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Duke Heart – April 25th 2020 – “Slow Burn and the New Normal”

By Manesh Patel, M.D. in Uncategorized on April 26, 2020.

Chief’s message:

Slow burn and the getting to a sense of normal

It is hard not to lament the life both in medicine and outside the hospital that we all were living just a few months ago. In fact, in the hospital where despite the entry screening for symptoms, mandatory masks, conversations with scared patient families, there is still somewhat a sense of purpose and normal order to the care we aim to deliver. Much more has been the work our faculty, fellows, and staff have been dealing with around our isolation, the sense of loss of routine, and the upcoming end of the academic year. By now it is clear that we are not at the Peak of COVID-19, rather we have all worked hard to reduce the peak – and hopefully have helped “Flatten the Curve.” We are likely in the important slower longer care process – “Slow Burn” of the long time of learning and adapting to our new way of life in caring for patients, education, and even community commerce. As of writing this, we have as a group moved our entire clinical enterprise to telehealth and in-person urgent / semi urgent care settings. We will need to focus on ensuring our patients feel safe in getting care from us, as we deal with our own realization around the financial uncertainties in health care and the nation. One in six Americans are unemployed and several health systems have started to work to reduce their financial expenditures by furloughing and reducing wages.

It is in this setting, that we are supporting the COVID-19 care at Duke Health System while working to ensure coordinated care across our enterprise. We will be working with all of our colleagues in community to collectively help set the path forward. A path that will likely require persistence, flexibility, effort and characteristic innovation. I personally would like to thank the members of the Duke Heart Community, the Heart Center Leadership Council, the Clinical and Research section leaders, and most importantly our fellows and staff who help make if possible for our organization to pivot so quickly to care for our patients and each other.

Highlights of the week:

Celebrating Perfusion Week, April 27 – May 1

Please join us in recognizing our incredible perfusionists at Duke. Organized by the American Society of Extracorporeal Technology (AmSECT), Perfusion Week is an annual recognition of the positive impact that perfusionists have on the lives of patients. This year’s theme, “Saving Lives Is a Work of Heart,” honors the dedication of this team to improving the lives of patients around the world.

Given the increasing frequency of heart surgery and other cardiac procedures, perfusion is growing in importance in the healthcare community. In the past decade, perfusion has expanded to areas of perioperative blood management, wound healing, ventricular assistance, and advanced uses of extracorporeal circulation.

“Perfusionists are the backbone of open heart surgery and essential in conducting complex heart operations,” said Adam Williams, MD, cardiothoracic surgeon and Medical Director for Perfusion Services. “We are fortunate to have such a talented team of perfusionists at Duke. We thank all of you for your dedication and hard work!”

You may not know, but Duke perfusionist William Scott Snider serves as Treasurer on the national AmSect Board of Directors and pediatric perfusionist Amy Evans has a nice review article in the current issue (March/April 2020) of AmSECTODAY discussing the topic of fresh frozen plasma administration in infant cardiopulmonary bypass. Great work, Amy!

Take some time this week to show appreciation of the amazing work they do each and every day here in Duke Heart. Thank you and have a great #PerfusionWeek!

Administrative Professionals Day

Happy Administrative Professionals Day (officially celebrated on Wednesday, April 22) to all members of the administrative staff – we literally could not keep our offices going without these supportive roles. Thanks for all that you do!

ICYMI: Flags Lowered at Duke in Memory of Dr. Wolfe

All flags were lowered at Duke University earlier this week in memory of Dr. Walter Wolfe, cardiothoracic surgeon, who died on April 13. Duke Today ran the following story: https://today.duke.edu/2020/04/duke-flags-lowered-cardiothoracic-surgeon-walter-wolfe-dies-age-83.

Flags at half mast for the passing of Dr. Walter Wolfe.

Telemedicine Transformation

Reflecting the rapid incorporation of telemedicine across Duke Health and Duke Cardiology related to COVID-19, cardiology fellow Jedrek Wosik and a team of co-authors have described the impact of telehealth so far. Their manuscript “Telehealth Transformation: COVID-19 and the Rise of Virtual Care,” was accepted and published by the Journal of the American Medical Informatics Association (JAMIA) in record time — 7 days!

