Chief’s message: The Greater Good
Hubert Humphrey once said that “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.” This statement has been uttered and is quoted in meetings and actions of Health and Human Services (CMS) in Washington DC. Both Hubert Humphrey, and the greater part of America would have to wait until the promise and potential of President Lyndon Johnson’s “Great Society”. Healthcare progress has always been a slow, and often difficult, and unfortunately political battle, when in many regards it is much more of an economic battle rather than a moral battle. On July 30, 1965, President Johnson traveled to the Truman Library in Independence, Missouri to sign the Medicare Bill into law…which would forever change what it means to be elderly and disabled in America. Something that we all now know moved our nation closer to good. Unfortunately, over the last few weeks we have had more and more members of our community lose their jobs, insurance and access to health care, and even more tragically their lives. This week the cardiology group started to brainstorm ways in which we can grow services including telehealth for minimal or no cost care to ensure medication refills, urgent care identification, and ways to integrate in the growing safety nets programs in our area. This is a small part of what Duke Heart can do and hopefully add to the large local and regional care provided by organizations such as federally accredited community health centers like Lincoln in Durham and others in the area. Regardless of political beliefs or outcomes of elections, we will continue to work in our community to be part of the greater good – the organized efforts to help our community. As the upcoming weeks and months stress our resources, resolve, and community, I am optimistic based on the people at Duke Health that I see every day.
Highlights of the week:
1500th Heart Transplant Performed at Duke University Hospital
Congratulations to the Duke Heart Transplant Program!! The team reached a major milestone recently when they performed the program’s 1,500th heart transplant. Only five other centers in the U.S. have achieved this distinction. We are proud of you and your dedication to excellence!
Taking a look back with Dr. Andrew S. Wechsler, emeritus professor of Cardiothoracic Surgery at Drexel University, who performed Duke’s first heart transplant and who shared part of that story with us this week:
“The first heart transplant at Duke was performed 1985 on a 55-year-old plumber who was totally disabled by his heart failure. It was the first heart transplant to be performed in North Carolina. The only other nearby centers performing heart transplants were the Medical College of Virginia and the University of Alabama in Birmingham. I had flown to Richmond the week before to observe the procedure.”
Heart transplants were controversial at that time, according to Wechsler.
“Initially, many transplants performed had problems associated with immune rejection which resulted in most programs ceasing the activity with the exception of MCV and Stanford University. David C. Sabiston, Jr., MD, who was the chairman of the Duke Surgical Department at the time, was initially quite reluctant to allow the procedure and after extensive discussions with me finally agreed to allow the operation if I could obtain permission from the hospital CEO, Dr. Andrew Wallace, a highly respected cardiologist.
“There were concerns about the financial implications of the procedure. Blue Cross finally indicated that they would make payment decisions on a “case by case” basis. Dr. Wallace approved the procedure and the heart team was assembled. It included myself as lead surgeon and Drs. Robert Jones and James Lowe.
The operation was performed on a hot summer day and the helicopter struggled a bit during takeoff, as it was quite full. The donor heart was retrieved from the Eastern part of the state by the operating team. The patient’s recovery was rapid and he was discharged from the hospital in good spirits.”
(See photo, courtesy of Dr. Andrew Wechsler. Shown are Dr. Wechsler, the patient and his wife, as well as various hospital staff members.)
Thirty-five years later, Duke boasts one of the top five centers for heart transplant by volume in the country and offers some of the shortest wait times in the region, according to the Organ Procurement and Transplantation Network.
Incredible work on the part of so many people over the years in order to transform lives. We are especially grateful to the donors and their families for making the decision to donate life.
Passings: Eric S. Williams, MD, Electrophysiologist; Former Duke Fellow
Eric Sean Williams, MD, a cardiac electrophysiologist at Mercy Clinic Heart and Vascular Hospital (St. Louis, MO) passed away on October 15, 2020. He was 44.
