Department Of

Brown University Department of Department of Emergency Medicine Newsletter mergency Our newsletter is edicine published twice a E M year to provide news and information O PROVIDE EXCEPTIONAL EMERGENCY MEDICAL CARE EDUCATION RESEARCH AND about Emergency T , , SERVICE TO THE PEOPLE OF RHODE ISLAND AND BEYOND. Medicine to the health system, VOLUME 8, ISSUE 1 SPRING 2013 medical school, our alumni and friends. Message from the Chair Academic when we know that better communication gets better results. We tolerate long Emergency Medicine’s waits, and make excuses for poor service. Accountability Gap And rather than taking control of what we can control, we blame others – “the hospi- Academic emergency physi- INSIDE THIS tal”, “administration”, “the system”. We also cians are under some pressure as of late. account for a substantial amount of health ISSUE: As ED visits rise, we are asked to see sicker, care spending, and could be more in- more complex patients. With inadequate volved in controlling excessive health care Anderson AC 3 community resources and a persistent lack costs. Until we hold ourselves and each of primary care, we continue to be the Brown Faculty 5 other accountable in the clinical arena, we safety net for the world of medicine and will not deliver the type of emergency care Chest Pain Center 7 beyond. Ten years ago there was a sense that we all want to deliver. EM Residency 6 of appreciation for this safety net role of emergency medicine (EM). How things Education: Part of the accountability gap EMS 5 have changed. Now ED’s are derided by in education is our lack of training as medi- Grand Rounds 14 policy makers and the media, and some- cal educators. For too long we have relied Hamolsky Award 20 times other academic physicians, as ven- on the few “naturals” in our departments ues of “inappropriate” visits where we test who can teach well and connect with International EM 16 too much and rack up huge health care trainees without much help. But most of In the Spotlight 17 bills and keep patients from using their us have deficiencies in our ability to teach primary care doctor. While we know that – we could be much better. Whether it is Injury Prevention 8 this is a gross misrepresentation of EM, giving feedback, presenting a high quality Medical 19 and must constantly push back with facts lecture, or assessment and evaluation, spe- Humanities and data to correct wrong impressions, cific training can make us better. We won’t The Miriam ED 3 there are some things that we must own. I all be able to get Masters degrees in medi- Pediatric EM 4 think medicine, including EM, suffers from cal education, but we can aspire to learn an accountability gap. Accountability is to be better teachers through study, work- Publications 12 the willingness to accept (“own”) responsi- shops, courses, etc. Another part of the Regional/ 13 bility for our actions and approaches. As accountability gap in EM education is how National we look at our traditional tripartite aca- we handle burgeoning clinical volume Research 10 demic mission there are significant gaps in without sacrificing bedside teaching. If we Simulation Center 15 accountability in each area. rely too heavily on our residents for service, we are not fulfilling the promise that Clinical Care: While there have been some Sports Medicine 8 we made when these residents were appli- champions of quality and patient safety for Toxicology 18 cants. We must preserve teaching mo- over 20 years, EM, like the rest of medicine ments, rounds, and time for feedback in Women’s Health 18 has been far too slow to adopt the practic- our busy shifts. es that improve quality and safety (see Re- search below). We still find reasons NOT to Research: The amazing growth of EM re- practice evidence-based medicine, and search has produced a wide variety of resist standardization of practice. We accept poor communication and teamwork (continued on page 2) PAGE 2

