summer 2014 (pdf)

E Department of

The summer months on the seashore in Rhode Island are a big part of the identity of the state – beaches, swimming,

surfing, clambakes, festivals – a time of lei‐sure and relaxation. Those of us in the De‐partment of Emergency Medicine certainly partake in the glorious Rhode Island sum‐mer. While it rejuvenates us, the time away from work may help our work in terms of opening our creative minds to new ap‐proaches. In keeping with this, the theme of our late May annual faculty retreat was “Creativity with Purpose”. The proceedings are summarized on page 6, but allow me to reflect a bit on what we learned and creativi‐ty in general.

In previous faculty retreats when we mapped out our desired organizational cul‐ture with the competing values framework of Quinn and Cameron, the creativity quad‐rant was one where we wanted to grow as a department. But, we did not want unbridled, random, free‐thinking creativity for creativi‐ty’s sake – we wanted our creative efforts to occur with an overall purpose and vision in mind. Hence the theme of our retreat ‐ Crea‐tivity with Purpose.

My first observation during the retreat was a sense of amazement at what a bunch of cre‐ative minds ‐ given even a few minutes ‐ can come up with a bit of direction and materi‐als. Our small group tables used common materials – paper plates, straws, paper clips, cups and tape to make something useful. There appeared within minutes a fanny pack ED fluid hydration device; a cell phone hold‐er; a primitive communication device; and a

decorative, candy‐holding pinwheel fan. My next observation was how infectious creativ‐ity can be – how it can seep in to others and multiply. I wasn’t feeling particularly creative that day, but the ideas from my colleagues that were bouncing around the table primed my creative pump and I could see that hap‐pening around the room – a catalysis of crea‐tivity.

Is medicine an inherently creative field? As we look at the great discoveries, cures, and treatments that have emerged in the past 100 years, we would have to say “yes” – cre‐ative physician investigators were responsi‐ble for amazing progress in improving health. But at the same time, our medical education system does not champion crea‐tivity. One could argue that the core content of medical school is delivered in a pretty dull and unimaginative manner. Each year an en‐tering class of gifted, creative individuals is put through a regimen that does not do much to exercise their creative thinking abili‐ties. Residency education has become more and more standardized with an emphasis on competency assessment and milestones. Health care reform includes a push for stand‐ardization in the clinical practice in emergen‐cy medicine. The overall result of our training and eventual practice can be an anesthetiza‐tion of the creative mind. Some physicians are more resistant – our talented research colleagues seem to emerge from the fog of creative dampening to use their creative minds in their research efforts. But for many of us, lost creativity may be a subtle but sub‐stantial consequence of becoming a physi‐cian.

As our Retreat day went on and we heard from numerous presenters, we wondered

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Message from the Chair

Anderson AC 3

Ask the AEC 12

Awards 8

Brown Faculty 9

Chest Pain Unit 5

EDHI 12

Education 14

EM Residency 14

EM Faculty Retreat 6

EMS 20

Global EM 7

Injury Prevention 10

Med. Development 21

Med. Humanities 23

The Miriam ED 3

TMH ED Dedication 7

National 11, 21

New Faculty

New Fellows 18

Pediatric EM 4

Research 24

Simulation Center 19

Toxicology 22

Women’s Health 22

Visiting Professor 16

Stroke 5

15,18

In the Spotlight 13,21

Mid‐Level Providers 20

(continued on page 2)

M mergency edicine

V O L U M E 9 , I S S U E 2 S U M M E R / F A L L 2 0 1 4

INS IDE THIS

I SSUE :

Considering Creativity

Brian Zink, MD

D E P A R T M E N T O F E M E R G E N C Y M E D I C I N E

P A G E 2

Message f rom the Cha i r fresh thinking and approaches to advance our mission at a topsy‐turvy time in healthcare. Where does creativity live in each of us? Is it like a prairie dog colony that is mostly hidden underground, but pops its head up and ven‐tures out intermittently? If so, what can we do to uncover our creative spirit and contribute to the improvement of medicine? To summarize

lessons from our Retreat:

1. Creativity travels in packs – boost your own creativity by surrounding yourself with other creative thinkers.

2. Creatively fail. Then use the lessons from the failure and try it again.

3. Disrupt your normal routine to find the reflective time that spawns creativity – take a walk, or lock your door, play some music, go to a museum, call your mentor, read something that you normally would‐n’t read.

All easier said than done, but big changes don’t result from small thinking. I hope

you will find the time with the rest of our beautiful sum‐mer to tap in to your creative side and find the purpose for that creativity. We will look forward to seeing many of you at the Brown Department of Emergency Medicine Reception at ACEP in Chicago in October.

Frances Weeden Gibson ‐ Edward A. Iannuccilli, MD Professor & Chair, Physician‐in‐Chief Department of Emergency Medicine Alpert Medical School of Brown University Rhode Island & The Miriam Hospitals Assistant Dean, Medical Student Career Development

(continued from page 1)

about how we can stimulate creative ex‐change in our clinical, educational and re‐search teams. We agreed that we should probably spend less time following strict meeting agendas and have more open time when we get together to create and brain‐storm around an opportunity, problem or theme. Creative time allotment seems to be a key requirement. On a personal level, sched‐uled reflective time, vacations, and spending time with others who have a creative approach may stimulate our minds to think of the next best thing. Some of our best researchers find that time with people in other fields, who think differently, but whose ideas or approaches can be adapted to our issues, can be very valuable in generating new ideas and approaches.

Another lesson was that truly innovative, creative ideas don’t just hatch and take off. They often crash land and burn. Some ideas get rebuilt, and have wobbly initial flights before they eventually fly. Initial failure is a com‐mon and perhaps even necessary part of the creative process, but acceptance of failure is not. After the initial brilliant “aha moment” of a creative impulse, there is a lot of detail‐oriented hard work to move to implementa‐tion of the idea. And since the creative thinkers who gen‐erate ideas or inventions may not be as good at manag‐ing the process to finish the job, it is important that a team is developed with members who can do the detail work and organize and manage the next steps.

Medicine is direly in need of the creative energies of aca‐demic emergency physicians. Whether it is in research, clinical operations and service, or education, we need

Brian J. Zink, MD

“Initial failure is a common & perhaps even necessary part

of the creative process, but acceptance of failure is not.”

The Department of Emergency Medicine Faculty ‐ May 2014 Alpert Medical School, Brown University; Anderson Emergency Center, Rhode Island Hospital; The Miriam Hospital Emergency Department; &

Hasbro Children’s Hospital Emergency Department Attendees of the 8th Annual Department of EM Faculty Retreat

P A G E 3

The Miriam Hospital Emergency Department Gary Bubly, MD, Medical Director, The Miriam Hospital, Emergency Department

Summer has come to signify a time of high clinical activity and numerous transitions‐‐ more pa‐

tients presenting, senior residents graduat‐ing, freshly minted interns arriving, new at‐tending physicians diving in to work— while we all try to enjoy the weather, spend time with family and squeeze in vacations.

Summer has always been our busiest time from a volume perspective, and this year is no exception. In fact we just had our busiest day ever on July 7th with 228 visits! Kudos to the teams on that day; they managed to pull this off with a back up nurse, but without calling in the backup physician. I was surprised to learn that May had been our busiest month ever…These record highs testify to both incredible the work ethic and commitment of our staff and the efficien‐cy of our emergency department layout.

Our newest attending physicians, Bill Binder, David Curley, Alexis Lawrence and Patrick Sullivan, have all un‐

dergone orienta‐tion and encultura‐tion to TMHED. Clinically they seem to have hit the ground run‐ning! In addition, our 12 new emergency medi‐cine interns have spent time orienting to the Miriam and attending lectures and workshops with EM faculty here.

I am happy to report that our ED renovation and expansion project is finally complete. The last clinical phase, the construction of a 13 bed pod known as ”Team 5,” opened in February and has been a pleasure to work in. The final phase of

the project entailed moving and consolidating the emer‐gency medicine physician administrative offices for Ilse Jenouri, MD, MBA, the Associate Medical Director, and Nancy Leech, our Executive Assistant and my office in together with emergency nursing leadership in a com‐bined ED leadership suite. We are located on the first floor of TMH, midway between endoscopy and the cath lab in room B1036. This has led to enhanced communica‐tion within our team.


“We launched a direct‐to‐bed

initiative in May, in which patients

are brought directly to an open bed if

available, rather than stopping in the triage bays.”


Anderson Emergency Center

Process Redesign at Both Entrances

There are many changes and tweaks going on at the An‐derson Emergency Center to improve our delivery of care and service to our patients and staff. Ma‐jor initiatives are concentrated on our walk‐in and ambulance triage areas.

Walk in Triage: Nurses are now initiating pro‐tocol orders on patients which has freed up our MLP to concentrate their efforts on identi‐fying, evaluating and managing as many pa‐tients as they can from triage. For every pa‐tient (usually ESI 4&5) they are able to send home from triage, we have another “main” ED bed to evaluate an ESI level 3 patient. This is especially important as the ESI 3 patient makes up most of the pa‐tients who leave without being seen (LWBS) or leave without completing treatment (LWOT). The G pod team will then absorb more complicated ESI level 4 patients but can also function as a “mid‐track” where we can see “low level” ESI 3 patients quickly and efficiently. Analysis of the first 3 weeks of this process demonstrated a de‐crease in the combined LWBS/LWOT volume by roughly

25% when compared to previous weeks with similar volume.

Ambulance triage: At the other entrance to the ED, we are also working hard to create an efficient, safer, and more welcoming experience for our patients, staff and EMS. The ambulance triage process is the focus of a hospital‐sponsored OpX project. OpX stands for Oper‐ational Excellence and employs the tools and principles of Lean and Six Sigma to identify improvement opportunities, implement changes, and track their impact. This method‐

ology advocates “rapid tests of change” to implement and test new ideas and determine their feasibility in real time. We have been exploring “direct to bed” with EMS when beds are available in the urgent areas

David Portelli, MD, Medical Director, Anderson Emergency Center, Rhode Island Hospital


“The strength of the team is each individual mem‐ber. The strength of each member is the team.”

P A G E 4


Pediatric EM at Hasbro Children’s Hospital Bill Lewander, MD ‐ Vice Chair for Pediatric Emergency Medicine

Congratulations to Dr. Frank Overly, who was appointed Associate Medical Director of the Pediatric Emergency Department. Frank brings his experience in medical simu‐lation, operations, and pediatric trauma to

the leadership team. Also, congratulations are in order for Dr. Linda Brown, a pediatric EM attending, who was appointed as Assistant Director of the Lifespan Medical Simulation Center. Linda, already a key faculty member in simulation, will bring her significant experience in pe‐diatric resuscitation to the operations and administrative side of the Sim Center.

On the clinical side, PEM attendings are working with PEM nursing leadership on a program to improve flow throughout Hasbro Children's Hospital.

To enhance the care of the growing number of patients with psychological distress, the Hasbro ED, like Bradley Hospital has adopted “Safety Care” as the method used for observation and de‐escalation of behavioral health patients. All PEM faculty and staff received 16 hours of training in Safety Care management techniques. This effort was jointly supported by a grant from the Risk Management Foundation, Rhode Island Hospital and UEMF. A patient‐centered, developmentally‐focused team approach to care was development to manage be‐havioral crises in the HCHED.