Per the abstract: “Using examples reported by US healthcare organizations including ours, we describe the role telehealth has played in transforming healthcare delivery during the three phases of the US COVID-19 pandemic: 1) Stay-at-Home Outpatient Care; 2) Initial COVID-19 Hospital Surge, and 3) Post-Pandemic Recovery. Within each of these three phases, we examine how people, process and technology work together to support a successful telehealth transformation.” The text, figures and tables describe the rationale for and implementation of telehealth approaches, providing a framework for other enterprises to follow.

Congrats to the full team of authors: Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric Poon, Jeffrey Ferranti, Jason N Katz and James Tcheng. Outstanding work!

Courtney Stierwalt Named Clinical Lead, 3300

We are pleased to announce that Courtney Stierwalt, BSN, RN, PCCN will become Clinical Team Lead for 3300 effective April 27. Courtney started as a new graduate RN on 3300 in July of 2015. Courtney completed her Bachelor’s degree through Saint Mary’s College in Notre Dame, Ohio. Courtney was recently promoted to a Clinical Nurse IV and has held multiple Leadership roles on 3300 serving as a Charge Nurse, Preceptor, and has on-boarded several new hires through her Unit Orientation Committee Chair role. Please join us in congratulating and welcoming Courtney to her new role.

Sonographers Advance to Level III

Congratulations to Cardiac Diagnostic Unit (CDU) cardiac sonographers: Robert “Curtis” Fitzhugh, Jeanne Gentry, Jon Owensby, and Carissa Marsiglio for achieving Level III on the Sonographer Clinical Ladder.

The entire CDU would like to thank them for their commitment and dedication to our patients and the Duke Team. Please take a moment to congratulate them on this great career achievement when you see them.

We know you’ve worked hard. This is well-deserved, Curtis, Jeanne, Jon, and Carissa! We are proud of you!

New Cardiac Sonographer Clinical Leads Appointed

The Cardiac Diagnostic Unit (CDU) leadership is excited to announce we have added three Cardiac Sonographer Clinical Leads to our leadership team. Congratulations to Jose “Danny” Rivera, Jon Owensby, and Brenda Sedberry. Their expertise, management, and mentorship of the cardiac sonographer group will strengthen the CDU and leadership teams.

Danny Rivera, Cardiac Sonographer Level III, attended Santa Fe College in Gainesville, Florida where he earned a degree in Cardiopulmonary Technology in December 2001. Danny began his career in January 2002 as an entry level cardiac sonographer in the Duke CDU. During his time at Duke, he has demonstrated leadership while being a charge technician, preceptor, Echo Advisor and serving on the TAVR OR and Cath Echo teams. He has taught student cardiac sonographers as well as cardiac and CT anesthesia fellows while performing his regular clinical duties. Danny excelled in learning and teaching new echo technologies through the years, including 3D echo and speckle track strain imaging. Early in his career he enjoyed being faculty and participating in “ECHO in Context” – one of the largest telemedicine broadcasts at the time. He holds RCS and ACS sonographer certifications.

Jon Owensby, Cardiac Sonographer Level III, started his medical career as a Respiratory Therapist at Vidant Health after graduating from Pitt Community College with an Associate of Applied Science: Respiratory Therapy degree in May, 2006. He returned to Pitt Community College and earned a diploma in echocardiology in August of 2007. Jon came to Duke in November of 2007 as a new cardiac sonographer graduate. Jon has grown to be a leader in the CDU. He serves as a charge technician, preceptor, an Echo congenital expert, and as a member of the TAVR OR and Cath Echo teams. He is involved in many research and education projects. Jon is the point sonographer for the Cardiology fellowship program. In 2018 Jon won selected by the cardiology fellows as their recipient of the Fellows Education Mentor award. In February, he received the Advanced Cardiac Sonographer certification, which is a benchmark of seasoned sonographers in the field.

