September 2012 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine



Two Emory hospitals receive quality awards from UHC

UHC 2012 Quality Awards to EUH & EUH-Midtown

University HealthSystem Consortium (UHC), a national organization comprised of many of the nation's leading academic medical centers focusing on excellence in quality and safety, has ranked Emory University Hospital (combined with Emory University Orthopaedics & Spine Hospital) second and Emory University Hospital Midtown sixth in the 2012 UHC Quality Leadership Awards. This is the first time UHC has ever ranked two hospitals from one health care system in the national top 10.

The UHC rankings reflect the performance of its member teaching hospitals in multiple dimensions of quality and safety, and are traditionally looked upon as providing the best, most non-biased national quality measurement system available for teaching hospitals. Formed in 1984, UHC is an alliance of 116 leading academic medical centers and 276 of their affiliated hospitals representing a majority of the nation's academic medical centers.

The intensive efforts of the clinical quality and patient safety program of the Department of Surgery at Emory, directed by Dr. John Sweeney, to improve treatment and service indicators at these facilities, from mortality to readmission to infection rates, contributed to these rankings.

"In 2011, EUH jumped from 45th to 10th and Midtown from 42 to 11th in the rankings. That was amazing enough," says Dr. Sweeney. "Our leap this year is virtually unprecedented."

The ongoing projects of the Department's quality program include clinical data analyses, outcomes studies, statistical modeling, and the initiation and evaluation of new protocols, all framed by participation in such national alliances as UHC, Best Practices for Better Care (BPBC), American College of Surgeons National Surgical Quality Improvement Program (ACS/NSQIP), and the Surgical Care Improvement Project (SCIP).

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patient at EUH

Cutting readmissions requires reducing complications

According to “Risk factors for 30-day hospital readmission among general surgery patients,” a study in the September 2012 issue of Journal of the American College of Surgeons, complications after surgery are the most significant risk factors that send general surgery patients back to the hospital within 30 days of discharge. Dr. John Sweeney was the senior author of the study.

Using standard National Surgical Quality Improvement Project protocol, Dr. Sweeney and his co-investigators analyzed records of 1,442 general surgery patients at Emory University Hospital between October 2009 and July 2011. Of those, 11.3% were readmitted within 30 days. The investigators found that nearly half of readmissions were due to gastrointestinal complications and surgical infections. The top surgical complications were pulmonary complications and wound and urinary tract infections.

Hospitals face increasing pressure to reduce readmissions and will see reduced Medicare payments for excessive readmissions under the Affordable Care Act. "Decreasing complications will benefit the patient, the hospital and the payer, and will improve quality of care,” said Dr. Sweeney. “Steps can be taken and protocols established that will minimize postoperative complications. For example, at EUH we have just embarked on a pilot protocol to standardize the use and monitoring of indwelling urinary catheters, which account for 80% of nosocomial urinary tract infections.”

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Heather Hamby
Heather Hamby
Lisa Fisher
Lisa Fisher
Jimmy Owen
Jimmy Owen
Lisa Carlson
Lisa Carlson
Hillary Harding
Hilary Harding

Administrative changes

As Heather Hamby assumes her new role as vice chair of administration and executive administrator of the Department of Medicine, effective October 1, Lisa Fisher will begin transitioning to Ms. Hamby's former position as senior clinical administrator for the Department of Surgery. In addition to overseeing all aspects of the Department's academic affairs, Ms. Fisher will work directly with our clinical and administrative leaders as well as The Emory Clinic and Emory Healthcare on a variety of high level strategic planning and performance improvement projects.

"I can't thank Heather enough for the exceptional and transformative work she has done for the Department over the past three-and-a-half years," says department chair Dr. Chris Larsen. "She built an outstanding leadership team in Surgery and helped revitalize the sense of purpose and teamwork in Emory Healthcare's Surgical Services."

Ms. Fisher comes to us from the Department of Rehabilitation Medicine, where she served as department administrator. She has also served as interim administrator for the departments of Family Medicine, Neurology, and Psychiatry. Before Emory, Ms. Fisher was director of financial operations and executive office operations at the University of Miami School of Medicine and managed corporate business development at Piedmont Healthcare. She received her BS in psychology from Texas A&M University and her MHCA from Baylor University.

James Owen recently filled our vacant development officer position, which was being covered by Paige Martin, senior director of development for the School of Medicine and Emory Vaccine Center—we thank Ms. Martin for her efforts on our behalf. Mr. Owen will continue to support the Department of Urology, which he joined in January 2011, as he leads our fundraising efforts. With a background in development and commercial real estate, Mr. Owen received a BS in business management from Auburn University, and was director of annual giving at The University of the South before coming to Emory.

Lisa Carlson's recent promotion to director of academic affairs for the Department of Surgery will expand her pre-existing duties as research administrator to include faculty development and promotions. Ms. Carlson joined the Emory Transplant Center in 2004 and broadened her role to include the Department of Surgery in 2009. In 2011, she was elected to a four-year term on the Executive Board of the American Public Health Association, the oldest and most diverse organization of public health professionals in the world.

Hillary Harding, who served as the Department's administrator of finance and operations for the past three years, has left Emory to move back to her family's home state of New York. Ms. Harding was essential to the reinforcement of the discipline, structure, and accountability required for the efficiency of our Emory University business operations.

