March 2013

March 2013

Welcome to the March 2013 edition of the Round Table.

Roundtable Header

Change is coming; change is here. When we talk about change in healthcare, some of the first thoughts that come to mind involve legislation and proposed bills, insurance and exchanges, politics and policies. As physicians, this change can (and likely will) dramatically affect our practice and our patients. And as patients, we are concerned how this change will affect the care we receive as well as provide.

However the evolution in healthcare that is happening right now is more than just business. The very culture of healthcare is changing across the nation and here at the University of Virginia. Shifting expectations of physicians and organizations are transforming us, from without and within. The public has more interest in and knowledge of, and access to public data about, how their hospitals are performing — more so than even just a few years ago. When they come through our doors, they are expecting teamwork, quality, and excellence. And there is no reason we cannot deliver upon that expectation.

A great example of this comes from Todd W. Bauer, MD, Associate Professor of Surgery, and his team here at UVA, who have been implementing a new pathway to increase safety and decrease the length of stay after a Whipple procedure, a highly complex surgery. A typical hospital stay for a Whipple procedure is 10 days to two weeks. The team tested a streamlined approach aimed at reducing that to 6 days. The clinical trial found that median stay was seven days, with 41 percent of patients out of the hospital by the sixth day. Dr. Bauer attributed this success to minimizing blood loss and avoiding transfusions, taking a meticulous approach to the surgery to prevent complications, establishing a clear timeline charting milestones after surgery, ensuring all care providers were working in concert, and educating patients and families about what to expect each day and keeping them actively involved in their own care. This is a great example of how teamwork, quality, patient satisfaction, and costs align wonderfully.

As our patients become more involved in their own care, the way we communicate must evolve, too. We talk about increasing access, but it is not always access to appointments to which we are referring. It is essential to keep health information safe and secure, and electronic means such as MyChart are a fantastic way to increase access and protect communication. Patients can view test results, safely access information, and communicate with their doctor's office. This is an outstanding way of increasing access for our patients — many of whom do not live in Charlottesville.

In the coming months, as healthcare evolves, I ask that you be willing to adapt and evolve with it, to embrace the change — not just in your day-to-day practice, but in the culture and how it affects all of us here in the School of Medicine and at UVA.

Even as we discuss the clinical affects of rapid changes in medical care, similar changes are approaching in our other pride and joy, our research programs. Decreasing NIH budgets, causing higher grant scores and lower percentages to be funded, require innovative research, interdisciplinary collaboration, and first-rate core facilities subsidized by the School of Medicine and the Vice President for Research, to enable our researchers, both basic and clinical, to remain at the cutting edge of research utilizing new and unique methods, or ever faster analytic techniques, such as genomics instrumentation. Reaching across departments to colleagues, especially in the College and School of Engineering and Applied Science (SEAS), increases our interdisciplinary capabilities. We are working to ease the way for such collaboration, especially across the processes for submission and finance and accounting allocation, which currently interfere with rapid development and submission of grants.

Respectfully,

Steven T. DeKosky, MD, FAAN, FACP

CLINICAL NEWS

189 UVA Doctors Named to "Best Doctors in America" List

The 2013 Best Doctors in America list has been released and I am pleased to see that it includes 189 UVA physicians. Awards such as these reflect not only the dedication of our physicians but also the entire team of healthcare providers here at UVA Health System.

About 5 percent of U.S. doctors earn inclusion on the list, according to Best Doctors. Our total of 189 physicians represents between 20-25% of our medical staff, indicating that we have many more physicians on the list than expected, and far more than anyone in the region.

Selections to the list are based on physician surveys; physicians cannot pay to be included on the list nor are they paid to provide their input. According to Best Doctors, physicians are asked questions that include, “If you or a loved one needed a doctor in your specialty, to whom would you refer them?” Based on the initial list from the physician survey, Best Doctors then checks the nominated physicians in several areas, including credentials and clinical activity, to create the final list of honorees.

The complete list of UVA physicians who received this honor is available here.

New Scrubs: Slate Gray

A few weeks ago we introduced new surgical attire for surgical and procedural areas: slate gray scrubs. Starting Monday, Feb. 18, staff members in restricted areas — including the ORs, Labor and Delivery, Outpatient Surgery Center, the Urology Operating Room, Interventional Radiology, and the Cardiac Catheterization Lab — are required to wear the new slate gray scrubs.

