Chief’s message: The “Gut” Feeling

Running into my office after getting through some of the patients I was rounding on this Saturday, I logged onto the Fellows Zoom interview welcome session.  There was a brief moment and then the screen clicked into the “Hollywood Stars” gallery view of zoom so I could see all the welcoming faces of potential cardiology fellow applicants.

This week we held our third zoom interview/ recruitment session for our cardiology fellows next year.  In this year with all the changes, the recruitment season has also become another challenge and possible opportunity.  We have had over 750 applicants for the 60-70 interviews that we conduct to get to our final matched 8-10 cardiology fellows.  Each year we are reminded about the immense talent and dedication we have the honor of attracting as possible cardiology fellows.  We have seen a rise in both the number applicants, the diversity, and the locations of training for the applicants to our fellowship.

Our fellowship lead by Anna Lisa Crowley with our associate program directors, Neha Pagidipatti, Rob Mentz, Chris Holley, and Camille Frazier-Mills along with numerous faculty and fellows have done an amazing in tailoring the experience for the perspective fellows.  We have assigned “Big Sibs” to answer questions prior to the interview day, we have breakout zoom rooms, options for one on one, and group discussions, and most notably – we take the opportunity to introduce the applicants to each other. They are certainly the next generation of cardiovascular leaders that will shape the way we teach, discover, and deliver cardiovascular care.  We have done videos of our fellowship and Duke/Durham – in an effort to flip the classroom so they can have the information before the visit.  As with many things during COVID, some of these innovations will be long lasting.

I was reminded as we did our welcomes at how hard it must be to be making important life decisions this year.  It was 20 years ago this year, that I started fellowship at Duke.  Like many I had a pro/con list with all the facts and details around fellowship that would help make the rational decision.  But, as I now tell the applicants, the other side of the leger is the “Gut” feeling about being at a place that fits/ seems right for the kinds of things you want to accomplish.  Perhaps the largest part of that “Gut” feeling comes from the people, the co-fellows, the faculty, the nurses, the staff and the way they interact, joke, support, and most importantly care about each other.  This is also potentially, our greatest strength and my biggest concern about the process.  Without being present, how do we convey who we are through zoom.  Hopefully, through the commitment, time, and discussions this will hopefully come through.  Looking back – it was certainly the people in Duke Cardiology that were the most important for me.  So, despite all the rational considerations our fellow applicants will have, we hope they get that “gut” feeling about our program to train the next generation of CV leaders.  Thanks to all of our faculty, fellows, and staff during this important recruitment season.

Highlights of the week:

STS Star Rating for DUH Adult Cardiac Surgery Program

We are pleased to share with you that our Adult Cardiac Surgery program at Duke University Hospital has, for the first time, earned three simultaneous distinguished three-star ratings from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in the following areas: isolated coronary artery bypass grafting (CABG) procedures; isolated aortic valve replacement (AVR) surgery, and isolated mitral valve replacement and repair (MVRR) surgery. The three-star rating, which denotes the highest category of quality, places our program among the elite for CABG, AVR and MVRR in the U.S.

“This is a significant validation of the quality and performance that we are able to deliver in cardiac surgery — the three-star rating means that our outcomes are in the top 10 percent of all centers in the United States,” said Peter K. Smith, MD, chief of the division of Cardiovascular and Thoracic Surgery and co-director of Duke Heart Center. “That we have achieved this within each of the three most important domains of cardiac surgery — bypass surgery, aortic valve replacement, and mitral valve repair or replacement – is a tribute not just to the surgeons but our entire team of dedicated health care professionals in our Operating Room, Intensive Care Unit, and Step-down Units.”

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs in the U.S. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database (ACSD) participant. We achieved a two-star rating in each of the remaining two areas of reporting: AVR+CABG and MVRR+CABG.

“Any scoring system has its limitations, but this is one of the most scientifically validated systems for heart surgery. It involves a huge amount of data from almost all centers in the U.S. and a very complicated and well thought out risk-adjustment model,” according to Carmelo Milano, MD, Chief of the Section of Adult Cardiac Surgery in the division of Cardiovascular and Thoracic Surgery. “Not only are they looking at raw outcomes like survival, but they take into consideration the pre-operative conditions that may make certain cases much higher risk. This is a very well respected grading system for heart surgery.”

The latest analysis of data for CABG covers a 1-year period, from January 2019 to December 2019; the analysis of data for isolated AVR, isolated MVRR, AVR+CABG and MVRR+CABG surgeries covers a 3-year period, from January 2017 to December 2019.