Eric was born and raised in Brooklyn, New York. He attended the prestigious Stuyvesant High School and then matriculated at Cornell University, where he earned his Bachelor’s degree in Applied and Engineering Physics. He graduated with honors from Harvard Medical School in 2004. An avid traveler, he spent two years conducting medical research and learning Spanish in Costa Rica during his time in medical school. He then trained at the University of California, San Francisco (UCSF) for his residency in internal medicine, serving an additional year as chief resident before moving to Duke University for his Cardiology fellowship and then University of Washington, Seattle, for his electrophysiology fellowship.
His full obituary can be found here: https://www.luptonchapel.com/obituary/eric-williams-md-facc-fhrs?fh_id=15972.
He is remembered at Duke as a kind and great clinician and friend.We extend our condolences to the Williams family and to his friends and colleagues.
DMP 7 East Moved To 6 East October 24
The cardiothoracic stepdown unit on DMP 7 East moved to DMP 6 East on Saturday, October 24. This was the first move as part of the planned move sequence for Heart Services. Special thanks to 6 East Nurse Manager, Eric McClenny and 6 East Clinical Leads, Ciarra Ashley and Amanda Rooney for the significant role they played in making this a successful move! We are also grateful for additional leadership team members, staff, and support services who also contributed to the move. Some of our team members are pictured during preparation and move-day action.
Great work, everyone! Your teamwork helped the day go as smoothly as possible!
Fellowship Recruitment Wraps Up
The Duke Cardiology fellowship program completed their 7th and final day of virtual CV fellowship interviews. The team interviewed 64 incredibly talented fellowship applicants with diverse backgrounds and interests (~8.5% of the total applications we received). Anna Lisa Crowley, MD, fellowship program director, in a note to faculty, fellows and several staff members, wrote: “I personally want to thank each of you for rising to the challenge this new recruitment process presented by participating in virtual interviews, breakout groups, big sib-little sib conversations, virtual happy hours, and informal conversations. In addition, I want to recognize the extra efforts of Arlene Martin & Christina Ryerson this year who became Zoom experts and helped us all navigate the virtual interview days. In fact, many applicants shared that our interview day was the best organized and executed one they had. It is a tribute to all of your efforts so THANK YOU again! I feel privileged to work with such an AMAZING and inspiring team!”
Well done, everyone!!
Shout-out to Carlisle, Narcisse, Flores Rosario & Spates
We received a very special shout-out this week to the fellows team. In a note to Anna Lisa Crowley:
“I just wanted to send a very personal thank you and kudos to your fellows. Specifically this group: Matthew Carlisle, Dennis Narcisse, Karen Flores Rosario and Toi Spates.
My [family member] came to the hospital yesterday with 3rd degree heart block and was pretty close to death. Your fellows provided rapid triage in the ER, mobilized a bed in the CCU, and then placed a temp wire under significant duress (dopamine @ 20, transcutaneous pacing going, and my family member actively vomiting).
Basically, your fellows saved my family member’s life yesterday and for that I am deeply grateful!”
-Yuriy Bronshteyn, MD
Way to go, Duke Heart fellows!!!
Poster Earns Top 10 Score at Duke’s Annual Quality and Safety Conference
Congratulations to Myra Ellis, Bradi Granger, Debra Farrell, Heather Pena, Allen Cadavero, Mollie Kettle, Tonda Thomas and Kamrouz Ghadimi — their poster presentation, Race to the Finish: Engaging the Team in an Early Extubation Quality Improvement Project was one of the top ten scoring posters for the 2020 Duke Health Annual Quality and Safety Conference, originally scheduled for March 26, but cancelled due to COVID-19.
According to Myra Ellis, “the 7West Nursing Research committee collaborated with a CT Surgery multidisciplinary team to conduct a quality improvement initiative to increase the number of cardiac surgery patients that achieved early extubation cardiac surgery. The Society of Thoracic Surgeons defines early extubation as occurring within 6 hours after admission to the ICU. Early liberation from the mechanical ventilator important because it increases patient comfort and is associated with improved outcomes and lower costs. Our collaborative team worked to reduce barriers to extubation and promote early extubation by the use of a standardized Fast-track Extubation (FTE) Protocol and staff education. In data collected prior to implementation of the project, 49 percent (49/101) of patients were extubated in under six hours. In the first month after protocol implementation, this improved to 72 percent (60/83) and even included patients with high-disease severity that had undergone complex operations. One year after FTE protocol initiation, 75 percent (582/779) of FTE eligible patients were extubated within the six-hour window.