Message from the Chair (continued from page 1) new knowledge, but the accountability deficit here is I will close with a few examples where EM has dealt one of dissemination in to practice. We have created with an issue of accountability and did the right the evidence but too often it sits in magnificent peer- thing for patients and our field. In the clinical arena reviewed journal articles and does not result in evi- we have responded to less than stellar performance dence-based practice. The accountability equation in with quality improvement changes to improve out- this case is simple, but hard to achieve - investigators comes in some of our sickest patients – acute MI and who do the research must own their work all the stroke – by pushing down the time to diagnosis and way to changes in clinical care, and clinicians must treatment. This has required meticulous attention to pull evidence-based research in to their practices. detail, constant reinforcement, and measurement Otherwise the millions of dollars that we spend in and reporting – and it is now routine for us to have basic science and clinical research have not top decile performance in these areas. In the been a meaningful investment. Accountability area of resident education, faculty supervi- can be the thread sion of residents on a 24 hour a day basis Before you accuse Dr. Eternal Optimist of to weave our way was not routine even in to the late 1980’s. getting off to a grumpy start in 2013, know to future success. Some in EM began to push for 24 hour facul- that I am still bullish on academic medicine, ty supervision, but many resisted doing this, and particularly academic EM. But I strug- with rationalizations and arguments playing out in gle with the big bear of accountability just as you do. the editorial pages of our journals. Finally, the RRC- So how do we get more accountable? In most situa- EM mandated 24 hour faculty supervision in 1989 tions, it is not a lack of knowledge, or methods, or and we were fully accountable in providing resident resources that creates the accountability gap – it is supervision. It took a long time, but EM eventually the inability to change our culture. Solutions to en- led the way among specialties in full-time supervision hance accountability in any of the areas of our mis- of residents. In the research realm we have used EM- sion are not accomplished in a month –they make derived research to change clinical practice with ap- take a decade - but we need to own every step for- plication of the NEXUS cervical spine clearance rules, ward, and confront the forces that hold us back. and the implementation of early goal-directed thera- The process of “holding you accountable” invokes py in sepsis. mental images of finger wagging, a looming pres- Accountability can be elusive and take a while to ence, and growling voice. But, we don’t have to be achieve, but it is clearly possible. It can be the thread confrontational or irascible in our push for accounta- that we use to weave our way to future success in bility. Excessively demanding, punitive behavior academic emergency medicine. might get a short term result, but is not a long term solution for change. The more enduring approach is If you have thoughts on this essay, to involve the entire team in identifying accountabil- or anything else in this Newsletter, ity gaps, make a plan together for how to gain ac- please email me at countability through small changes, collect data, set [email protected] Happy 2013. standards, define and regularly share metrics, and Please enjoy this edition of our then incentivize for strong performance. With this Brian J. Zink, MD Newsletter, and keep in touch. approach, penalties and confrontations can be few – Frances Weeden Gibson—Edward A. Iannuccilli, MD as long as the whole team is willing to hold each Professor & Chair, Physician-in-Chief Department of Emergency Medicine other accountable. And the best thing we can each Alpert Medical School of Brown University do is lead by example. Rhode Island & The Miriam Hospitals Assistant Dean, Medical Student Career Development

RIH—150 Years Celebration Rhode Island Hospital has planned various events throughout 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

DEPARTMENT OF EMERGENCY MEDICINE PAGE 3

Frantz Gibbs, MD, Medical Director, Anderson Emergency Center Rhode Island Hospital, Anderson Emergency Center We have seen patient volume Our C-Pod has been converted into an ur- increase over the past year. Pa- New staffing & gent area and care for more acute patients. tients continue to select us as space utilization The physician, midlevel and nursing staff- their provider of choice for plans are already ing has been increased accordingly to cov- emergency care and our care- improving er these patients. The Pod opens earlier in teams work hard every day to meet their patient flow. the day, having all rooms available at 8 am, expectations. In January, we made adjust- and remain open until 1 am. This area has ments to the staffing and Pod utilization to better helped us increase the throughput of ESI 2 and 3 accommodate the growing patient volume. The patients over more of the day. changes increase the areas we use for patient The E-Pod serves to concentrate patients coming care and make more spaces available for waiting out of the Critical Care area and continue to tran- patients. In particular, one of these areas focuses sition admitted patients. Patients cleared from on the care of low acuity patients, and better ad- Critical Care will move to the E-Pod to continue dress the needs for this patient population. Cur- their care. In addition to increased nurse staffing, rently, the new Pod operations only occur during a midlevel provider was also assigned to this area. the week, and the Pods will function as they do This provider works and coordinates with the during the weekends. As we increase staffing in Critical Care attending and residents, to ensure the future, the changes to Pod functions will also patients continue to progress through their man- include the weekends. (continued on page 16 )

