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Duke Heart Newsletter May 3rd 2020

By Manesh Patel, M.D. in Uncategorized on May 3, 2020.

Chiefs Message

Goodbye April and cautiously looking forward to May:

Undoubtedly, that will be an April that our country, region, and health system will never forget. Certainly, people will remember the COVID-19 pandemic and the too many lives lost and sick. However, we will also remember the tremendous efforts of entire communities, health systems, and of course the people. The people that in Heart that have organized, joined daily calls, volunteered to come in and be the clinic staff, the procedure labs, the CRU staff ensuring our research studies keep going, the heart center that called and set up patients, and of course the fellows and faculty that continually worked to find ways (sometimes creatively) to help. As we enter May, the country seems to unfortunately moving towards widespread soft opening of businesses and industries. In healthcare, we are facing a different challenge, a challenge gauge and open to the patients that have waited 6 weeks or more for care, patients that have cardiovascular disease that has remained the leading cause of morbidity and mortality through these months, and all too often – patients that are scared to come and get care. So we too will be moving in calibrated and cautious ways to help care for our patients and ensure we can continue to support our community and reduce viral spread. All the while, as spring comes, we will try to ensure we appreciate our teams, our staff, and of course our fellows who will be graduating. This upcoming week will allow us to appreciate our nursing colleagues who have been at the heart of our response and care. The good news from my perspective is that our group has demonstrated the cohesiveness and the ability to change that will be needed as we continue to adapt to the upcoming challenges with COVID-19 and our delivery of heart care, discovery, and training of the next generation. So for the traditional first weekend in May, a weekend without the Kentucky Derby but clearly the start of spring, we welcome the opportunity to turn the page on April and focus on our steps to shaping our future care for heart patients.

It’s National Nurses’ Week

National Nurses Week (May 6-12) starts on Wednesday, and concludes on the birthday of Florence Nightingale. The World Health Organization designated 2020 as the “Year of the Nurse” to mark the 200^th anniversary of Florence’s birthday. Please give them a shout-out this week – we have an incredible team of nurses throughout Duke Heart! The COVID-19 pandemic has done a great deal to change the way we live our day-to-day lives, but more than anything it has opened the eyes of the world to the incredible value and selflessness of all healthcare workers.

Duke Heart nurses represent the outstanding care delivered to our patients every day through clinical excellence, compassion, and innovation. Help us celebrate their contributions and achievements by recognizing their work!

WRAL has a list of organizations with special offers this week for nurses and other healthcare professionals – to learn more, visit: https://www.wral.com/coronavirus/free-offers-for-healthcare-employees-and-first-responders/19078377/.

The Economist has a great story commemorating the work of Nightingale and nurses overall. Check it out here: https://worldin.economist.com/edition/2020/article/17519/florence-nightingale-and-changing-face-nursing.

Happy Nurses Week!

Special Message to Perfusionists

Dr. Peter Smith, Chief of Cardiovascular and Thoracic Surgery, shared a photo message with the perfusion team last week in honor of their recognition week, which ended Friday.

DUHS Leaders Visit CICU, Celebrate CLABSI Reductions

Members of DUHS leadership, including Dr. Eugene Washington, Chancellor, and Dr. Tom Owens, President of Duke University Hospital, as well as Dr. Richard Shannon, Chief Quality Officer for DUHS, visited with our Cardiac Intensive Care Unit team on Wednesday (April 29) to celebrate the work they’ve done to reduce central line-associated bloodstream infections (CLABSI).

Dr. Shannon provided lunch for the staff to show appreciation for the extra efforts the team has put in. The CICU team explored a variety of channels, including increasing education for all staff around CLABSI risks and prevention, and looking at various products that could be more effective for our patients. Overall, the team was able to decrease the CLABSI rate by 88.3 percent since implementing all initiatives earlier in this fiscal year. The team has had only one CLABSI in the past five months.

Washington, Owens and Shannon all discussed sharing this great work with other areas of the hospital as well as coordinating the next steps in CLABSI prevention related to blood culture ordering and drawing.

They were also able to learn more about the new Duke Heart iPad program during their visit. Our iPad project allows patients and families to visit virtually during the pandemic while visitor restrictions are still in place; the team was able to showcase how family members outside the hospital are able to have conversations with the care teams of their loved one.

Many thanks to Amy Wilkerson, Elizabeth Alderton, Lauren Coggins, Greg Flynn, Kelly Kester and Heather Pena for their efforts to pull together the area visit and tour; congratulations to the entire CICU team for reducing CLABSI rates at Duke – impressive work!

Duke Heart Family Grows by One!

We are very happy to welcome Isaac Alexander Rouse to the Duke Heart family! Isaac was born April 29 to Kelsey Rouse, PA-C, (one of the wonderful PAs in the inpatient rounding cardiology group) and her husband, Austin. This is their first child. Kelsey is doing well and reports that Isaac Alexander weighed in at 7 pounds, 9.5 ounces, and is 20 inches long.

He is beautiful and we can’t wait to meet him. Kelsey is appreciative of all the support they received over the past few months.

Congratulations, Kelsey and Austin!