We made this change from the former teal-colored scrubs because many staff outside of the surgical and procedural areas also wore teal, making it difficult to distinguish who works in what area and what precautions needed to be followed.

All scrubs are loaded into vending machines for ease of access and close control of inventory. In addition, the scrubs must be turned in at the end of the shift, as all surgical attire must be laundered by an approved facility to ensure cleanliness and proper disinfection. Staff must not take the slate scrubs home to launder in personal machines. Residential water heaters are not hot enough to adequately clean scrubs.

It is important to remember, if you are wearing the slate gray scrubs, you cannot go outside. You may walk in the enclosed links, but you cannot go outside.

Other safety and quality measures to consider:

  • Cloth surgical caps are not personal protective equipment. A disposable surgical cap must be worn over the cloth caps.
  • If you wear a T-shirt under your scrub top, the sleeves cannot extend past the scrub sleeves.
  • Surgical masks must have two ties, and a new mask must be used for each surgery or procedure unless you work in anesthesiology; keep it over your face and do not touch it.
  • The masks should not hang around your neck and should not be reused. The filter holds bacteria. When you hang it around your neck, that bacteria is right by your face.
  • All jewelry should be removed. Rings, watches and bracelets hold bacteria and make hand hygiene difficult.

 

By making these changes, we are improving our patient safety and giving them the superlative care they have entrusted us to provide.

EDUCATION UPDATES & EVENTS

Update: Developmental Assessment Process

An assessment philosophy has been developed for undergraduate medical education students that emphasizes knowledge acquisition at the systems level as well as longitudinal skill development. In order to assess knowledge acquisition, assessment questions will be developmental in nature, and the level of questions demonstrating higher learning will increase over time. The first system, Foundations of Medicine, will have a relatively larger number of higher-level reasoning questions, with recall and integrated clinical questions contributing smaller but equal percentages of items. However, this ratio will shift as the systems progress, until ultimately the bulk of assessment questions will test integrated clinical reasoning.

The summative assessments in the final systems will be similar to the United States Medical Licensing Examination (USMLE) Step 1 exam. Objective Structured Clinical Examinations (OSCE) are a form of performance-based assessment and are used to measure a student's clinical competence. This form of "hands-on" assessment allows a student to "show" what they can do by "doing." For example, a student might perform a head-to-toe physical examination on a standardized patient who is trained to portray a given set of clinical conditions. Currently, students perform an OSCE at 1) the end of their pre-clerkship education (before the USMLE Step 1 exam and before beginning clinical rotations), 2) at the end of their medicine clerkship, and 3) at the end of the clerkship year.

Medical Education Week Is March 25–29

Please join us as the School of Medicine celebrates this year’s Medical Education Week, March 25–29. This annual week of activities is presented and arranged as a joint effort among the UVA Academy of Distinguished Educators (ADE), the Center for Biomedical Ethics & Humanities, and the Anne L. Brodie Medical Education Committee. Posters will be displayed outside the Claude Moore Health Sciences Library all week, describing the accepted medical education research submissions from faculty throughout the School of Medicine, innovations in medical education, and "big ideas" in medical education. The 2013 recipients of the Anne L. Brodie Medical Education Scholar Award, Drs. Arnold P. Gold and Sandra Gold, from the Arnold P. Gold Foundation, Englewood Cliffs, New Jersey, will be our special guests on Wednesday and Thursday, March 27 and 28. On Wednesday, 5-7 p.m., please join the Golds for a poster-session reception inside the Claude Moore Health Sciences Library.

On Thursday, March 28 (note the different day of the week!), the Golds will present a Medical Center Hour seminar, "Humanism as Activism: Preparing Future Champions in the New Medicine," from 12:30–1:30 p.m., in the Medical Education Auditorium, third floor, Claude Moore Medical Education Building. This program will also serve as Medical Grand Rounds and Medical Education Grand Rounds, with CME credit available.

These celebrations portend to be an exciting week for medical education, and I urge you to come out and participate in the discussion, lectures, and to view our colleagues' posters. For more information please contact Ashley Ayers, Coordinator, Faculty Leadership Programs, at ala5t@virginia.edu. More information on the ADE can be found at: www.medicine.virginia.edu/administration/faculty/ade.

National Patient Safety Awareness Week: March 3–9

The 2013 Patient Safety Awareness Week is underway and will run through March 9. This event is dedicated to raising awareness about patient safety and encouraging the engagement of patients, families, healthcare providers, and the public in safety awareness, vigilance, and habits.

