winter 2012-2013 (pdf)

E

I N S I D E T H I S

I S S U E :

Department of

Academic emergency physi-cians are under some pressure as of late. As ED visits rise, we are asked to see sicker, more complex patients. With inadequate community resources and a persistent lack of primary care, we continue to be the safety net for the world of medicine and beyond. Ten years ago there was a sense of appreciation for this safety net role of emergency medicine (EM). How things have changed. Now ED’s are derided by policy makers and the media, and some-times other academic physicians, as ven-ues of “inappropriate” visits where we test too much and rack up huge health care bills and keep patients from using their primary care doctor. While we know that this is a gross misrepresentation of EM, and must constantly push back with facts and data to correct wrong impressions, there are some things that we must own. I think medicine, including EM, suffers from an accountability gap. Accountability is the willingness to accept (“own”) responsi-bility for our actions and approaches. As we look at our traditional tripartite aca-demic mission there are significant gaps in accountability in each area.

Clinical Care: While there have been some champions of quality and patient safety for over 20 years, EM, like the rest of medicine has been far too slow to adopt the practic-es that improve quality and safety (see Re-search below). We still find reasons NOT to practice evidence-based medicine, and resist standardization of practice. We ac-cept poor communication and teamwork

when we know that better communica-tion gets better results. We tolerate long waits, and make excuses for poor service. And rather than taking control of what we can control, we blame others – “the hospi-tal”, “administration”, “the system”. We also account for a substantial amount of health care spending, and could be more in-volved in controlling excessive health care costs. Until we hold ourselves and each other accountable in the clinical arena, we will not deliver the type of emergency care that we all want to deliver.

Education: Part of the accountability gap in education is our lack of training as medi-cal educators. For too long we have relied on the few “naturals” in our departments who can teach well and connect with trainees without much help. But most of us have deficiencies in our ability to teach – we could be much better. Whether it is giving feedback, presenting a high quality lecture, or assessment and evaluation, spe-cific training can make us better. We won’t all be able to get Masters degrees in medi-cal education, but we can aspire to learn to be better teachers through study, work-shops, courses, etc. Another part of the accountability gap in EM education is how we handle burgeoning clinical volume without sacrificing bedside teaching. If we rely too heavily on our residents for ser-vice, we are not fulfilling the promise that we made when these residents were appli-cants. We must preserve teaching mo-ments, rounds, and time for feedback in our busy shifts.

Research: The amazing growth of EM re-search has produced a wide variety of

Brown University Department of

Emergency Medicine

Newsletter

Our newsletter is

published twice a

year to provide news

and information

about Emergency

Medicine to the

health system,

medical school, our

alumni and friends.

V O L U M E 8 , I S S U E 1 S P R I N G 2 0 1 3

TO PROVIDE EXCEPTIONAL EMERGENCY MEDICAL CARE, EDUCATION, RESEARCH AND SERVICE TO THE PEOPLE OF RHODE ISLAND AND BEYOND.

Message from the Chair

Academic Emergency Medicine’s

Accountability Gap

Anderson AC

Brown Faculty

Chest Pain Center

EM Residency

EMS

Grand Rounds

Hamolsky Award

International EM

In the Spotlight

Injury Prevention

Medical Humanities

Pediatric EM

Publications

Regional/National

Research

Simulation Center

Sports Medicine

Toxicology

3

5

7

6

5

14

20

16

17

8

19

4

12

13

10

15

8

18

Women’s Health 18

The Miriam ED 3

(continued on page 2)

M mergency edicine

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 Chai r I will close with a few examples where EM has dealt with an issue of accountability and did the right thing for patients and our field. In the clinical arena we have responded to less than stellar performance with quality improvement changes to improve out-comes in some of our sickest patients – acute MI and stroke – by pushing down the time to diagnosis and treatment. This has required meticulous attention to detail, constant reinforcement, and measurement and reporting – and it is now routine for us to have

top decile performance in these areas. In the area of resident education, faculty supervi-sion of residents on a 24 hour a day basis was not routine even in to the late 1980’s. Some in EM began to push for 24 hour facul-ty supervision, but many resisted doing this,

with rationalizations and arguments playing out in the editorial pages of our journals. Finally, the RRC- EM mandated 24 hour faculty supervision in 1989 and we were fully accountable in providing resident supervision. It took a long time, but EM eventually led the way among specialties in full-time supervision of residents. In the research realm we have used EM-derived research to change clinical practice with ap-plication of the NEXUS cervical spine clearance rules, and the implementation of early goal-directed thera-py in sepsis.

Accountability can be elusive and take a while to achieve, but it is clearly possible. It can be the thread that we use to weave our way to future success in academic emergency medicine.

If you have thoughts on this essay, or anything else in this Newsletter, p l e a s e e m a i l m e a t [email protected] Happy 2013. Please enjoy this edition of our Newsletter, and keep in touch.

(continued from page 1)

new knowledge, but the accountability deficit here is one of dissemination in to practice. We have created the evidence but too often it sits in magnificent peer-reviewed journal articles and does not result in evi-dence-based practice. The accountability equation in this case is simple, but hard to achieve - investigators who do the research must own their work all the way to changes in clinical care, and clinicians must pull evidence-based research in to their practices. Otherwise the millions of dollars that we spend in basic science and clinical research have not been a meaningful investment.

Before you accuse Dr. Eternal Optimist of getting off to a grumpy start in 2013, know that I am still bullish on academic medicine, and particularly academic EM. But I strug-gle with the big bear of accountability just as you do. So how do we get more accountable? In most situa-tions, it is not a lack of knowledge, or methods, or resources that creates the accountability gap – it is the inability to change our culture. Solutions to en-hance accountability in any of the areas of our mis-sion are not accomplished in a month –they make take a decade - but we need to own every step for-ward, and confront the forces that hold us back.

The process of “holding you accountable” invokes mental images of finger wagging, a looming pres-ence, and growling voice. But, we don’t have to be confrontational or irascible in our push for accounta-bility. Excessively demanding, punitive behavior might get a short term result, but is not a long term solution for change. The more enduring approach is to involve the entire team in identifying accountabil-ity gaps, make a plan together for how to gain ac-countability through small changes, collect data, set standards, define and regularly share metrics, and then incentivize for strong performance. With this approach, penalties and confrontations can be few – as long as the whole team is willing to hold each other accountable. And the best thing we can each do is lead by example.

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

Brian J. Zink, MD

Accountability can be the thread to weave our way to future success.

Rhode Island Hospital has planned various events through-out 2013 commemorating the hospital’s 150 years of providing quality health care to the State of Rhode Island & beyond.

Check out the website: www.rhodeislandhospital.org/150th-Anniversary

RIH—150 Years Celebration

http://rhodeislandhospital.org/150th-Anniversary

P A G E 3

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

If you have been around the exte-rior of The Miriam Hospital Emer-gency Department lately, the pic-

ture below exemplifies what you and patients may have seen. Inside a construction fence, an excavator digs up the driveway leading into what will soon be the new TMHED walk-in en-trance. The dig will enable installation of a new electrical feed for the hospital. This is a valuable infrastructural improvement that was wisely tied into the ED renovation project. This redundant electrical feed will help reduce our chance of sus-taining a power outage, and ensure the entire hos-pital's viability in a disaster. The walk-in entrance is

starting to taking shape in the back-ground. Rescues and ambulances are shoe-horned into the driveway. The pic-ture captures the feel of the cramped nature of things at TMH, the disruption entailed by the renovation project, as well as the excite-ment of what a new ED, better prepared for the future will mean for us.

That new walk-in entrance, waiting room and ren-ovated triage area opened in January. Besides be-ing a beautiful professional space, it provides bet-ter patient flow. The next phase of the project will then involve the conversion of the "Annex" into the ED CT suite. This will include installation of a new bariatric 650lb capacity scanner, and a 5 bed observation/holding area. Another important ele-ment of this phase will be an upgrade of the ED plain film room to digital equipment. This imaging equipment should help enhance our ED through-put. That phase will be complete around July of 2013.

Patients and rescues have been undeterred by the inconveniences of our renovation and those creat-


Despite our active

renovation, we are

seeing more patients

than 1 year ago.

Anderson Emergency Center We have seen patient volume increase over the past year. Pa-tients continue to select us as their provider of choice for emergency care and our care-

teams work hard every day to meet their expectations. In January, we made adjust-ments to the staffing and Pod utilization to better accommodate the growing patient volume. The changes increase the areas we use for patient care and make more spaces available for waiting patients. In particular, one of these areas focuses on the care of low acuity patients, and better ad-dress the needs for this patient population. Cur-rently, the new Pod operations only occur during the week, and the Pods will function as they do during the weekends. As we increase staffing in the future, the changes to Pod functions will also include the weekends.

Our C-Pod has been converted into an ur-gent area and care for more acute patients. The physician, midlevel and nursing staff-ing has been increased accordingly to cov-er these patients. The Pod opens earlier in the day, having all rooms available at 8 am, and remain open until 1 am. This area has

helped us increase the throughput of ESI 2 and 3 patients over more of the day.

The E-Pod serves to concentrate patients coming out of the Critical Care area and continue to tran-sition admitted patients. Patients cleared from Critical Care will move to the E-Pod to continue their care. In addition to increased nurse staffing, a midlevel provider was also assigned to this area. This provider works and coordinates with the Critical Care attending and residents, to ensure patients continue to progress through their man-

Frantz Gibbs, MD, Medical Director, Rhode Island Hospital, Anderson Emergency Center

(continued on page 16 )

New staffing & space utilization plans are already

improving patient flow.


P A G E 4

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


The Hasbro Children’s Hospital Emergen-cy Department patient volume and acui-ty has risen sharply this winter season. Significant numbers of influenza and RSV cases are being reported.

As part of our winter plan to address increasing vol-ume and to assist evening staff to meet late evening and overnight patient care demands, we have estab-lished a 9pm to 4am clinical attending shift. This will be the staffing configuration through March, 7 days a week. The staff change will be closely monitored to see if desired goals are being achieved.

On the clinical side, the HCHED has rolled out a sep-sis triage tool and protocol this past fall. Part of the protocol is a sepsis bundle order including IV and labs.

