Duke Heart Pulse — October 6, 2024 – The Pulse

Chief’s message:

This week we continued to support our neighbors and communities in western North Carolina while we worked to ensure we continue to care for our patients. See the stories below on the work we are doing at the Health system to ensure we continue to have IVF and support our clinical operations. There are also efforts by many to support our communities with Hurricane Helene relief efforts you will see below.

This monday we also had our annual faculty celebration re-capping the last year and also welcoming in our new faculty. We have a wonderful panel discuss (image) where leaders in our cardiology group shared their vision for clinical care, research, training. The event was well attended with over 65 faculty members and we will share the slides with everyone this week.

This upcoming week we will continue to work with our teams to ensure we can think about supporting groups as we hopefully have our state health systems return to full operations.

Highlights of the week:

Rosh Hoshana & Yom Kippur

To all who celebrated Rosh Hashanah this past week, we hope you have a good and happy new year. This week, which marks the October 7 anniversary and culminates in Yom Kippur, we wish you and your loved ones peace.

Duke Health Operations Update: Baxter IV Fluid

DUHS and hospitals nationally anticipate upcoming shortages of Baxter IV fluids due to critical damage to their Marion, NC manufacturing plant. Baxter supplies approximately 60% of IV solutions used in North America.

Duke Health has convened a system-wide committee of clinical and administrative leaders to lead a conservation strategy and reduce the impact on our patients and team members. To ensure the continuity of patient care is maintained, we have consolidated our inventory of IV fluid for normal saline and lactated ringers to a central distribution point.

For Duke University Hospital:

If a patient is hemodynamically decompensating and there is a clinical emergency (including sepsis), proceed as you would normally do in ordering IV fluids to resuscitate the patient. The IV fluid supply will come from your clinical units’ supply and be replenished by restocking from the central distribution room. When a patient has stabilized, please follow previously distributed guidelines on the appropriate use of IV fluids.
If a patient does not have a clinical emergency and you are considering ordering IV fluids (bolus or continuous infusion) then you must contact your responsible covering attending for approval of that fluid order and this approval must be documented in a progress note. There will be an auditing process to confirm compliance with this process.
As of Friday, (Oct. 4), every team must daily review their list of ongoing continuous IV fluids to confirm clinical need. All clinicians are strongly encouraged to add an IV Fluid column to their patient lists.
To order IV fluids, call the Fluid Distribution Center at 919-681-6851. Once confirmed, the fluids will be delivered to you.

Following is a list of system-wide recommendations that should be implemented ASAP. If you have additional suggestions for conservation within your specialty area, please escalate through the tiered huddle process.

Maintenance Fluid

When appropriate, limit maintenance fluids to a specific total volume or time frame.
Consider oral hydration strategies when possible. Duke will be increasing the availability of electrolyte PO fluids in partnership with Food Services (ex. Gatorade and Pedialyte).
Frequently review and consider elimination of continuous intravenous fluids (IVFs) for patients who are not NPO (or able to take an oral diet).

Procedural/OR

Consider opportunities to reduce sterile fluid use (intravenous and irrigation) in procedural cases when appropriate

Nursing Processes

Extend the use of IV and flush bags from 24 to 96 hours when changing tubing.
Use small-volume bags for low infusion rates.
- Don’t use 1L bags when a 100ml bag will do.
- Prime A-lines with 500mL bags instead of 1L bags, changed every 4 days
Eliminate the use of Keep Vein Open (KVO) protocols.
Limit quantities of IV bags placed in warmers to avoid early expiration.
Verify ongoing fluid needs with providers before a new IV fluid bag is spiked.
Finish IV bags from the OR or procedure area when going to the unit from surgery rather than switching over to a new bag immediately.

Clinical Practice

Do not empirically start IVF unless indicated.

The incident command center remains active and available to assist with any needs. Hours are from 7 a.m. – 7 p.m. To contact the command center, call 919- 684-2222.

