LEADERTHE

When you are at your weakest, we are at our strongest.

QUESTION + ANSWERwith Dr. Hal Minnigan What it was like being the last EM Physician at Wishard.

VOL I ISSUE 4

DR. FRANK MESSINA named Medical Director of

the Wishard-Eskenazi Health Transition Support Department

CLINICAL STATISTICS

Third Quarter Hospital Statistics

DR. ALICE MITCHELLRecieves AHA Award

EDITOR IN CHIEFDaniel Rusyniak

MANAGING EDITORMegan Palmer

CHIEF REPORTERPamela Durant

MARKETING & GRAPHICSLauren Hernandez

ACEP IN SEATTLE

Upcoming Conferences

& Events

JT Finnell Honored by the American Medical Informatics Association at their Leadership Awards dinner held in Washington DC at the National Press Club. JT is a member of the Clinical Informatics Board Review and is a journal editor. He was given this honor for his outstanding leadership and service.

Julie Welch Named Assistant Dean of Faulty Affairs and Professional Development (July 2013) Co-Director of Mentoring, CTSI (grant funded July 2013).

Jen WalthallNamed Decision Editor for the Journals Pediatrics and Academic Emergency Medicine.

Frank Messina has been named the medical director of the Wishard-Eskenazi Health Transition Support Department. In this role, he will develop systems for coordinating the care of Eskenazi Health patients between different clinical departments and venues. In addition, Dr. Messina will provide guidance as medical director for the Eskenazi Health Clinical Decision Unit. Here he leads a multidisciplinary group as they develop processes, protocols and the support services necessary for patients who don’t need admission but require more care and workup then time permits in the ED. These new titles add to Frank’s already impressive list of titles (in no particular order): Associate Clinical Professor of Emergency Medicine; past-chair and current member of the Indiana University School of Medicine’s Faculty Community Relations Committee; husband; and father. Sounds like it is good that he is getting new business cards with the move. 

AWARDSleading in

Frank Messina named Medical Director

We are proud to brag about the amazing team of Eskenazi nurses (Elizabeth Burleson, Danielle Gilyan, Jackie Chandler, and Mary Shaw) who won this year’s Emergency Nursing Association academic challenge. This is a repeat for them. Rumor has it they won on a toxicology question. 

New appointments

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EDUCATIONleading in

Kate Pollard: Future EM LeaderKate Pollard received an ACEP outstanding medical student award. Each year ACEP awards up to ten of these to students who meet their high standards of humanism, professionalism, clinical judgment, scholarship, and community service. We’re lucky to have her in our program. Besides a plaque, Kate gets a free one year membership to ACEP and free registration to their annual meeting.

On Oct 4-7th at the American Board of Emergency Medicine’s Oral Board Certification Examination, Jamie Jones served as a team leader while Cherri Hobgood and JT Finnell were oral examiners. 

This fall, medical students judged Ben Hunter as an outstanding educator. On the AAMC survey under the question “overall effective-ness as a teacher” Ben received an average of 4.75 (or above). At least 11 more of our EM faculty also got this rating. If you receive an award let us know so we can acknowledge you.

Elizabeth Weinstein spoke on “Concussions and Pediatrics” for the IU Health advanced practice conference.

Andrew C Stevens will present a poster called “Standardizing patient handovers in paramedic education improves communication” at the National Association of Emergency Physicians January 2014 meeting in Tuscon, AZ.

Jen Walthall gave Grand Rounds at Medstar (Washington Hospital center/Georgetown/National Children’s) in December on Pediatric Injury Prevention and General Pediatrics. She’s will also give Grand Rounds in Pennsylvania (LeHigh Valley) and New Jersey (St. Joseph Regional Medical Center) in February 2014.

Welch J, Jimenez H, Allen S. Teamwork & Conflict Management Workshop. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9605 

EDUCATION PRESENTATIONS

EDUCATION PUBLICATIONS

Leading the Next Generation

Our Outstanding Educators

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HAL BABYQuestion + Answer with

What did it mean to you to be the last EM physician on the last day before they shut down the doors at the old Wishard?

It was a rare and wonderful opportunity for me. It was my work home for so many years, and there were so many good memories there. I was fortunate to have had the opportunity to work there with the best nurses, faculty and residents for 13 years. The people are the reason it matters – both my colleagues and the patients. We take that with us as we move on.

But you didn’t even start out to be a physician, what career path did you start out on?