“Achieving the elite STS three-star rating, one of the most sophisticated and highly regarded overall measures of quality in health care, is a testament to our program’s commitment to quality improvement and safety across the cardiac surgical patient journey – from careful preoperative planning and optimization, to relentless attention to detail and coordination of intraoperative and postoperative decision making among multi-disciplinary heart team members,” added Mihai Podgoreanu, MD, chief of Cardiothoracic Anesthesiology and Critical Care. “In these unprecedented times, we are united in our dedication, resilience, compassion, and innovative spirit to continue pursuing our highest purpose – excellence and quality care for patients in need of cardiac surgery and their families.”

“As an organization and a group – the STS three star rating is evidence of the dedication of our entire Heart Center around how we care for our patients with multi-disciplinary teams that start with the evaluation and identification of patients needing coronary revascularization or valve surgery all the way through recovery, rehab, and return to life,” said Manesh Patel, MD, chief of the division of Cardiology and co-director of Duke Heart Center. “I am excited that during these challenging times our teams have continued the dedication and work to stay focused on patient outcomes.”

The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The STS ACSD houses approximately 6.9 million surgical records and gathers information from more than 3,800 participating physicians, including surgeons and anesthesiologists from more than 90 percent of groups that perform heart surgery in the US. The Database includes three other components: the Congenital Heart Surgery Database (CHSD), the General Thoracic Surgery Database (GTSD), and the mechanical circulatory support database (Intermacs). Duke has participated in the STS National Database since its inception.

We are extremely pleased and wanted to share this news with each of you, because without you this could not have happened. Thank you for your outstanding work and your dedication. This is very well deserved and the entire team is to be commended. Thank you and congratulations!

New CT Anesthesiologist, Sundar Krishnan

Earlier this week, Mihai Podgoreanu, chief of Cardiothoracic Anesthesiology, announced the hiring of Sundar Krishnan, MBBS, to the CT Anesthesiology faculty. A native of India, Sundar obtained his medical degree and anesthesiology residency from All India Institute of Medical Sciences in New Delhi, followed by fellowships in adult Cardiothoracic Anesthesia and Critical Care Medicine at the University of Iowa. He joined the faculty at University of Iowa in 2009, where he rose through the ranks to Associate Professor and Vice Chair for Education prior to being recruited to Duke. Sundar will start in the CTOR later this month, and in the CTICU in November.

Please join us in welcoming Sundar Krishnan to the faculty and to Duke Heart!

Celebratory Grand Rounds Held for Peterson

Duke Cardiology held a celebratory Grand Rounds for Eric Peterson this week with about 170 attendees and terrific presentations and tributes by Matt Roe, Sreek Vemulapalli, Jon Piccini, Tracy Wang, Neha Pagidipati and Ann Marie Navar. From his work as a clinician and researcher, to the influence of his work on health policy; his innovative thinking on how data is extracted and interpreted, to his mentorship and leadership over the years – each spoke to Peterson’s legacy in science, at Duke, in the field of cardiovascular disease, and on them professionally. It was a wonderful event and we thank all who were able to join us!

Best wishes, Eric!

Celebrating Duke Heart Physician Assistants

We’ve been celebrating National Physician Assistants Week, which runs through October 12, in recognition of the PA profession and its contributions to the nation’s health. In the midst of this challenging year, we are deeply grateful for the efforts and contributions of these vital members of the Duke Heart team and we remain particularly proud to celebrate the PA profession that began right here at Duke University.

Prior to becoming a week-long event, PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program; October 6 is the birthday of the profession’s founder, Eugene A. Stead, Jr., MD, former chair of the Duke Department of Medicine and founder of the Duke Cardiovascular Disease Research Database.

As part of highly skilled multidisciplinary care teams, PAs provide diagnostic and therapeutic patient care in virtually all medical specialties and settings. They have very diverse job descriptions and play important roles throughout patient care, medical education, health administration, leadership, and research studies.

We asked two of our PAs why they chose the profession and what they enjoy most as part of their affiliation with Duke Heart:

“I chose to become a PA so I could have a meaningful career helping people through some of the most challenging experiences of their lives,” said Joanna Newman, a PA on our Cardiothoracic Surgery Step-Down Unit. “Duke Heart is a special place to work because our outstanding team collaborates to offer hope and healing to patients with incredibly complex conditions that may have run out of treatment options elsewhere. I am proud of the work that we do and am honored to serve as part of the team.”

“I decided to become a PA after working as a Paramedic for several years, said Allen Stephens, a PA with Duke Cardiology at Southpoint. “I desired to be able to do more for patients than in the short amount of time I spent caring for them in the pre-hospital environment. The PA route was a perfect avenue to do that and provides

versatility and work-life balance. PAs get to practice medicine and develop a trusted relationship with their patients. Duke Heart is a great place to work as a PA. The team supports advanced practice providers, values the care we provide, and truly embodies team-based healthcare!”