In academics, The Hasbro ED is enrolling participants in three PECARN studies and three other multicenter studies. Our own PECARN study (Project ASSESS—Age Specific Screen for Ethanol and Substance Sta-tus) was initiated in September and we will be con-ducting formal training with the other 16 participat-ing pediatric emergency departments from the study in Providence in early April.

Bonnie MacKenzie, MD, an EM pediatric fellow, gave a lecture entitled “ Evaluation of the Effects of a State Concussion Law on Pediatric Visits to an Emergency Department”. Dr. MacKenzie presented at the Na-tional American Academy of Pediatrics Conference and Exhibition in New Orleans in October 2012. Another pediatric EM fellow, Frances Benedict, MD, gave an oral presentation on the Association Be-tween Mental Health Disorders and Bullying in the US Among Children Aged 6 to 17 Years on October 22, 2012 in the section of the conference for Injury, Violence, and Poison Prevention. Two of our pediat-ric EM fellows, Drs. Matthew Wyllie and Marleny Franco, gave a presentation at the Hasbro Children’s Hospital 2012 Pediatric Trauma Symposium in No-vember called “ The Collapsed Athlete”.

Jane Preotle, MD, a graduating pediatric EM fellow, will join us as the newest pediatric EM/EM attend-ing, boarded in EM and anticipates Board –eligibility in pediatric EM. Jane will work in the HCHED, An-derson Emergency Center, and The Miri-am Hospital Emergency Department.

The pediatric EM fellowship is pleased to welcome two new fellows arriving in Ju-

ly. Mariann Nocera, MD is a graduate of University of Connecticut Medical school and is completing a pediatric residency at Yale University School of Medicine. Robyn Wing, MD graduated from University of Massachusetts Medi-cal School and is currently a pediatric chief resident. Please join us in welcoming our new fellows.

In recapping 2012, HCHED has had many accom-plishments. The emergency department had 52, 591 patients through the door. This was the 5th con-secutive year of caring for over 50,000 patients.

Throughout the year, there have been many clinical ED initiatives developed by collaborating with other clinical providers to meet common goals in patient care and treatment of common illnesses.

HCHED joined with 14 other children’s hospitals in a pediatric sepsis collaborative. This group formed a multidisciplinary sepsis planning team and designed and initiated a sepsis triage tool and management protocol.

The HCH emergency department established best practice initiatives and aligned with PEM/Emergency Medical Services for Children best practices includ-ing, minimizing chest x-rays in patients with asthma, decreasing head CTs in patients with minor head injury, expediting the time to antibiotics for neonates with fever, and immune compromised patients with fever.

Pediatric emergency medicine worked with various departments throughout the Lifespan health system on improving patient care. Pediatric EM collaborat-ed with the pediatric trauma service to adopt new level of trauma criteria. Pediatric EM worked with neurosurgery, radiology and pediatric trauma to de-velop pediatric s-spine guidelines to reduce excessive radiation in children. We also joined together with radiology to reduce excessive radiation by develop-ing a protocol to utilize ultrasound and MRI to evalu-ate patients with abdominal pain at risk for appendi-citis. To improve the evaluation process in the chil-dren’s ED for patients with primary mental health complaints, we partnered with child and adolescent psychiatry. This demographic of patients has in-creased 25% from 2011. This partnership reduced the turnaround time for discharged child psychiatry patients by 2 hours. The RN/MD Collaborative Care Committee has been expanded. This committee worked on shared care initiative, such as team train-Sue Duffy, MD -

Medical Director, Hasbro Children’s Hospital ED (continued on page 15)

P A G E 5

EMERGENCY MEDICINE FACULTY

Clinical Assistant Professor David Bouslough, MD, MPH Erica Constantine, MD Catherine Cummings, MD Thomas Germano, MD Kirstin Gregg, MD Andrew Griscom, MD Thomas Haronian, MD Ilse Jenouri, MD, MBA David Kaplan, MD Matthew Kopp, MD John LaFleur, MD David Lindquist, MD James Monti, MD James Rayner, MD John Riedel, MD Marcia Robitaille, MD Dana Sparhawk, MD Brian Wiley, DO

Clinical Instructor Amir Bernaba, MD Laura Forman, MD Katherine Kimbrell, MD Megan McNamara, MD

Teaching Associate Christine Garro, PA Allison Jackson, PA Lisa Murphy, FNP John Pliakas, MSN Research Associate Julie Bromberg, MPH Teaching Fellows Bryan Choi, MD—Disaster & EMS Allysia Guy, MD—Ultrasound Tracey Madsen, MD— Women’s Health in Emergency Care Stephanie Midgley, MD—Ultrasound Catherine Pettit, MD— Medical Simulation Allison Riese, MD— Injury Prevention Center

Associate Professor Adam Chodobski, PhD (Research) Thomas Chun, MD, MPH Susan Duffy, MD Jason Hack, MD Leo Kobayashi, MD Michael Mello, MD, MPH R. Clayton Merchant, MD, MPH, ScD Ted Nirenberg, PhD (Secondary) Frank Overly, MD Daniel Savitt, MD Dale Steele, MD Jonathan Valente, MD

Professor Bruce Becker, MD, MPH Gregory Jay, MD, PhD William Lewander, MD James Linakis, MD, PhD Selim Suner, MD Brian Zink, MD

Assistant Professor Siraj Amanullah, MD, MPH Janette Baird, PhD (Research) Jay Baruch, MD Francesca Beaudoin, MD, MS Linda Brown, MD, MSCE Joanna Szmydynger-Chodobska, PhD (Research) Geoffrey Capraro, MD, MPH Esther Choo, MD, MPH Brian Clyne, MD Jeffrey Feden, MD Rachel Fowler, MD, MPH Aris Garro, MD, MPH Eric Goldlust, MD, PhD Nathan Hudepohl, MD, MPH Michael Lee, MD Adam Levine, MD, MPH

Associate Professor (Clinical) Deirdre Fearon, MD Gregory Lockhart, MD Kenneth Williams, MD

Assistant Professor (Clinical) David Bullard, MD, MEd Charles Callahan, MD, MPH Sarah Case, MD Laura Chapman, MD Ciarallo, Lydia, MD Jamieson Cohn, MD Michelle Daniel, MD John Foggle, MD Sarah Gaines, MD Frantz Gibbs, MD Mark Greve, MD Tobias Kummer, MD Elizabeth Jacobs, MD Joseph Lauro, MD Laura McPeake, MD Krithika (Meera) Murgunandan, MD, MPH Lynne Palmisciano, MD Paul Porter, MD Jessica Smith, MD Elizabeth Sutton, MD Lynn Sweeney, MD Otis Warren, MD

Assistant Professor cont, Otto Liebmann, MD Alyson McGregor, MD, MA Lisa Merck, MD, MPH Christopher Merritt, MD, MPH Anthony Napoli, MD Megan Ranney, MD, MPH Neha Raukar, MD, MS Lisa Schweigler, MD, MPH Todd Seigel, MD Matthew Siket, MD Robert Tubbs, MD

Clinical Associate Professor Gary Bubly, MD Mihir Kamat, MD Matthew Kopp, MD James Monti, MD Andrew Nathanson, MD David Portelli, MD Lawrence Proano, MD Francis Sullivan, MD


Clinical Professor Elizabeth Nestor, MD, M Div.

Upcoming Grand Rounds Speakers

Jesse Pines, MD, MBA, MSCE Associate Professor of EM & Director of the Center for Health Care Quality George Washington University Health Policy/ED Overcrowding March 20, 2013 Kip Benko, MD Clinical Associate Professor of EM University of Pittsburgh, School of Medicine UPMC—Presbyterian Hospital Dental Emergencies May 22, 2013 Gregory Jay, MD, PhD Professor of EM & Vice Chair, EM Research Alpert Medical School, Brown University Topic to be announced June 19, 2013

P A G E 6

The residency program recently affirmed its five year vision and established new goals to define our success. Our vision “to have the most highly-regarded, sought-after, and high quality Emergency Medicine residency program in the nation” will be measured according the following criteria:

Continuous maximum allowable ACGME accreditation

Top decile performance for education on the annual ACGME resident survey

>90% resident compliance with clinical quality measures

A 5% annual increase in residency applications

100% of graduating residents who meet or ex-ceed Level 4 competency on the EM Milestones

A 100% first-time ABEM pass rate for graduates

Consistently produce >50% of graduates who pursue advanced training or skills to become clinical, academic, and service leaders in emergency medicine.

Some of these goals will be harder to achieve than others, but we be-

lieve that pursuing them will continue to set us apart.

I am also pleased to announce the recent approval of an exciting new fellowship sponsored by our de-partment. The Medical Education Research Fellow-ship in Emergency Medicine is a two year mentored fellowship that provides advanced training in class-room and bedside teaching, curriculum design, and medical education research for a graduate of an accredited Emergency Medicine residency program. It is one of only twelve such programs in the coun-try affiliated with EM residency programs. Fellows will have protected time and structured guidance to develop expertise in an area of medical education research as a means to becoming an independent researcher and educational leader at the local and national level. The strength of the program is its multi-disciplinary approach, offering mentorship from faculty across the medical education spectrum. The program includes a master’s degree in Medical Education Leadership and is designed to provide a strong foundation for a career in academic Emer-gency Medicine. This new fellowship will expand opportunities for EM residents and fellows to en-gage in educational research, scholarship, and teaching.


Brian Clyne, MD Director EM Residency

New Program Goals & a New Education Fellowship

In September 2012, The Joint Commission reviewed and certified Rhode Island Hospital as a Primary Stroke Center again. This certification is good for 2 years. Recently , we standardized the ordersets in our ED documentation sys-tem MedHost for stroke (and related problems) at both TMH and RIH.

We have made excellent progress in the treatment of acute stroke at TMH. The data of our progress was presented at the monthly meetings in November and December. We track 4 ED-related stroke metrics. Our performance was commendable on each metric. Next year we have set even higher goals. Our performance in these areas has improved significantly since the prior year.