HCC Team Shines with Innovation, Adaptability During Pandemic

Like so many other groups at Duke, the Heart Center Communications (HCC) team has been adapting to the challenges of dealing with COVID-19. Although well positioned due to their past experience managing high-volume schedule changes during short periods of severe weather, the pandemic has been something else entirely. It has forced the HCC to adapt and innovate to manage schedules at a time when dates, times, hospital restrictions and state orders change almost daily.

Since the end of March, when NC stay at home orders were put in place, the team dealt with approximately 300 clinic cancellation calls per week; they have managed 107 procedure cancellations across the invasive labs, and collaborated with clinics to schedule more than 500 cardiology telehealth visits. As one might imagine, many Duke Heart patients were nervous about the novel coronavirus and anxious about getting necessary care during the pandemic. To handle this took a great deal of patience and finesse, as well as compassionate listening skills and excellent customer service.

The HCC and medical team created tracking logs for all elective cancellations so that, as the team works to reschedule cases, they can ensure all patients are accommodated safely and efficiently. Over time, daily scheduling call volume has decreased but the duration of calls has increased.

“We have spent longer periods on the phone helping to alleviate the anxieties patients feel,” said Greg Shelton, administrative director of the HCC. “People quite naturally have had a lot of questions. It has been a team effort, not only in partnering and supporting our medical providers, but making sure we could get each patient’s questions answered and that we could triage the calls coming in.”

Shelton noted that all patient case procedures were reviewed by cardiology medical directors prior to any cancellation or delay. This was done on a case-by-case basis to determine which patients could safely wait and who needed a more immediate intervention.

Another need for adaptability came when HCC staff began working to coordinate COVID-19 screening tests for EP patients who could not be rescheduled to later dates for procedures. The team continues to coordinate when and where patients can be tested. Local patients are accommodated at Duke. For non-local patients, the HCC team works to identify locations closer to their home. Simultaneously, the team is managing an increase in “patient advice” emails coming in via MyChart, as well as an increase in requests for prescription refills.

Shelton said the undertaking throughout the team has been highly collaborative. The HCC moved two-thirds of their staff to working successfully and productively from home. For the remaining one-third of the staff who is coming to campus, social distancing measures were established by using empty offices to ensure a minimum of six feet between co-workers.

The transition to telehealth visits went fairly smoothly, Shelton added.

“Patients have been very appreciative of having the option to meet with their care provider from the safety and privacy of their home and they understood immediately that changes were being made for their safety as well as the safety of healthcare providers.”

As Duke Heart moves toward a gradual reopening of clinics, we know that telehealth visits will continue to be important, but the decisions will be provider driven. Some patients will absolutely need to be seen in person, while some can continue to have either a video-based or telephone-based call with their provider.

The HCC team has done an outstanding job in providing support to our patients and our care teams. Please join us in celebrating their excellent teamwork!

HCC’s Chavis Moving to New Role

LaChandra Chavis, Service Access Manager with Heart Center Communications (HCC), will be stepping into a new role within Duke Heart on May 12. Chavis will become the first dedicated Service Access Manager to support Cardiac Catheterization, Electrophysiology, Cardiac MRI and Clinic 2K. She will be based in Clinic 2K and will continue to report to Greg Shelton, administrative director of HCC.

The new position was created largely due to program volume but also because of the complexity of the interventional labs, 2K and cardiac MRI spaces. These areas have been in need of a range of resources and an increased level of support that a Service Access Manager is equipped to handle.

Chavis has worked at Duke Health for more than 20 years and with HCC for the last 14. She has demonstrated a dedication to excellence and integrity, according to Shelton.

“LaChandra is excellent both from an employee relations and customer service point of view – these are two of her key strengths, said Shelton. “She’s very good at team building and has been a go-to person for us. We know she’ll be great in this new role.”

Please join us in congratulating LaChandra and wishing her well as she starts this next phase of her career.

Vangel Leaving Duke Heart; Stephens to Lead Ambulatory APPs

Ashley Vangel, PA-C, clinical team lead for cardiology APPs at Duke Cardiology of Southpoint/South Durham, will be leaving the practice in mid-May to move closer to her family in the Northeast. Vangel has been a wonderful member of our Duke Heart team in no small part because of her leadership and the outstanding care she has provided to all of our patients.

Allen Stephens, PA-C, will take over as clinical team lead for the Southpoint/South Durham team. Stephens joined the outpatient Duke Heart team from the Cardiothoracic ICU nearly two years ago.

“From the start, Allen has demonstrated outstanding clinical decision making along with great compassion and empathy towards the patients in our practice,” said Mike Blazing, MD, medical director for Duke Cardiology of Southpoint. “More recently he has been instrumental in organizing the group and keeping people in touch during this monumental period of change in our outpatient practice. He has embraced phone and tele-visit practices and quickly has gone from learner to a teacher.”

Given his strengths in clinical, technical and communication skills, and the ease with which he has been able to step up and take on these tasks without interfering with any of his clinical responsibilities, we feel he is an outstanding choice to lead our Southpoint APP team.

Congratulations, Allen!

Please join us in wishing Ashley all the best in this new phase of her career. Ashley, you’ll be missed!