The Miriam Hospital Emergency Department Gary Bubly, MD, Medical Director, starting to taking The Miriam Hospital, Emergency Depart- Despite our shape in the back- active ground. Rescues If you have been around the exte- renovation, and ambulances rior of The Miriam Hospital Emer- we are are shoe-horned into the driveway. The pic- gency Department lately, the pic- ture captures the feel of the cramped nature ture below exemplifies what you and patients seeing more patients of things at TMH, the disruption entailed by may have seen. Inside a construction fence, an the renovation project, as well as the excite- excavator digs up the driveway leading into than 1 year ago. ment of what a new ED, better prepared for what will soon be the new TMHED walk-in en- the future will mean for us. trance. The dig will enable installation of a new electrical feed for the hospital. This is a valuable That new walk-in entrance, waiting room and ren- infrastructural improvement that was wisely tied ovated triage area opened in January. Besides be- into the ED renovation project. This redundant ing a beautiful professional space, it provides bet- electrical feed will help reduce our chance of sus- ter patient flow. The next phase of the project will taining a power outage, and ensure the entire hos- then involve the conversion of the "Annex" into pital's viability in a disaster. The walk-in entrance is 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 throughput. That phase will be complete around July of 2013. Patients and rescues have been undeterred by the inconveniences of our renovation and those creat- (continued on page 20)