Updates will continue as conditions unfold. Our Supply Chain colleagues are working diligently to ensure we continue providing quality care to those who need us. Thank you for your partnership, collaboration, and dedication to providing remarkable care to our patients, their loved ones, and each other.

Duke VAD Team Supporting Patients Caught in Helene

Multiple Left Ventricular Assist Device (LVAD) patients living in western NC have been significantly impacted by Hurricane Helene. Last weekend, our Duke VAD team worked tirelessly to track down each of them to ensure they were okay and had access to power to charge their batteries.

On Monday, there were four people the team had yet to locate. By working the phones and partnering with Jason Zivica and Duke’s State Emergency Response Team, the team coordinated assistance from local fire departments in those western counties, the National Guard, and Mission Hospital to assist in tracking them down. Thankfully, by Wednesday evening all had been found and all were safe.

Our Duke team has worked all week to get medication refills, wound dressings, batteries, and battery chargers to patients who lost them in the storm. Due to issues with ground transport, these supplies had to be airlifted into the area and brought directly to those patients.

“This is just one of many examples of the LVAD team going above and beyond for the patients,” says Stu Russell, MD, Duke’s regional director for advanced heart failure.

Many thanks to Stephanie Barnes, Kevin Cox, Vanessa Francalangia, Grayson Griggs, and Michelle Kern for their efforts – and that of the entire team supporting our VAD patients.

“Amazing work by this group,” added Jill Engel, service line vice president for Heart & Vascular. “The LVAD team has a well-organized approach tied into the emergency management system to ensure the patients are supported during natural disasters, going above and beyond to get them what they need. Kudos to Stu for his leadership as well!”

Outstanding work by a deeply caring and dedicated group!

Duke Health Hurricane Helene Relief Efforts

Duke Health is actively supporting Hurricane Helene relief efforts in Western North Carolina. Many team members have been deployed with our Duke State Medical Assistance Team (SMAT), including Duke Heart & Vascular nurses.

Here in the Triangle, our teams are coordinating care for patients living in the affected areas. We are also working to support our partners at Duke Lifepoint community hospitals by identifying needs and ensuring we can help them by transporting patients to Duke and other local hospitals.

You can join Duke Health’s support efforts in several ways:

Sign up to volunteer with our SMAT team to deploy to provide disaster relief.
Make a financial donation to the American Red Cross.
Donate items to the Duke Hurricane Helene Relief Drive

Thank you to all who have helped so far and those willing to help in the future. The needs in western NC are great and will continue for a long time.

ECMO Specialist Team Certification Achievement

We are thrilled to share that Duke’s Extracorporeal Membrane Oxygenation (ECMO) Specialist Team has, for the very first time, achieved 100 percent ELSO Adult ECMO Practitioner Certification (E-AEC) for our experienced ECMO Specialists.

The Extracorporeal Life Support Organization (ELSO) is an international consortium of healthcare institutions, researchers, providers, and industry partners that supports ECMO providers with continuing education, guidelines, research, and certification. They also maintain a comprehensive registry of patient data.

“To my knowledge, we are the first ECMO program to achieve 100 percent ELSO Adult ECMO Practitioner Certification,” said Desiree Bonadonna, director of Extracorporeal Life Support at Duke and chief of Perfusion Services. “Duke’s newest class of ECMO Specialists will become eligible and pursue certification in the coming months.”

Our ECMO Specialist team includes Allison Bartlett; Amy Zinn; Benjamin Brown; Christopher Lappe; Dirk Mattin; Christian Oland; Jess Brown; Joanna Mischke; Joel Kester; Blake Hazelwood; Kristin Johnson; Mel Caccamise; Michael Blank; Taylor Miller; Tia Forbes; Vincent Yeboah; Van Lewark; and William Poorboy. Outstanding!

We are very proud of this team. Please join us in congratulating our ECMO Specialists for their hard work and dedication!

Shout-out to Bullock!

Last week, in clinic 2F2G, a patient was checking in for a heart failure follow-up appointment. While checking in, one of our front desk team members — Ethan Bullock — observed the patient to be experiencing stroke-like symptoms.