In college I had interest in medicine, and had strongly considered this as a career. I had a great mentor who got me interested in research, so I went to graduate school at Vanderbilt straight out of college. I enjoyed my time immensely. Grad school was long and a lot of hard work. At the end I made a connection through one of my colleagues with a research mentor in San Francisco who I really wanted to work with. At the 11th hour, he accepted a position in Minnesota—so I was off to the Land of 10000 Lakes.

Minnesota? That doesn’t sound like fun for a boy from Tennessee.

It turned out okay, mostly because I ended up meeting and marrying one of the grad students in the lab. I enjoyed research, but at the same time I learned what it takes to be a career researcher. It requires a lot of dedication and single-minded focus to be successful. The competition was brutal. I have great respect for those who take this path.

Do you think this is still true?

I’d say fighting for funding is even worse now. Back then I feared for my future in research. As I was completing my post-doctoral fellowship; I decided to step back and reevaluate my path. So I left research and took a couple of different jobs—interesting jobs but nothing permanent. In the end it became clear that medicine would give me the greatest opportunity for contribution, and personal growth and satisfaction.

Did lots of trips to the ED as a kid make you want to grow up to work in the Emergency Department?

Not really. I don’t come from a family of doctors or anything like that. I grew up working with my dad in construction and remodeling. I knew that whatever kind of medicine I ended up in would be something up close and personal, and something hands-on. I liked the pace of the ED, and the wide variety of patients. I was attracted to the opportunity to work with disadvantaged people. When I was finishing my residency I saw an ad for a position at Wishard, and I talked to Rolly McGrath. He’s a man who is easy to trust and the rest is history. That’s how I got here, and why I stay here.

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Q + A with HAL BABYAnd your Minnesota bride is she okay with that?

I sure hope so. Jane and I have been married 25 years and have two great kids who’ve grown up as Hoosiers. Our twins, a son and a daughter, are seniors in high school.

A next generation of Minnigan Doctors?

I don’t think so. I’m so proud of both of them, and I know they’ll succeed no matter what they decide to pursue. Our daughter Sadie is leaning toward IU Bloomington. She wants to be a teacher, and is doing something called cadet teaching, where she works as an assistant to an elementary teacher for part of the school day. Our son Jordan wants to be an engineer and will likely attend IUPUI.

Your focus area is emergency ultrasound. Could you tell me about the grant you got this year?

It’s from the ACEP Emergency Medical Foundation. With help from many others, I applied for and got a $19,700 grant to use a strict three step process to look at five specific uses for ultrasound in the ED: pneumothorax; acute hydronephrosis; right ventricular dilation and suspected PE; left ventricular systolic dysfunction in the hypotensive patient; and acute lower extremity DVT.

The other day I got to see a V-Scan, a pretty nice, compact ultrasound machine. Is it different than what you used to work with?

The V-scan is cool. I fought to get our first ultrasound in the ED at Wishard. It was a beast, we called it the Zamboni. It was a classic analog machine, but was incredibly slow and a monster to move. As our knowledge base and use of ultrasound has increased, we have tried to keep pace by acquiring better equipment to be able to do a better job of patient care. We are set up very well at Eskenazi with nine new machines distributed throughout the department, and I hope to improve the set up at Methodist. Bedside ultrasound is an essential part of our daily practice, and a required area of expertise for residency training, so we are continually trying to

keep our educational operation at the leading edge.

Is this part of what the Mindray grant is about?

Our goal is to collect data to support the safe use of ultrasound in routine ED practice to be safer and more efficient in patient care. Currently much of our imaging in the ED uses ionizing radiation, which we know has cumulative negative health effects for patients. We hope that our data will show that we can use ultrasound safely to minimize or avoid exposure to ionizing radiation. I’m not exactly sure what the results will be, that’s why they call it research, right?

Besides ultrasound, how has technology changed medicine?

In many ways, and often for the better. For example when CT scans first came out they just weren’t reliable, so there wasn’t much use to order them because you wouldn’t get much information. Now they are so good, that they can end up showing more than we really need to know, things that don’t have to do with the patient’s chief complaint in the ED

What do you think about this year’s crop of residents and new faculty?

I’m amazed that each year the committees do such an amazing job of recruiting. They select great people. It is odd how they can come in with different skill sets, from all over the country, yet somehow after a while these great people work together and all end up with the right tools for success. Lots of intangibles, I don’t know how the recruiters do it so well.

So is there something that most people don’t know about you?

Many people do know this, but I love tools. I love working with tools, the feel of tools, collecting the right tool for the right job. I have even built some tools of my own. I grew up around tools. My grandfather and uncles were carpenters. My dad worked two jobs. Besides being a full time engineer, he worked part time remodeling houses; my brother and I would often help him. We were his free labor. My favorite way to help was to work on his construction vehicles like bobcats and such—as well as working on the family car. I paid for part of college by working at different garages. I love all things mechanical.