The American College of Surgeons designated Hasbro Children’s Hospital as a Level 1 Trauma Center this past Spring. As of May 2014, all patients less than 18 years of age with traumatic injuries will be transported to the HCHED for care. Previously, the age cut off for victims of serious trauma to receive care in the HCHED was age 16. The change in practice now streamlines all patients < 18 years of age arriving by ambulance to the HCHED, which is accustomed to caring for the medical and develop‐mental needs of adolescents. In addition, the HCHED continues to care for adolescents regardless of age who are patients of pediatricians or pediatric specialists.

Welcome to Frances Turcotte‐Benedict, the newest member of the PEM faculty. Frances is “home‐grown faculty’ having completed her pediatric residency and pediatric EM fellowship here at Hasbro. She earned a MPH from Brown during her fellowship and completed research in her focus area of adolescent violence preven‐tion.

Two nurse practitioners, Kathleen Smith FNP and Mollie Latcher‐Katz NP, have joined our talented group of PNPs. Both Katie and Mollie were nurses for a number

of years in the HCHED while earning their graduate de‐grees. Katie completed an additional year fellowship in EM at Rhode Island Hospital and will be working in both the Anderson Emergency Center and the Hasbro Chil‐dren’s Hospital ED.

The HCHED continues as a leader in the treatment of pe‐diatric sepsis as a participant in a nationwide children’s hospital collaborative focused on the early identification and treatment of pediatric septic shock sponsored by the American Academy of Pediatrics Section of Emergen‐cy Medicine. Dr. Laura Chapman is the PEM faculty member leading the initiative. During the first year of involvement, the HCHED was one of the sites demon‐strating the greatest improvements in the early identifi‐cation and treatment of septic shock.

An “in situ” simulation program in the HCHED has been developed by Drs. Overly and Brown to facilitate team‐work around the care of critically ill children in the ED. The program called PEDI STARS (Simulation Training Around Resuscitation) includes monthly simulation exer‐cises of critical care scenarios in the HCHED for both phy‐sicians and nurses followed by debriefings that identify educational and system issues that need attention. This is a popular educational program that benefits the care of patients.

As the Alpert Medical School of Brown University’s ex‐pands their class size, the pediatric EM faculty are gear‐ing up to increase our role in the clinical teaching and accommodate the growing student body. Dr. Greg Lock‐hart will coordinate the effort along with his existing role as Director of the 4th year PEM medical student elective.

Dr. Chris Merritt will lead a new 2nd year EM residency elective in PEM that will blend both the experience of caring for the patients in the HCHED with the follow up with the patients after their discharge or admission. This will be a great program for EM residents to learn the full circle of caring for the patient.

Dr. Deirdre Fearon is serving as advisor to pediatric resi‐dents interested in careers in pe‐diatric EM as they craft their resi‐dency track. This year, she is guid‐ing 2 residents along the path and

helping interns map their careers. In academ‐

Sue Duffy, MD , Medical Director, Hasbro Children’s Hospital ED

(Continued on page 18)

P A G E 5


Matthew Siket, MD Co‐Director

Stroke Center

The stroke centers at RIH and TMH continue to provide excellent stroke care to our pa‐tients. Both sites will welcome the Joint Com‐mission this summer, as TMH will recertify as a primary stroke center in August, and RIH will

look to achieve the distinguished designation as a compre‐hensive stroke center with a site visit likely in September. Both sites have been busy preparing, and anticipate smooth and successful surveys. Both centers are treating acute ischemic stroke patients with symptoms <4.5 hours with TPA more often and faster than ever before. At RIH, an institutional best door‐to‐treatment time of 27 min was achieved in April, and we are meeting our institutional goal of <45 min with increasing frequency (currently slightly less than half of cases).

One area in need of improvement is door‐to‐CT time <25 min, which has historically been a challenge at both RIH and TMH. Although eliminating early steps such as IV access and a 12‐lead ECG from pre‐CT interventions, there is still plenty of room to improve on this metric. Thanks to in‐creasing advanced prenotification of inbound stroke pa‐tients, I am proud to announce that later this summer, both RIH and TMH will introduce “direct‐to‐CT” models, wherein hemodynamically stable suspected acute stroke patients that arrive by EMS will be transported directly to CT. We anticipate that this change will save >20 minutes in throm‐bolytic treatment times, which translates to more than a month of disability‐free life for stroke patients on the

whole. (Meretoja et al. 2014) This evolution in care has been demonstrat‐ed by only a few leading stroke centers around the world, and is made possi‐ble locally through prior work by members of our group, EMS and nursing leadership committed to improving prehospital care.

The successful implemen‐tation of pharmacy prepa‐ration of tPA at TMH led to a simulated pilot study at RIH to identify logistical barri‐ers to adopting a similar model. After >40 simulated sce‐narios, it was ultimately felt best to continue ED prepara‐tion of tPA stored in CC room 6. Meanwhile, continued efforts at TMH have improved pharmacy hand‐offs to ED nurses and decreased inefficiencies.

The TIA Observation Unit at RIH has cared for well over 200 patients since inception in March of 2013. Patients are re‐porting high patient satisfaction scores and our median length of stay is 23 hours, during which nearly all patients obtain a diffusion‐weighted MRI of the brain, MR angio‐

The chest pain center continues to be a leader in ensuring optimal outcomes of ap‐propriately selected patients and in identify‐ing the lowest risk patients for early dis‐charge. Our research, and subsequent early discharge guidelines for those age<40, has safely reduced admissions of this subgroup

by 70%. Our recent publication in Academic Emergency Medicine also highlights a risk stratification tool to iden‐tify another low risk group, that if validated, could safely reduce testing and/or admissions further. Together, the implementation of this research could reduce utilization by as much as 20%. This has the potential to significantly lower healthcare costs in this population as well as re‐allocate resources toward other important observation diagnoses. With a recent submission for publication, we also continue our research on observation unit utilization and risk factors for observation failure in an effort to bet‐ter understand this increasingly prevalent care pathway.

Rhode Island Hospital—Chest Pain Unit Anthony Napoli, MD Medical Director

We also continue to focus our resuscitation research efforts on therapeutic hypothermia after cardiac arrest, advancing nonin‐vasive resuscitative techniques, and inflammatory markers in sepsis. In each case, collaboration is the key. Our thera‐peutic hypothermia program continues to exceed expec‐tations with the excellent teamwork between the Emer‐gency Department and Cardiology. Our latest work in noninvasive resuscitation, a collaborative project with Pulmonary/Critical Care, aims to examine the predictive nature of sonography of the inferior vena cava in identi‐fying fluid responsiveness in severe sepsis. We also con‐tinue to leverage our close relationship with Immunolo‐gy as we explore several novel inflammatory molecules, the role they play in the endothelial damage that is com‐mon in severe sepsis, and their association with the in‐creased morbidity and mortality of these patients.



P A G E 6

The 8th Annual Department of EM Faculty Re‐

May 30, 2014 ‐ It was an exceptionally beautiful day at the Squan‐tum Association in East Providence, with over 50 EM Faculty and administration in attendance at the Annual Department of EM Fac‐ulty Retreat Creativity with Purpose: Innovative Ideas & Approaches to Transform Academic EM. This retreat was remarkably different than prior years. In previous years, as part of group exercises, the faculty measured the Department’s organizational leadership pro‐file. The group had emphasized creativity as a quadrant to expand upon. This year’s retreat highlighted our group’s flexibility and dynamic innovations to meet the challenges in health care. Presentations focused on how creativity can be a secret to suc‐cess in our challenging health environment. The group was en‐couraged to use creativity with purpose to be effective and trans‐form and innovate in the ever changing health care landscape.

The Faculty started off with a mindfulness centering exercise with Dr. Laura McPeake leading the group. Dr. Brian Zink reviewed the Department’s progress on the 5‐year vision & metrics the group defined at 2012 retreat & noted that creativity is a tool for the group to use to meet goals. He presented the group’s challenges, opportunities, & strengths in each category. Drs. Jay Baruch & Brian Clyne gave and led a presentation & interactive exercise enti‐tled Creative Thinking: Or...The Need for Silliness & Failure to help the group tap into their creative juices using everyday objects, such as paper plates & cups, paperclips, straws, etc. As a team exercise, each table had to come up with an idea & tool to solve a problem.

This year’s agenda consisted of multiple 10‐minute mini‐presentations titled “Creative Capsules”. Many of the mini‐presentations focused on EM Faculty’s visionary thinking in their approach to medicine. Presentations included An Amp of Fiction for Reptile (not a typo) Dysfunction by Dr. Jay Baruch; Digital Health & the Future of Medicine: Where EDHI Fits In by Dr. Megan Ranney; 5 Points for Developing Women as Leaders by Kirsten Rounds; mMed‐icine by Dr. Paul Porter; Variability in Physician Practice Patterns: Beyond Walls Versus Sieves by Dr. Mike Lee; Epic Customization by Dr. Dan Savitt; Oh the ‘Thinks‐You‐Can Think’… with the Tools You Can Tool! By Dr. Leo Kobayashi; Our Creative Resource Engine by Keith Neal; and Rosenberg’s Arboral v. Rhizomal Concept by Dr. Bri‐an Zink. In addition to the mini‐presentations, the group partici‐pated in various physical activities like walking/running, kayaking, biking, or yoga in order to stimulate creative energies. During their luncheon, groups discussed “out of the box” ideas. The De‐partment has many EM Faculty focused on identifying and re‐searching cutting‐edge technologies as through our Emergency Digital Health Innovation (EDHI) program; TeleHealth; the Lifespan Medical Simulation Center; and the 5S group, just to name a few of our resource engines for technology.

Besides the creativity focus for meeting goals and providing best quality patient centered health care, many presentations focused on innovation & technology. Dr. Gregory Jay and guest speaker Dr. Angus Kingon, the Director of the Commerce, Organization, &

Some Highlights...

Article continued on page 19

See more EM Faculty retreat pictures on page

24


P A G E 7


TMH Campaign Emergency Department Dedication

June 19, 2014 ‐ The Miriam Hospital Emergency Depart‐ment hosted a reception thanking its donors for their contributions to the completed ED renovations. The much needed renovation project began 2 years ago and was competed this past May. Guest speakers in‐cluded Alan Litwin, Chair of TMH Campaign for Excel‐lence Committee and Chair for the TMH Foundation Board of Directors; Arthur Sampson, President of TMH; Dr. Brian Zink, Chair & Chief, Department of Emergency Medicine; and Gary Bubly, Medical Director for TMH ED. Speakers discussed the state‐of‐the‐art advance‐ments in the newly renovated space; the transfor‐mation to a better, more accommodating ED; how the new redesign factored in to handling the busiest month for TMH ED to date of over 5,426 patients in May 2014 with the ED being able to overcome challeng‐es of increased utilization; and thanked all the donors, physicians, and staff who helped make the temporary construction inconveniences work with the least dis‐ruption to patients and workflow.

