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


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Grady Trauma Program re-designated as a Level I Trauma Center

Grady ambulance bay.

Metro Atlantans and Georgians within a 100-mile radius of downtown are so accustomed to the Level I designation assigned to the trauma program at Grady Memorial Hospital, they might be startled to learn that the most advanced trauma center in the state had to re-earn that ranking in 2013—trauma centers in Georgia must renew their designation every three years. Unsurprisingly, the Grady Health System retained its Level I Trauma Center designation following a successful site visit conducted by J. Patrick O'Neal, MD, Director of Health Protection for the Georgia Department of Public Health (DPH), and Renee Morgan, State Trauma System Manager of the DPH, on February 27.

In the official notice of re-designation addressed to Dr. Jeffrey Nicholas, Chief of Trauma and Director of the Marcus Trauma Center at Grady, Dr. O'Neal wrote, "We commend Grady on the formation of an impressive process improvement program. We also would like to acknowledge the fine leadership of you as Chief of Trauma and the obvious commitment of the entire trauma team. We would be terribly remiss if we did not also commend the extraordinary administrative support of Mr. John Haupert." Mr. Haupert is President and CEO of Grady Health System.

To achieve Level I designation, a trauma center must have a full-range of specialists and equipment available 24 hours a day, 365 days a year; admit a minimum required volume of 1,200 severely injured patients (Grady admits approximately 3,500 annually); have a research program; be a leader in trauma education and injury prevention; a referral source for communities in neighboring regions; and be committed to continued improvement through a Performance Improvement and Patient Safety (PIPS) Program.

"The re-designation comes after significantly rebuilding the infrastructure and organizing the performance improvement plan over the last six months, a process more than ably managed by Dr. Nicholas," says Dr. Sheryl Gabram, Emory’s Surgeon-in-Chief of Grady Memorial Hospital. "The Grady Trauma Program, supported by Grady administrative leadership, also sponsored an on-site Trauma Outcomes and Performance Improvement Course (TOPIC) in November 2012 for all Grady trauma healthcare providers. This nationally recognized course, taught by Jorie Klein, RN, from the Society of Trauma Nurses, and Glen Tinkoff, MD, representing the American College of Surgeons, consisted of detailed training for structuring a PI program from the ground up. Many of the initiatives suggested during the course were implemented for Grady's re-designation visit."

Other upgrades included the renovation of the resuscitation bay into the high tech and larger capacity Marcus Trauma Center, the development of assessment tools for tracking the continuum of trauma care and monitoring patient outcomes, and the addition of new staff in positions that were originally unsupported at the time of the prior site visit. These include Injury Prevention Coordinator Emma Frank, Outreach and Education Coordinator Felicia Mobley, Research Coordinator Julie Mayo, Performance Improvement Coordinator Tony Volrath, and five paramedic dispatch coordinators that have streamlined communication with pre-hospital personnel and improved documentation and activation of the trauma team.

The growth in research involving the center has also been significant. New grants include Dr. Chris Dente's Department of Defense-funded pilot study of wound closure, his National Cancer Institute-backed evaluation of the detection and management of non-compressible hemorrhage by vena cava ultrasonography, and Dr. Ravi Rajani's participation in the multi-center TRANSFIX study of a special endovascular graft for treating blunt thoracic aortic injury.

"I am fortunate to have taken over the trauma program at a time of tremendous administrative support from Grady, and our progress demonstrates that," says Dr. Nicholas. "Trauma care is a team effort, and I am blessed with a great supporting cast of players. Fran Lewis, the Trauma Program Director, has been outstanding in leading the changes we have made. Our clinical care has always been top notch, but we are finally capable of seeing and using our data and leveraging it to take the program to new heights. It is a great time for Grady and the city of Atlanta, and I am extremely proud of our entire team and our momentum."