Coumadin News

Bristol-Myers Squibb, the company making Coumadin® (warfarin sodium) tablets, announced that it will discontinue the sale and distribution of Coumadin®. Many thanks to Ed Hammitt, RN, for alerting us and sharing this post from Clot Connect: https://clotconnect.wpcomstaging.com/2020/04/28/coumadin-discontinuation-of-sale/.

TransPop Registry Enrolls 1000^th Volunteer

The Duke TransPop Volunteer Registry recently enrolled their 1000^th volunteer. Kannapolis resident Andy Yoos, 49, joined shortly before the outbreak of the novel coronavirus, which causes COVID-19. As a member of the registry, he receives emails about health studies that may interest him, based on information he provided to the Duke Clinical and Translational Science Institute (CTSI). Duke CTSI’s Translational Population Health Research group, or “TransPop,” manages the registry from Duke’s office on the North Carolina Research Campus in Kannapolis.

Duke cardiologist Dr. L. Kristin Newby is the principal investigator for the Volunteer Registry. Newby, who is the faculty director for the TransPop group, also leads the MURDOCK Study, a groundbreaking Duke CTSI health research project based in Kannapolis entering its second decade.

“This virtual registry is a powerful tool for investigators and makes participating in research studies easy and convenient for volunteers,” said Newby. “I’m once again amazed and humbled by the support of our community, and we are proud to offer this new opportunity to people throughout North Carolina and beyond. Any adult can sign up.”

The Volunteer Registry is designed to collect and maintain information about participants who may be contacted for future studies. Adults 18 and older can join the registry, which has no zip code or geographic restriction. Healthy participants, as well as people suffering from a disease or condition, are invited to join.

The full story can be found here. Congratulations to our colleagues at CTSI and to the TransPop team!

Global Genomics Meeting Going Virtual

Geoff Ginsburg, founder of the Global Genomic Medicine Collaborative, has let us know that they’ve converted their annual meeting to a virtual meeting that will be open to the public. The event, the 5th G2MC Conference: Genomic Medicine Implementation in Low-Resource Settings, will take place this week, from May 6-8. For more information, please visit https://g2mc.org/events/.

Similarly, the 3^rd summit for the International 100K+ Cohorts Consortium, co-chaired by Ginsburg, has shifted into a virtual meeting. Keynote speakers include Francis Collins, Jeremy Farrar, Elias Zerhouni, and Soumya Swaminathan; they join an amazing array of speakers. For the full list and information related to the meeting, please visit https://ihcc.g2mc.org/eventlist/. This meeting will take place May 4-5 and is by invitation only. If you’re interested in attending, please contact Geoff Ginsburg.

ICYMI: IT Security & Impersonation Attacks

DHTS has issued an alert regarding impersonation attacks. Please be on the lookout – to learn more, visit: https://security.duke.edu/news-alerts/impersonation-attacks-rise

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 24 — Michael Dee Gunn

Men’s Health

What Your Gym Might Look Like When It Reopens for Business

https://www.menshealth.com/fitness/a32272303/gyms-reopening-after-coronavirus/

April 24 — John Alexander

MDEdge/Cardiology News

AUGUSTUS: After ACS or PCI, aspirin gives AFib patients scant benefit

https://www.mdedge.com/cardiology/article/221239/interventional-cardiology-surgery/augustus-after-acs-or-pci-aspirin-gives

April 24 — Ann Marie Navar

Consultant Live

Off-Label DOAC Use Not Appropriate for LV Thrombi, Increases Stroke Risk

https://www.consultantlive.com/news/off-label-doac-not-appropriate-for-left-ventricular-thrombi-increases-stroke-risk

April 24 — Michael Dee Gunn

USNews.com

The Coronavirus Choice

https://www.usnews.com/news/the-report/articles/2020-04-24/as-georgia-reopens-americans-get-mixed-message-about-coronavirus-safety

April 27 — Michael Dee Gunn

NC Health News

NC health officials want testing of all residents, staff of nursing homes with COVID-19

NC health officials want testing of all residents, staff of nursing homes with COVID-19

April 27 — Tracy Wang

Healio/Cardiology Today

Dietary salt reduction initiative effective, with modest BP benefits

https://www.healio.com/cardiology/vascular-medicine/news/online/%7B63ef414f-8113-4c86-a141-c5da6393a4c8%7D/dietary-salt-reduction-initiative-effective-with-modest-bp-benefits

April 27 — Michael Dee Gunn

HealthDay

There Aren’t Enough Coronavirus Test Kits to Safely Reopen America, Experts Warn

https://consumer.healthday.com/infectious-disease-information-21/coronavirus-1008/there-aren-t-enough-coronavirus-test-kits-to-safely-reopen-america-experts-warn-757017.html

April 28 — Michael Dee Gunn and Thomas Denny (DHVI)

Healthline

What to Know About COVID-19 Testing Right Now

https://www.healthline.com/health-news/what-to-know-about-covid-19-testing-right-now

April 28 — John Haney

The Coastland Times (Manteo, NC)

Third double lung transplant surgery a success for Tricia Lawrenson