Pictured (L to R) Drs. Neha Raukar, Brian Zink & Ilse Jenouri

Below ‐ Food Court including the UEMF dona‐

tion plaque (enlarged)

Global Emergency Medicine Dave Bouslough, MD, Director, Global EM

In July, the Division for International Emer‐gency Medicine welcomed Naz Karim, MD, our incoming fellow for 2014‐2016! Dr. Karim attended Rosalind Franklin University of Med‐

icine and Science, and has completed her Emergency Medi‐cine residency at West Virginia University School of Medi‐cine. She has a passion for GH education and quality im‐provement!

We have also welcomed a new residency Intern Class, who, I am proud to say, after surviving our annual welcome luau, have the necessary “gustatory” resolve to thrive in their new clinical appointments! This year’s event was also at‐tended by special guests Dr. Brian Zink and wife Dana, who competed with the best of them, and choked down their fare share of South Pacific “mystery meats” (Was that Spam, mackerel, or canned clams? Hmmm)! The moniker “Ol’ Iron Sides” has already been claimed in history, but perhaps Dr. Zink has now earned the right to be referred to as “Ol’ Iron InSides!”

In homage to our creativi‐ty exercises at this year’s faculty retreat, the Divi‐sion of IEM repeated a version of the same in our June educational meeting! Straws, paper cups/plates,

toothpicks, paperclips, tinfoil and scotch tape were used to fashion models representing “something that will fix a global health prob‐lem.” The results included: a low cost water purifier (DKato), physician interconnectivity model (JMackey), a telemedicine/educational interconnec‐tion model (GWanjiku), the “NCD Reducer 2014” to modu‐late caloric intake (DBouslough), and a bedside traction device for pediatric fractures (ALevine). The exercise was a good reminder, that with new ideas and thinking outside the box, we can come up with simple remedies to some of the Globe’s biggest healthcare problems!

November 2014 will bring the Division’s traveling trauma educational module to the South Pacific! Received with great reviews in Nicaragua(2012) and Rwanda(2013), the newest update of the course will be taught to approximate‐ly 80 physicians and nurses at the LBJ Tropical Medical Cen‐ter, Pago Pago, American Samoa. A team of 8‐10 attend‐ings, residents, and mid‐levels will administer the course, while also providing clinical support to the emergency de‐partment/operating room, bedside teaching for local physi‐cians, and mentorship for hospital leadership!

As always, attending physicians, residents, and midlevels are welcome to join us at our monthly Educational Meet‐ings (first Friday monthly 11:00am‐12:30pm) and in any of our ongoing global health projects!

P A G E 8

Frank Overly, MD ‐ Associate Medical Director of HCHED

Congratulations to Dr. Frank Overly. He has been appointed to Associ‐ate Medical Director for the Hasbro Children’s Hospital Emergency Department. He will continue as Co‐Director of the Lifespan Medical Simulation Center.


Dean’s Excellence in Teaching Awards At a reception held at the Alpert Medical School of Brown University on June 11, 2014, the following Depart‐ment of EM Faculty were recognized and presented with awards for their outstanding clinical teaching. Sarah Gaines, MD Joseph Lauro, MD Gregory Lockhart, MD Laura McPeake, MD Otis Warren, MD

On July 1, 2014, The Department of Emergency Medicine held a reception on the Brown EM Terrace to celebrate the Department’s 2014 Outstanding Physician & Exemplary Service Awards and the 2014 Alpert Medical School of Brown University’s EM Faculty Promotions.

Department of EM Awards Reception ‐ 2014

(Pictured above L to R) Megan Ranney, Tom Haronian, Aris Garro, & Francis Sullivan

(Pictured left ‐ L to R ) Anthony Napoli, Jessica Smith, & Andrew Nathanson

Brown’s Emergency Medicine’s Senior Promotions were recognized and celebrated. These promotions were effective July 1, 2014 in the following tracks.

Teaching Scholar Track: Michael Mello, MD, MPH, promoted to Professor and Anthony Napoli, MD promoted to Associate Professor;

Clinical Voluntary Track: Andrew Nathanson, MD, Clinical Professor;

Clinician Educator Track: Jessica L. Smith, MD, Associate Professor (Clinical).

Ceremonial plaques were given to 2014 Outstanding Phy‐sician Awards recipients (as previously announced in the Spring 2014 newsletter) included Aris Garro, MD, MPH; Thomas Haronian, MD; Megan Ranney, MD, MPH; and Francis Sullivan, MD. Dr. Zink accepted the 2014 Exem‐plary Service Award on behalf of Kenneth Williams, MD, who could not attend.

Congratulations ‐ New EM Chief Residents 2014‐15 Nicholas Asselin Patrick Axtmayer Charmaine Lieu

Faculty Diversity, Advancement & Leadership March 5, 2014 ‐ Dean Jack Elias presented awards to EM Facul‐ty Drs. Frantz Gibbs & Ilse Jenouri in Recognition of 2013 Wom‐en & Underrepresented Fac‐ulty Senior Promotions & Appointments in Biology & Medicine in a reception spon‐sored by the Office of Wom‐en in Medicine & Science (OWIMS) & the Office of Di‐versity & Multicultural Affairs (ODMA) (Pictured left ‐ L to R ) Drs. Cummings, Gibbs, & Jenouri

Linda Brown, MD ‐ Associate Medical Director of LMSC

Congratulations to Dr. Linda Brown. He has been appointed to Associ‐ate Medical Director of the Lifespan Medical Simulation Center .

Eric Goldlust, MD, PhD ‐ Assistant Medical Director of AEC

Congratulations to Dr. Eric Goldlust. He has been named Assistant Medical Director of the Anderson Emergency Center at Rhode Island Hospital . Dr. Goldlust, in coordination with Drs. David Portelli & James Monti & the ED nursing leadership, is responsible for optimizing emer‐gency care and flow and AEC operations.

(Pictured left ‐ L to R ) Drs. Lockhart, Lauro, Gaines, Warren & McPeake

P A G E 9

Emergency Medicine Faculty

Clinical Assistant Professor David Bouslough, MD, MPH Erica Constantine, MD Laura Forman, MD Thomas Germano, MD Kirstin Gregg, MD Mark Greve, MD David Kaplan, MD Megan McNamara, MD James Rayner, MD John Riedel, MD Marcia Robitaille, MD Eric Schwam, MD Dana Sparhawk, MD Tenny Thomas, MD Clinical Instructor

Nadine Himelfarb, MD Katherine Kimbrell, MD Matthew Sarasin, MD Patrick Sullivan, MD (Clinical) Devin Tsai, MD

Teaching Associate Karina Bertsch, MSW Christine Garro, PA Rebecca Hassel, PA‐C Allison Jackson, PA Dina Morrissey, MD, MPH Lisa Murphy, FNP

Research Associate Julie Bromberg, MPH

Teaching Fellows Jessica Schoen, MD ‐ Medical Simulation Fellow

Naz Karim, MD, MHA ‐ Global Emergency Medicine Fellow

Pediatric EM Fellows Almaz Sara Dessie, MD Marleny Franco, MD Mariann Nocera, MD Elizabeth Prabhu, MD Robyn Wing, MD

Associate Professor Jay Baruch, MD Adam Chodobski, PhD (Research) Thomas Chun, MD, MPH Brian Clyne, MD Susan Duffy, MD, MPH Jason Hack, MD Leo Kobayashi, MD R. Clayton Merchant, MD, MPH, ScD Anthony Napoli, MD Frank Overly, MD Daniel Savitt, MD Dale Steele, MD Jonathan Valente, MD

Professor Brian Zink, MD ‐ Frances Weeden Gibson ‐ Edward A. Iannuccilli Professor of Emergency Medicine Bruce Becker, MD, MPH Gregory Jay, MD, PhD William Lewander, MD James Linakis, MD, PhD Michael Mello, MD, MPH Selim Suner, MD

Assistant Professor Siraj Amanullah, MD, MPH Janette Baird, PhD (Research) Francesca Beaudoin, MD, MS Linda Brown, MD, MSCE Joanna Szmydynger‐Chodobska, PhD (Research) Geoffrey Capraro, MD, MPH Esther Choo, MD, MPH Bryan Choi, MD, MPH David Curley, MD, PhD Jeffrey Feden, MD Rachel Fowler, MD, MPH Aris Garro, MD, MPH Elizabeth Goldberg, MD Eric Goldlust, MD, PhD Nathan Hudepohl, MD, MPH Michael Lee, MD Sadiqa Kendi, MD John Lafleur, MD Adam Levine, MD, MPH Otto Liebmann, MD Alyson McGregor, MD, MA Tracy Madsen, MD, ScMCTR Lisa Merck, MD, MPH Christopher Merritt, MD, MPH Catherine Pettit, MD Megan Ranney, MD, MPH Neha Raukar, MD, MS Steven Rougas, MD Matthew Siket, MD Robert Tubbs, MD Frances Turcotte‐Benedict, MD, MPH

Associate Professor (Clinical) Deirdre Fearon, MD John Foggle, MD Frantz Gibbs, MD Gregory Lockhart, MD Jessica Smith, MD Kenneth Williams, MD

Assistant Professor (Clinical) William Binder. MD David Bullard, MD, MEd Charles Callahan, MD, MPH Sarah Case, MD Laura Chapman, MD Lydia Ciarallo, MD Jamieson Cohn, MD Michelle Daniel, MD Whitney Fisher, MD Sarah Gaines, MD Elizabeth Jacobs, MD Joseph Lauro, MD Alexis Lawrence, MD David Lindquist, MD Melanie Lippmann, MD Laura McPeake, MD Lynne Palmisciano, MD Jane Preotle, MD Paul Porter, MD Noah Rosenberg, MD Elizabeth Sutton, MD Lynn Sweeney, MD Otis Warren, MD

Clinical Associate Professor Gary Bubly, MD Catherine Cummings, MD Thomas Haronian, MD Ilse Jenouri, MD, MBA Mihir Kamat, MD Matthew Kopp, MD James Monti, MD David Portelli, MD Lawrence Proano, MD Francis Sullivan, MD


Clinical Professor Andrew Nathanson, MD Elizabeth Nestor, MD, M Div.

Injury Prevention Center

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At the start of 2014 the Injury Prevention Center (IPC) was awarded a grant from the Rhode Island Department of Transportation (RIDOT) to expand our already very active child passenger safety program. The RIDOT

funding allows the IPC to hire an additional full time staff member to help increase the outreach of our child pas‐senger safety activities as well access to 2000 car seats for distribution to qualifying low income families. Our new staff completed a four day training course to be cer‐tified as a child passenger safety technician and has al‐ready planned, organized and held several car seat edu‐cation and distribution events targeting low income fam‐ilies. Most recently we held an event in conjunction with Ready to Learn Providence where we were able to dis‐tribute over 50 car seats to local families in need. We have also held successful car seat distribution events in collaboration with the Providence Community Health Center and East Bay Community Action Program with several more similar events scheduled for the summer.