I refuse to join any club that would have me as a member.- Groucho Marx“So it is a bit of a double edged sword?

Yes and the law of unintended consequences is certainly at work here. Think of Alice Mitchell’s work on contrast-induced nephropathy. Sometimes we have to re-think procedures. That’s part of what I like about ultrasound, it cuts radiation exposure, while still giving us information.

You seem passionate about your research; do you like the teaching aspects of your job as well?

Very much so. IU is a great place to teach and to learn. Learning is certainly a two way process, I learn something when I am supposed to be teaching all the time. Being around learners keeps you charged up and sharp.

In these interviews I’ve been asking everyone an invention you’d like to see, what would help you?

I wish there was a way of documenting everything without having to spend so much time on it. Most shifts I see patients, supervise others, do procedures, and it’s hard to get everything on paper. Electronic technology has not made this better. Imagine being able to think “this patient needs a liter of saline” and it would be automatically documented. Obviously there would need to be thought filters on this connection for some of us. I could spend my time treating the patient, attending to their problem, and later return for a repeat exam to see if they are doing better. Voice recognition isn’t there yet, templates are boring and impersonal, and a checklist is hard to fit everyone into.

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CLINICAL SERVICEleading in

SERVICE PUBLICATIONS

Jamie Jones hosts Horizon House FundraiserNot only did Jamie and Lisa Jones host a fundraiser for Horizon House in September, but they also served breakfast there on Thanksgiving Day. It’s not too late for you to donate to this worthy charity, which provides a variety of services to help the homeless: e.g., shower & laundry facilities, as well as telephones and mail delivery service.

To Donate visit:

http://www.horizonhouse.cc/donate.aspx

Easter JS, Haukoos JS, Claud J, Wilbur L, Hagstrom MT, Cantrill S, Mestek M, Symonds D, Bakes K. Traumatic intracranial injury in intoxicated patients with minor head trauma. Acad Emerg Med 20: 753-760, 2013. PMID: 24033617

Wagers B, Gittelman M, Bennett B, Pomerantz W. Prevalence of male adolescent dating violence in the pediatric emergency department. J Trauma Acute Care Surg 75(4 Suppl 3): S313-S318, 2013. PMID: 24061506.

Messina FC, McDaniel MA, Trammel AC, Ervin DR, Kozak MA, Weaver CS. Improving specialty care follow-up after an ED visit using a unique referral system. Am J Emerg Med 31:1495-1900. PMID: 24034046.

House DR, Nyabera SL, Yusi K, Rusyniak DE. Descriptive study of an emergency centre in Western Kenya—challenges and opportunities. African J Emerg Med. Available online Sept 27, 2013.

From the Fall 2013 EM Pulse: President JT Finnell’s “A view from the top”. Christian Ross “Indiana and the Opiate Epidemic” and Eric Ferraris and Cory Showater “Roundworm Meningoencephalitits: A potential case.

Jen Walthall published a feature article titled “Pediatric Sedation” for the November edition of emedhome.com

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leading in CLINICAL SERVICE

IUEM Advocacy Blogby Alex Rhea

SERVICE PRESENTATIONSGoing Above & Beyond

CLINICAL STATISTICS

The School of Medicine sponsors a Student Outreach Clinic run out of a Neighborhood Fellowship church at 3120 E. 10th St. Different clinical departments provide the clinical coverage. Our ED residents and faculty tackled November, filling slots for five different Saturdays. This clinic provides primary care services free of charge to uninsured members of the community. It also has partnered with other schools on campus to provide a growing array of services including Pharmacy, Legal, Social Work, and Dental. Thanks to all who participated in this worthy cause.

Have you seen the IUEM Advocacy Blog? Here you will find some excellent posts including a recent one by Terez Malka focusing on foster care? If you have interest in contributing, please let Alex Rhea know and the advocacy committee will be happy to post your comments. Faculty, residents or any other member of the community are invited to submit entries. Remember residents, this can count for your end of the month portfolio entry!   Visit: http://iuemadvocacy.wordpress.com

Lindsay Weaver will be presenting a poster at the American Academy of Hospice Palliative Medicine and Hospice and Palliative Nursing Association annual assembly called “Emergency Physicians Current Practice and Barriers to Palliative Focused End of Life Care in the Health Care System”. This meeting will take place March 12-14, 2014 in San Diego, CA. Lindsay wants to give credit to Robin Chisholm who helped with the survey design and Jen Walthall who mentored her on the project.