We are moving forward with the TIA Observation Unit at RIH on March 1, 2013. As of that date, we will be placing patients in this pathway to arrange rapid evaluation and neurology follow-up for patients with sus-pected TIA. With this Observation Unit, we plan on addressing a num-ber of issues related to TIA, such as eliminate significant physician prac-tice variation; expedite throughput of TIA patients awaiting neurology consultation; decompress inpatient volume; create an excellent oppor-tunity for data collection and participation in clinical trials and potential-ly decrease the incidence of short-term stroke after TIA by standardizing and front-loading the diagnostic evaluation.

Stroke Programs at RIH & TMH

Todd Seigel, MD Director

Dr. Bubly Named Public Health Hero

Gary Bubly, MD, Medical Director of TMH ED, was named a "Public Health Hero” by the Association of State & Health Territori-al Officials (ASTHO). Dr. Bubly was nominated by the RI Department of Health “for his assistance in writing reg-ulatory language regarding emergen-cy dispensing of medications from emergency rooms. He has also been a driving force in developing Rhode Is-land's legislation on the state's new Pre-scription Monitoring Program, which allows for daily real time reporting from pharmacies and web access for provid-ers, so ER physicians can make sound decisions when writing prescriptions for controlled substances.” Excerpt from TMH press release. Only 41 physicians/researchers have been recognized as a “Public Health Hero” nationwide.

P A G E 7

Re-accreditation of our institution as a Chest Pain Center is a testament to the quality of care we provide our chest pain patients. Our chest pain unit and our advanced treatment of out of hos-

pital cardiac arrest victims with neuroprotective hypothermia are key components of that; they con-tinue to thrive operationally and academically.

Identifying acute coronary syndrome amongst low risk chest pain patients can be challenging. Admis-sion to observation units can save hospital admis-sions and result in protocol-based safe and effec-tive care, but can be at the expense of admitting patients of whom the overwhelming majority have no cardiac disease. Research from our own CPU has effectively demonstrated this. However, as we advance into an era of cost containment and self-examination of the necessity of healthcare utiliza-tion in select situations, we must examine our own practice. Research outside and now within our own institution has shown this to be the case. Pa-tients less than 40 years old without a history of coronary artery disease, with a non-ischemic ECG and normal initial troponin are at very low risk of

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

adverse outcomes such that discharge from the Emergency Department has been shown to be safe. In our own cohort, over the last 2.5 years, we have seen over 400 patients in the CPU who met such criteria – none of them had an infarct, none have had a positive stress test, and none had an adverse outcome at 30 day follow-up. As such, we have revised our CPU admission guidelines to rec-ommend discharge of such patients so that we can better utilize the resources we have while safely providing quality care to those in need. We also continue to have great success in our 2 year old program to provide neuroprotective hypothermia for out of hospital cardiac arrest victims with spon-taneous return of circulation. Between The Miriam and Rhode Island Hospital we have now treated over 50 patients. Thanks to the hardwork and dedi-cation of our clinical staff in the EDs and ICUs, our outcomes have been excellent. Our neu-rologically intact survival rate for out of hospital cardiac ar-rest stands at 41%, nearly dou-ble what it was preceding im-plementation.


Division of EMS - LIfePACT

Where’s the PIF? - As you may know, EMS became an ACGME-approved subspecialty of emer-gency medicine in October 2011. The rules for becoming an accredited fellowship and for tak-ing the qualifying examination are now being finalized. The fellowship application process in-cludes a 27-page program information form, or PIF, that was released on November 1. Despite amazing cooperation and effort from everyone at UEMF, particularly, Wendy Wesley, and includ-ing a GME consultant to help with curriculum formatting, we will not be able to move our PIF through the Rhode Island hospital GME committee (a process that usually takes 3 to 6 months) in the few weeks remain-ing before the January 4 submission deadline for this cycle. We will, however, have an excellent PIF to sub-mit early this spring, and hope to have an accredited fellowship within a year. Meanwhile, our GME-approved fellowship continues. Bryan Choi is doing excellent work related to the Providence Fire Department prioritized dispatch change as part of his MPH studies, and continues to work clinically in our emergency departments and on LifePACT.

Since when does LifePACT do scene calls? - Since, well, forever! Rhode Island Hospital provided horse-drawn, and then motorized, ambulance service to the citizens of Provi-dence early in its history. Thanks to Rob Hager, from Decision Support, for the loan of both

Rhode Island hospital’s history book and an ambulance hat worn by one of his relatives, a surgical resident who responded as part of the RIH ambulance crew many years ago. As Rhode Island Hospital celebrates its 150th anniversary, notice the many historical pictures that include hospital-based ambulances, and the stable, garage, and pond that served LifePACT’s predecessors. Although Rhode Island Hospital no longer provides primary 911 ambulance service to the Providence community (this is provided by the Providence Fire Department), LifePACT (which celebrates 4 years of 24/7/365 service on January 1) has always been available for mutual aid at incident scenes when indicated. We get about one or two such requests from 911 ambulances a


Kenneth Williams, MD Director, EMS

Injury Prevention Center

P A G E 8

Injury Prevention Center Completes Study & Presents Findings

As part of the American College of Sur-geons verification to be a level 1 trauma center, centers are required to have the

capacity to identify trauma patients with risky alcohol use and provide an intervention. With funding provid-ed by CDC’s National Center for Injury Prevention and Control, the Injury Prevention Center at Rhode Island Hospital partnered with seven Injury Free Coalition for Kids sites, a coalition of 42 trauma center based, com-munity oriented injury prevention programs, to trans-late SBIRT to the adolescent patient. The research study was divided into three phases: adoption, implementa-tion and maintenance, each lasting one year. Sites par-ticipated in 24 months of technical assistance activities. Each site conducted a blinded retrospective review us-ing one month of medical records of injured adoles-cent patients eligible for SBIRT services admitted at baseline before the start of the adoption phase, at the end of the implementation phase and at the end of the maintenance phase.

Dr. Michael Mello, Ms. Julie Bromberg and representa-tives from the participating sites presented study find-

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

ings and related recommenda-tions in November at the 2012 Injury Free Coalition for Kids Annual Conference in Kansas City, MO. At the end of the implementation phase, all seven sites had effectively adopted and implemented SBIRT policies for injured adolescent inpatients. Ac-cording to the medical record review, across sites 11% of eligible patients received alcohol screening at base-line but this increased to 73% of eligible patients re-ceived alcohol screening at both the end of the imple-mentation and maintenance phases. The experience and data accumulated was utilized to produce “Implementation of Alcohol Screening, Brief Interven-tion and Referral to Treatment Policies in Pediatric Trauma Cen-ters”, a manual containing rec-ommendations for the develop-ment and implementation of SBIRT programs at pediatric trau-ma centers. It was distributed at the conference to all attendees as well as will be mailed to all pediatric trauma services nation-ally.

The Center for Sports Medicine has seen over 1000 concussion visits in 2012, making us one of the big-gest sports concussion programs in the State.

Mark Greve, MD has started to see patients at the Cen-ter. Dr. Greve’s specific interest is cycling injuries.

Since being named to the Institute of Medicine’s Com-mittee on Sports-Related Concussions in Youth, I at-tended the first meeting in Washington, DC. The group is very diverse. It is wonderful to have the op-portunity to contribute the EM perspective on the top-ic.

In November 2012, I gave a lecture entitled “ Tackling Concussions: What’s the Hype?” at the Hasbro Chil-dren’s Hospital Pediatric Trauma Symposium.

Fall 2012 was busy for the Center. Besides seeing pa-tients at the Center, Dr. Jeff Feden has been the teams

physician at Roger Williams University and the Physician Medical Director/ Advisor to RWU’s Emergency Medical Technician Program.

Sports Medicine

Neha Raukar, MD Director, Division of Sports Medicine


Visit us at http://www.thecenterforsportsmed.org/

Welcome Back, Dr. Paul Porter Dr. Porter returns this month from active National Guard duty after being deployed since August 2012. Dr. Porter was stationed at Walter Reed Medical Center in Bethesda, Maryland. This is Dr. Porter’s se-cond tour of active duty. In 2011, he was deployed to Iraq where he cared for injured soldiers. Dr. Por-ter beamed, “This was an Incredibly, emotionally, fulfilling experience. I fell in love with America again. I took care of the most decent, kind, people you would ever want to meet in your life.” At Walter Reed, Dr. Porter treated numerous amputees. They have a large prosthetic department at Walter Reed. He was able to learn more about the complications that some patients have with limb loss. Dr. Porter

was featured in the Novem-ber/December 2012 edition of the Lifespan D i v e r s i t y N e w s l e t t e r (pictured be-low) recogniz-ing Veterans’ Day.

http://www.thecenterforsportsmed.org

Gr and Rounds

This past year

P A G E 9


EMS—LifePACT

month. In November, Brandon Maughan was fortunate enough to accompany the LifePACT crew on two mutual aid calls to motor vehicle crashes, and took the pictures that accompany this note. These scene calls provide not only opportunity for resident education and patient care, but they also strengthen our relation-ship with Rhode Island’s EMS community.

EMS—RIde — We have awarded EMS RIde certificates for excellent EMS care at the Department of Health Am-bulance Service Advisory Board meetings for over a decade now. This month, we presented 17 certificates to deserving EMTs and other first responders who participated in three different EMS events: an asthmatic child whose mother is one of our ED nurses, the tragic crash that took the life of a pregnant woman, and sadly her child, who was delivered by peri-mortem C-section at Kent Hospital and then transferred to Women & Infants Hospital but died a few weeks later, and a serious motorcycle crash that took place in Norton, Massachusetts. If you witness excellent EMS care, please let us know so that we can reward the service provided by the involved EMTs.

Personal Safety — The recent tragedies in Newton Connecticut, Clackamas Oregon, Chenpeng China, the Philippines and across the Middle East remind us that disasters may not happen to us individually every day, but the potential is always there. A few minutes spent planning and preparing with your family may make an important difference. Consider developing personal plans for: Supplies at home to survive a few days without power, including food, warmth, light,

and drinkable water. Consider what would happen if you were stuck at work and your family had to make do without you. How will you communicate? Do they have adequate supplies and plans to weather the storm without you?