Michael J. Mello, MD Medical Director, Injury Prevention Center

More recently, this summer the IPC was awarded an‐other grant from the RIDOT to support placing a child passenger safety technician full time within a communi‐ty based pediatric practice. Waterman Pediatrics in East Providence, part of the Coastal Medical group, will be partnering with us to launch this new program. We will be conducting a rigorous evaluation of this program to determine effi‐cacy of this model and its potential for adoption by other pediatric practices in the state.


Congratulations to Roland “Clay” Merchant, MD, MPH, ScD and his research team on receiving a prestigious R01 Grant from the NIH (National Institute of Nursing Research) for his research entitled Facilitating HIV/AIDS and HIV Testing Literacy for Emergency Department Patients. This is a significant accom‐plishment in a crucial area of investigation, and provides sub‐stantial funding for Dr. Merchant's excellent research pro‐gram. The study is summarized below:

The CDC recommends that all patients should receive infor‐mation about HIV/AIDS & HIV testing orally or in writing at eve‐ry HIV testing encounter. However, for busy emergency de‐partments (EDs), delivering information orally is a barrier to HIV testing, and written brochures likely are not useful for those with lower health or general literacy. Videos might be as or more efficacious than orally‐delivered information in im‐proving HIV/AIDS & HIV testing knowledge, particularly for those with lower health literacy skills. Though, the resources required to show videos might limit their use in EDs. Pictorial brochures are a promising alternative, but are of unknown efficacy.

Regardless of how patients are informed, we do not know how well or for how long this knowledge is retained, if this information should be delivered according to patient needs and abilities, and if retention of this knowledge impacts future HIV testing behavior. This R01 study will address these gaps in our understanding.

We will conduct a multi‐site, randomized, controlled, longitudi‐nal trial among 600 English‐ and 600 Spanish‐speaking 18‐64‐

year‐old ED patients to investigate these questions. Using a valid measure of health literacy, we will stratify our sample within language by health literacy level (lower vs. higher). We will randomly assign patients to receive HIV/AIDS & HIV testing information by video or pictorial brochure. At one year post‐enrollment, we will offer participants an opportunity to be tested again for HIV.

As primary aims, we will compare the efficacy of pictorial bro‐chures and videos in improving short‐term (in ED) HIV/AIDS & HIV testing knowledge and retaining this knowledge over 12 months. More specifically, we will determine if and how short‐term improvement and longer‐term retention of knowledge interacts with information delivery mode (pictorial brochure or video), patient health literacy level (lower or higher) and language (English or Spanish).

As secondary aims, using the Information‐Motivation‐Behavioral Skills (IMB) model as a heuristic framework, we will examine components of the IMB model relevant to our study and their interrelationships, their impact on HIV re‐testing be‐havior, and the moderating influence of information delivery mode, language and health literacy level through the model. In regards to HIV re‐testing behaviors, we will assess: (1) testing uptake at one year post‐enrollment when offered as part of the study, (2) testing utilization during the study period but not as part of the study, and (3) change in testing utilization one year pre vs. post study enrollment.

Study findings will guide ED‐based delivery of HIV/AIDS and HIV testing information.

Child Passenger safety seats ready for distribution at East Bay Community Action Program, June 14, 2014

Congratulations ‐ Dr. Merchant ‐ R01 Grant

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The Brown/Lifespan Department of EM faculty had outstanding SAEM Annual Meeting participation in all areas: special sessions, didactics, poster presentations, abstracts, workshops, oral abstracts, interest

groups, etc. Highlights include:

AEM Consensus Conference ‐ Drs. Esther Choo, Tracy Madsen, Alyson McGregor, Megan Ranney, & Neha Raukar;

Senior Faculty Leadership Forum/ Chair Development Program ‐ Dr. Brian Zink;

Maximize Your Career Potential: Strategies to Increase Your Academic Productivity ‐ Drs. Choo & Madsen;

Taking Your Academic Writing Skills to the Next Level: Tips from the Experts ‐ Dr. Madsen;

Exploring Traditional & Nontraditional Training Opportunities in Emergency Health Services Re‐search Drs. Choo & Zink;

Super Utilizers: Patient‐Centered Care ‐ Kirsten Rounds;

Bringing Sports Medicine to the Emergency Physician ‐ Dr. Jeff Feden;

Leadership Roundtable: Leading Through Change ‐ Drs. Brian Clyne & Zink;

EMS Feedback by Hospitals as a Means to Improve Pre‐Hospital Stroke Care ‐ Dr. Bryan Choi;

Low‐Dose Ketamine Improves Pain Relief in Patients Receiving Intravenous Opioids for Acute Pain in the ED: Results of a Randomized Double‐Blind Clinical Trial ‐ Dr. Francesca Beaudoin;

Ultrasound in Resource‐Limited Settings: Discussion of Use, Benefits, Research & Sustainable Pro‐gram Design ‐ Dr. Adam Levine, et al;

“Shark Tank”: Real‐World Research Proposal Development ‐ Dr. Ranney;

What Does Remediation & Probation Status Mean to EM Residencies? A Survey of EM Program Directors ‐ Dr. Jessica Smith;

Academy for Women in Academic EM (AWAEM) Meeting: Life Happened? Now What? Career Restructuring After a Major Life Event ‐ Drs. Matt Kopp & Laura McPeake;

Evidence‐Based Operations: Using Discrete‐Event Simulation to Enhance ED Operations Research ‐ Dr. Eric Goldlust;

Across Genders & Generations: Effective Feedback & Communication in EM ‐ Dr. Madsen;

The Distribution of Outpatient ED Expenditures & Low‐Intensity ‐ Dr. Mike Lee;

Evaluating Your Job Offers in Academic EM ‐ K. Rounds;

Detection, Measurement, & Characterization of Unhealthy, Environment‐Derived Aerosols in an ED: Preliminary Results from the AETHER2 Study ‐ Dr. Leo Kobayashi;

Policy Change 102: Public Scholarship for Emergency Physicians ‐ Dr. Ranney;

Written Informed Consent for Computerized Tomography Decreases CT Utilization in Low Risk ED Patients ‐ Dr. Lisa Merck;

The Predictability of ED Admissions ‐ Dr. Goldlust ;

Effect of Formation of an Accountable Care Organization on Characteristics of ED Visits ‐ Dr. M. Lee;

Revisiting the Status of Women in Academic EM ‐ Dr. Choo;

Lack of Gender Disparities in ED Triage of Ischemic Stroke Patients ‐ Dr. Madsen;

Implementation of a Magnetic Resonance Protocol for Patients with Transient Ischemic Attack in an EF Observation Unit ‐ Drs. Merck & Matt Siket;

Determining the Prevalence & Chronicity of Hyperlipidemia in Patients Admitted to an ED‐Based Chest Pain Observation Unit ‐ Dr. Nate Hudepohl;

The DISPARITY Study: Factors Associated with Time to Antibiotics in the Surviving Sepsis Cam‐paign Database ‐ Dr. Madsen;

Dept. EM on the National Scene

SAEM Annual Meeting 2014 ‐ Dallas, TX


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Emergency Digital Health Innovation (EDHI)

The Emergency Digital Health Innovation (EDHI) program: An introduction!

What is Digital Health?: “Digital health” con‐sists of the use of digital technologies – text‐messaging, “apps,” tablets, social media,

wireless sensors, etc. – to improve health. Despite the re‐cent proliferation of digital health investors and mobile ap‐plications, there is a notable lack of evidence‐based, effec‐tive, workflow‐facilitating tools. EDHI’s goal is to capitalize on our department’s extensive research, administrative, and clinical experience with digital health to fill this gap.

What is EDHI?: EDHI is the only digital health program in the nation that focuses on the acute care environment. Our mission is to use digital health to transform the care of pa‐tients with acute care needs ‐ before, during, and after their visit. We are working on creating evidence that digital health tools are acceptable and effective, for both clinicians and patients in the emergency care setting; providing ex‐pertise in the implementation of these tools; and provid‐ing training in their use in clinical care.

What is EDHI doing?:

Our collaborators are a truly impressive collection of physi‐cians, administrators, and researchers, all committed to achieving our mission in a myriad of ways. Just a few high‐lights from our first few months of existence include:

We have held monthly journal clubs on topics ranging from Twitter to telemedicine. Drs. Peter Chai and Roger Wu (at the time, PGY‐4 and PGY‐2 residents) led our most recent

journal club, to great accolades.

We have launched our website at www.brownedhi.org ‐‐ please check it out and offer feedback!

We presented 2 “creative capsules” at our 2014 UEMF Fac‐ulty Retreat

Dr. Ranney has been invited to be a member of HIMSS’ mHealth Physician Task Force and of the Institute of Medi‐cine workgroup on Digital Learning Collaborative

Dr. Choo has submitted grant applications to NIH and, in conjunction with our Injury Prevention Center, to the CDC

Dr. Porter is collaborating with two large corporations re‐garding novel telemedicine opportunities for our depart‐ment

Dr. Goldlust presented on the use of electronic health rec‐ords to conduct Discrete Event Simulation at SAEM

We are developing research and clinical relationships with a variety of collaborators at other institutions, within other departments, and with industry

We are particularly proud of Dr. Tony Zhang (PGY2) who has submitted an EDHI‐mentored grant to EMRA!

How can I get involved? Please join us at upcoming journal clubs and planning meetings (July 16, August 20, Septem‐ber 16); follow us on Twitter (@brownEDHI); be an early adopter; or talk to Megan Ranney ([email protected]) if you are interested in know‐ing more!

Megan Ranney, MD, MPH EDHI

In emergency medicine, It is sometimes hard for us to ap‐preciate how stressful it can be to be a patient coming in for care. Whether the condition is life‐threatening or mi‐nor, it is stressful to come to the ED ‐ to have an unknown possible ailment; to have nurses, techs and doctors each ask you a series of personal questions; to change out of your clothes into a flimsy gown; to wait to start your care; and to find out your results; and so on. While we, as health care workers, strive to provide excellent patient care and service and get to the heart of the patient’s condition and resolution, it is challenging with the sheer number of pa‐tient demands.

In an effort to reach out to patients and reduce some of the situational stress, we have developed an iPhone app called "Ask the AEC." This app is available for free at the iTunes store, and is designed to usher patients through the pro‐cess of going to the Anderson Emergency Center. It is some combination of an online brochure and a frequently asked questions (FAQ) list, designed to help patients and

their families understand what is happening ‐‐ registration, triage, and so on ‐‐ and why these things often take more time than we'd like ‐‐ as well as to put a friendly face on our department.

Even if some patients don't have an iPhone, they may have family or friends in the room who do. In an article in Annals of Emergency Medicine entitled ED Patients’ Prefer‐ences for Technology‐Based Behavioral Interventions, Dr. Megan Ranney et al, suggest‐ed that smartphone use is sur‐prisingly high in the ED patient population (Vol. 60, Issue 2, Aug 2012). The clinical providers at the

Ask the AEC! Online Now!


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The Resident Scholarly Development Fund provides scholarships for Brown emergency medicine residents to carry out projects or training in the research or education realms. The fund was created in 2009 with an initial $5,000 dona‐tion from University Emergency Medicine Foundation.