Ethan very quickly alerted the clinical team. A stroke code was called and the patient was rapidly transported to the emergency department where occlusion of an intracranial artery was confirmed.

Ethan’s attention to detail and quick response ensured this patient was treated as fast as possible. Our clinic nurses, Julie Parham and Debra Means, were also instrumental in helping with the care of this patient.

Great job and great save, Ethan!

Shout-out to Pendyal!

We received a terrific patient compliment this week regarding cardiologist Akshay Pendyal, MD:

“[Earlier this year]I was in the ER for A-Fib and told to see my cardiologist asap. Referral was sent to (another hospital), but I asked with Duke. Due to high turnover of Drs., mine was gone. Earliest I could be seen was within a couple of weeks, which was earlier than I could be seen at the other hospital. I was incredibly impressed with Dr. Pendyal. I am a complex patient. Rarely have I had a new Dr who reviews my record before seeing me, and listens before treating. His willingness to discuss my condition and medication in conjunction with my other conditions and medications was refreshing and encouraging. I last saw a cardiologist 8 months before this and have received three notifications of a change in Drs since. I was ready to jump to a different health clinic, but Duke offered the earlier appointment. I am so pleased with Dr. Pendyal that I really hope he stays at Kernodle Clinic. A friend of mine has seen him as well and was very impressed. Based on our experiences we believe Dr. Pendyal is more than a cut above other providers in his interactions with his patients.” – a grateful patient

Excellent communication and great patient care — way to go, Akshay!

Open Enrollment Starts Oct. 14

Open enrollment is your opportunity to review your medical, dental, vision, and reimbursement account benefit elections and make any changes necessary to ensure your choices continue to meet your needs.

If you wish to participate in the Health Care or Dependent Care Reimbursement Accounts for 2025, you must enroll (or re-enroll). Participation in the reimbursement accounts does not automatically continue from year to year.

If you do not make changes to your medical, dental, or vision coverage, your current medical, dental, and vision coverage elections for 2024 will continue for 2025.

Duke’s annual open enrollment period for medical, dental, vision, and reimbursement account benefits for 2025 is from October 14 at 8 a.m. — October 25 at 6 p.m.

Up to $640 of your unused Health Care and Dependent Care Reimbursement Account funds from 2025 can be carried over to the subsequent year.
All selections made during the open enrollment period will be effective January 2025.

Benefits information has been mailed to all staff. All information can also be found on Duke’s Open Enrollment 2025 website.

Early Voting at Karsh Alumni Center

Durham County registered voters can vote early at Karsh Alumni Center starting Thursday, October 17, and ending Saturday, November 2.

Hours are as follows:

Monday – Saturday: 8 a.m. – 7:30 p.m.
Sundays: 2 p.m. – 7:30 p.m.
2: 8 a.m. – 3 p.m.

Same-day voter registration will also be available during this time.

Winter Respiratory Virus Season Masking Guidance

As respiratory virus season ramps up, Duke’s Infection Prevention/Infectious Disease specialists anticipate another “tripledemic” related to COVID-19, influenza, and RSV. Patients, visitors, and team members should protect themselves and others using established prevention strategies.

We strongly recommend masking for patients, visitors, and team members during respiratory virus season – September 18, 2024, through March 1, 2025. Masking is still required in high-risk clinical areas, during clusters or outbreaks, and during the active COVID-19 infectious period.

For more details, masking guidance documents can be found on SharePoint.

Upcoming Events & Opportunities

Sept. 15 to Oct. 15: Hispanic Heritage Month

Oct. 17-Nov. 2: Early voting period, November 2024 General Election.

Oct. 20-Oct.26: Respiratory Care Week

Cardiology Grand Rounds

Oct. 8: Coronary Function Testing in 2024: Where Are We Now? with Nadia Sutton, MD. 5 p.m. Zoom only.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

2024 CGR Recordings

NET ID and password are required. Enjoy!