At the Cerner Health Conference in October, Chris Strachan gave a presentation titled “Somebody Call 911: My ER Needs Resuscitated after EMR Adoption”

Jen Walthall presented a talk called “Pediatric urban violence” at the Midwest Injury Prevention Alliance Annual meeting held, at the end of September, in Ann Arbor, Michigan.

Carey Chisholm headed south to UTSW in Dallas in August where he gave a Journal Club and a faculty development session.

Jamie Jones was an invited professor at the Maimonides Medical Center in Brooklyn on Sept 18, 2013 and at the University of Arizona in Tucson on October 30, 2013.

Carey Chisholm gave grand rounds and two faculty development sessions at the Albert Medical School at Brown University in Providence Rhode Island.

Chuck Shufflebarger presented “Emergency Department Operational Metrics 2012” at the October IUH morning webcast.

The third quarter numbers are in. Riley is still seeing volume increases but the volumes at our adult sites are likely to be down, a wee bit, compared to last year. Mind you no one is taking a break, as we have had to juggle these patient volumes with a new electronic medical record, new physician order entry, new bench marks, a move to a new hospital, and an ever increasing number of learners. Look up the word resilient in the dictionary and you will see a picture of an EM physician.

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Wishard Methodist Riley IU| 7

This fall’s Research Boot Camp put eight faculty members from the ED and the Department of Family Medicine through their paces.

Rather than using actual drill sergeants, Alice Mitchell enlisted local help from a number of experts: Tom Emmett (Ruth Lilly library), Kaci Allgood (MESH), six librarians from Ruth Lilly for 1:1 consultations; Amy Waltz to cover ORA/IRB issues; and Anthony Perkins covered Biostatistics. Of course she drafted ED faculty (including Jeff Kline and Marie Vrablik) to help as well. The turnout was great and the participants left battle tested and ready to conduct their research studies. Great job Alice!

RESEARCHleading in

Research Boot Camp Debrief

Alice Mitchell received a national American Heart Association Mentored Clinical & Population Research Award. This will provide her with 2-years of funding for research and training.  She considers the best part to be mentorship from a diverse group of experts:

• Bruce Molitoris, MD Nephrology --acute kidney injury expert

• David Basile, PhD Physiology--renal physiologist

• Shaun Teague, MD Radiology—cardiothoracic imaging expert

• Jonathan Helm, PhD IU Bloomington Kelly School of Business--industrial engineering/healthcare operations expert

• Sebastian Heese, PhD Germany, EBS School of Business—industrial engineering/decision-making expert

• Chirag Parikh, MD PhD Yale Nephrology—kidney injury biomarker expert

Alice Mitchell receives AHA Award

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Neto-Neves EM. Cell-free DNA as a marker for risk stratification of pulmonary embolism. Crit Care 17:464, 2013. PMID:24245555.

Kline JA, Stubblefield WB. Clinician Gestalt estimate of pretest probability for acute coronary syndrome and pulmonary embolism in patients with chest pain and dyspnea. Ann Emerg Med Sep 23, 2013. PMID: 24070658.

Kline JA, Shapiro NI, Jones AE, Hernandez J, Hogg MM, Troyer J, Nelson RD. Outcomes and radiation exposure of Emergency Department patients with chest pain and shortness of breath and ultralow pretest probability—A multicenter study. Ann Emerg Med. Oct 10, 2013. PMID: 24120629 Froberg BA, King KJ, Kurera TD, Montee AA, Prosser JM, Walsh SJ, Riffenburgh RH, Rusyniak DE, Tanen DA. Negative predictive value of acetaminophen concentrations within four hours of ingestion. Acad Emerg Med Oct 20, 2013. PMID 24127715.

Kline JA, Hernandez J, Hogg MM, Jones AE, Courney DM, Kabrhel C, Hordenholz KE, Diercks DB, Rondina MT, Klinger JR. Rationale and methodology for a multicenter randomized trial of fibrinolysis for pulmonary embolism that includes quality of life outcomes. Emerg Med Australas. Nov 13, 2013. PMID: 24224521.

Kline JA, Watts J, Courtney D, Lee Y, Hwang S. Severe pulmonary embolism decreases plasma L-arginine. Eur Respir J. Online Nov 14, 2013. PMID: 24232703

Kline JA, Jones AE, Shapiro NI, Hernandez J, Hogg MM, Troyer J, Nelson RD. Multicenter randomized trial of quantitative pretest probability to reduce unnecessary medical radiation exposure in Emergency Department patients with chest pain and dyspnea. Circ Cardiovasc Imaging. Online Nov 25, 2013. PMID: 24275953.