DEPARTMENT OF EMERGENCY MEDICINE PAGE 4

Bill Lewander, MD - Vice Chair Pediatric EM at Hasbro Children’s Hospital for Pediatric Emergency Medicine The Hasbro Children’s Hospital Emergen- ly. Mariann Nocera, MD is a graduate cy Department patient volume and acui- of University of Connecticut Medical ty has risen sharply this winter season. school and is completing a pediatric Significant numbers of influenza and RSV residency at Yale University School of cases are being reported. Medicine. Robyn Wing, MD graduated from University of Massachusetts Medi- As part of our winter plan to address increasing vol- cal School and is currently a pediatric ume and to assist evening staff to meet late evening chief resident. Please join us in welcoming our new and overnight patient care demands, we have estab- fellows. lished a 9pm to 4am clinical attending shift. This will be the staffing configuration through March, 7 days In recapping 2012, HCHED has had many accom- a week. The staff change will be closely monitored plishments. The emergency department had 52, to see if desired goals are being achieved. 591 patients through the door. This was the 5th con- secutive year of caring for over 50,000 patients. On the clinical side, the HCHED has rolled out a sepsis triage tool and protocol this past fall. Part of the Throughout the year, there have been many clinical protocol is a sepsis bundle order including IV and ED initiatives developed by collaborating with other labs. clinical providers to meet common goals in patient care and treatment of common illnesses. In academics, The Hasbro ED is enrolling participants in three PECARN studies and three other multicenter HCHED joined with 14 other children’s hospitals in a studies. Our own PECARN study (Project ASSESS— pediatric sepsis collaborative. This group formed a Age Specific Screen for Ethanol and Substance Sta- multidisciplinary sepsis planning team and designed tus) was initiated in September and we will be con- and initiated a sepsis triage tool and management ducting formal training with the other 16 participat- protocol. ing pediatric emergency departments from the The HCH emergency department established best study in Providence in early April. practice initiatives and aligned with PEM/Emergency Bonnie MacKenzie, MD, an EM pediatric fellow, gave Medical Services for Children best practices includ- a lecture entitled “ Evaluation of the Effects of a State ing, minimizing chest x-rays in patients with asthma, Concussion Law on Pediatric Visits to an Emergency decreasing head CTs in patients with minor head Department”. Dr. MacKenzie presented at the Na- injury, expediting the time to antibiotics for neonates tional American Academy of Pediatrics Conference with fever, and immune compromised patients with and Exhibition in New Orleans in October 2012. fever. Another pediatric EM fellow, Frances Benedict, MD, Pediatric emergency medicine worked with various gave an oral presentation on the Association Be- departments throughout the Lifespan health system tween Mental Health Disorders and Bullying in the on improving patient care. Pediatric EM collaborat- US Among Children Aged 6 to 17 Years on October ed with the pediatric trauma service to adopt new 22, 2012 in the section of the conference for Injury, level of trauma criteria. Pediatric EM worked with Violence, and Poison Prevention. Two of our pediat- neurosurgery, radiology and pediatric trauma to de- ric EM fellows, Drs. Matthew Wyllie and Marleny velop pediatric s-spine guidelines to reduce excessive Franco, gave a presentation at the Hasbro Children’s radiation in children. We also joined together with Hospital 2012 Pediatric Trauma Symposium in No- radiology to reduce excessive radiation by develop- vember called “ The Collapsed Athlete”. ing a protocol to utilize ultrasound and MRI to evalu- Jane Preotle, MD, a graduating pediatric EM fellow, ate patients with abdominal pain at risk for appendi- will join us as the newest pediatric EM/EM attend- citis. To improve the evaluation process in the chil- ing, boarded in EM and anticipates Board –eligibility dren’s ED for patients with primary mental health in pediatric EM. Jane will work in the HCHED, An- complaints, we partnered with child and adolescent derson Emergency Center, and The Miri- psychiatry. This demographic of patients has in- am Hospital Emergency Department. creased 25% from 2011. This partnership reduced the turnaround time for discharged child psychiatry The pediatric EM fellowship is pleased to patients by 2 hours. The RN/MD Collaborative Care welcome two new fellows arriving in Ju- Committee has been expanded. This committee Sue Duffy, MD - worked on shared care initiative, such as team train- Medical Director, Hasbro Children’s Hospital ED (continued on page 15)