A very special thank you to all PAs throughout Duke Heart for the great work

you’re doing!

 

Shout-Out: CICU Team Effort by Blumer, Banks, Gordon, Zwischenberger!

We received word of a particularly great save this week via Jamie Jollis and L. Kristin Newby. The note from Jollis reads, in part: “Just wanted to call your attention to a patient who was likely saved by the excellent intervention and decision making of CICU fellows this week:

JR is a 69 yo woman who was brought to the Duke ED by Orange county EMS with 1 week of progressive weakness and intermittent chest pain and an ECG showing ST elevation in V1-V3.

In the ED, the patients BP was recorded as 60/20, and an echo showed acute severe AR due to endocarditis, and a distal anterior septal wall motion abnormality.

Realizing the severity of the situation and likely impending complete hemodynamic collapse, Vanessa Blumer consulted CT surgery, and worked with the team to get the patient directly to the OR at 9 PM.

The patient received tissue aortic and mitral valves and a VG to the LAD. JR is now walking the floors and doing well.

I have no doubt the patient was “saved” by an excellent diagnostic approach and referral to surgery.

The note from Newby reads (in part), “Your work is a great example of the team culture we so highly value (and sometimes lose sight of) at Duke. It took a remarkable team effort to get this patient the care she needed.”

Many, many thanks to the quick thinking and teamwork of Vanessa Blumer, Adam Banks, Maggie Gordon of our sonography team, and Brittany Zwischenberger. Outstanding work, CICU fellows, surgeons and sonographers and to the full CICU staff for the care of this patient! Well done.

 

Duke Heart Grows By One!

We are very excited to welcome Celia Burgess Friede, to the Duke Heart family! She arrived on Oct. 2, at 7 lbs., 15 oz and 19 inches. “Mom, baby, and big sister are doing well!” according to dad (and cardiology fellow), Kevin Friede.

Congrats, Friede family!! We look forward to meeting her!

Wellness Tip: Why sending letters might help your loved ones

A recent article in The Washington Post suggests letter writing instead of Zoom calls as a mental health break and a good way to demonstrate you care. And who doesn’t appreciate ‘real’ mail that isn’t a bill or a campaign flyer?

Summary: Picture the recipient before you begin – what do you like about them? Why are you grateful to have them in your life? Focus on the future — share something you hope to do/experience in the future with this person; exude hope. Remember the elderly – they may be less tech-savvy and more prone to loneliness. A letter provides a means of connection.

To read the full article, visit: https://wapo.st/2GMap1M

 

Important Reminders

• Open Enrollment for Duke Benefits is October 19-30.
• Do not come to work if you are not well – if you are showing symptoms of a cold, of COVID, of influenza, etc. – stay home. Coming to work sick puts patients and colleagues at risk.
• Please get your Flu Vaccination: All team members must get their vaccination or otherwise demonstrate policy compliance by Tuesday, Nov. 10. Details and resources all available on the Duke Health Influenza Resources site (NET ID required): https://influenza.dh.dukehealth.org.

 

Upcoming Opportunities/Save the Date:

 

Cardiology Grand Rounds

Oct. 13:  Approach to Antibody-Mediated Rejection in Heart Transplantation. Presenter: Michelle Kittleson, MD, PhD of Cedars-Sinai. 5 p.m., Webex. Details in email invitation.

Oct. 20:  The Albert L. Williams Cardiovascular Genetics Lecture Series. Presenter: Wendy Chung, MD, PhD, of Columbia. 5 p.m., Webex. Details in email invitation.

Oct. 27: Cardiology Faculty meeting

Nov. 10: TBA

Nov. 17: No CGR. AHA Scientific Sessions

 

Conferences, Symposia & Webinars

Nov. 13: 12th Annual NC Research Triangle Pulmonary Hypertension Symposium. Noon – 4:30 p.m. For more information, please visit this page. This event will be held virtually and is co-sponsored by Duke and the University of North Carolina in partnership with the Pulmonary Hypertension Association through the Building Medical Education in PH program. Please join us!

Nov. 13–17: AHA Scientific Sessions 2020, a virtual experience. Registration is now open. See the website for details.

 

COVID-19 Updates:

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

• Recommended Eye Protection
• PDC intranet site
• Duke Health intranet site
• Well-Being Resources

 

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:

October 6 — DUHS is mentioned

Becker’s Hospital Review

CHIME names 2020 ‘Most Wired’ hospitals

https://bit.ly/36VP8NW

 

October issue — DUH & Cardiology are mentioned

Newsweek – special report/rankings

World’s Best Specialized Hospitals 2021

https://www.newsweek.com/worlds-best-specialized-hospitals-2021