The fund has received great support from past graduates and current faculty. And we are again asking our Brown EM faculty members and alumni to help build the Resident Scholarly Development Fund through donations. The strength of any fund raising effort is not just in the amount of contributions, but also in the level of participation of those who care about the cause. Many of you have invested a great deal of time and effort in making the Brown Emergency Medicine residency one of the premier EM residencies in the nation. Now you can make a financial investment into an EM resident’s future.

Your contribution is tax deductible. Please consider sending a check as follows: UEMF, Resident Scholarly Development Fund, Attn: Michelle Costa Department of Emergency Medicine 593 Eddy Street, Claverick 2, Providence, RI 02903

Resident Scholarly Development Fund

Dr. Paul Porter, Director of UEMF Special Projects, gave an interview regarding Google Glass use in the ED featured on the www.lifespan.org website. Dr. Porter, Roger Wu, & Peter Chai were interviewed for a front page story in the Providence Journal on Friday, 3/7/14 featuring the Google Glass program.

3/7/14 ‐ Dr. Paul Porter, with Drs. Wu & Chai were interviewed on ABC6 News for the new Google Glass program in the ED in partnership with the Department of Dermatology. http://www.abc6.com/story/24918171/google‐glass‐makes‐medical‐communication‐easier‐at‐hospital

Drs. Porter, Chai, & Wu were featured in the July 2014 issue of ACEP Now in an article entitled One Step Closer to the Star Trek Tri‐corder: Google Glass Debuts in the ED, Help‐ing EPs Streamline Patient Care.

In the August 2014 edition of Emergency Physicians Monthly publication, Drs. Megan Ranney, Wu, Chai & Porter were inter‐viewed for the article Making Google Glass a Reality in the ED in the section The Wired ED.

Drs. Porter, Wu, & Chai were also featured in the Spring 2014 edition of the Brown Medicine magazine in the article Through the Google Glass: A New Study Tests Medical Applications of Mobile Video Technology.

Feb 14 ‐ Dr. Megan Ranney gave an interview on WPRO (630 AM and 99.7 FM) re‐garding the poten‐tial benefits of mo‐bile health (or mHealth) for emer‐gency department patients and clini‐cians.

DEANS Award Funding to Adam Chodobski, PhD

Adam Chodobski, PhD along with John Marshall, PhD were funded by the Biomedical Sciences Division & Alpert Medical School through the DEANS Awards. The Dean’s Emerging Areas of New Science Awards were developed in 2014 to fund and promote transla‐tional research bridging clinical and academic focus‐es and specialties. Dr. Chodobskis project Develop‐ment of a New Treatment for Traumatic Brain Injury was funded for $80,000 over 2 years.

Google Glass in the News

Dr. Ranney ‐ Honored with a RI Award August 2014 ‐ Megan Ranney, MD, MPH was recognized as a 2014 RI Bioscience Award re‐cipient by the Tech Collective, a local bioscience and information technology industry associa‐tion. This award is given to local people for their contributions and accomplishment in ad‐vancing technology and innovation in any relat‐ed field. Dr. Ranney was recognized for her work as Director of the Emergency Digital Health Innovation program promoting the use of technology and social media in EM care.

Screen shoot of projo.com edition

From the Turnto10 feature

In the Spotlight—Media

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EM Education

Jessica Smith, MD Director EM Residency

Nothing says summer in the ED like wide‐eyed residents navigating new roles! July is officially transition time, and it brings a new season of growth and responsibility to each PGY level. Interns are encouraged to stop asking permission (as they were so accus‐tomed in medical school), PGY2s are ex‐

pected to run the pod on those lonely overnight stretch‐es and trauma calls, PGY3s are battling sepsis and lethal cardiac dysrhythmias, and seniors are learning to under‐stand new global EM department needs, like how to bal‐ance teaching, throughput, & patient satisfaction and what responsibility as an attending truly entails.

Along the way, our huge faculty shares the equally huge responsibility of shaping and molding these young physi‐cians. The investment in our residents directly affects the 80,000 collective patients our senior residents will have treated at the end of their 4 years, plus another 200,000 patients each resident will treat over the course of a ca‐reer. That’s >2 million patients per graduating class! Please do your best to teach and give timely feedback to influence good practice habits for those millions of lives in your hands!

EM Residency As we look to create and lead new Education Innova‐tions this Academic Year, we will rely on all of you to help deliver the message. We are fortunate to have one of the strongest EM Residencies in the country, which allows us to recruit amazing residents! We owe it to them to be invested in their training at every step of the way. Please make plans now to volunteer to lead a small group, give a didactic, teach in the Sim Center, post on the Blog, take it to the bedside, give pointed feedback, run a Mock Oral case, or flip the class‐room. Resi‐dents have a strong appe‐tite for Evi‐dence Based Medicine, so please ask them what they have re‐



Peering Out To Develop The Master Within

At the end of a long night shift we huddled around the patient, closely inspecting her extremities for IV access sites. The most experienced nurse had tried to place a func‐tioning line in vain (pun intended). I pressed the ultrasound probe against the patient’s

arm searching for a vessel, surrendering to the idea she would need a central line. In walked my relief—a junior colleague with much more ultrasound experience—who rescued me with a few technical tips for placing an ultra‐sound‐guided IV. On my next shift, I overheard a col‐league’s carefully worded “chronic pain” negotiation with a patient. It was delivered with such compassion and confidence that I wrote down a few key phrases and tried them out myself. Another colleague recently shared cutting edge literature, which I was unaware of, that changed how I work patients up for subarachnoid hemorrhage. These experiences highlighted how much my peers have to teach me, and how rarely I take ad‐vantage of their expertise. I began to consider the hu‐man capital of my peers as an untapped source of pro‐fessional growth.

Brian Clyne MD Vice Chair, EM Education

L to R, front to back: Anatoly, Eric, Mike, Tess, Jordan, Rebecca, Anu, Thomas, Michael, Adam, Mat, & Ben

Beyond curb‐siding a colleague to get a second opinion on a rash, have you ever sought help mastering an area of your practice? Do you wonder how some colleagues achieve the results they do? In a group like ours—filled with perennial Top Docs, Outstanding Physicians, niche experts, communication gurus, award‐winning educa‐tors, and productivity rainmakers—it seems we could all improve something with the help of those around us every day. In this rich environment, peer observation and coaching has significant appeal for faculty development.

Peer coaching as a method of faculty development has been described in the educational literature. According to Flynn, key elements of peer coaching include: identifi‐cation of individual learning goals (e.g. improving spe‐cific teaching skills), focused observation by colleagues, and the provision of feedback, analysis and support. This underutilized approach has particular appeal because it occurs in our own practice setting, enables individualized learning, and fosters collaboration. In studies of peer coaching programs, noteworthy outcomes include: in‐creased participant confidence, increased appreciation of new ideas, and an improved sense of institutional sup‐port and collegiality. Subjects especially appreciated the

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More New Faculty & Fellows on page 18

Welcome New EM Faculty & Fellows Tracy Madsen, MD, ScMCTR ‐ Assistant Professor in EM ‐ Dr. Madsen recently completed the SAEM en‐

dorsed Women’s Health in Emergency Care 2‐ year fellowship. Dr. Madsen recently received her ScM in Clinical and Transla onal Research from the Brown University School of Public Health. She received her MD from Bos‐ton University School of Medicine. She is a graduate of the Alpert Medical School/ Rhode Island Hospital EM Residency program, serving as a chief resident in 2012.

Tracy is very active on a national level with research and women’s health including SAEM & AWAEM commit‐tees. She will be an EM Attending at both The Miriam Hospital ED (TMH ED) & the RIH Anderson Emergency Center (AEC).

Steven Rougas, MD ‐ Assistant Professor in EM ‐ Dr. Rougas received his MD and completed his EM Resi‐dency from the Alpert Medical School of Brown University. He is currently completing his Masters in Medical Education Leadership at the University of New England in Maine. In 2013, he received a certificate in Medical Education Research from the American Association of Medical Colleges. He recently completed a fellowship in Medical Education Research in the Department of EM here at Brown/Rhode Island Hospital.

Steven participates in the AMS’ Program in Educational Faculty Development Oversight Committee. He is a Mentor & Small Group Co‐Leader in the Doctoring Course; participates in the Clinical Skills Clerkship and the Objective Structured Clinical Encounters (OSCE) among some of his AMS medical education work. He will be an EM Attending at both TMHED & the RIH Anderson EC.

Bryan Choi, MD, MPH ‐ Assistant Professor in EM ‐ Dr. Choi recently completed a 2‐year Fellowship in EMS & Disaster Medicine at Brown University/Rhode Island Hospital while completing his MPH at Brown Uni‐versity’s School of Public Health. He graduated from the Brown/ Rhode Island Hospital Residency Program in 2012. He received his MD from University of Texas Southwestern Medical Center.

Bryan will continue his work with LifePACT and EMS and will be a core faculty member in our EMS Division and is conducting EMS research in a number of different areas. Dr. Choi is on the RIH/TMH Stroke Committee. He will be an EM Attending at TMH ED & the Anderson EC at RIH.

Alexis Lawrence, MD ‐ Assistant Professor (Clinical) in EM ‐ Dr. Lawrence is a recent graduate of the Alpert Medical School/ Rhode Island Hospital EM Residency program, and served as an EM Chief Resident in 2014. She graduated from the University of Massachusetts Medical School in 2010 and was an AOA honoree. Alexis was the Director of the EM Wilderness Medicine program in 2014 and participated in the RIH GME Com‐mittee and the EM Curriculum Committee. She will be an EM Attending at TMH ED & the RIH Anderson EC.

Frances Turcotte‐Benedict, MD, MPH – Assistant Professor in EM & Pediatrics ‐ Dr. Turcotte‐Benedict received her MD from SUNY Stony Brook School of Medicine, where she was named to the Gold Humanism Honor Society and received an award for excellence in Pediatrics. She completed her Pediatric Residency and Pediatric EM Fellowship at the Alpert Medical School/ Hasbro Children’s Hospital. Dr. Turcotte‐Benedict re‐cently completed her MPH at the Brown University School of Public Health. Frances is on the HCH Trauma Committee. Her current research focuses on prevention of youth violence & bullying. She will be an EM Attending at Hasbro Children’s Hospital Emergency Department.

Patrick Sullivan, MD – Instructor (Clinical) in EM, Emergency Physician‐Administrator Development (EPCAD) ‐ Dr. Sullivan received his MD from Tufts University School of Medicine as an AOA member. In 2014, he graduated from the Alpert Medical School/Rhode Island Hospital’s EM Residency Program. In 2013, he was selected to participate in the EM Residency Association’s (EMRA) ED Directors Academy Scholarship Program.

Patrick will be an EM Attending at both TMH ED and the RIH Anderson EC. For the EPCAD program, he will be working on an ED Medical Scribe Staffing Efficiency Project.

David Curley, MD, PhD ‐ Assistant Professor in EM ‐ Dr. Curley is a 2014 graduate of the Harvard Universi‐ty Medical School EM Residency Program at Brigham & Women’s & Massachusetts General Hospitals. He re‐ceived his PHD in Cell & Molecular Biology and MD from the University of Vermont College of Medicine, receiv‐ing a prestigious award for his research dissertation.