Dr. Nicholas views the re-designation as a major step towards the Trauma Program's goal of hosting an American College of Surgeons (ACS) consultative visit and ultimately striving to become an ACS-verified Level I Trauma Center. There is currently no trauma center in the state with this distinction. "The ACS endorsement is the gold standard of recognition for a trauma center," he says. "It signifies that a trauma center has demonstrated true commitment from pre-hospital care through discharge and rehabilitation, and that it has a robust PIPS Program aimed at providing the highest quality trauma care for all injured patients."

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On a related note: Niki Taylor thanks Dr. Nicholas and blood donors

Niki Taylor (center) with Dr. Nicholas (left) and several donors.
Niki Taylor (center) with Dr. Nicholas (left of Taylor) and several donors.

Supermodel Niki Taylor was critically injured in an April 2001 car accident in Atlanta, sustaining severe liver and abdominal injuries. In the first 24 hours of her arrival at Grady, trauma surgeon Dr. Jeffrey Nicholas and his team operated on her three times and replaced her blood volume 10 times. This was but the beginning of weeks of surgeries and more than 100 transfusions, which were made possible by the donations of more than 300 blood donors. The care Ms. Taylor received at Grady saved her life, and on March 20 she visited the Metropolitan Atlanta Chapter of the American Red Cross to reunite with Dr. Nicholas and 15 of the blood donors who contributed to her survival.

"Coming here, knowing that I was going to meet some of the donors that rolled up a sleeve and ultimately gave me another chance at life was such a blessing," Ms. Taylor said. Her experience inspired her to become a member of the National Celebrity Cabinet of the Red Cross and to strive to raise awareness about the ongoing need for blood donation.

The Emory Clinic will sponsor an Emory employee blood drive on Monday, April 15 from 12 p.m. to 5 p.m. in Winship Cancer Institute, Conference Room 5012. Donors should bring photo ID. Contact Mike Bird at michael.bird@emoryhealthcare.org with any questions.

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Paces Plastic Surgery joins Emory, Dr. Eaves reunites with Dr. Hester and Dr. Nahai

Dr. Eaves, Dr. Nahai, and Dr. Hester.
(left to right) Dr. Eaves, Dr. Nahai, and Dr. Hester.

"Dr. T. Roderick Hester and Dr. Foad Nahai were extremely significant mentors for me when I was an Emory plastic surgery trainee," says Dr. Felmont Eaves, III, who has rejoined the plastic surgery faculty of the Emory University School of Medicine after 15 years in Charlotte, North Carolina. He has been a partner at Charlotte Plastic Surgery and a clinical associate professor at the University of North Carolina, an appointment he will retain. "To have the opportunity to work with them again as we build Paces' new relationship with Emory is extremely exciting."

As of March 4, 2013, Paces Plastic Surgery became the Emory Aesthetic Center at Paces and Dr. Eaves was named its medical director. Originally founded by Dr. Hester in 1993, the former private practice aesthetics and reconstructive surgery center will now expand into a highly versatile, multidisciplinary operation under the Emory Healthcare umbrella. "This transition allows us to incorporate a variety of Emory talent from dermatology, otolaryngology, ophthalmology, and vascular surgery so that we can expand our services to include facial plastic surgery, oculoplastic surgery, aesthetic dermatology, and vein treatments. In short, it will allow the center to provide the entire spectrum of aesthetic surgical and non-surgical procedures," says Dr. Hester. "Frankly, I've wanted Paces to become part of Emory for some time, and circumstances finally lined up to make that a reality."

After leaving Emory in 1993 to found Paces, Dr. Hester returned to lead the division of plastic and reconstructive surgery in November 2001—he stepped down in January 2010 while remaining on the faculty. With the assistance of Dr. Nahai, who joined Paces in 1998 after 20 years with Emory, Dr. Hester maintained Paces' clinical activities throughout as well as its position as the primary aesthetic surgery training rotation for Emory's plastic surgery residency.