A plan to evacuate your home if it becomes unsafe due to storm, fire, or a violent home invasion. Is there a safe gathering place that your family all knows and will proceed to if necessary?

Safe transportation for yourself and your family during winter storms and other transportation challenges. Is your car battery in good shape? Do you have jumper cables, a blanket, a flashlight, and a pair of work gloves in your car? How about a first aid kit? We developed the “RI Roll” first aid kit for people to carry in their cars -- it contains BLS emergency supplies in a convenient visible roll.

University Emergency Medicine Foundation In 2012, UEMF welcomed several new employees, reorganized and streamlined business operations.

Kirsten Rounds has been named Senior Executive Administra-tive Director. Kirsten is located at Claverick.

Danielle Renzo has become the Director of Human Resources. Danielle is located at Imperial.

Jodi Remick will continue her role as Director of Revenue Oper-ations. Jodi is located at Whipple Street.

Keith Neal is the Director of Finance and is located at Imperial.

Alison Zangari is now an HR Generalist located at Imperial.

Paul Marino is a new Data Analyst located at Claverick.

Dennis Ferrante is a new Data Manager located at Claverick.

Michelle Lindros is a new Administrative Assistant located at Imperial.

UEMF has expanded its office space at 125 Whipple Street, Providence. The location will have business offices, as well as, physician offices.

Welcome Catherine Cummings & Frank Overly to the UEMF Board of Directors. Welcome back Matt Kopp for his 3rd term on the Board. Special thanks to Drs. Sue Duffy & Dave Portelli for their service on the Board.

Good Luck, Kavita!

November 2012, Kavi-ta Babu, MD, bid fare-well to the Brown Uni-versity Department of Emergency Medicine.

Dr. Babu is an Assistant Professor of Emergency Medicine and Medi-cal Toxicology Fellowship Director at University of Massachusetts Medical School General Hospital. Kavita completed her Toxicology Fellowship at UMass-Memorial Medical Center. For Kavita, this position was a great opportunity closer to home. Dr. Babu will con-tinue to work per diem clinically at Anderson Emergency Center and The Miriam Hospital ED.

(continued from page 7)

Additional space at Whipple Street

Chest Pain Unit Medical Director

P A G E 1 0

EXTRAMURAL FUNDING James Linakis, MD, PhD was awarded a 5-year, $3,278,096 R01 grant from the National Institute on Alcohol Abuse and Alcoholism at NIH. His project, entitled “Teen Alcohol Screening in the Pediatric Emergency Care Applied Research Network” will utilize 15 sites in the HRSA-funded PECARN network to determine if the NI-AAA two-question screen is an efficient and valid alcohol screening instrument among US pediatric emer-gency department patients. This study has the potential to validate a screen that can then be used in pediat-ric emergency departments, which in turn will likely result in earlier identification of and intervention with alcohol-using youths.

Adam Levine, MD, MPH was awarded a 5-year, $679,529 K01 grant from the Fogarty International Center at NIH. His project, entitled “Assessment of Dehydration in Children with Diarrhea in Resource-Limited Set-tings,” will develop new and improved clinical and ultrasound-based methods for diagnosing severe dehy-dration in children with diarrhea. These new methods will help doctors and nurses in the developing world identify those children at greatest need for emergent intervention, prevent adverse events, and improve health outcomes, all while conserving scarce healthcare resources.

Aris Garro, MD, MPH was awarded a 2-year, $80,000 grant from the American Lung Association. His study, entitled “Optimizing Use of Inhaled Corticosteroids after Emergency Department Visits for Children with Un-controlled Asthma,” will develop a systematized method to prescribe inhaled corticosteroids (ICS) to children with uncontrolled asthma after an emergency department (ED) visit, and identify factors associated with medication adherence to develop an educational component to accompany prescriptions.

INTRAMURAL FUNDING Chris Merritt, MD, MPH was awarded a 1-year, $26,759 development grant from Lifespan. His study, entitled “Proinflammatory Biomarkers as Predictors of Delayed Recovery in Pediatric Concussion,” will delineate the role of neuroinflammation in neurocognitive recovery from concussion in adolescents and develop a predic-tive model to identify adolescents at increased risk for delayed neurocognitive recovery from concussion.

Elizabeth Jacobs, MD was awarded a 1-year $17,893 grant from Lifespan Risk Management. Her study, enti-tled “Vital Signs: A Quality Improvement Project to Improve Patient Outcomes and Reduce Return Visits in the Pediatric ED,” will study the utility of electronic medical records in decision-making. Timely documenta-tion of vital signs and response to abnormal vital signs, as well as the documentation of normal vital signs before discharge, may reduce the risk of medical error, return visits to the ED, morbidities or even death.

Emergency Medicine Research


593 Eddy Street, Claverick 2, Providence, RI 02903

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

The fund has received great support from past graduates and current faculty. And we are again ask-ing 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 contribu-tions, but also in the level of participation of those who care about the cause. Many of you have in-vested 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

P A G E 1 1


MedHost PhysDoc Roll Out

Congratulations to Dr. Jessica Smith on her 2012 ACEP National Faculty Teaching Award. She was presented the award at ACEP’s Scientific Assembly in Denver, CO in October. Dr. Smith, an Assistant Professor of EM (Clinical), has been the Associate EM Residency Program Director since 2009. Dr. Smith is well-known as an innovative medical educator and consistently sets a high standard with her peers in bedside and

didactic teaching. She is an excel-lent communicator committed to giving our EM residents the best clinical care experience and feed-back. Jessica energizes both resi-dents and faculty, working with both groups to find better teach-ing methods. Dr. Smith also pre-sented a poster at ACEP’s assem-bly.

Check out the Department of EM Residency’s newly redesigned website: http://brown.edu/academics/medical/about/departments/emergency-medicine/residency/welcome-emergency-medicine-residency-alpert-medical-school. Special thanks to resi-dents Josh Jauregui, Dan Nelson & Yvonne Wang.

EMRA In October 2012, Dr. Jordan Ce-leste was named President-elect of the Emergency Medicine Resi-dents Associa-tion. Dr. Celeste will spend the coming year pre-paring an agenda for her Presi-dency and organizing the EMRA committees. As President, she will be the primary spokesperson for EMRA and represent EM resident interests on several national boards.

Brown EM Residency Clinical Pathological Case (CPC) Results

The resident winner: Arlene Chung The resident runner up: Jordan Celeste The faculty winner: Jeff Feden The faculty runner-up: Ilse Jenouri

The scores were very very close. Drs. Chung and Feden will partici-pate in the Regional semi-finals in Atlanta in May. If they are unable to participate for any reason the run-ners up will take their place.

Late 2011 and all of 2012 saw the Department of Emergency Medicine transition to electronic physician documentation. The EDs working with MedHost, have implemented the change over the past year. Dr. Daniel Savitt, Vice Chair for Emergency Medicine Medical Development, and Rebecca Armitage, EM Informatics Systems Specialist, have blazed the path for ED attending training and education, process implementation, screen modification and improvements, and de-velopment throughout all three emergency departments. This project includes work and participation from Lifespan Information Technology Services, and coordinating with University Emergency Medicine Foundation’s Compliance Team; Coding and Billing; as well as Quality and EM Scribes.

As PhysDoc was rolled out in 2012, and a new electronic health record is in the planning stages, EM Medical Develop-ment is learning from their experience with the MedHost Phys Doc roll out. The Medical Development team has been compiling data and experiences to utilize when the team is faces with the next transition to electronic medical records. Medical Development is collecting thoughts on ‘What Worked’, some ‘Challenges’, and ‘Actions to take next time’. They are looking to share ideas with other teams in other departments who do not have any experience yet with transition-ing departments with various locations to a totally electronic systems.

Some items relayed to the team regarding the Physician Documentation module roll-out included technical issues such as server performance; positive training by maintaining good charting techniques and training a ‘super group’ to train others; more communication with ED staff; 1:1 training & tutorials in a test environment; and more practice time before going live.

Jessica Smith, MD - Receives the 2012 ACEP National Faculty Teaching Award

Upcoming International Speaker—In June 2013, The Depart-ments of Emergency Medicine and Neurology will be co-sponsoring a Neuroscience lecturer Felix Schlachetzki, MD, PhD is a Professor of Neu-rology at the University of Regensburg in Germany and internationally recognized as an expert in his field. Dr. Schlachetzki is a well-published researcher and is the Director of the Stroke Unit in the Department of Neurology. He will be giving a lecture “Prehospital Transcranial Ultra-sound and Recanalization in large Vessel Occlusions in Ischemic Stroke. More information to come.

http://brown.edu/academics/medical/about/departments/emergency-medicine/residency/welcome-emergency-medicine-residency-alpert-medical-school









Chest Pain Unit Medical Director

P A G E 1 2

1. Armstrong GW, Kim JG, Linakis JG, Mello MJ, and Greenberg PB. Pediatric eye injuries presenting to United States emergency departments: 2001-2007. Graefes Arch Clin Exp Ophthalmol. epub 2012 14 Jan. 10.1007/s00417-011-1917-0.

2. Baird J, Nirenberg T, Longabaugh R, and Mello MJ. The effect of group adapted motivational interviewing on traffic convictions and driving behaviors of court-adjudicated youth. Traffic Inj Prev. epub 2012 02 Nov. 10.1080/15389588.2012.734666.