David is interested in ED redesign, patient flow, as well as communication & handoffs.

EM Residency (continued from page 14)

cently learned or teach them what you just discovered in your LLSA readings. Please use your expertise to give the podcasts they listen to some context and help frame their understanding of new material and practice varia‐tion. Here are a few more teaching tips for your next shift:

Top 10 Teaching Tips:

10. Do be a pressure valve by picking up patients primari‐ly 9. Do feed and water the team 8. Do get in the room quickly, so adjustments in manage‐ment are timely 7. Don’t micromanage or change plans without talking to the PHCP 6. Don’t disappear during shift 5. Do close the loop and discuss the pearls/EBM with jun‐iors directly


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4. Do elevate the conversation to the level of the learner 3. Do give balanced and specific face‐to‐face feedback 2. Do take residents to the bedside 1. Do explain WHY/HOW you drew conclusions

As always: Contact Laura for Program Logistics: [email protected]; Contact me for Program related concerns: [email protected]; Contact Bob Tubbs for didactics and curriculum: [email protected]; & Contact the Chiefs for resident staffing concerns: er‐[email protected], or call their hotline: 400‐CHIEF (400‐2443).

To reach the residents, use their listservs: Class of 2015: [email protected]; Class of 2016: [email protected]; Class of 2017: [email protected]; Class of 2018: [email protected]

f 2017

David Sklar , MD ‐ Visiting Professor April 15 & 16, 2014

Dr. David Sklar, Professor Emeritus of EM at the University of New Mex‐ico was our guest Visiting Professor in the Spring of 2014. Dr. Sklar has held numerous academic health care administrative leadership roles over the years including: EM Residency Program Director, Chair , Senior As‐

sociate Dean for Clinical Affairs & Associate Dean for Graduate Medical Education. He also has held multiple leadership positions on a national level including Presi‐dent of CORD, SAEM and the Chair of the Board of Direc‐tors of the ACEP. Dr. Sklar is a well‐known author of over 150 articles and a 2008 memoire entitled La Clinica describing the intersection of international health, EM & personal development. In 2012, Dr. Sklar completed a Robert Wood Johnson Health Policy Fellowship dealing with such timely topics as physician payment issues; graduate medical education; drug shortages; and end of life care. Dr. Sklar is the Editor‐in‐Chief of Academic Medicine, sponsored by Association of American Medical Colleges (AAMC), the leading journal in medical educa‐

tion.

Dr. Sklar conducted a faculty development workshop on Scholarly Writing entitled “Get Published! ‐Pearls For Successful Scholarly Writing”. He participated in clinical “Walk Rounds” in the Anderson Emergency Center at Rhode Island Hospital and also toured the Hasbro Chil‐dren’s Hospital’s ED, Lifespan Medical Simulation Center, and the Alpert Medical School of Brown University. Dr. Sklar joined the EM Faculty in a moderated dinner and discussion on hot EM issues.

Dr. Sklar gave 2 Grand Round lectures: “:Humanities & Creative Writing” and “Addressing the Health Reform Imperative: What Can Academic Medical Centers Do?”. He ended his visit with conducting individual mini‐career development/ mentoring sessions with EM Faculty.

Dr. Edward (Mel) J. Otten, MD, Professor of Emergency Medicine & Pediatrics; Division Director, Toxicolo‐gy at the University of Cincinnati College of Medicine gave 2 grand rounds lectures on May 28, 2014: Disas‐ter Preparedness Planning & Response and Heat Illness.

Dr. Otten spoke of disaster responders being prepared and flexible for different scenarios, expecting the unexpected. He also covered heat illness as a potentially fatal problem in the wilderness and discussed the pathophysiology, diagnosis, prevention and treatment of the common heat illness conditions.

Esther Choo, MD, MPH received the 2014 SAEM Young Investigators’ Award during the Ple‐nary Session at the SAEM Annual meeting in May in Dallas. Also, she was featured in the Annual Meeting Award Winners Section of the July/August SAEM Newsletter highlighting her professional accomplishments that were some of the reasons why she was chosen as a 2014 winner. Dr. Choo’s work focuses on research at the correlation between substance abuse and intimate partner violence (IPV) in female patients presenting in the ED. She is working on improving health care in this population with innovation, which was funded by a K23 grant. Esther has continually published peer‐reviewed manuscripts and abstracts with her research findings. She continually choses to do research in much needed in under‐served populations. She also works well in disseminating her findings through local and social media to “get the word out” to help impact ED practices and how others can better

serve these neglected groups. Besides the IPV re‐search, Dr. Choo also investigates many gender‐specific topics; injury prevention; marijuana use; etc.

Dr. Choo is on the cutting‐edge of study designs and statistical processes. She also mentors and works with other physician researchers aiding them with using in‐novation in their own processes. Dr. Choo is the co‐creator and Assistant Director of the EM division of Women’s Heath in Emergency Care. She served on the SAEM AEM Consensus Conference.


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Increased Speed Equals Increased Wait: The Impact of Reduction in ED Ultra‐sound Processing Time ‐ Dr. M. Lee;

The Effect of Variations in Decision Rules on Length of Stay & Bed Usage in a Chest Pain Unit ‐ Dr. Goldlust;

Federal Funding Streams for Global Health Research‐ Dr. Levine;

Top 10 Tips for Getting Started in Research ‐ Drs. Choo & Ranney;

Does a Brief Intervention Increase HIV/ACV Screening Among Drug‐Using ED Pa‐tients ‐ Dr. Clay Merchant;

Effects of a Web‐Based Educational Module on Pediatric EM Physicians’ Knowledge, Attitudes, & Behaviors Regarding Youth Vio‐lence ‐ Drs. Choo, Madsen & Ranney.

(Left) Dr. Zink pic‐tured with the PGY‐2 EM Residents at the 2014 Annual Meeting. The PGY‐2s attended the annual Brown/Lifespan EM resi‐dent luncheon hosted by Dr. An‐thony Napoli & Dr. Zink. (Below) Drs. Feden, Hudepohl, Seigel, & Lee.

SAEM Annual Meeting 2014 ‐ Dallas, TX (continued from page 11)

Brown/Lifespan ABEM Oral Examiners

Special thanks to the De‐partment of EM Faculty who participated in the ABEM Oral Boards for 2014. Our representatives were:

Dr. Dave Bullard

Dr. Catherine Cummings

Dr. Tom Haronian

Dr. Ilse Jenouri

Dr. Mihir Kamat

Dr. Libby Nestor

Dr. Dave Portelli

Dr. Beth Sutton

Esther Choo ‐ 2014 SAEM Young Investigator Award Recipient

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Publication Highlights

In Annals of EM ‐ Megan Ranney for her article in the Gen‐eral Medicine/ Editori‐al ‐ Extending Our Reach: Use of mHealth to support Patients After Emergency Care in the June 2014 issue (vol 63 number 6).

Chris Merritt for his article in July 2014 (vol 64 number 1) in the Change of Shift section entitled Pet Peeve.

gram of the cerebrocephalic vascula‐ture, transthoracic echocardiogram and attending neurologist consultation. We continue to identify small infarctions, which are the most dangerous harbin‐ger of recurrence in ~20% of patients with completely resolved symptoms, and so far our 30‐day recurrence rate is far lower than expected. Overall, we have safely reduced hospital admis‐sions by >80%, while improving overall care.

Thank you to all who have contributed to the excellent care provided to >1500 patients per year at TMH and RIH with cerebrovascular emergencies.

William Binder, MD ‐ Assistant Professor (Clinical) in EM ‐ Dr. Binder received his MD from George Washington University School of Medicine & Health Sciences. He completed residencies in both internal medicine & emergency medicine here at Rhode Island Hospital/ Brown University. He has a Masters in the History of Science from Harvard. Dr. Binder was an EM At‐tending physician at Massachusetts General Hospital since 1998 and served on the Quality & Safety Committee there. Dr. Bind‐er was also the Director of the Radiology/EM Clinical Practice Management group. Dr. Binder has worked on a per diem basis in The Miriam Hospital Emergency Department for many years.

Dr. Binder will be a part time EM attending at both TMH ED & The Anderson EC at RIH.

Almaz Sara Dessie, MD PEM Fellow ‐

Dr. Dessie is a graduate of Alpert Medical School of Brown University.

She recently completed her pediatric residency at UCSF Benioff Children’s Hospital & Research Center in Oak‐land, CA.

Almaz is interested in global health. She received a Global Health Global Scholars’ Award in 2010.

Welcome New EM Faculty & Fellows! Continued from page 15

Elizabeth Prabhu, MD PEM Fellow ‐

Dr. Prabhu is a graduate of St. George’s Universi‐ty School of Medi‐

cine in Grenada, West Indies. She completed her pediatric residency as Chief Resident at the University of Vermont College of Medicine where she received a Resident Recognition Teaching Award.

Elizabeth has been a fast track pedia‐trician in the Hasbro Children’s Hos‐pital ED since last year.

Naz Karim, MD, MHA ‐ Global Emergency Medicine Fellow ‐ Dr. Naz Karim received her MD and Master of Science in Healthcare Administration & Management from the Chicago Medical School. She also has a MS in Biomedical Sciences from Rosalind Franklin University of Medicine & Science. She recently completed her EM residency at the West Virginia University School of Medicine.

At WVU, Naz was on the Healthcare Disparities Committee for GME that created physician & resident aware‐ness of health care inequalities. She will be an EM Attending at both TMH ED and the RIH Anderson EC.

Jessica Schoen, MD ‐ Medical Simulation Fellow ‐ Dr. Jessica Schoen received her MD from the University of California Irvine School of Medicine. She received her MS in Biological Science from California State Uni‐versity, Fullerton. She recently completed her EM residency at the Mayo School of Graduate Medical Education where she was the Resident Director of the EM Medical Student Clerkship & was on the EM Clinician Award Selection Committee.

Dr. Schoen received a Mayo Clinic Excellence through Teamwork Award for the interde‐partmental collaboration on QI methodolo‐gies to improve communication & patient safety between DI & ED.

ics, Dr. Deirdre Fearon will be teaching a course at the Alpert Medical School in the upcoming academic year entitled, “Primetime Bioethics ‐ Ethics in the Media”. In this biomedical ethics class, students will watch assigned medical shows & read articles and discuss the ethical dilemmas. The students will create their own ethical dilemma episode with a resolution.

Dr. Jane Preotle, a former EM trained PEM fellow and now on joint EM/PEM faculty will become the Assis‐tant Director of the EM Residency Program in Sep‐tember.

And just to mention, our PEM faculty will be well‐represented at the upcoming American Academy of Pediatrics (AAP) national conference in San Diego October 11‐14,2014.

HCHED (Continued from page 4) (Continued from page 5) Stroke

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The Simulation center continues to work on expanding simulation programs and develop innovative projects leveraging the strength of medical simulation. In order to achieve these goals, the adminis‐trative roles have been restruc‐tured; Dr. Linda Brown has accept‐

ed the position of Associate Director to assist Dr. Frank Overly as the Director. Dr. Leo Kobayashi has assumed a new role of Director of Research and Innovation to oversee the various research programs.