This year our theme is "Chasing Zero Preventable Harm Events," and will focus on the new Quality Reporting system that will launch in April. To eliminate preventable harm events, and get to zero adverse outcomes (such as infections), we need to identify and remedy barriers to delivering safe care. This Quality Reporting system is essential to that process, as it is the avenue for anyone in the Health System to report concerns or observations that may involve systems issues we can address. I encourage you to attend the drop-in sessions to see the new Quality Reporting system on March 6, 7, and 8 in Dining Conference Rooms in the hospital.

RESEARCH HONORS & DEADLINES

Kipnis' Research Featured in Discover Magazine

Congratulations to Jonathan Kipnis, PhD, Professor of Neuroscience, and Director of the Center for Brain Immunology and Glia. His research into the connection between the immune system and the brain was the basis for a March 2013 Discover magazine feature, "Can boosting immunity make you smarter?"

This article, featured on the cover, discusses the processes and research into taking away and restoring T cell function in mice before and after being subjected memory testing in the Morris Water Maze. As Dr. Kipnis says in the article, "We could target the immune system and get benefits in the brain. It could be an amazing therapeutic tool." Alteration of T cell function in patients receiving anticancer chemotherapy may be associated with "chemo brain," a highly disturbing, blurring of concentration and memory that can potentially be addressed. You can find the full article online, at discovermagazine.com/2013/march/18-immunity-intelligence.

Don't Be Late: Impacts of Late Grant Applications

Nearly two years ago, the School of Medicine implemented a new deadline policy stipulating that grant applications must be submitted to the Office of Grants and Contracts seven business days prior to the due date. This policy was in response to two factors: the large number of applications being delivered to the Office of Grants & Contracts on or within a day of the National Institutes of Health (NIH) submission deadline, and the NIH's decision to provide no post-deadline opportunity to correct failed electronic applications.

For the first year and a quarter after the policy was implemented, compliance was good — at or above 80 percent. However, since spring of last year, we have noticed a significant regression, with many proposals arriving within 24 hours of the deadline. There have been too many close calls, as well as missed deadlines, resulting in failed NIH applications.

In an environment where application success rates are about 1 in 10, we cannot afford to create additional risk with late proposals. I encourage everyone — chairs, faculty and staff — to continue to work with Stewart Craig, Assistant Dean for Research Administration and Director of the Office of Grants & Contracts, in advance of proposal deadlines to ensure your applications are fully reviewed and submitted early, in order to provide a window of opportunity to address any problems that may arise.

MilliPub Club: 2013 Inductees

Getting exemplary research funded and then having that work published in a reputable peer-reviewed journal is the goal of many of our academic faculty members. When that work is cited heavily in literature, it often is transformational and becomes an accomplishment worthy of formal recognition from the University. Having a single paper cited over 1,000 times deserves both commendation and commemoration.

Founded in 2012, the MilliPub Club acknowledges and honors the scholarly achievements of current School of Medicine faculty members who have authored at least one article that has been cited 1,000 times.

The 2013 MilliPub Club Inductees are:

  • W. Kline Bolton, MD, Nephrology
  • Daniel J. Burke, PhD, Biochemistry and Molecular Genetics
  • Steven T. DeKosky, MD, Neurology and Administration
  • E. Clarke Haley Jr., MD, Neurology
  • Ira M. Hall, PhD, Biochemistry and Molecular Genetics
  • Donald F. Hunt, PhD, Chemistry and Pathology
  • Jeh-Ping (Serena) Liu, PhD, Neuroscience
  • Aaron R. Quinlan, PhD, Public Health Sciences
  • Frank T. Saulsbury, MD, Pediatrics
  • P. Todd Stukenberg, PhD, Biochemistry and Molecular Genetics
  • Michael J. Weber, PhD, Microbiology, Immunology, and Cancer Biology

     

Congratulations to all of you who have been cited!

VRGTP Delivers Talented Students to Labs

The University of Virginia-University of Chicago Visiting Research Graduate Traineeship Program (VRGTP) brings talented students to Charlottesville and Chicago from select universities in Poland for a year of research experience. This program has been in operation for nine years, and has trained more than 150 students. At UVA, we retain approximately 30 percent of these students, who have all gone into the Biomedical Sciences Graduate Program (BIMS), biology, or chemistry. The program is well-suited for labs that have funds for a limited time, but cannot hire long-term associates or graduate students, yet still are in need of capable and hard-working assistants for a year.