3. Baruch JM. Dr. Douchebag: A Tale of the Emergency Department. The Hastings Center Report. 2012;42(1):9-10. 4. Beutel BG, Trehan SK, Shalvoy RM, and Mello MJ. The Ottawa Knee Rule: Examining Use in an Academic Emergency Department. Western Journal of Emergency Medicine. epub 2012 Feb. 10.5811/westjem.2012.2.6892. 5. Canino G, Garro A, Alvarez MM, Colon-Semidey A, Esteban C, Fritz G, Koinis-Mitchell D, Kopel SJ, Ortega AN, Seifer R, and McQuaid EL. Factors associated with disparities in emergency department use among Latino children

with asthma. Ann Allergy Asthma Immunol. 2012 Apr;108(4):266-70. 6. Carey JL and Napoli AM. Tension pneumoperitoneum during routine colonoscopy. Am J Emerg Med. 2012 Jan;30(1):261 e1-2. 7. Chen AJ, Kim JG, Linakis JG, Mello MJ, and Greenberg PB. Eye injuries in the elderly from consumer products in the United States: 2001-2007. Graefes Arch Clin Exp Ophthalmol. epub 2012 25 Apr. 8. Choo EK. Springtime in the emergency department. Acad Emerg Med. 2012 Jul;19(7):883. 9. Choo EK, McGregor AJ, Mello MJ, and Baird J. Gender, violence and brief interventions for alcohol in the emergency department. Drug Alcohol Depend. epub 2012 24 Jul. 10.1016/j.drugalcdep.2012.06.021. 10. Choo EK, Nicolaidis C, Newgard CD, Hall MK, Lowe RA, McConnell MK, and McConnell KJ. Association between emergency department resources & diagnosis of intimate partner violence. Eur JEmerg Med.2012 Apr;19(2):83-8. 11. Choo EK, Ranney ML, Aggarwal N, and Boudreaux ED. A systematic review of emergency department technology-based behavioral health interventions. Acad Emerg Med. 2012 Mar;19(3):318-28. 12. Choo EK, Ranney ML, Mello MJ, Clark MA, Charest T, Garro CF, Bertsch K, Larsen S, and Zlotnick C. High risk health behaviors and healthcare access among female adult entertainment club employees. Women Health. 2012

Oct;52(7):646-57. 13. Choo EK, Ranney ML, Wong Z, and Mello MJ. Attitudes toward technology-based health information among adult emergency department patients with drug or alcohol misuse. J Subst Abuse Treat. 2012 Dec;43(4):397-401. 14. Choo EK, Sullivan AF, LoVecchio F, Perret JN, Camargo CA, and Boudreaux ED. Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers. Addiction

Science & Clinical Practice. 2012;7(1):4. 15. Chun TH and Linakis JG. Interventions for adolescent alcohol use. Curr Opin Pediatr. 2012 Apr;24(2):238-42. 16. Clyne B. Multitasking in emergency medicine. Acad Emerg Med. 2012 Feb;19(2):230-1. 17. Conners GP, Melzer SM, Betts JM, Chitkara MB, Jewell JA, Lye PS, Mirkinson LJ, Shaw KN, Ackerman AD, Chun TH, Dudley NC, Fein JA, Fuchs SM, Moore BR, Selbst SM, and Wright JL. Pediatric observation units. Pediatrics.

2012 Jul;130(1):172-9. 18. Daniel M, Rougas S, Zink D, and Taylor JS. Teaching oral presentations in pre-clinical skills courses. Med Educ. 2012 Nov;46(11):1104-5. 19. Daulaire S, Fine L, Salmon M, Cummings C, Liebmann O, Shah S, and Teismann N. Ultrasound assessment of optic disc edema in patients with headache. Am J Emerg Med. 2012 Oct;30(8):1654 e1-4. 20. Drewniak EI, Jay GD, Fleming BC, Zhang L, Warman ML, and Crisco JJ. Cyclic loading increases friction and changes cartilage surface integrity in lubricin-mutant mouse knees. Arthritis Rheum. 2012 Feb;64(2):465-73. 21. Elsaid KA, Zhang L, Waller K, Tofte J, Teeple E, Fleming BC, and Jay GD. The impact of forced joint exercise on lubricin biosynthesis from articular cartilage following ACL transection and intra-articular lubricin's effect in exer-

cised joints following ACL transection. Osteoarthritis Cartilage. 2012 Aug;20(8):940-8. 22. Garro AC, Jandasek B, Turcotte-Benedict F, Fleming JT, Rosen R, and McQuaid EL. Caregiver Expectations of Clinicians during the Asthma Diagnostic Process in Young Children: Thematic Analysis of Focus Groups. J Asthma.

2012 Sep;49(7):703-11. 23. Harrington M, Baird J, Lee C, Nirenberg T, Longabaugh R, Mello MJ, and Woolard R. Identifying subtypes of dual alcohol and marijuana users: a methodological approach using cluster analysis. Addict Behav. 2012 Jan;37

(1):119-23. 24. Jay GD, Elsaid KA, Kelly KA, Anderson SC, Zhang L, Teeple E, Waller K, and Fleming BC. Prevention of cartilage degeneration and gait asymmetry by lubricin tribosupplementation in the rat following anterior cruciate ligament

transection. Arthritis Rheum. 2012 Apr;64(4):1162-71. 25. Kobayashi L, Dunbar-Viveiros JA, Devine J, Jones MS, Overly FL, Gosbee JW, and Jay GD. Pilot-phase findings from high-fidelity In Situ medical simulation investigation of emergency department procedural sedation. Simul

Healthc. 2012 Apr;7(2):81-94. 26. Kobayashi L, Overly F, and Gosbee J. Emergency department procedural sedation simulation package (SLIPSTREAM Program scenarios A+B. MedEdPortal. epub 2012. https://www.mededportal.org/publication/9155. 27. Kobayashi L, Parchuri R, Gardiner FG, Paolucci GA, Tomaselli NM, Al-Rasheed RS, Bertsch KS, Devine J, Boss RM, Gibbs FJ, Goldlust E, Monti JE, O'Hearn B, Portelli DC, Siegel NA, Hemendinger D, and Jay GD. Use of in

situ simulation and human factors engineering to assess and improve emergency department clinical systems for timely telemetry-based detection of life-threatening arrhythmias. BMJ Qual Saf. epub 2012 13 Oct. 10.1136/bmjqs-2012-001134.

28. Kobayashi L, Sweeney LA, Cousins AC, Bertsch KS, Gardiner FG, Tomaselli NM, Boss RM, Gibbs FJ, and Jay GD. Web survey and embedded intervention on emergency department personnel perceptions of role in patient experience. Eur J Emerg Med. 2012 Apr;19(2):112-6.

29. Levine AC and Shetty P. Managing a front line field hospital in Libya: Description of case mix and lessons learned for future humanitarian emergencies. African Journal of Emergency Medcine. epub 2012 10 Feb. 10.1016/j.afjem.201201.005

30. McGregor AJ and Choo E. Gender-specific Medicine: Yesterday's Neglect, Tomorrow's Opportunities. Acad Emerg Med. 2012 Jul;19(7):861-5. 31. McQuaid EL, Garro A, Seifer R, Hammond SK, and Borrelli B. Integrating asthma education and smoking cessation for parents: Financial return on investment. Pediatr Pulmonol. 2012 Oct;47(10):950-955. 32. Mello MJ, Baird J, Nirenberg TD, Lee C, Woolard R, and Longabaugh R. DIAL: a randomised trial of a telephone brief intervention for alcohol. Inj Prev. epub 2012 26 May. 10.1136/injuryprev-2012-040334. 33. Mello MJ and Longabaugh R. A brief intervention by emergency department providers decreased 12 month alcohol use. Evid Based Med. epub 2012 06 Nov. 10.1136/eb-2012-101024. 34. Merchant RC, Waxman MJ, Maher JG, Clark MA, Celada MT, Liu T, Simmons EM, Beckwith CG, and Mayer KH. Patient and Clinician Ethical Perspectives on the 2006 Centers for Disease Control and Prevention HIV Testing

Methods. Public Health Rep. 2012 May;127(3):318-29. 35. Napoli A and Choo EK. Gender and stress test use in an ED chest pain unit. Am J Emerg Med. 2012 Jul;30(6):890-5. 36. Napoli AM. Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring. Cardiol Res Pract. 2012;2012531908. 37. Napoli AM, Arrighi JA, Siket MS, and Gibbs FJ. Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients. Crit Pathw Cardiol. 2012 Mar;11(1):26-31. 38. Napoli AM, Fast LD, Gardiner F, Nevola M, and Machan JT. Increased granzyme levels in cytotoxic T lymphocytes are associated with disease severity in emergency department patients with severe sepsis. Shock. 2012 Mar;37

(3):257-62. 39. Nestor E. I speak doctor. Acad Emerg Med. 2012 Jan;19(1):114. 40. Park JH, Linakis JG, Skipper BJ, and Scott SM. Factors that Predict Frequency of Emergency Department Utilization in Children With Diabetes-Related Complaints. Pediatr Emerg Care. 2012 Jul;28(7):614-9. 41. Ranney ML, Choo EK, Wang Y, Baum A, Clark MA, and Mello MJ. Emergency department patients' preferences for technology-based behavioral interventions. Ann Emerg Med. 2012 Aug;60(2):218-227 e48. 42. Ranney ML, Madsen T, and Gjelsvik A. Predictors of being unsafe: participation in the Behavioral Risk Factor Surveillance System 2006 intimate partner violence module. J Interpers Violence. 2012 Jan;27(1):84-102. 43. Rosen LM, Liu T, and Merchant RC. Efficiency of International Classification of Diseases, Ninth Revision, Billing Code Searches to Identify Emergency Department Visits for Blood or Body Fluid Exposures through a Statewide

Multicenter Database. Infect Control Hosp Epidemiol. 2012 Jun;33(6):581-8. 44. Rosenbaum CD, Carreiro SP, and Babu KM. Here today, gone tomorrow...and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and

piperazines. J Med Toxicol. 2012 Mar;8(1):15-32. 45. Schroeder ED, Jacquet G, Becker TK, Foran M, Goldberg E, Aschkenasy M, Bertsch K, and Levine AC. Global Emergency Medicine: A Review of the Literature From 2011. Acad Emerg Med. 2012 Oct;19(10):1196-1203. 46. Seigel TA, Cocchi MN, Salciccioli J, Shapiro NI, Howell M, Tang A, and Donnino MW. Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection. J Emerg Med. 2012 Mar;42

(3):254-9. 47. Szmydynger-Chodobska J, Strazielle N, Gandy JR, Keefe TH, Zink BJ, Ghersi-Egea JF, and Chodobski A. Posttraumatic invasion of monocytes across the blood-cerebrospinal fluid barrier. J Cereb Blood Flow Metab. 2012