DEPARTMENT OF EMERGENCY MEDICINE PAGE 5 EMERGENCY MEDICINE FACULTY

Professor Assistant Professor cont, Clinical Instructor Bruce Becker, MD, MPH Otto Liebmann, MD Amir Bernaba, MD Gregory Jay, MD, PhD Alyson McGregor, MD, MA Laura Forman, MD William Lewander, MD Lisa Merck, MD, MPH Katherine Kimbrell, MD James Linakis, MD, PhD Christopher Merritt, MD, MPH Megan McNamara, MD Selim Suner, MD Anthony Napoli, MD Brian Zink, MD Megan Ranney, MD, MPH Neha Raukar, MD, MS Teaching Associate Clinical Professor Lisa Schweigler, MD, MPH Christine Garro, PA Elizabeth Nestor, MD, M Div. Todd Seigel, MD Allison Jackson, PA Matthew Siket, MD Lisa Murphy, FNP Associate Professor Robert Tubbs, MD John Pliakas, MSN Adam Chodobski, PhD (Research) Thomas Chun, MD, MPH Clinical Research Associate Susan Duffy, MD Assistant Professor Julie Bromberg, MPH Jason Hack, MD David Bouslough, MD, MPH Leo Kobayashi, MD Erica Constantine, MD Teaching Fellows Michael Mello, MD, MPH Catherine Cummings, MD Bryan Choi, MD—Disaster & EMS R. Clayton Merchant, MD, MPH, ScD Thomas Germano, MD Allysia Guy, MD—Ultrasound Ted Nirenberg, PhD (Secondary) Kirstin Gregg, MD Tracey Madsen, MD— Frank Overly, MD Andrew Griscom, MD Women’s Health in Emergency Care Daniel Savitt, MD Thomas Haronian, MD Stephanie Midgley, MD—Ultrasound Dale Steele, MD Ilse Jenouri, MD, MBA Catherine Pettit, MD— Jonathan Valente, MD David Kaplan, MD Medical Simulation Matthew Kopp, MD Allison Riese, MD— Clinical Associate John LaFleur, MD Injury Prevention Center Professor David Lindquist, MD Gary Bubly, MD James Monti, MD Upcoming Mihir Kamat, MD James Rayner, MD Matthew Kopp, MD John Riedel, MD Grand Rounds Speakers James Monti, MD Marcia Robitaille, MD Jesse Pines, MD, MBA, MSCE Andrew Nathanson, MD Dana Sparhawk, MD Associate Professor of EM & David Portelli, MD Brian Wiley, DO Director of the Center for Health Lawrence Proano, MD Care Quality Francis Sullivan, MD Assistant Professor (Clinical) George Washington University David Bullard, MD, MEd Health Policy/ED Overcrowding Associate Professor (Clinical) Charles Callahan, MD, MPH Deirdre Fearon, MD March 20, 2013 Sarah Case, MD Gregory Lockhart, MD Laura Chapman, MD Kenneth Williams, MD Kip Benko, MD Ciarallo, Lydia, MD Clinical Associate Professor of EM Assistant Professor Jamieson Cohn, MD University of Pittsburgh, Siraj Amanullah, MD, MPH Michelle Daniel, MD School of Medicine Janette Baird, PhD (Research) John Foggle, MD UPMC—Presbyterian Hospital Jay Baruch, MD Sarah Gaines, MD Dental Emergencies Francesca Beaudoin, MD, MS Frantz Gibbs, MD May 22, 2013 Linda Brown, MD, MSCE Mark Greve, MD Joanna Szmydynger-Chodobska, Tobias Kummer, MD Gregory Jay, MD, PhD PhD (Research) Elizabeth Jacobs, MD Professor of EM & Vice Chair, Geoffrey Capraro, MD, MPH Joseph Lauro, MD EM Research Esther Choo, MD, MPH Laura McPeake, MD Alpert Medical School, Brian Clyne, MD Krithika (Meera) Brown University Jeffrey Feden, MD Murgunandan, MD, MPH Topic to be announced Rachel Fowler, MD, MPH Lynne Palmisciano, MD June 19, 2013 Aris Garro, MD, MPH Paul Porter, MD Eric Goldlust, MD, PhD Jessica Smith, MD Nathan Hudepohl, MD, MPH Elizabeth Sutton, MD Michael Lee, MD Lynn Sweeney, MD Adam Levine, MD, MPH Otis Warren, MD

DEPARTMENT OF EMERGENCY MEDICINE PAGE 6 New Program Goals & a New Education Fellowship The residency program recently affirmed its five lieve that pursuing them will continue to set us year vision and established new goals to define our apart. success. Our vision “to have the most highly- I am also pleased to announce the recent approval regarded, sought-after, and high quality Emergency of an exciting new fellowship sponsored by our de- Medicine residency program in the nation” will be partment. The Medical Education Research Fellow- measured according the following criteria: ship in Emergency Medicine is a two year mentored Continuous maximum allowable ACGME fellowship that provides advanced training in class- accreditation room and bedside teaching, curriculum design, and medical education research for a graduate of an Top decile performance for education on the accredited Emergency Medicine residency program. annual ACGME resident survey It is one of only twelve such programs in the coun- >90% resident compliance with clinical quality try affiliated with EM residency programs. Fellows measures will have protected time and structured guidance to develop expertise in an area of medical education A 5% annual increase in residency applications research as a means to becoming an independent 100% of graduating residents who meet or ex- researcher and educational leader at the local and ceed Level 4 competency on the EM Milestones national level. The strength of the program is its multi-disciplinary approach, offering mentorship A 100% first-time ABEM pass rate for from faculty across the medical education spectrum. graduates The program includes a master’s degree in Medical Consistently produce >50% of graduates Education Leadership and is designed to provide a who pursue advanced training or skills strong foundation for a career in academic Emer- to become clinical, academic, and service gency Medicine. This new fellowship will expand leaders in emergency medicine. opportunities for EM residents and fellows to en- Some of these goals will be harder gage in educational research, scholarship, and teaching. Brian Clyne, MD to achieve than others, but we be- Director EM Residency