The simulation fellowship continues to thrive under Dr. Ko‐bayashi’s leadership. Dr. Yasser Alaska is about to complete his one‐year fellowship, which has included research on simulation‐based assessment of arterial catheter insertions and discipline‐specific variations in procedural technique and processes. Dr. Alaska also started a simulation journal club which will continue after his graduation and we are excited to welcome our next fellow in August, Dr. Jessica Schoen, an emergency physician from the Mayo Clinic.

Additional growing interest in simulation can be seen in the resurgence of the Simulation Interest Group and the growth of the Simulation Elective, both of which are orga‐nized and orchestrated under the guidance of Dr.’s Brown and Overly with additional help from PEM Fellow, Dr. Mar‐leny Franco.

The Emergency Medicine Division of Simulation had anoth‐er strong showing at the 2014 International Meeting for Simulation in Healthcare in San Francisco, CA. The group had multiple abstracts and presentations including a pre‐conference workshop focusing on using simulation to teach strategies in triaging pediatric victims in the setting of a disaster. This was led by Dr. Frank Overly with assistance from Dr. Brown, Dr. Alaska and Max Dannecker, EMT.

Several new programs were developed over the past 6 months. One of these courses was titled “Office Emergen‐cies for Oral Surgeons”. A group of Emergency Medicine physicians; Dr. Frank Overly, Dr. Linda Brown, Dr. Brian

Clyne and Dr. Ron Van Ness‐Otunnu, developed this course which included 10 different office emergencies ranging from over sedation to full pulseless arrest. Each scenario was designed to provide oral surgeons, from the region an opportunity to manage these emergencies. The oral sur‐geons were then debriefed and given reflective feedback on best strategies when facing office emergencies. The course received rave reviews and will be run on an annual basis.

Using simulation to test preparedness of both teams and systems has been and continues to be an area of focus for the Emergency Medicine Simulation Division and the Lifespan Medical Simulation Center. Two new programs which are extensions of office preparedness are in the de‐velopmental phases. One project is being led by Dr. David Lindquist, working with the Lifespan Cardiovascular Insti‐tute. The second program is a new venture with the Lifespan Women’s Collaborative and Dr. Linda Brown is leading this project.

Finally, summertime at the simulation center has become synonymous with high school students. Between the Na‐tional Youth Leadership Forum (NYLF) and a new outreach program with Cranston West High School, between 400 and 500 young minds will come to the simulation center and learn about both medical simulation and what it means to be an emergency physician. These courses are run by Dr. Frank Overly and John Callahan with assistance from a group of EM resident , PEM fellows, Andrew Buksar ( Emer‐gency Department nurse) and the incredible sim center team (Jenn Taveira, Mark Jones and Max Dannecker).

Lifespan—Medical Simulation Center Leo Kobayashi, MD & Frank Overly, MD Co‐Directors, RIHMSC


(Continued from page 6)

Entrepreneurship Program at Brown University, gave a 2‐part presentation Vehicle for Creative Ideas: Moving Ideation to Product Development. This lecture focused on the process, timeline, successes and failures, trials and tribulations that hap‐pen in bringing ideas to fruition and the patent process. The last presentation of the EM retreat was given by William Jestings from Bengtson & Jestings, LLP and Suzanne Duni, Loss Prevention Program Manager for Lifespan/ RISE. Their presentation, Vexillum Cura: The Dy‐namic Concept of Standard of Care in the ED outlined both nationally and locally the ins & outs of the legal definition and precedents associ‐ated with “standard of care”.

The 8th Annual Department of EM Faculty Retreat

P A G E 2 0


AEC will men‐tion the app to their pa‐tients. There are posters (pictured right) in and around the ED to “advertise” the new app and it’s pur‐pose. The post‐ers have a QR code that can be scanned for a direct link to download the app. The app can be found by searching the iTunes store for "Ask the AEC", or click the link provided: https://itunes.apple.com/gb/app/ask‐the‐aec/id871579017?mt=8. This is the first ver‐sion of this app. Any future versions will rely on feedback from patients and healthcare providers.

RIH Anderson EC (Continued from page 3)

and the D‐Pod. This process decreases transitions and handoffs, puts pa‐tients in front of their care team sooner and helps decompress ambulance triage.

There are many other initiatives going on simultaneously in the ED and in the hospital. While change can be confusing and uncomfortable at times, it is all an effort to improve our patient service. We thank you for your willingness to try new ideas (and return to old ones as well) and appreciate your contin‐ued cooperation as we continue to meet the needs of our patients.

“The strength of the team is each individual member. The strength of each member is the team.”

April 2014 ‐ Esther Choo was interviewed by Channel 10 regarding medical marijuana & her research studies.

The new ambulance is coming ‐‐ slowly. We have a replace‐ment for LifePACT 1, our origi‐nal ambulance, under con‐struction. It should be done by Christmas!

Applications for our ACGME‐approved EMS fellowship are coming in. If you know of a

qualified candidate, please let them know that we are accepting applications now.

In May, 2014, Dr. Williams recently re‐ceived a certificate of grat‐itude from RI Department of Health Division of Emer‐gency Medical Services for his outstanding service and commitment to im‐proving pre‐hospital emer‐gency care in the State of RI.

The completion of the entire ED project was marked by a Donor Celebra‐tion that was held in Team 5 on June 18th!

We launched a Direct‐to‐bed initiative in May, in which patients are brought directly to an open bed if available, rather than stopping in the triage bays. This seems to have shortened the door to provider time and overall turnaround times. We are all still adjusting to the flow through our entire clinical space. Mixing acuity throughout the department has been helpful to level the workload. We are working with consultants to improve services and reduce overall turnaround times. Inpatient bed availability is often a problem for us.

In June The Miriam Hospital underwent a complete unannounced survey by The Joint Commission. The Joint Commission surveyors were extremely laudatory in their appraisal of our emergency department. We know we have a lot more work to do, but we should all take pride in that stellar re‐view!

TMH ED (continued from page 3)

Ask the AEC! Online Now! (continued from page 12)

Division of EMS ‐ LifePACT

Ken Williams, MD, Director, EMS, LifePACT

Midlevel Provider Update

During Spring of 2014, the Midlevel group welcomed it’s forth EMPED training class. The four new graduate trainees are off to a productive start, training at the Anderson and Hasbro EDs. We also welcomed 4 new hires from our 2013 class, who graduated this past April. Beginning in August, 2014, will welcome our fifth class of two train‐ees.

The State of Rhode Island welcomed its first Physician Assistant Program through Johnson and Wales University. They are UEMF neighbors on Claverick Street. UEMF’s Director of Midlevel Services, Alli‐son Jackson, PA‐C, is an Assistant Profes‐sor of the university and functions in the role of Clinical Site Coordinator for the PA program. Other UEMF midlevel providers will be functioning as Adjunct Lecturers’ for the program.

P A G E 2 1

More Media


May 2014 ‐ Dr. Jason Hack

was interviewed in the Health Connections seg‐ment on WJAR Channel 10 evening news discussing National Poison Prevention Week. Dr. Hack also gave an interview on WPRO am.

A poignant essay from Jason Hack, MD in the February 2014 issue of Academic Emergency Medicine entitled Telling Loved Ones.

May 2014 ‐ Jason Hack, Janette Baird, & Traci Green were panelists in the Brain Power Series ‐ “Addiction: The Sub‐stance Behind the Substance” as part of the NPNI sponsored lectures at the Alpert Medical School.

May 2014 ‐ Adam Chodobski, PhD; Joanna Chodobska; PhD & Neha Raukar, MD were fea‐tured in the RIMJ special Nor‐man Prince Neurosciences Insti‐tute (NPNI) edition regarding the Brown University Traumatic Brain Injury Research Consorti‐um & NPNI.

Pediatric Academic Societies (PAS) & Asian Society for Pediatrics Joint Spring Meeting, Vancouver, May 3‐6,

2014 Some of the Brown University/ Lifespan PEM Faculty Partici‐pant Highlights:

Poster Sessions ‐ Resuscitation/EMS: Current Evolving National Trends in Resuscitation Documenta‐tion ‐ M. Franco, J. Baird, L. Brown, F. Overly An Evaluation Instrument for Prehospital Pediatric Disaster Triage Simulation ‐ included L. Brown, F. Overly Sepsis/Shock: Evaluation of a Pediatric ED Sepsis Screening Tool ‐ Included L. Chapman, G. Capraro, S. Duffy Assessing Differences in Experiences with Management of Criti‐cally Ill Children in Pediatric EDs & General EDs ‐ included L. Brown Administrative Health Services: Treating Children at Urgent Care Centers: A Qualitative Study to Determine How Providers Triage Pediatric Patients ‐ included T. Canares, L. Brown, A. Garro Type I Diabetes: Plasma Matrix Metalloproteinase‐9 (MMP‐9) Levels in Children with Diabetic Ketoacidosis: Correlation with Proinflammatory Mediators & Illness Severity ‐ included A. Garro, A. Chodobski, J. Chodobska Substance Abuse & Risk Behaviors: Use of an Electronic Pre‐Visit Questionnaire & Effect on Patient‐Provider Discussion of Youth Violence in Primary Care ‐ Included A. Riese, M Ranney, J. Baird, M. Mello

Presentations with Brown/Lifespan PEM Faculty: Platform Presentation: Standardized Simulation Assessment of the Quality of Pediatric Cardiopulmonary Resuscitation Across a Spectrum of EDs ‐ Included Linda Brown, MD Diabetic Ketoacidosis Results in Elevation of Plasma Levels of Matrix Metalloproteinase‐9 (MMP‐9) in Children with Type I Dia‐betes ‐ included A. Garro, A. Chodobski, J. Chodobska

Dr. Michelle Daniel was featured in The Beat section of the Spring 2014 issue of Brown Medicine Magazine. The article entitled Anatomy of an Emergency Medicine Physi‐cian highlighted her professional & personal activi‐ties with the heading of Scuba Diva. Michelle is course leader of the Alpert Medi‐cal School Doctor‐ing Program. Taken from Brown Medicine Spring14

The Epic installation is going according to schedule. All but minor adjustments in the building portion of the software are complete. Our existing ordersets have been reconsti‐tuted from Medhost and will be available at go live. We have made some neat upgrades with regards to the inci‐dental findings on radiology studies so that you will be no‐tified of their presence and be able to act on them with a single click. We have also built in a color coded alert to notify you of critical radiology results. These are things that no other Epic system has! Other improvements in‐clude our use of single tap in tap out sign on using your badge....this also allows us to access Dragon on the central server meaning you will have only a single constantly im‐proving voice file and no need to train each machine.

Our current work involves exhaustive testing of the sys‐tem to debug it and several of you have volunteered to

participate in this. Those who were unable to sign up will have a second opportunity in late September. Training for superusers will begin in January, the masses in February and early March, and then go live is March 27,2015.