Jan;32(1):93-104. 48. Taylor JS, Daniel M, George PF, Warrier S, Dodd K, and Dollase RH. Warren Alpert Medical School's Doctoring program: a comprehensive, integrated clinical curriculum. Med Health R I. 2012 Oct;95(10):313-6. 49. Trillo AD, Merchant RC, Baird JR, Liu T, and Nirenberg TD. Sex differences in alcohol misuse and estimated blood alcohol concentrations among emergency department patients: implications for brief interventions. Acad Emerg

Med. 2012 Aug;19(8):924-33. 50. Tsze DS, Asnis LM, Merchant RC, Amanullah S, and Linakis JG. Increasing Computed Tomography Use for Patients With Appendicitis and Discrepancies in Pain Management Between Adults and Children: An Analysis of the

NHAMCS. Ann Emerg Med. 2012 May;59(5):395-403. 51. Tsze DS, Steele DW, Machan JT, Akhlaghi F, and Linakis JG. Intranasal Ketamine for Procedural Sedation in Pediatric Laceration Repair: A Preliminary Report. Pediatr Emerg Care. 2012 Aug;28(8):767-770. 52. Valente JH, Jay GD, Schmidt ST, Oh AK, Reinert SE, and Zabbo CP. Digital imaging analysis of scar aesthetics. Adv Skin Wound Care. 2012 Mar;25(3):119-23. 53. Van Ness-Otunnu R, Kobayashi L, Ford S, and Overly F. 28-day-old male with non-obstructing supracardiac total anomalous pulmonary venous connection and atrial septal defect presenting with pulmonary overcirculation.

MedEdPortal. epub 2012. 54. Waller KA, Zhang LX, Fleming BC, and Jay GD. Preventing Friction-induced Chondrocyte Apoptosis: Comparison of Human Synovial Fluid and Hylan G-F 20. J Rheumatol. 2012 Jul;39(7):1473-80. 55. Warren OU, Sena V, Choo E, and Machan J. Emergency Physicians' and Nurses' Attitudes towards Alcohol-Intoxicated Patients. J Emerg Med. epub 2012 25 Apr. 10.1016/j.jemermed.2012.02.018. 56. Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NT, Dhillon A, Eikermann M, and Schmidt U. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of proce-

dure-related complications*. Crit Care Med. 2012 Jun;40(6):1808-1813. 57. Wolk BJ, Ganetsky M, and Babu KM. Toxicity of energy drinks. Curr Opin Pediatr. 2012 Apr;24(2):243-51. 58. Woolard R, Baird J, Longabaugh R, Nirenberg T, Lee CS, Mello MJ, and Becker B. Project REDUCE: reducing alcohol and marijuana misusue: effects of a brief intervention in the emergency department. Addict Behav. epub

2012 23 Sep. 59. Yamamoto LG, Manzi S, Shaw KN, Ackerman AD, Chun TH, Conners GP, Dudley NC, Fein JA, Fuchs SM, Moore BR, Selbst SM, and Wright JL. Dispensing medications at the hospital upon discharge from an emergency

department. Pediatrics. 2012 Feb;129(2):e562. 60. Zhao C, Sun YL, Jay GD, Moran SL, An KN, and Amadio PC. Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair. J Orthop Res. 2012 Dec;30(12):1940-44.


EM Peer-Reviewed Publications 2012

P A G E 1 3


Brown EM at ACEP Our Brown EM department had excellent participation at the annual American Col-lege of Emergency Physicians (ACEP) Scien-tific Assembly in October 2012 held in Den-ver, Colorado. There were posters by Drs. Megan Ranney & Kim Pringle; Drs. Jessica

Smith, Brian Clyne, & David MacKenzie; Dr. Michelle Daniel; and 2 posters from Dr. Lisa Merck. Dr. Bob Tubbs presented 2 lectures “Don’t Blink: Plain Film Diag-noses You Cannot Afford to Miss” and “Pitfalls inn Pediatric Chest and Abdominal Radiog-raphy”. The department host-

ed a reception at the Hyatt Regency at the Colo-rado Convention Center and invited all past alumni of our program that was well attended.

Brown EM on the National Scene

Neha Raukar, MD was named to the IOM’s Committee on Sports-Related Concussions in Youth by the Institute’s Board on Children, Youth, and Families. This IOM committee is sponsored by the Centers for Disease Control and Prevention, Department of Defense, De-partment of Education, Health Resources and Services Administration, National Academies President’s Fund, National Athletic Trainers’ Association, and National Institutes of Health. The group will be studying sports-related concussions in youth using available litera-ture and data on concussions. The group will be looking at causes; effectiveness of protec-tive equipment; screening and diagnosis, treatment and management, and long-term consequences. The group will produce an evidenced based report and make recom-mendations and identify areas requiring fur-ther in depth research to the supporting agencies and some regulating government bodies.

Dr. Raukar Named to Institute of Medicine(IOM)’s Committee on Sports-Related Concussions in Youth

Lifespan’s Medical Simulation Center (LMSC) Receives $24,000

Grant December 2012, The Edward J. & Virginia M. Routhier Foundation, based in RI, awarded $24K toward upgrading the technology used to train physicians from all over RI. The Lifespan Medical Simulation Center trains phy-sicians on real-life patient care scenarios with the aid of computerized mannequins portray-ing patients with symptoms. The LMSC rec-ords and reviews the training sessions with participating physicians and instructors. The LMSC needs to stay on the cutting edge of technology in order to produce high-quality educational sessions. The AV equipment will be updated to a high-definition digital format as a result of the generous grant from the Routhier Foundation.

The LMSC was created to look like a real treatment area.

January 2013—Both Libby Nestor & Gary Bubly were predominantly featured on the Lifespan website for their significant awards.

P A G E 1 4

October 17, 2012 - Frank J. Bia, MD Medical Director, AmeriCares Foundation Professor of Internal Medicine (Emeritus) Yale University School of Medicine Presented “Disaster Relief, Cholera & the AmeriCares Model” & “Fevers of Unknown Origin in the 21st Century”

January 8, 2013—Nader Shaikh, MD Assistant Professor of Pediatrics The University of Pittsburgh School of Medicine Dr. Thom Chun coordinated a special Pediatric EM Grand Rounds in support of PECARN grant. Dr. Shaikh presented “Diagnosis & Management of Urinary Tract Infections in Children” Dr. Shaikh is one of our PECARN partners.

January 30, 2013—Tracy Sansone, MD Associate Professor, Educa-tion Director University of San Francisco Health, Morsani College of Medi-cine Presented: Lecture 1: ““Generations at Work” Lecture 2: The Educational Balancing Act: Bedside teaching & Productivity”

December 19, 2012- Dr. Brian Zink Presented The History of Emergency Medicine


Visiting Professor— James Adams, MD

Holiday Party 2012 The Department of EM had its annual holiday party and fund raiser on December 14, 2012 at the Alpine Country Club in Cranston, RI.

The party raised over $2,000 for the Rhode Island Free Clinic surpassing last year’s charitable collection and we had a record number of party goers! Good times!

November 7th & 8th, 2012, The De-partment of Emergency Medicine welcomed Dr. James Adams as our Visiting Professor. Dr. Adams is Pro-fessor and Chair of the Department of Emergency Medicine at the Feinberg School of Medicine at Northwestern University and Northwestern Memo-rial Hospital. Dr. Adams is an expert in professionalism, communication,

and health care policy.

As our visiting professor, Dr. Adams participated in 2 days of scheduled events. This included a moderated dinner discus-sion with Brown Emergency Medicine faculty, fellows, and residents on hot topics in academic EM. Dr. Adams present-ed 2 lectures—one on communication and another on Drug Seeking Patients in the ED. He also participated in bedside teaching rounds at the Rhode island Hospital An-derson Emergency Center, gave a faculty development workshop, and provided one-on-one mini-mentoring sessions for faculty.

It was an honor and pleas-ure for us to host one of the premiere leaders in emer-gency medicine as our visit-ing professor.

Thank you Dr. Adams.

September 19, 2012—Ravi Morchi, MD Assistant Clinical Professor, Health Sciences Director, Medical Screening Exam-ination Program Harbor, UCLA Medical Center Presented: International Emergency Interven-tions in the Undifferentiated Medi-cal Environment

Dr. Zink presented Dr. Adams with a plaque commemo-rating his visit at the EM Faculty dinner.

P A G E 1 5

In July 2012, we were excited to welcome Dr. Catherine Pettit as our simulation fellow for AY 2012-2013; we also have another fellow lined up for AY 2013-2014. The

simulation fellowship is growing and developing a rep-utation as one of the best in the country.

On November 29th, the Medical Simulation Center cel-ebrated 10 years of simulation. It was an opportunity to reflect on the past decade and all of the simulation related accomplishments. Starting with the initial ef-forts of Dr. Gregory Jay and Dr. Marc Shapiro, the simu-lation center was born from the MedTeams project. Dr. Ken Williams and the RIDI project served as the next significant stepping stone in the launching of the simu-lation program.

There have been many projects over the years– during the annual simulation center retreat, we took time to reflect on everything that has come from 10 years of true teamwork and dedication toward high quality sim-ulation-enhanced training courses, innovative research projects and simulation-related quality initiative pro-grams. When we tally the numbers, the center has been busy; the simulation team has worked with over 16,893 participants and run over 5,664 sessions. Aca-demically, the center (and specifically the EM simula-tion faculty) have also been productive; 67 abstracts, 54 publications (8 more have been submitted) and 96 national and international invited presentations. The

simulation faculty has brought in a total of $4,650,000 from externally funded research grants and another $1,330,000 from courses, industry and hospital funded projects.

Dr. Timothy Babineau, President of Lifespan, Rhode Island & The Miriam Hospitals, & Dr. Zink both spoke about what Medical Simulation has meant to the health system in Rhode Island. Dr. Babineau has offi-cially changed the “Sim Center’s” name from the Rhode Island Medical Simulation Center to the Lifespan Medi-cal Simulation Center. The Sim Center has been a great part of the Rhode Island Hospital history providing training to a large number of medical personnel. Peter Snyder, PhD, Vice President of Research for Lifespan, also praised the Sim Center’s strides over the past dec-ade. There were various “stations” that showcased as-pects of the Sim Center: History of the Simulation Cen-ter; OR based simulation and movie making capabili-ties; Meet SimMan, “A shocking experience”; Pediatric Simulation, “Somebody help my baby”; High Quality CPR, “Manikins giving us feedback; Task trainers, “Practicing on body parts”; and The CLEAR Initiative.