Stroke Programs at RIH & TMH Dr. Bubly Named Public Health Hero In September 2012, The Joint Commission reviewed and certified Rhode Island Hospital as a Primary Stroke Center Gary Bubly, MD, Medical again. This certification is good for 2 years. Recently , we Director of TMH ED, was standardized the ordersets in our ED documentation sys- named a "Public Health tem MedHost for stroke (and related problems) at both Hero” by the Association of State & Health Territori- Todd Seigel, MD TMH and RIH. Director al Officials (ASTHO). Dr. Bubly was We have made excellent progress in the treatment of acute nominated by the RI Department of stroke at TMH. The data of our progress was presented at the monthly Health “for his assistance in writing reg- meetings in November and December. We track 4 ED-related stroke ulatory language regarding emergen- metrics. Our performance was commendable on each metric. Next cy dispensing of medications from year we have set even higher goals. Our performance in these areas emergency rooms. He has also been a has improved significantly since the prior year. driving force in developing Rhode Is- We are moving forward with the TIA Observation Unit at RIH on March land's legislation on the state's new Pre- 1, 2013. As of that date, we will be placing patients in this pathway to scription Monitoring Program, which arrange rapid evaluation and neurology follow-up for patients with sus- allows for daily real time reporting from pected TIA. With this Observation Unit, we plan on addressing a num- pharmacies and web access for provid- ber of issues related to TIA, such as eliminate significant physician prac- ers, so ER physicians can make sound tice variation; expedite throughput of TIA patients awaiting neurology decisions when writing prescriptions for consultation; decompress inpatient volume; create an excellent oppor- controlled substances.” Excerpt from tunity for data collection and participation in clinical trials and potential- TMH press release. Only 41 physicians/ ly decrease the incidence of short-term stroke after TIA by standardizing researchers have been recognized as a and front-loading the diagnostic evaluation.  “Public Health Hero” nationwide. 

DEPARTMENT OF EMERGENCY MEDICINE PAGE 7

Anthony Napoli, MD Medical Director Rhode Island Hospital—Chest Pain Center Re-accreditation of our institution as a adverse outcomes such that discharge from the Chest Pain Center is a testament to the Emergency Department has been shown to be quality of care we provide our chest safe. In our own cohort, over the last 2.5 years, we pain patients. Our chest pain unit and have seen over 400 patients in the CPU who met our advanced treatment of out of hos- such criteria – none of them had an infarct, none pital cardiac arrest victims with neuroprotective have had a positive stress test, and none had an hypothermia are key components of that; they con- adverse outcome at 30 day follow-up. As such, we tinue to thrive operationally and academically. have revised our CPU admission guidelines to rec- ommend discharge of such patients so that we can Identifying acute coronary syndrome amongst low better utilize the resources we have while safely risk chest pain patients can be challenging. Admis- providing quality care to those in need. We also sion to observation units can save hospital admis- continue to have great success in our 2 year old sions and result in protocol-based safe and effec- program to provide neuroprotective hypothermia tive care, but can be at the expense of admitting for out of hospital cardiac arrest victims with spon- patients of whom the overwhelming majority have taneous return of circulation. Between The Miriam no cardiac disease. Research from our own CPU and Rhode Island Hospital we have now treated has effectively demonstrated this. However, as we over 50 patients. Thanks to the hardwork and dedi- advance into an era of cost containment and self- cation of our clinical staff in the examination of the necessity of healthcare utiliza- EDs and ICUs, our outcomes tion in select situations, we must examine our own have been excellent. Our neu- practice. Research outside and now within our rologically intact survival rate own institution has shown this to be the case. Pa- for out of hospital cardiac ar- tients less than 40 years old without a history of rest stands at 41%, nearly dou- coronary artery disease, with a non-ischemic ECG ble what it was preceding im- and normal initial troponin are at very low risk of plementation. 