Please take the time before this to access the elearnings on the Epic Userweb so that you

are ahead of the game. Daniel Savitt, MD, Vice Chief Medical Development

Medical Development & Informatics

More on the National Scene

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EM Toxicology


The Division of Medical Toxicology would like to bid a fond farewell to the graduating residents and a hardy welcome to the new interns! This time of change is also one of reflec‐tion—what has happened and what will happen.

Although the Division is currently just me, I am buoyed by great colleagues and this year’s academic output was out‐standing.

We have published seven peer‐reviewed papers on a varie‐ty of topics ranging from Intralipid’s effects… on Epineph‐rine (J Med Toxicol. 2013 Sep), on Dabigatran (Acad Emerg Med. 2013 Oct), on Cocaine (Ann Emerg Med. 2013 Dec)—all stemming from work in our new rat lab. We reviewed, condensed and created a new algorithm for the emergency treatment of Hyperglycemic Crisis (J Emerg Med. 2013 Nov). We reported the Difficulty Creating an Anticholiner‐gic Rat Model with Atropine. (Clin Toxicol 2013 Nov) and we were the cover article discussing Antabuse in the trau‐ma patient (In Vino Veritas? Emerg Med. 2013 Sept). And, dear to my heart, we published the pilot data from my Mid‐Career grant entitled The HII Score as a Novel Assessment of Alcohol Impairment, Evaluation of a Tool. (Am J Drug Alco‐hol Abuse. 2014 Mar)!

We have completed, but not yet published, research inves‐tigating intralipid’s effects on cocaine induced cardiac ar‐rested rats, and a report on a hand cranked small animal CPR device that I invented; and I am working on two case reports. Additionally, I am working on a Tox App on Anti‐dotes with a national group.

Jason Hack, MD Director of Toxicology

WHEC completed a very successful 2014 Aca‐demic Emergency Medicine (AEM) consensus conference “Gender‐Specific Research in Emer‐

gency Care” held this past May 2014, during the SAEM An‐nual Meeting in Dallas, TX. With over 100 registrants that included key stakeholders in various EM subspecialty fields such as cardiovascular, neurovascular, trauma, substance abuse, pain, diagnostic imaging and mental health. Look out for the December 2014 issue of AEM where you will see over a dozen peer‐reviewed publications written by WHEC members.

The WHEC Public Campaign “Your Emergency is as Unique as You Are. We Know The Difference” has been in full swing with posters displayed throughout the emergency department. This was tied in with nine Educational Videos on various topics related to sex and gender emergency care with monthly drawings for winners of an Amazon.com gift certificate. We are thrilled to report that winners included

Alyson McGregor, MD Director, WHEC

faculty, residents, staff and mid‐level providers showcasing the involvement of our entire department. The videos are still available at https://vimeo.com/home/myvideos/ with password “WHEC”.

We welcome Dr. Tracy Madsen as a full time faculty re‐searcher since her completion of the WHEC Fellowship this past June. She was recently awarded the RI Foundation Grant for Medical Research for her project “Gender Differ‐ences in the Acute Care of Stroke Patients”.

We aim to develop a WHEC Community Advisory Board and welcome sugges‐tions for key people within our communi‐ty that have poten‐tial interest in sex and gender medicine as well as women’s health.

Ongoing research includes The H Intoxication Index (HII, a novel standardized quantitative nursing assessment of alcohol‐induced impair‐ment in intoxicated ED patients) research is in full swing. Since the pilot data’s publication, I’ve been contacted by two university hospi‐tals elsewhere to explore piloting the HII score at those institutions.

This year I founded the first Toxicology Section of RIACEP. To bring attention to National Poison prevention week in March, we created and distributing posters throughout RI EDs and I did several radio and TV news spots. In April, I designed, printed and distributed posters to RI EDs to get the word out about the DEA’s drug Take‐Back day which received the largest amount of returned drugs in RI since it began.

Poison center funding was and is at risk here in RI. We’d be the only state in the country hearing that “poison center information is unavailable in your area code” when calling 1800 222‐1222. Along with many people advocates for a poison center in RI, I met with DOH leadership over the past few weeks to try and convince them why not having a poison center is a bad idea. The curtain hasn’t closed but it appears that funding may come through—whether its per‐manent or temporary isn’t clear.

What’s in the future for the Tox Division? Continuing to investigate quantitative assessment of alcohol induced im‐


National Research Collaborators at the AEM Consensus Conference. (Left to Right) Marna Greenberg, Alyson McGregor, Basmah Safdar, Esther Choo.

P A G E 2 3

Foundry of Arts & Humanities in Emergency Medicine (FAHEM)


The program in medical humanities has sought to expand the scope of its projects. Dr. Bonnie Marr, fourth year EM resident, is involved with a unique collaboration and research project with the Rhode Island School of Design. Her project, 'The Weight of Pain: What Does a 10 on the Pain Scale Mean? An Innovative Use

of Art in Medical Education to Enhance Pain Management,' presented her project and preliminary results at the SAEM NERDS symposium and at the Brown Emergency Medicine Research Symposium. Bonnie gave a wonderful PGY4 Grand Rounds presentation on this work, which included the perspective of Hollis Mickey, RISD Museum educator.

The academic work with the RISD Museum educators will be presented at the New England Museum Educators na‐tional meeting in Boston this fall. Along with co‐editor Dr. Noah Rosenberg, we're scheduling the launch of our new blog, Littoral Zone. The littoral zone is the tidal area along the shore. Like the emergency department, it is a zone of great diversity and flux. The Littoral Medicine Blog is a space that captures emergency medicine’s stories, its com‐plex voices and issues, for the purpose of deepening under‐standing, encouraging dialogue, and improving the care of the communities we serve. We encourage faculty, residents and staff to submit posts to this blog. As a general rule, posts should be no longer than 300 to 400 words. We will work with writers, if necessary, to help shape the posts. We also plan on launching an EM writing group for interested faculty. Stay tuned for further details.

Jay Baruch, MD

We are in the process of updating our website, Foundry of Arts in Humanities in Emergency Medicine. http://med.brown.edu/fahem/about. More information about pro‐jects and events will be located on the site. Additional projects include the Design and Health project which unites our department, Alpert Medical School and Rhode Island School of Design. We are planning our second course in fall, 2014 with a generous grant from the Creative Arts Council at Brown University. Last fall, Dr. Leo Koba‐yashi graciously spoke to the class about his work on sound in the ED, and he is now faculty advisor for an EM project that includes students from Alpert Medical School and RISD.

We'd like to acknowledge the terrific PGY4 Grand Rounds presentation by Dr. Sarah Harkness, who spoke about mag‐ic in medicine. This talk evolved out of her early work as an undergraduate, with further shaping during her medical humanities elective.

At Alpert Medical School, the Medical Humanities and Bio‐ethics Scholarly Concentration accepted five new students into their program, and they all received summer funding.

The Creative Medicine Series continue to thrive as a collab‐oration between the Department of Emergency Medicine, Cogut Center for the Humanities and the Creative Arts Council. Scheduled quarterly throughout the academic year, usually on Wednesday evenings, it brings to the Brown community local and national experts in medicine and the arts.

pairment (HII score); investigating a novel GI decontamination substance; develop a new Tox syllabus. Additionally, I’m hoping to attract 1‐2 more Tox trained people who meet the high standards for Brown faculty and are excited to teach, do innovative research, and direct care for patients in our system suffering from overdoses and exposures.

Additional Tox related work includes becoming a Panel Member for the Community Listening Forum on Drug Overdose Prevention and Rescue. The Miriam Hospital, Providence, RI. 2014 and also becoming a Member of the Naloxone Work Group. Working to get Naloxone into the hands of people at risk for opioid related overdose (and their loved ones); through hospital, state and nationally funded channels. Increasing naloxone availability and opioid education.

EM Toxicology (Continued from page 22)

The 18th Annual New England Regional Directors SAEM Meeting (NERDs) ‐ March 26, 2014

NERDs was hosted by Yale Uni‐versity School of Medicine, De‐partment of Emergency in New Haven, CT. The Brown/Lifespan faculty was well‐represented with 14 lightning orals and 10 poster presenta‐tions at meeting. On the right is a picture of the Brown/Lifespan EM attendees.

P A G E 2 4


More Images from the 2014 Department of EM Faculty Retreat

opportunity to have their individual needs met and re‐ceive specific suggestions for improvement. Many also reported developing an increased sense of connected‐ness with their peers.

In medical school and residency, there is an emphasis on direct observation and feedback to demonstrate compe‐tency. Once we graduate, however, our development toward mastery can fade without deliberate practice. Atul Gawande wrote about this phenomenon and the value of coaching in his October 2011 New Yorker article Personal Best: Top athletes and singers have coaches. Should you? He concludes, “Coaching done well may be the most effective intervention designed for human per‐formance. Yet the allegiance of coaches is to the people

they work with; their success depends on it. And the ex‐istence of a coach requires an acknowledgment that even expert practitioners have significant room for im‐provement.”

As talented and multidimensional as emergency physi‐cians are, nobody can do it all. Whether it’s teaching, clinical reasoning, documentation, or efficiency—we can all identify areas we’d like to improve. So, the next time you set a goal to improve or master a skill, look to peers who deliver the best care, the best teaching, or who have the best productivity. Opening ourselves up to be‐ing coached, and in turn coaching others, creates a peer‐driven system where everybody wins.

(continued from page 14) Medical Education

EXTRAMURAL FUNDING Tracy Madsen, MD was awarded a1‐year $14,663 grant from The Rhode Island Foundation for her project entitled, “Gender Differ‐ences in the Acute Care of Stroke Patients in Rhode Island.” This project will investigate whether gender differences exist in acute aspects of care of ischemic stroke patients at Rhode Island Hospi‐tal.

Roland C. Merchant, MD, MPH, ScD was awarded a 2‐year, $462,825 R21 grant from NIH / NINR for his project entitled, “Facilitating HIV Testing Among Young Adult MSM Through Social Networking.” The study will investigate a novel internet‐based approach to facilitate HIV testing among young adult black, His‐panic and white MSM through social networking and a new rapid HIV self‐test. The ultimate aim of this project is to help improve HIV testing outreach among this at‐risk population.

Recent EM Research Funding INTRAMURAL FUNDING Elizabeth Goldberg, MD was awarded a 1‐year, $39,966 Research Development Grant from UEMF for her project “Is ED Hyperten‐sion Predictive of Future Hypertension?” This study hopes to es‐tablish that ED hypertension has prognostic value for the diagno‐sis of hypertension. It will provide data for future sample size cal‐culations and studies and it will help establish a target group for future research. The public health importance is that earlier inter‐vention and diagnosis may help to decrease rates of uncontrolled hypertension, cardiovascular disease, and stroke.

Michael Lee, MD was awarded a 1‐year, $38,069 Research Devel‐opment Grant from UEMF for his project “ED Practice Intensity Costs and Outcomes from Random Provider Spending Variation.” This project will investigate the strategy of using individual prac‐tice patterns of randomly‐assigned ED physicians as an instrumen‐tal variable is a novel methodological contribution to EM that can be applied to a wide range of clinical questions.

See Article on page 6

summer 2014 (pdf)

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