Finally, the simulation center staff and faculty came away from this 10 yr. anniversary with a refined mis-sion statement, a new 5-year vision statement and increased enthusi-asm to continue lead-ing the way in the field of medical simulation.

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


Hasbro ED (continued from page 4)

ing and addressing pain management and included bimonthly educational sessions for the nursing staff.

In 2012, as all of emergency medicine rolled out the MedHost physician documentation component, pediatric EM worked with EM Medical Development to include developmentally appro-priate templates.

The Hasbro Children’s Hospital Emergency Department worked on clinical initiatives throughout 2012. Intranasal medications, such as midazolam and fentanyl, were intro-duced as needleless ways to reduce pain and anxiety. Resources and programs were implemented for patients with autism and developmental disabilities including ac-cess to specialized toys and equipment to minimize the stress of a visit to the ED. Hasbro Artists worked to create an art project cart and developed a volunteer program to bring art projects to children receiving care in the ED.

Zink Appointed to Lifespan Board of Directors Lifespan reorganized and condensed its various hospital Boards from Newport, Bradley, The Miriam, and Rhode island Hospitals and the Lifespan Board to be form one Lifespan Board of Directors. Dr. Bri-an Zink was appointed to a 3 year term. The new Board will meet 8 times a year for extended meet-ings.

P A G E 1 6

RIH Anderson EC (Continued from page 3)

agement. Admitted patients from all Pods will be moved through this area whenever possible. Overall, utilizing the E-Pod in this manner will ex-pedite the care of patients once they leave the Critical Care rooms, and make more beds availa-ble in the A, B and C-Pods for patients from the triage areas.

A new area has been established primarily for the care of low acuity patients, ESI 4-5. The team in this area also assists in expediting waiting pa-tients when possible. The B-Pod Procedure Rooms and surrounding area has been reor-ganized and equipped to promote the efficient care of these patients. This area is now staffed from 11 am to 11 pm. In addition to nursing and tech staff, an attending and midlevel coordinates patient management. With the Procedure Room area in operation during peak hours, low acuity patients can be largely removed from the other clinical Pods. Moreover, the staffing in this area provides the department with more options when the department experiences surges in pa-tient arrivals.

The preparation and planned adjustments assist us in continuing to deliver our standard of high quality care and service. The support and re-sources committed by UEMF and our hospital leaders has been implemented to the best ad-vantage of our patients and our teams that care for them. It is our great teamwork and dedication to improvement every day that validates the great confidence our hospital leaders have placed in us, and makes us central to the ad-vancement of Rhode Island Hospital.


International EM

In September 2012, Dr. Dave Bouslough partici-pated in the Clin-ton Global Initia-tive reception. The topic was Health Resources for Health. Dave met the Ministers of Health for Libe-

ria & Rwanda & Former President Bill Clinton.

In November 2012, IEM welcomed Joseph Novik, MD as the inaugural Global Emergency Medicine Fellow. Dr. Novik received his MD from the University of Min-nesota Medical School. Most recently he was the Asso-ciate Director of Emergency Ultrasound and Co-Fellowship Director of EUS at NYU/Bellevue Medical Center. Dr. Novik’s fellowship is in partnership with the Rwandan government. Dr. Novik will be staying in Kigali, Rwanda for approximately 8 months. Brown is one of eleven universities participating with the Clin-ton Foundation and Rwandan government to organ-ize medical education there. When Dr. Novik returns to the US he will be presenting his experiences and

research to our department.

In October, we hosted 2 physicians from Managua, Nicaragua. Dr. Mar-tha Bendana Morales from the Roberto Calderone Hospital and Dr. Rebeca Herrera Chavarria from the Lenin Fon-seca Hospital. Both hospitals are part-nering with our IEM Division at Brown.

The 2 physicians went to the ACEP Scientific Assembly in Denver, toured our facilities and shadowed in the AEC for clinical shifts; met with Dr. Zink; and were the guests of honor at a dinner held their last night here.

Several of our Brown emergency medicine attendings recently left for Managua for a visit. They will be teach-ing a trauma course to emergency physicians and resi-dents at the Universidad Nacional Autónoma de Nica-ragua– Managua. The group has an overall goal of improving access and standards of care for the under-served of that country. Ultimately, we hope to estab-

lish an EM elective and enhance the Nicara-guan’s knowledge of ABEM EM Model Core Content including critical care resuscitation and trauma in low-resource settings. We look forward to further developing the clini-cal relationships in both areas of the world.

Welcome Back, Dr. Mark Greve

In November 2012, Dr. Mark Greve, Clinical Assistant Professor of Emer-gency Medicine, rejoined UEMF and the Department of Emergency Medi-cine as a clinical attending.

“Just when I thought I was out, they pull me back in.” (quote from the Godfather Part III)

Dave Bouslough, MD, Director, International EM

Dr. Jay Baruch, Selim Suner, & Leo Koba-yashi all participated in Lifespan/ RISD’s Fall Symposium 2012.

P A G E 1 7

In August 2012, Lifespan’s Lifelines, Online newsletter, featured articles regarding the reac-creditation of the Chest Pain Center at RIH with quotes from Dr. Anthony Napoli. Also featured in online edition an interview with Dr. Dina Morrissey from the Injury Prevention Center.

In the Spotlight—Media

Medscape and WebMD recently carried a list of the top 10 most read articles by emergency medicine physicians. The article that topped the list at number one was Dr. Jay Baruch’s story Dr. Douchebag—A Tale of the Emergency Department which was published in the Hastings Center Report.

December 2012—Dr. Brian Zink was inter-viewed by Kristin Gourlay for NPR regard-ing the problem of substance abusers fre-quent need of emergency services focus-ing on visits to emergency departments and what is being done to help provide a better way to care for this group of pa-tients.


Dr. Douchebag—The Most Read EM Article in 2012

WNRI Interview: RI Hospital ER chief:

“There has to be a better way.”

September 2012—Adam Levine was fea-tured in the Providence Business News in-

cluding an inter-view regarding his International EM work and his award given by the Global EM Academy of SAEM.

Suner Talking:

Selim Suner, MD was featured on www.Brown.edu on the anniversary of September 11, 2001.

He was also interviewed on WRNI the local NPR regarding the Rhode Islanders who helped who in the disaster’s after-math.

January 2013, Dr. Suner was interviewed & featured on Lifespan.org with Q&A regarding the flu & how to limit your exposure.

In August, Dr. Dina Morrissey was featured on the Rhode Show with Cardi’s Furniture discuss-ing car seat safety.

Todd Seigel, MD appears in a starring role in the Video Tour of the Stroke Unit. It appears in the October issue of Lifelines.

November 2012—Dr. Jason Hack was quoted in an article in the Providence Journal Fake Drugs, Real Danger.

The Injury Prevention Center was all over the news in September 2012. IPC/Kohl’s Cares – Kids on the Go Car Seat Safety Program ad-vertising campaign hit all outlets: WebMD, Yahoo, Facebook, RIPTA buses, radio, & the HCH homepage.

Laura McPeake, MD was interviewed and featured on Channel 10 regarding widespread flu on 1/4/13.

On January 3rd, Dr. Brian Zink was interviewed by Kristen Gour-lay for WRNI, RI public radio, regarding the usual surge in flu patients in the EDs.

1/10/13—Frantz Gibbs, M.D., was fea-tured on Channel 10pm news in a story about the flu season and the high volume of patients many hospitals are seeing.

1/22/13—RIH EM physician Megan Ranney, M.D, MPH., wrote a com-mentary in response to a recently published paper on the use of Twit-ter as a vital tool to disseminate pub-lic health information.

In the Journal of Resuscitation, Dr. Ranney challenged the paper and encouraged further study as provid-ers of care need to respond to social media appropriately in disseminat-ing information. Dr. Ranney’s com-mentary was highlighted in Provi-dence Business News on January 28, 2012 in an article entitled “More Study Needed to Measure Twitter’s Health Impact”.

On January 26, Dr. Ranney was in-terviewed on WPRO-AM regarding the use of Twitter as a public health communication tool.

Dr. Brian Zink participated with area leaders in health care video coordinated by Blue Cross Blue Shield of RI called Let’s Cure Healthcare Together. The vid-eo supports patient centered care and how the whole health care system needs to collaborate on system wide goals to optimize quality care.

11/28/12—Dr. Esther Choo was featured on the Lifespan website regard-ing a study on Adult Entertain-ment Workers & the benefits of health care intervent ion . Dr. Choo was the PI on the Study.

Lynn Sweeney, MD was interviewed and featured on the front page of the Providence Journal Au-gust 10th regarding Pro-ject CLEAR. The story was called “Practicing Better Bedside Manners”.

8/12 -Tracy Madsen, MD & the Women’s Health in Emergency Care Fellowship was featured in the AWAEM Newsletter.

January 2013, Dr. Dina Morrissey was featured in a public service video on the Lifespan website for preventing scalding injuries at bath time.

http://www.lifespan.org/rih/

Drs. Hack and Babu, Division of Medical Toxicolo-gy, have been very hard at work and as produc-tive as ever!

Dr. Kavita Babu served as the course director for the Prescription Opioid Misuse Academy, a na-tional conference produced by the ACMT in March. The evaluations were overwhelmingly positive, and ACMT hopes to repeat this course in the future.

Dr. Babu also presented a collection of her prac-tice-changing moments in a Departmental Grand Rounds, called “Lessons Learned from the Pre-scription Opioid Academy.”

Dr. Joshua Jauregui, was selected from a highly competitive field of applicants to win the Medical

P A G E 1 8

Dr. Hack was liberally quoted in a front page article on Synthetic Cannabinoids in the Provi-dence Journal on November 18th.

