surgical checklist "from day 1 essentially," says Dr. Keith Delman, program director of the general surgery residency program. Checklist reviews are also regular features of the EUH surgical services performance days that are held quarterly to examine and analyze surgical services performance among anesthesia, surgery, and OR staff of Emory University Hospital.

Watch a Fox News spot on the use of the checklist at Emory University Hospital.

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Dr. Ingram supervising treatment at the Grady Burn Center.
Prior to being appointed director of the Grady Burn Center, Dr. Ingram completed his trauma/burns fellowship at Grady.

Dr. Ingram to be honored at upcoming Grady Gala

Dr. Walter Ingram will be presented with the Senior Sage Award at the third annual White Coat Grady Gala to be held March 16, 2013, at the Georgia Aquarium. The black tie dinner and awards ceremony is sponsored by the Grady Health Foundation, which is dedicated to encouraging corporations, foundations, and citizens to invest in the continued health and well-being of Grady Memorial Hospital, which has become Georgia's largest safety net hospital.

Dr. Ingram began directing the Grady Burn Center in 1992. His leadership catalyzed numerous advances, including standardized wound care protocols, expanded hydrotherapy facilities, upgraded and refined pain control processes, and the addition of services for patients with complex wound problems secondary to burns. Today, he presides over a program that admits over 500 burn patients per year and provides the vast majority of pediatric burn care in Georgia.

Dr. Ingram also led the effort to obtain verification from the American Burn Association (ABA)—the highest recommendation a burn center can receive. Verification was granted in May 2012 and officially acknowledged the Grady Burn Center for providing high quality adult and pediatric patient care and meeting the ABA's demanding standards for organizational structure, personnel qualifications, facilities resources, and medical care services. As recognized by the Senior Sage Award, Dr. Ingram is indeed a Grady healthcare hero.

Additional honorees at the event will include Dr. Nadine Kaslow, chief psychologist at Grady and professor of the Emory Department of Psychiatry and Behavioral Sciences (Inspiring Mentor Award); Dr. L. Joy Baker of the Morehouse School of Medicine (Next Generation Healer Award); and the Metro Atlanta Chamber (Ada Lee and Pete Correll Healthcare Legacy Award).

For additional information regarding the gala, please call 404.489.1550 or email asmith2@gmh.edu.

Go here to register for the event.

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Dr. Steed-mentored GA Tech BME Team fetches first prize for device design

(from left) Dr. Steed with BME student team members Charlie Bloodworth, Binbin Chen, Freddy Damen, and Lu Ling.
(from left) Dr. Steed with BME student team members Charlie Bloodworth, Binbin Chen, Freddy Damen, and Lu Ling.

The Senior Design Project course of the Wallace H. Coulter Department of Biomedical Engineering of the Georgia Institute of Technology and Emory University facilitates the formation of ventures involving senior undergraduate Georgia Tech BME student capstone project teams and qualified faculty mentors to develop a medical product. By volunteering to mentor a team, an Emory faculty member with a viable concept for an innovative device can lead a group dedicated to overcoming the engineering hurdles inherent to creating any prototype, possibly resulting in a marketable product.

Over the Fall semester, Dr. Martin Steed, residency program director of the division of oral and maxillofacial surgery, mentored a four-member BME student team as they applied their knowledge of the phases of design research, generation of engineering alternatives, prototyping and testing, and the FDA 510(k) regulatory pathway for medical device clearance to design a prototype of a surgical instrument for the safe exposure of the inferior alveolar nerve.

"Instrumentation and repair of nerves within bone requires the same principles found in all of surgery: obtaining access and providing continuous visualization," says Dr. Steed. "The students were able to incorporate novel design elements that would not only enable atraumatic lateralization of the nerve, but also a self irrigating element that keeps the field clear."

Competing against 74 other teams of Georgia Tech students, Dr. Steed's team presented their prototype at the Senior Biodesign Capstone Project Competition on December 6th, 2012, and won 1st place, receiving a cash prize of $1000. The team consisted of Charlie Bloodworth, Binbin Chen, Freddy Damen, and Lu Ling. The team was also awarded entry into the annual InVenture Prize @ Georgia Tech, a faculty-led competition that features a first-place package of $20,000, a free US patent filing by Georgia Tech’s Office of Technology and Licensing, and other prizes.