Dr. Eaves left Emory for Charlotte in 1997, temporarily suspending the day-to-day routines with Dr. Hester and Dr. Nahai that began during the years of his Emory-based 1992-1994 plastic surgery residency and 1994-1995 fellowship in aesthetic and minimally invasive plastic surgery—all three surgeons completed their plastic surgery training at Emory. Dr. Eaves went directly from his fellowship to joining the Emory plastic and reconstructive surgery faculty, and he and Dr. Nahai became colleagues at the forefront of the development of endoscopic techniques and instruments in plastic surgery. One of their most significant achievements was co-authoring Endoscopic Plastic Surgery with the late, great Dr. John Bostwick, chief of plastic and reconstructive surgery at Emory at the time. Published in 1995, it was the first textbook of its kind to describe the burgeoning field.

As Dr. Hester and Dr. Nahai continued developing and refining aesthetic-cosmetic and reconstructive procedures at Paces, Dr. Eaves populated his years in Charlotte with becoming a highly skilled practitioner of body contouring after massive weight loss in addition to his other specialties; making academic contributions in patient safety, system and process improvement and quality of care, and evidence based plastic surgery; and serving as president of the American Society for Aesthetic Plastic Surgery from 2010-2011 and president of Charlotte Plastic Surgery from 2010-2012.

"I am delighted with this sequence of events," says Dr. Nahai. "The wonderful symmetry of Dr. Eaves' return and of us all doing what we do best, together, in a familiar setting is an incredible opportunity to create a world-class multi-specialty aesthetic center." Coming from a seasoned and innovative physician and educator who is president-elect of the American Association for Accreditation of Ambulatory Surgical Centers, served as director of the American Board of Plastic Surgery from 2001-2007, president of the American Society for Aesthetic Plastic Surgery from 2007-2008, and president of the International Society of Aesthetic Plastic Surgery from 2008-2010, these words alone portend a bright future for this new consortium.

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Dr. Walt Ingram
Dr. Ingram


Dr. Ingram presented with Senior Sage Award at White Coat Grady Gala

Sponsored by the Grady Health Foundation, the 3rd Annual White Coat Grady Gala at the Georgia Aquarium on March 16 was a sell-out with more than 750 guests, and raised $1,010,00 for Grady Health System. The centerpiece of the event was the honoring of Atlanta's healthcare heroes, one of whom was Dr. Walt Ingram, who received the Senior Sage Award.

Dr. Ingram did his general surgery residency and fellowship in trauma/burns at Emory, after which he assumed directorship of the Grady Burn Center in 1992. Presiding over a program that has grown to admitting over 500 burn patients per year and also provides the vast majority of pediatric burn care in Georgia, Dr. Ingram has dedicated himself to fine-tuning the center's capabilities. He led the effort to obtain verification from the American Burn Association, which was granted in May 2012 and is the highest recommendation a burn center can receive. Watch the honoree video (scroll down to mid-page).

Dr. Vinod Thourani
Dr. Thourani

Dr. Thourani receives illustrious ACC Teaching Award

Cardiothoracic surgeon-researcher Dr. Vinod Thourani was awarded the W. Proctor Harvey, MD, Young Teacher Award at the 2013 American College of Cardiology's (ACC) annual meeting in San Francisco. He is one of two recipients to receive the prestigious honor, which is awarded every two years.

In addition to identifying and celebrating promising young members of the ACC who have distinguished themselves by dedication and skill in teaching, the award is intended to stimulate the awardees to continue their careers in education. Dr. Thourani was selected from among a highly competitive group of academic cardiologists to receive the award.

"I am honored to be given this teaching award from the ACC," says Dr. Thourani. "Teaching the next generation of physicians, and mentoring them to be the best they can be, is critical in academic medicine and to the health care system as a whole. I thoroughly enjoy the teaching component of my profession."

Dr. Thourani's research and clinical efforts in Transcatheter Aortic Valve Replacement (TAVR) and minimally invasive valvular surgery for high-risk patients with severe aortic stenosis has been particularly significant, especially his work as local co-principal investigator of the multicenter PARTNER I and II trials. At the ACC meeting, Dr. Thourani presented five invited lectures, including the three-year safety and outcomes data of the PARTNER I trial that measured TAVR against traditional open heart surgery, stating that the SAPIEN valves used in TAVR appeared to be durable and not to have suffered structural deterioration. Mortality rates between patients who had received TAVR and those who had open-heart surgery were nearly identical, and TAVR patients had no increased risk of stroke.