Zygmunt Derewenda, PhD, DSc, Molecular Physiology and Biological Physics, will be traveling to Poland this month to conduct more than 30 interviews with potential students. If you are interested, please contact him at 243.6842 or zsd4n@virginia.edu. More details can be found at www.virginia.edu/vpr/gradstudies/poland.html.

2013 Faculty Research Retreat a Success

Thank you to all who came out last month to the 2013 Faculty Research Retreat at Boar's Head Inn. It was a wonderful weekend full of roundtable discussions and stimulating lectures on focused scientific topics.

The keynote speaker was William N. Hait, MD, PhD, Global Head, Research and Development, Janssen Research & Development, LLC, Johnson & Johnson. Dr. Hait discussed “Emerging models for effective interactions between academic and industrial scientists and clinicians.” During the concurrent Saturday sessions, we heard presentations on new frontiers of genetics, hypertension and stroke, translational imaging, pathogenesis of asthma, brain immunology and glia, systems biology, cardiovascular and neuro-oncology research, and human biology during infection and inflammation. Additionally, I would like to thank all who provided the excellent posters and led and participated in lunch roundtable discussions. It is my hope that you came away from this retreat with future collaborative opportunities and a greater understanding of the range and scope of the work that is being accomplished here at UVA.

A few photos of the event have been posted at www.medicine.virginia.edu/research/offices/research/home/som-faculty-research-retreat-2013.html.

Also, I encourage you to take a brief, one-question survey about the retreat to help us better plan the next retreat. Feedback and comments can be offered at www.medicine.virginia.edu/research/offices/research/2013-faculty-research-retreat-feedback. Our deep thanks to Peggy Shupnik, PhD, Senior Associate Dean for Research; Steve Wasserman, PhD, Assistant Dean for Research; and the Research Advisory Committee members: Douglas Bayliss, PhD; David Brautigan, PhD; Stephen Caldwell, MD; Karen Fairchild, MD; Brent French, PhD; Brant Isakson, PhD; Christopher McCartney, MD; Benjamin Purow, MD; W. Gerald Teague, MD; Bettina Winckler, PhD; and Judith Woodfolk, MD, PhD.

March & April: Dean's New Faculty Seminar Series

Thank you to everyone who attended the February Dean's New Faculty Seminar series, “Structural basis for cellulose synthesis and membrane translocation,” presented by Jochen Zimmer, PhD, Assistant Professor of Molecular Physiology & Biological Physics. In addition to education, the seminars are an opportunity for presenters to introduce themselves (and their research programs) to other faculty and to make contacts with others in their field and around the School of Medicine and the Grounds.

All faculty, students, and staff are welcome to attend these seminars, held in Jordan Hall Conference Center Auditorium. Upcoming seminars include:

Laura Jansen, MD

  • Wednesday, March 27, 4 p.m.
  • Presenter – Laura Jansen, MD, Associate Professor of Neurology
  • Topic – “Inhibitory neurotransmission in normal brain development & epilepsy”

Max Wintermark, MD

  • Wednesday, April 17, 4 p.m.
  • Presenter – Max Wintermark, MD, Associate Professor of Radiology & Medical Imaging
  • Topic – “Advanced stroke imaging”

 

For a full schedule, please visit: www.medicine.virginia.edu/research/offices/research/home/som-new-faculty-seminars.html/

OTHER SCHOOL OF MEDICINE NEWS

SOM Launches New Emergency Planning Site

The School of Medicine has revamped and launched its Emergency Planning website. To view the new site, please go to: www.medicine.virginia.edu/emergency-planning. It is vital that you review the site now, before an emergency.

On this site you will be able to view upcoming scheduled drills, sign up for alerts (more on that below), educate yourself about emergency "best practices," read the procedures for notifying SOM employees, and learn where find spare extension cords and an extra -80 freezer, in case of a power outage or freezer failure. There are also emergency response sheets that I urge you to print out and post in your area.

In order to stay safe during an emergency, there are two communication systems for which I strongly urge you to sign up. SOM Alerts is an incredibly fast way for us to notify School of Medicine employees of emergency situations. Users can sign up to receive SMS texts on their mobile device(s) and/or e-mails to their account(s). Please visit www.virginia.edu/uvaalerts/ today to activate your UVA Alerts account and automatically be signed up for SOM Alerts.