CD Fellows Core Curriculum Conference

October 9: EP Fellows’ Case Conference with Jonathan Kusner and Hannah Schwennesen. Noon, In-person, DN 2003, or via Zoom.

October 11: DHP Fellows’ Case Conference with Cosette Champion. Noon, via Zoom.

October 16: No conference. Interview Day.

October 18: Fellows’ Meet and Greet Lunch with visiting professor Bernard Gersh. Noon, DMP 2W91

October 23: HF/Txp Fellows’ Case Conference with Mike Cosiano. Noon, DMP 2W96

October 25: No conference. Interview Day.

October 30: Board Review with Paula Rambarat and Nishant Shah. Noon, DN 2001

Duke Heart Fall 2024 CME Courses

The following symposia will be held this fall:

October 12: Duke Cardiac Imaging Symposium at Trent Semans Center, 7:55 a.m. to 3:30 p.m. Course directors are Drs. Sreekanth Vemulapalli and Anita Kelsey.

November 1: the 16th Annual NC Research Triangle Pulmonary Hypertension Symposium at Durham Convention Center, 8:00 a.m. to 3:15 p.m. Course directors are Dr. Terry Fortin and Dr. Jimmy Ford (of UNC).

Questions? Contact Christy Darnell.

New Faculty Orientation

October 22 & 23: 2024 School of Medicine Academic New Faculty Orientation, Trent Semans Center. Registration is required. Questions? Contact the SOM Office for Faculty at facdev@dm.duke.edu.

All faculty hired in the past three years are welcome to attend. While content specifically targets newer faculty, many topics apply to all faculty regardless of career stage.

DIHI – Innovation Projects RFA 2025

The Duke Institute for Health Innovation (DIHI) announces the next emerging ideas and innovation funding cycle. Applications are open to faculty, staff, trainees, and students of Duke University and Duke University Health System. Proposed innovation projects should address actual and important problems encountered by care providers, patients, and their loved ones in our clinical enterprise and represent urgent health challenges nationally.

For the 2025 funding cycle, priority will be given to ideas aligned with the thematic area of improving provider and staff experience, the patient journey, and clinical outcomes using advanced technology solutions.

Due Date: Proposals are due by 11:59 p.m., October 25, 2024.

The application packet can be found here.

Up to ten applications will be selected for support. Most proposals are expected to request funding in the range of $25,000 to $60,000 over one year.

Questions? Please email DIHIrfa@duke.edu.

Call for Nominations: MLK Humanitarian Award

Nominations are now open for Duke’s first Dr. Martin Luther King, Jr. Humanitarian Award. This initiative is inspired by Dr. King’s enduring legacy and will celebrate Duke Health faculty and staff who embody his vision of “It starts with me…” The award will honor those who have gone above and beyond in their dedication to a nonprofit’s mission in keeping with the principles of Dr. King.

Nominations will be accepted through October 29. The awards will be announced during Duke’s annual recognition of the MLK holiday in January.

Learn more about the award here.

SOM Leadership Development Programs Update

Applications for the 2025 SOM Leadership Development Programs are now open. This includes the ADVANCE-UP, ALICE, DCLP, and LEADER programs.

Applications are due by Friday, Nov. 1. To learn more, click here. Programs are hosted by the SOM Office for Faculty.

Have news to share?

If you have news to share with the Pulse readership contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 interest our team. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Duke Heart in the News:

September 27 — Annemarie Thompson (CT Anesthesiology)

Medical Dialogues (IN)

New insights on perioperative cardiovascular management in noncardiac surgery: AHA/ACC 2024 guidelines release

September 27 — William Kraus

Voz Populi (Sp)

Este es el alimento que ayuda a mantener el corazón fuerte y que recomiendan los cardiólogos

September 28 — Crystal Tyson (Cardiometabolic Prevention/nephrologist)

The New York Times

The Heart-Healthy Diet Hardly Anyone Is Talking About

September 30 — Duke University Hospital/Mary Martin

WTVD (Durham, NC)