Dr. Wood with unidentified surgical trainees at Soodo Hospital, Ethiopia.
Dr. Wood with surgical trainees at Soddo Hospital, Ethiopia.

Dr. Wood honored with 2013 Second Century Award

On March 21st at the Atlanta History Center, acclaimed surgical oncologist and researcher Dr. William C. Wood, chair of the Department of Surgery of the Emory University School of Medicine and EUH's chief of surgery from 1991-2009, was presented with the Lettie Pate Whitehead Evans Award for Emory University Hospital by Emory Healthcare. The award is one of four named awards that recognize physicians and community philanthropists at Emory University Hospital, Emory University Hospital Midtown, Emory Johns Creek Hospital, and Saint Joseph's Hospital. Honorees are selected for their significant impact on the care of countless Georgians, as nominated by supporters of the participant hospitals and previous award recipients.

Dr. Wood retired from The Emory Clinic in August 2011 to become more active in global health. He was appointed the first academic dean of the Pan African Academy of Christian Surgeons and now travels periodically to Africa to assist the program directors of various surgical residencies in such countries as Gabon, Cameroon, and Ethiopia. Watch honoree video.

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Dr. Staley comments on survivorship report on CNN

Dr. Charles Staley and CNN's Brooke Baldwin.

Dr. Charles Staley, chief of the division of surgical oncology of the Emory University School of Medicine and associate director for clinical operations of the Winship Cancer Institute of Emory University, appeared on CNN on March 27 to discuss the Annual Report on Cancer Survivorship in the United States, released by the American Association for Cancer Research. The report was released in advance of the AACR Annual Meeting 2013, which will be held in Washington, D.C., April 6-10. Dr. Staley was joined by Time Magazine health and medicine writer Alice Park and interviewed by CNN's Brooke Baldwin.

As a spokesperson for the status of cancer treatment and research in the nation, Dr. Staley is a distinguished choice. A cancer survivor himself and an Emory faculty member since 1995, his busy clinical practice focuses on treating rare and difficult cancers of such organs as the pancreas and liver, and his translational research and novel clinical trials in gastrointestinal cancers are powered by such grants as being principal investigator of The Emory Clinic and Emory VA Medical Center-based trials of the Eastern Cooperative Oncology Group.

The AACR report shows that as of January 2012 there were approximately 13.7 million cancer survivors in the United States, a number that is expected to rise by 31 percent to 18 million by 2022. When asked about the reasons for this rise, Dr. Staley responded, "I think it's a combination of better prevention, finding tumors at an earlier stage, and better treatment plans."

"I've been doing cancer treatment for twenty years, and when I first started it was hard to go to work every day," he elaborated. "Now it's just exciting. Every day you hear about new preventions, new trials, new drugs, new treatments. It's a great time to be involved in cancer care."

When asked about the report's implications for the future, Dr. Staley replied, "The take away is that more people are going to be surviving with cancer. There's so many problems, scars of many varieties, from cancer care that we don't pay a lot of attention to, and I think as people are living with these issues, we need to spend more time understanding them, documenting them, and helping these people."

At the close of the spot, Ms. Baldwin noted that Emory was a "great place to get treatment, I know folks who have been there myself." Watch the video.

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Dr. Felmont Eaves

App review: Johns Hopkins ABX Guide

by Michael Konomos, MS, CMI, biovisualist and lead multimedia developer, Emory Surgery, and Ankit Patel, MD, endosurgery fellow, Emory Surgery

Who should buy this app: Medical students and junior residents in internal medicine or infectious disease.

The good: Unlike Epocrates®, this guide allows the user to review the ABX options that correspond to a patient's diagnosis. The extremely thorough, descriptive, and well-referenced entries can also be accessed by antibiotic name, brand name, pathogen name, and management.

The bad: For what the app offers, $29.99 is a bit high to be competitive. The interface on the iPad is also unbalanced, with most of the screen space consumed by the "about" page rather than the content itself.