Alertus Desktop enables a full-screen alert message to display on your desktop or laptop. It will take over the whole screen of your computer with a warning that is impossible to miss. Alertus Desktop works if you are using your computer on Grounds and on the UVA network, or off Grounds if you're connected to UVA via virtual private network (VPN). Health System Computing Services (HSCS) computers should already have Alertus pushed to them. Please double-check that yours is running Alertus. For non-HSCS computers, download this program from ITS Software Central: its.virginia.edu/central/, and install it on your PC or Mac. If you have questions or problems downloading or installing, please contact the Help Desk at its.virginia.edu/helpdesk/, 924.4357, or send email to 4help@virginia.edu.

Much of your ability to respond to an emergency relies upon the timely information distributed by these systems.

CVC Breaks Donation Records — Again!

Thank you to all in the School of Medicine who participated in the 2012 Commonwealth of Virginia Campaign (CVC) and helped to raise a record-setting $1,072,953! Aside from handily beating last year's donations (which itself was a record-setter), this year marks the first time in CVC history that a single agency has crossed the million-dollar mark, and it is because of you — all of you — who made that possible.

Significant increases were noted in both individual gifts and fundraising efforts, specifically those in support of Hospice of the Piedmont, March of Dimes, Michael J. Fox Foundation, and Blue Ridge Area Food Bank. In addition, your contributions again placed the Charlottesville Free Clinic as the highest pledge recipient in the Commonwealth.

I’m proud that for the past decade UVA employees have led all state agencies in giving to these worthy causes. Participation in the CVC by our faculty and employees from both the SOM and Medical Center, in addition to our other special-event fundraisers, resulted in our contribution of approximately 51.4 percent of UVA’s total contribution. In economic times like these, it’s an inspiration to witness such an abundance of giving and to work alongside such generous people.

Employee of the Month: Sarah Creef Baugher

Sarah Creef Baugher, Administrator for the Division of Endocrinology & Metabolism, Department of Medicine, is January 2013's School of Medicine Employee of the Month. She was recognized by her colleagues for her outstanding work in the evaluation of Rheumatology clinic operations and her hands-on approach to success in improving access and patient satisfaction. Sarah received many supportive comments, stating that her efforts have increased employee and faculty engagement and highly improved morale. She has accomplished this with a positive, "can do" attitude that serves as a wonderful role model for her colleagues.

In his nomination of Sarah, Russ Manley, Chief Operating Officer, Department of Medicine, says, "The entire Health System will benefit from the bridges she is building between the Department of Medicine and Medical Center staffs." Thanks to Sarah for her collaborative approach to problem solving and for her drive to make improvements within her department.

This Month: Uteam Meetings

It is important for UVA to foster a culture of engagement through communication and recognition. To that end, Uteam meetings are continuing this month. For your convenience, the presentation is offered at multiple venues and times and will provide an opportunity to share your thoughts with senior leaders.

Old Medical School Auditorium – 1st Floor West Complex

  • Wednesday, March 20 | 7:00 a.m. – 8:00 a.m.
  • Thursday, March 21 | 7:00 a.m. – 8:00 a.m.

 

Sandridge Auditorium in McKim Hall

  • Monday, March 25 | 7:00 a.m. – 8:00 a.m.
  • Monday, March 25 | 12:00 noon – 1:00 p.m.
  • Wednesday, April 3 | 12:00 noon – 1:00 p.m.

 

Night Shift Uteam Meeting --Dining Conference Rooms

  • Monday, March 25 | 8:00 p.m. – 9:00 p.m.

 

Off-Site Uteam Meetings:

Transitional Care Hospital/Northridge – 3rd Floor TCH Dayroom

  • Friday, March 22 | 2:30 – 3:30 p.m.

 

Lynchburg Dialysis – Conference Room

  • Tuesday, March 26 | 1:00 p.m. – 2:00 p.m.

 

Orange – MC Conference Room

  • Thursday, March 28 | 12:00 noon – 1:00 p.m.

 

Kluge Children’s Rehabilitation Center – KCRC Gymnasium

  • Monday, April 1 | 12:00 noon – 1:00 p.m.

 

Fontaine

  • Friday, March 29 | 1:30 p.m. – 2:30 p.m. – 500 Building – UPG Board Room 3rd Floor
  • Friday, March 29 | 3:30 p.m. – 4:30 p.m. – 545 Building 2nd Floor – Room 2318

 

Respectfully, -STDeK