Brenda Sedberry, Cardiac Sonographer Level III, is a 1982 graduate of the University of Florida with a Bachelor of Arts in Special Education. Prior to her arrival at Duke, Sedberry taught middle school special education, served as a Health and Rehab Protective Investigator for Children’s Services, and worked as a Human Services Counselor in a forensic psychiatric hospital. In 1995 Brenda received an Associate of Science Degree in Cardio-Pulmonary Technology from Santa Fe College and began her career in cardiac sonography at Duke in May of 1996. Brenda is a leader and mentor in the CDU unit. She actively serves on the Continuous Quality Improvement and accreditation teams, is involved in unit research, and is the primary staff scheduler. She has held a Cardiovascular Credentialing International (CCI) sonographer certification since 1996, and an American Registry for Diagnostic Medical Sonography (ARDMS) certification since 1997.

Please join us in congratulating Danny, Jon and Brenda!

McVeigh, Landa Taking New Roles within Duke Heart

Todd McVeigh is taking a position as an APP on the CTICU team starting August 1. He has taken this role to expand his wealth of knowledge as an APP and to expand his clinical role. Todd has been a tremendous asset to the Cardiology team in his APP role and as Co-Team Leader. He will be leaving the Team leader role as of July 1.

Rio Landa, FNP, MSN, has accepted the position of Co-Team Leader for Cardiology. Rio came to Duke in 2014 as a RN in the CTICU until 2017. She received her MSN degree and Family Nurse Practitioner from the Duke University School of Nursing. In October 2018, she joined the Duke Cardiology Team. Please welcome Rio in her new role as Co-Team Lead on the Cardiology team.

Congratulations, Todd and Rio!

Shout-out to Gentile, Cosgrove and Jollis!

We had some great teamwork out at the Southpoint clinic on April 15^th. Kevin Gentile, CDU exercise physiologist, did a stress test on a patient referred from one of our Duke Primary Care practices. Fran Cosgrove was the APP in clinic consenting the patient for stress tests. There was high suspicion the test would be positive, so Fran stayed in the room during the test. Immediately after the test (which was positive), Fran and Kevin called the CDU reader (Jamie Jollis). Jollis recommended next steps (a heart cath) and explained them to the patient via speakerphone. A cath was scheduled for the next day; the patient was found to have a high grade stenosis, and a stent was placed.

The great care this patient received looks a lot like it’s just another “regular” patient care experience here at Duke and in the CDU. Let’s not forget that we provide a level of care that exceeds what is offered elsewhere. This is what makes our team amazing: great skill sets, people who are devoted to patient care, and excellent teamwork! Way to go, Kevin, Fran and Jamie – thank you for all that you and our CDU team are doing to keep patients safe!

Team Spirit & Encouragement from Clinic 2F2G

Everyone is working hard to meet the challenges brought on by the pandemic. Our team in 2F2G is showing their team spirit with a thumbs-up to encourage everyone to keep up your spirits as well as the great camaraderie and teamwork. Have a great week, everyone!

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

Upcoming Opportunities/Save the Date:

Cardiology Grand Rounds

Cardiology Grand Rounds are cancelled through May, with the exception of internal faculty gatherings to discuss information related to COVID-19. Invitations to those will come via Outlook.

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged.

Duke Heart in the News:

April 17 — Jason Theiling (Duke Surgery/Emergency Medicine)

WRAL.com

Virus fear leads to fewer patients in ERs

https://www.wral.com/coronavirus/Virus-fear-leads-to-fewer-patients-in-ers/19061049/

April 19 — William Kraus

Natural News

Prevent diabetes and heart disease by cutting at least 300 calories every day, regardless of your BMI

https://www.naturalnews.com/2020-04-19-prevent-diabetes-heart-disease-cut-300-calories-per-day.html

April 20 — Adrian Hernandez and Emily O’Brien

American Medical Association

Share your COVID-19 story to improve doctors’ safety, well-being