“Part of the success of the project was the use of the Influencer Change Model (K Patterson, et al) that posits that results are achieved by changing personal and group aspects of behavior through 6 sources of influence. Team performance was reported with the percentage of eligible patients achieving early extubation each week. We used a racetrack that was updated weekly to include the names of the “pit crew” (nurse, respiratory therapist and advanced practice provider) who successfully extubated patients within the recommended time period. Social influence can be a key factor in the individuals’ adoption of new innovations. The racetrack generated enthusiasm and captured the power of peer influence. Having your name on the racetrack created healthy competition between peers, making best practice socially desirable.”
The conference received more than 100 abstracts. The posters were scored by a blinded, multidisciplinary team based on these criteria: practical to implement, effective use of patient safety/ performance improvement tools and methods, improvement documented with pre/post analysis, and includes strategies to sustain outcomes.
Great work, everyone! Thank you for all that you do to provide the best care possible while keeping patients safe.
Important Reminders
- Open Enrollment ends this week!!!!
- 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.
- DON’T FORGET TO VOTE!
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
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.
Conversations with Colleagues: A Deeper Dive on Racial Justice
During the initial Conversations with Colleagues (CwC): Racial Justice sessions attendees shared that they wanted a deeper dive and more action steps related to racial justice. During this next edition of CwC attendees will sign up for 6 weeks of conversations. Participants will be placed into small cohorts and will walk with this same group of colleagues throughout the entire 6 weeks. These cohorts will allow staff to build relationships, have colleagues to bounce ideas off of and have accountability partners to help them stay true to the mission of the deeper dive. You will read articles, watch videos and engage in other activities that will deepen your knowledge about racial justice. Attendees will also learn action steps that they can take to make a difference.
Dates/Links for CwC
The conversations will take place weekly, starting this week and running through 12/7 (with a break Thanksgiving Week). Conversations will be 1 hour long.
Mondays 2-3pm (10/16 – 12/7)
https://duke.zoom.us/meeting/register/tJUvdOCqrDgsEtQYipTJ7F4eZnPQZFTIx2ZD
Tuesdays 8-9am (10/27 – 12/8)
https://duke.zoom.us/meeting/register/tJAtde-grTsqGtxJl7M6huHcgA3yFQ18pO6P
Wednesdays 12noon-1pm (10/28 – 12/9)
https://duke.zoom.us/meeting/register/tJUkce-rqjIrHdPmAvmnM_L0GEaFrkeFZq5L
Thursdays 5-6pm (10/29 – 12/10)
https://duke.zoom.us/meeting/register/tJ0lcu6rqTMiEtOIeRMiWtRQcInZLR6LnmPB
Fridays 12 noon-1pm (10/30 – 12/11)
https://duke.zoom.us/meeting/register/tJMrf–trTwrHtB3TEX5B-7UUXW2RgDJWGko
Sundays 4-5pm (11/1 – 12/13)
https://duke.zoom.us/meeting/register/tJEucuqtrjIpGdx8gdnQst1yAS-5NDrgzrD2
Matters of Grief: The Duke Response
On Thursday, November 19th, join us for a free half-day symposium where we will learn about ways that we can support each other through both personal and professional grief, share stories of support, and identify resources available at Duke.
Matters of Grief: The Duke Response will feature diverse and multidisciplinary panels, engaging didactic sessions, and surprise guests from across the university. Just some of the highlights include:
- Coach K delivers a special message
- Duke medical students will discuss the research behind grief and finding support through peers
- Well-Being experts and Duke Health leadership discuss normalizing discussions about grief
The virtual event runs from 1-5PM on November 19th, 2020. Sessions will be recorded for those who cannot attend the live event. Reserve your space today at bit.ly/mattersofgrief
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.
Have a good week, everyone!
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