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Dr. Anuradha Subramanian
Dr. Subramanian

New arrival: Anuradha Subramanian, MD

Assistant Professor of Surgery, Trauma/Surgical Critical Care at Grady Memorial Hospital, Department of Surgery, Emory University School of Medicine

Dr. Subramanian earned her MD at University of Missouri-Kansas City, completed her general surgery residency at Metropolitan Hospitals, University of Illinois-Chicago, and did her surgical critical care residency and trauma fellowship fellowship at Grady Memorial Hospital. Prior to coming to Emory, she was an assistant professor of surgery at Baylor College of Medicine in Houston. Among numerous other appointments, she also served as director of medical student education for the Baylor Department of Surgery and project leader of the effort to prevent post-operative respiratory failure at Michael E. DeBakey VA Medical Center. Her clinical and research interests include surgical education, sepsis, temporary abdominal closure, ventral hernia, abdominal wall reconstruction, and biologic mesh.

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Emory CTS triathlon team finishes Kiawah Island Triathlon

Kiawah triatholon Emory team
(left to right) Amanda Weiland, Daniel Weiland, John Puskas, and Richard Heimbecker

The same four members of the (unofficial) Emory CT Surgery Triathlon Team that finished the Lake Placid Ironman Triathlon in July 2011 completed the Kiawah Island Olympic Distance Triathlon on September 16, 2012. John Puskas, MD, Rich Heimbecker, PA-C (formerly CT Surgery, EUHM, relocated to Boston), Amanda Weiland, RN (4a/5a CT ICU, EUH), and Daniel Weiland, PA-C (CT Surgery, EUH), successfully accomplished the Kiawah Triathlon's 1.5K ocean swim, 45K bike, and 10K run. These members of the CTS service work hard and play hard!

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App review: JiffPad teaches patients, frustrates users

by Michael Konomos, biovisualist and lead multimedia developer, Emory Surgery

JiffPad, a free app by Jiff Inc., allows healthcare providers to record slide presentations with narration onto an iPad and then email their "JiffTalk" to patients or other providers.

The app presents the user with a bank of illustrations sourced from A.D.A.M. Images, an online medical image library. The slides can be downloaded directly to the iPad, a deck of slides assembled, and narration recorded using the iPad mic. The app's drawing tool allows circles, arrows, and other notations to be incorporated into the presentation. Recording can be paused and then resumed. While not beautiful, the illustrations are generally accurate and cover many common subjects that might be discussed with a patient. In addition to the A.D.A.M. images, users can insert their own from personal photo galleries or other vendors.

With two logins necessary for access, JiffPad is HIPAA compliant. When JiffTalks are posted, they are uploaded to Jiff servers and then sent to the intended email addresses.

However, JiffPad's tools are highly limited. The home screen's "menu" button allows users to customize the pen tool and their profiles and to download the image catalog to their iPads, but the pen tool can no longer be altered once the JiffTalk is being created. Since there is no typing tool (?!), the often-clunky pen tool is the only writing option.

Perhaps the most glaring omission is the lack of an "undo" button, making errant marks permanent and a potential source of confusion for the viewer. The mystifying coup de grace is that once a page is added to Jiff Talk, it cannot be removed.

Certainly JiffPad is a smart, promising concept, though its execution is incomplete and intermittently frustrating. According to the Jiff Inc. website, the app is undergoing Beta testing. If so, missing features such as those I mention need to be added to JiffPad for it to be truly useful to the healthcare professional.

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Emory reception at the ACS Clinical Congress

ACS Clinical Congress

Emory Department of Surgery alumni, faculty, and trainees are invited to attend a buffet reception during the 98th Annual Clinical Congress of the American College of Surgeons in Chicago. The reception will be held on Tuesday, October 2, 2012, from 6:00 - 8:00 p.m. at the Chicago Firehouse Restaurant, 1401 South Michigan Avenue.

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Upcoming events

Laudable Pus: Harnessing T Cells to Cure Cancer

Presented by Andrew Page, MD
Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Oct. 11, 2012 EUH Auditorium
Genes, Biologics, Biomarkers: Are They Patentable?
1:00 - 2:00 p.m., Oct. 12, 2012 James B. Williams Medical Education Bldg, 170A
Second Annual Winship 5K Win the Fight Walk 5K Race Oct. 13, 2012 Details
Intrahepatic Cholangiocarcinoma: The Other Primary Liver Cancer

Presented by Timothy M. Pawlik, MD, MPH, PhD
Johns Hopkins Medicine:
Associate Professor of Surgery; Associate Professor of Oncology; Chief, Division of Surgical Oncology; John L. Cameron MD Professor of Alimentary Tract Diseases; Director, The Johns Hopkins Medicine Liver Tumor Center
7:00 - 8:00 a.m., Oct. 18, 2012 EUH Auditorium
Curriculum Reform in Cardiothoracic Residency Training – Producing Master Surgeons

Presented by Richard Harry Feins, MD
Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill
7:00 - 8:00 a.m., Oct. 25, 2012 EUH Auditorium
Department of Medicine Research Day
Info and RSVP
8:00 a.m. - 4:30 p.m., Oct. 26, 2012 Cox Hall Ballroom
EHC Quality Conference
Registration required, contact
7:30 a.m. - 12:00 p.m., Oct. 30, 2012 Cox Hall Ballroom
Surgery Faculty Meeting 5:30 - 7:00 p.m., Oct. 30, 2012 TEC, B6300 (please note location change)
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