The team plans to continue working together to further refine the device before creating a prototype that can be tested clinically.

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learning in the lab.

Call for Abstracts: 12th Annual Surgery Research Symposium

The 12th Annual Department of Surgery Research Symposium will be held on Thursday, June 13, 2013, and the keynote speaker will be Christian Larsen, MD, DPhil, dean of the Emory University School of Medicine. All Department of Surgery trainees (students, postdocs, residents, and fellows) are encouraged to submit their research, especially those in a dedicated laboratory rotation. All submissions will be considered for both oral and poster presentation. Please download the official PDF announcement for details and abstract specifics.

First and second place cash awards for oral presentations in both clinical and basic science categories will be presented, as well as awards for the top poster in each category. All winners will be invited to dinner with faculty immediately following the symposium.

For more information, please contact Griselda McCorquodale at 404-727-8461 or gmccorq@emory.edu.

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Elizabeth Ferry
Elizabeth Ferry

Elizabeth Ferry receives ETC promotion

Elizabeth Ferry, RN, MA, CCRC, has been promoted to research nurse supervisor for the clinical research program of the Emory Transplant Center (ETC). Elizabeth originally joined the ETC in August 2005 as a senior research nurse and quickly became an integral part of its research activities. Her primary role was to support clinical trials encompassing end-organ diseases and solid organ transplantation for the kidney, kidney/pancreas, liver, lung, islet, and vascularized composite allograft programs.

In her new position, Elizabeth will oversee the day-to-day operations of the clinical research program and supervise the research nurse and coordinator staff. She succeeds Beth Begley, RN, BSN, CCTC, in this role. Beth was promoted to manager of clinical research nursing in October 2012 and assumed leadership of a newly restructured clinical research group for the Department of Surgery on the Clifton Campus of Emory University, presently including transplantation, vascular surgery, general and GI surgery, and oral and maxillofacial surgery. We congratulate Elizabeth and Beth on their new roles!

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Upcoming events

Fragile X Syndrome: Completing the Circle from Basic Science to Therapeutic Intervention
Presented by Stephen Warren, PhD
– Chair, Department of Human Genetics, Emory
4:00 p.m., Feb. 5, 2013 Winship Ballroom, DUC
Academic & Industry Intersection Conference: Innovative Research Collaborations in Times of Uncertain Funding
Sponsored by ACTSI and Georgia Bio
Feb. 7, 2013 Emory Conference Center
More info
J. C. Thoroughman Visiting Professorship
Contemporary Workup and Management of Gastric Cancer

Presented by Daniel G. Coit, MD
– Professor of Surgery, Memorial Sloan-Kettering Cancer Center and the Weill Medical College at Cornell University
– Co-Leader, Melanoma Disease Management Team, Memorial Sloan-Kettering
7:00 - 8:00 a.m., Feb. 7, 2013 EUH auditorium
Melanoma Conference
Sponsored by Winship Cancer Institute
Feb. 9, 2013 Intercontinental Buckhead
More info
Multidisciplinary Treatment of Colorectal Cancer Liver Metastases
Presented by Neil Saunders, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Feb. 14, 2013 EUH auditorium
New Paradigms of Health Services Research
Presented by Robert Dittus, MD, MPH
Vanderbilt University Medical Center:
– Assistant Vice Chancellor for Public Health
– Director, Institute for Medicine and Public Health
4:30 - 6:00 p.m., Feb. 19, 2013 SOM education building auditorium
More info.
State of the WHSC Address
Presented by Wright Caughman, MD
– Exec VP for Health Affairs, Emory University
– CEO, Woodruff Health Sciences Center
4:30 p.m., Feb. 20, 2013 WHSCAB auditorium
Thyroid Cancer: Is it Time to Revise the Textbooks?
Presented by Jyotirmay Sharma, MD
– Assistant Professor of General and Endocrine Surgery, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
– Director of Core Curriculum, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Feb. 21, 2013 EUH auditorium
Biomedical Innovation and Development Conference 2013
For inventors, clinicians, and entrepreneurs
Feb. 21-22, 2013 Georgia Tech
More info
Surgery Division Chiefs Meeting 5:30 - 7:00 p.m., Feb. 26, 2013 EUH Whitehead Room
Breast Reconstruction 101
Presented by Angela Cheng, MD
– Assistant Professor of Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Feb. 28, 2013 EUH auditorium
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