Dr. Hack along with Dr Jordan Celeste and Dr. Elena Kapilevich gave an invited lec-ture on “Bath Salts” to Providence Center practitioner in October. They have also

been invited to give an additional bath salts lecture to the PC and also to Child Protective Services in the coming month.

Dr. Hack was appointed to the Pharmacy and Therapeutics committee for RIH and TMH.

EM Toxicology


The Women’s Health in Emergency Care Division (WHEC) has been moving forward. On the research front we are working with national collaborations to produce two

Peer-Reviewed Lectures (PERLs) for Academic Emer-gency Medicine in support of the 2014 Consensus Conference on Gender Specific Emergency Medicine Research. They will focus on both the aspects of Gen-der Specific research methods with showcasing updat-ed articles in emergency medicine while the second one will present clinical knowledge and skills to bring to the bedside of caring for patients in the emergency department. We will be filming in SAEM 2013 so stay tuned!

Our educational program continues to grow. We are actively working on curriculum development in sup-port of our fellowship missions. We also have had na-tional interest in the WHEC elective and enjoy show-casing our wonderful division and department to out-side rotators who have expressed an interest in wom-en’s health.

Dr. McGregor was also invited to the offices of Nation-al Board of Medical Examiners (NBME) along with oth-er physicians from the Sex and Gender Women’s Health Collaborative (www.sgwhc.org) to review medical school board testing for sensitivity and accura-cy in gender-specific medicine. This was a wonderful opportunity to contribute to the advancement of this science into medical school curricular.

Look for us at SAEM 2013 this year. We will be moder-ating two Didactics entitled: Mining the Hidden Sci-ence in Your Emergency Medicine Research: Gender-Specific Study Design and Analysis with Guest Present-ers: Roger Lewis, MD, Deborah Diercks, MD, and Da-vid Wright, MD. Followed by Top 5 Plays of the Day: How Gender-Specific Medicine Impacts Men’s Health with Guest Panel Speakers: Basmah Safdar MD, Neha Raukar MD, Federico E. Vaca MD, Nina Gentile MD and David C. Portelli, MD.

Moving forward for 2013, Alyson will be assuming the role of Divi-sion Director of WHEC and Es-ther Choo will be the Associate Director. This will give Esther some much needed time to focus on her research projects. As al-ways, if you have any interest in examining your area of research with a gender perspective – con-tact us!

Jason Hack, MD Director of Toxicology

Dr. Fowler shared her research on "Adolescent Sexual Risk Behavior

Determinants in Liberia“ on 09/11/2012.

EM Physician and Clinical Pro-fessor, Dr. Elizabeth Nestor, received the Rhode Island Hospital 2012 Milton Ha-molsky Outstanding Physician Award. This award was pre-sented to Dr. Nestor in a cere-mony following the RIH Medi-cal Staff Annual meeting on

January 23, 2012. The award is presented by the RIH medical staff to a member who leads by example as a role model and has made exceptional contributions to medicine, medical education and research. Dr. Nestor was given the honor for her outstanding of clinical care, impeccable ethics, and never failing dedication to edu-cating medical students and residents; as well as mentor-ing junior EM faculty.

Libby’s first career was as an ordained Episcopal minis-ter. She then decided to follow her father’s footsteps and become a doctor. Libby joined our emergency medicine group in 1994. She has been recognized for her commitment to medical education and clinical care with several Department of EM awards including 2006, Teaching Recognition; 2008, Teaching Excellence; 2010 & 2012, Jacek Franaszek Faculty Teaching Award; and 2008, UEMF/ DEM Outstanding Physician Award. Libby was also named the Rhode Island Medical Women’s As-sociation “Women Physician of the Year” in 2008. Resi-dents and medical students consistently rank Libby in the top of the group for teaching and mentoring. Dr. Nestor was also elected Employee of the Month during 2012 by the EM Staff in the Anderson Emergency Cen-ter. Drs. Zink and Hamolsky both spoke and presented the award.

There was an overwhelming social media response on Facebook when her award win was posted. Libby’s re-sponse was “All I can say is, the EM is a big department, and we’re all friends.” Such modesty!

Libby Nestor, MD— Recipient of the Rhode Island Hospital Hamolsky Award

Alyson McGregor, MD Director, WHEC

P A G E 1 9

Foundry of Arts & Humanities in Emergency Medicine (FAHEM)


Medical humanities was especial-ly busy the latter part of 2012. The 3rd year of The Creative Medicine Series was kicked off by artist and arts educator Alexa Miller, co-creator of Training the Eye program at Harvard Medical

School. Her talk was titled "Museum Rounds: What Art Can Teach Future Doctors." The second event welcomed Brown professors, dancers and choreographers Rachel Balaban and Julie Strandberg, as well as students involved in their grant funded project at Brown examining dance and patients suffering from Parkinson's Disease. The highlight of this special evening was the presence of several patients with Parkinson's who drove up from South County in terrible weather.

In September 2012, we had the pleasure of co-hosting an event with the Division of Women's Health in Emergency Care. We sponsored a delight-ful evening at the medical school with physician/writer Maggie Kozol. The presentation, "Doctors Sto-ries: Shaping the Healthcare Narrative," lead to a wonderful discussion.

In the fall, the first Bray Visiting Scholar/Artist, Deb Salem Smith, playwright-in-residence at Trinity Rep, taught a playwriting class at Trinity Rep that includ-ed Alpert medical students and Brown/Trinity Rep MFA students. They presented their work in a public event on December 13, titled, "Operating Theater: A reading of collaborative works from Brown/Trinity MFA Actors and Alpert Medical Students."

The second year of Integrated Clinical Arts took place at the medical school on December 7. Medical

Jay Baruch, MD

Know & Grow, Faculty Development —October 2012

The Department of EM held a Know & Grow session at the Alpert Medical School called “The Master EM Clinician Educator – Efficiency, Productivity, & Getting the Most Out of Your Team”. Presenters included Drs. Dan Savitt, Jessica Smith, Frank Overly, Jimmy Monti, and Anthony Napoli. A post lecture reception was held on the Emergency Medicine Terrace at the Alpert Medical School.

The Department of EM will be welcoming David Bachrach in April 25, 2013. Mr. Bachrach, Physician-Executive Coach, will be conducting a faculty development session entitled “How to Ef-fectively Manage People” from 4p-8p.

students spent the afternoon en-gaging with different modes of cre-ative thinking, and integrated the-se methods with clinical care. Workshops included music, dance, sculpture, acting, art at the RISD museum, medical illustration, and even acting and horsemanship.

We've had a growing collaboration with the RISD Museum, including a fascinating project lead by our own EM resident Bonnie Marr that explores the use of museums to improve our understanding and treatment of pain. We are mentoring several medi-cal students and EM residents, and are receiving inquiries from residents from other Brown pro-grams. We have been excited by the number of medical students who have expressed interest in the medical humanities and bioethics scholarly concen-tration.

We are looking forward to an exciting spring semes-ter. We will co-sponsor the AMSA Writer's Institute in Virginia at end of January for medical students from around the country. Locally, Liz Tobin Tyler, JD, MA, our spring Bray Visiting Scholar/Artist, will give a series of three seminars at the medical school: "Patient's Professionals and Policy: Narratives of Health and Justice. The Creative Medicine Series will continue with two speakers in the spring.

More information can be found on the recently launched Program in Clinical Arts and Humanities website, and the Foundry in Arts and Humanities in Emergency Medicine website. They are both works-in-progress.

Dr. Jay Baruch (left) is pictured with guest physician/writer Maggie Kozol and Dr. Alyson McGregor. The Foundry of Arts & Humanities co-sponsored Dr. Kozol’s presentation “Doctors’ Stories” with the division of Women’s Health in Emergency Care.

P A G E 2 0


Save the Date for the Annual Retreat!

Our Department of EM’s Annual Faculty Retreat will be held on Friday, May 31, 2013 at the Squan-tum Association Club, 947 Veterans Memorial Park-way in East Provi-dence.

The retreat is a full day of faculty develop-ment, wellness, and educational sessions that to focus the EM faculty on timely EM topics. An agenda will be out in late March/ early April. Please email Brenda to attend the pro-gram at [email protected].

ed by the Narragansett Bay Commission Project tearing up roads leading to the ED. Volume continues to trend upward. In the fall, we experienced our busiest day ever with 225 visits! Overall, since October 1, 2012 we are running 7% higher than the same time period last year. The recent flu outbreak has challenged our space constraints. With the increase in flu cases including admissions, we have reluctantly resorted to transferring medical admissions to our sister institution dur-ing over-capacity times.

In addition to a new place, we continue to add new staff, new shifts and new toys. Not surprisingly, given the robust selection process, things are going remarkably well with new staff. In January, we expanded the 1-9 shift from Monday through Thursday. We will be getting both the Glidescope and a fluid warmer soon. Having both the McGrath and the Glidescope should provide ad-ditional reassurance, particularly with the expansion of bariatric services at TMH.

TMH was recognized for its outstanding work on sepsis. The ED staff will undergo Project Clear Training. The Workload Distribution Task Force re-invigorated "Lightning" team rounds. The Op X Greenbelt projects continue to help benefit the ED, from re-organizing our clean utility room to the system wide status indicator. These pro-jects are the fruits of labor by many passionate, committed individuals and teams.

Overall, I remain impressed with our staff's ability to deal with the rising volume, construction inconveniences and temporary inefficiencies--and provide outstanding, compassionate care. We have a great team.

TMH ED (continued on page 3)

The Alpert Medical School of Brown University’s Department of Emergency Medicine is hosting this year’s New England Regional SAEM Meeting. We look forward to having our EM colleagues from all over New England joining us in Provi-dence April 17, 2013.

Significant Donation for Neurotrauma & BBB Research

Drs. Adam & Joanna Chodobski received an Anon-ymous $250K gift donation to their Neuroscience research. Their laboratory, Neurotrauma and Brain Barriers Research Laboratory in the Department of Emergency Medicine at Rhode Island Hospital and Alpert Medical School, will use the funds to im-prove understanding of and treatments for trau-matic brain injuries and other neurological emer-gencies.

winter 2012-2013 (pdf)

Documents