The bottom line: This app is overkill for most surgery residents and anyone else that is advanced in their training, especially since they are probably going to get an ID consult for anything unusual. The majority of potential users will just skip the price and use Epocrates®. However, this could well be the app for younger trainees who haven't quite mastered all of the names of antibiotics. While Hopkins has obviously invested much thought and effort into this highly detailed guide, it will probably and unfortunately be of a little use to the remainder of the academic surgical community.

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Acute Care Surgery: Implementation and Trends in Care

May 4-5, 2013, Intercontinental Buckhead, Atlanta

This CME program will introduce acute care surgery to a broad, national audience. It has been designed to benefit providers and administrators affiliated with acute care surgery, emergency and hospital medicine, critical care, emergency radiology, process design and improvement, quality and safety initiatives, and surgical education. Current issues in policy, implementation models, efforts in standardization of care, and the effects of safety, quality, and patient outcomes will be presented and discussed. Viewpoints and experiences of administration and other interested groups will be covered.

The course director is Dr. A. L. Jackson Slappy, director of acute care surgery of Emory University Hospital. Guest faculty are Dr. L. D. Britt, Chair of Surgery, Eastern Virginia Medical School; Dr. John Maa, University of California-San Francisco Medical Center; Dr. John Nelson, Nelson Flores Hospital Medicine Consultants; and Dr. John O' Shea, Senior Health Policy Advisor, Committee on Energy and Commerce, US House of Representatives. Download the PDF brochure.

Emory Surgery Faculty Development Seminar

May 11, 2013, 8 a.m.–12 p.m., SOM Room 110

While all faculty are welcome, faculty who joined the Department of Surgery after 2010 are strongly encouraged to attend this overview event for a series of seminars dedicated to equipping faculty early in their careers with the tools to be successful. Agenda items will include promotions, education, research, clinic operations, quality, and communications resources. Single-topic seminars covering most of these areas will be scheduled throughout the weeks to follow. Please contact surgery.facultydevelopment@emory.edu with any questions or concerns.

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Upcoming events

11th Annual Resident Lecture Program
Division of Cardiothoracic Surgery

Innovations in Cardiac Surgery: The Value of Bench to Bedside Thinking

Presented by Vivek Rao, MD, PhD
– Head, Division of Cardiovascular Surgery, University Health Network
– Surgical Director, Cardiac Transplantation and VAD Program, Peter Munk Cardiac Center, Toronto General Hospital
– Alfredo and Teresa DeGasperis Chair in Heart Failure Surgery
7:00 - 8:00 a.m., April 4, 2013 EUH auditorium
Novel Signalling Networks that Prevent the Development of Autoimmune and Inflammatory Diseases
Presented by Sir Philip Cohen, FRS
Sponsored by the Department of Biochemistry, Emory University School of Medicine
– Fellow of Royal Society (FRS)
– Foreign Associate of the National Academy of Sciences
– Professor of Enzymology, Medical Research Council Protein Phosphorylation Unit, University of Dundee, Scotland
4:00 - 5:00 p.m., April 8, 2013 WHSCAB auditorium
Preoperative Evaluation: Optimizing Outcomes and Improving Efficiency
Presented by Laureen L. Hill, MD
– Professor and Chair, Department of Anesthesiology, Emory University School of Medicine
7:00 - 8:00 a.m., April 11, 2013 EUH auditorium
6th Annual Ira Ferguson Lectureship
Surgical Training: A New Paradigm

Presented by Timothy J. Eberlein, MD
– Bixby Professor and Chairman, Department of Surgery, Washington University School of Medicine
– Spencer T. and Ann W. Olin Distinguished Professor and Director, The Alvin J. Siteman Cancer Center
– Surgeon-in-Chief, Barnes-Jewish Hospital
7:00 - 8:00 a.m., April 18, 2013 EUH auditorium
Current Strategies in the Management of Neuroendocrine Tumors of the Foregut and Midgut
Presented by Colin M. Brady, MD
– Administrative Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., April 25, 2013 EUH auditorium
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