RESEARCH PRESENTATIONS

leading in RESEARCH

RESEARCH PUBLICATIONS

Jeffrey Kline presented “Emerging Management Strategies in Acute Venous Thromboembolism: ED Assessment of the Patient with Suspected Pulmonary Embolism” at CHEST 2013 in Chicago, IL, October 27, 2013.

Jeffrey Kline presented “Your face tells me you are sick” at the TEDx Indianapolis in October 2013. This talk is available online at: http://www.youtube.com/watch?v=F9udzAHPnoI

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NEWwhat’s

Ode to Dry Hands by Adam Posner  It always happens in the winter     with constant washing my hands splinter Even if I use gel and lotion     skin becomes sandpaper in motion Fissures open, the knuckles turn red     a few times my hands even have bled How it stings me--such irritation!     The stigmata of sanitation! Yet, I still say as the water pours     “Let me clean my hands, then I’ll shake yours.” It is a soapy cross that I bear     an important way to show I care. For as a doctor I know this much     first do no harm starts with the first touch.

This poem was originally printed in JAMA 308(9):888, 2012Used with permission.

December 7th was a big day for Wishard Hospital and the new Eskenazi Hospital. At 6:59 a.m. Wishard Hospital closed its doors and at 7:00 a.m. Eskenazi Hospital opened theirs. A total of 149 patients were moved and 30 new patients were admitted that Saturday. The patients were moved with the help of medical personnel, some of our very own, and hundreds of volunteers from the Naval Reserve, and the National Guard. The last patient, a newborn boy, was discharged from Wishard at 2:50 p.m.

The Big Move: Wishard to Eskenazi

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EVENTSleading in

Jamie Jones gave three American Board of Emergency Medicine (ABEM) presentations at the ACEP Scientific Assembly in Seattle.• 2013 ACEP Council Meeting - Update on ABEM activities• 2013 ACEP New Fellows Breakfast - Spoke on ABEM’s involvement

during their professional career• 2013 Fall CORD Business Meeting - Update on ABEM activities

Elizabeth Weinstein had two talks and participated in a Master Panel. She spoke on “Classic Pediatric Rashes” and “Pediatric Seizures” and participated in the “Masters of Pediatrics Emergency Medicine Expert Panel: Myths and Controversies”. Christine Stehman presented a poster titled “The incidence of ventilator associated pneumonia in patients intubated in the Emergency Department”

The 2014 ACEP meeting will be in Chicago, so let’s gear up to have a giant presence there. Block October 27-30th off on your calendars now.

Daren Beam (research fellow) and Ben Petty (R3) created the inaugural Mustache Bash on November 11th. This event was held to raise money for the Student Outreach Clinic on the near  Eastside  where our EM residents and faculty periodically volunteer. Held at the ShoeFly Public house, it featured topnotch judges who are intimately familiar with facial hair: our very own Dr. Chisholm; Randy Ross, one of the new research RNs; and the much beloved Jim Graber. This year had three winners: JD Drew took home the overall winner, Adam Thomas won the most disturbing mustache award, and Ben Petty took home the worst mustache or “The Dirt Lip” Award.  All money raised went directly to the outreach clinic. Next year they hope to plan the event well in advance, giving all department members and their  significant  others (who are capable) plenty of time to come up with a winning ‘stach.

Mustache Bash UPCOMING EVENTS

ACEP in Seattle

Annual Scientific AssemblyFebruary 11-15, 2014New York City, NY

Indiana ACEPMay 1 & 2, 2014Keystone at the Crossing Marriott Indianapolis, IN

SAEM Annual MeetingMay 13-17, 2014Dallas, TX

OFAPD & CTLAdvancing Learning TechnologyFebruary 28 with Kevin Werbach

Stepping Stones of Women in Leadership• January 29 with Dr. Sharon Andreoli• February 19 with Dr. Tatiana Foroud• March 5 with Dr. Nicole Keith

AMWA Mentoring Mixer with the Women’s Advisory CouncilFebruary 11

The September Podcast of the Journal of Medical Toxicology by Dan Rusyniak and Howard Geller called “Something Old and Something New” features a wide variety of great topics. They talk about why toxicologists should use modern technology to go back to Tele-medicine rather than telephone calls, Methylene Blue antidotes, intralipids, and a reminder that there is no room in the house or backyard that is safe from hazards. You can listen to their podcast at https://soundcloud.com/acmt/sets/the-jmt-podcast-1/ or download it in iTunes, so you can find the correct way of pronouncing Toxicology, sort of.

Podcast

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