Kenneth Williams, MD Division of EMS - LIfePACT Director, EMS Where’s the PIF? - As you may know, EMS became an ACGME-approved subspecialty of emergency medicine in October 2011. The rules for becoming an accredited fellowship and for taking the qualifying examination are now being finalized. The fellowship application process includes 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 including 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 (continued on page 9)

DEPARTMENT OF EMERGENCY MEDICINE PAGE 8

Michael J. Mello, MD Injury Prevention Center Medical Director, Injury Prevention Center Injury Prevention Center Completes Study ings and related recommenda- & Presents Findings tions in November at the 2012 Injury Free Coalition for Kids As part of the American College of Sur- Annual Conference in Kansas geons verification to be a level 1 trauma City, MO. At the end of the implementation phase, all center, centers are required to have the seven sites had effectively adopted and implemented capacity to identify trauma patients with risky alcohol SBIRT policies for injured adolescent inpatients. Ac- use and provide an intervention. With funding provid- cording to the medical record review, across sites 11% ed by CDC’s National Center for Injury Prevention and of eligible patients received alcohol screening at base- Control, the Injury Prevention Center at Rhode Island line but this increased to 73% of eligible patients re- Hospital partnered with seven Injury Free Coalition for ceived alcohol screening at both the end of the imple- Kids sites, a coalition of 42 trauma center based, com- mentation and maintenance phases. The experience munity oriented injury prevention programs, to trans- and data accumulated was utilized to produce late SBIRT to the adolescent patient. The research study “Implementation of Alcohol Screening, Brief Interven- was divided into three phases: adoption, implementation and Referral to Treatment tion and maintenance, each lasting one year. Sites par- Policies in Pediatric Trauma Cen- ticipated in 24 months of technical assistance activities. ters”, a manual containing rec- Each site conducted a blinded retrospective review us- ommendations for the developing one month of medical records of injured adoles- ment and implementation of cent patients eligible for SBIRT services admitted at SBIRT programs at pediatric trau- baseline before the start of the adoption phase, at the ma centers. It was distributed at end of the implementation phase and at the end of the the conference to all attendees maintenance phase. as well as will be mailed to all Dr. Michael Mello, Ms. Julie Bromberg and representa- pediatric trauma services nation- tives from the participating sites presented study find- ally.

Sports Medicine Welcome Back, Dr. Paul Porter The Center for Sports Medicine has seen over 1000 Dr. Porter returns this month from active National concussion visits in 2012, making us one of the big- Guard duty after being deployed since August 2012. gest sports concussion programs in the State. Dr. Porter was stationed at Walter Reed Medical Mark Greve, MD has started to see patients at the Cen- Center in Bethesda, Maryland. This is Dr. Porter’s se- ter. Dr. Greve’s specific interest is cycling injuries. cond tour of active duty. In 2011, he was deployed to Iraq where he cared for injured soldiers. Dr. Por- Since being named to the Institute of Medicine’s Com- mittee on Sports-Related Concussions in Youth, I at- ter beamed, “This was an Incredibly, emotionally, tended the first meeting in Washington, DC. The fulfilling experience. I fell in love with America again. group is very diverse. It is wonderful to have the op- I took care of the most decent, kind, people you portunity to contribute the EM perspective on the top- would ever want to meet in your life.” At Walter ic. Reed, Dr. Porter treated numerous amputees. They have a large prosthetic department at Walter Reed. In November 2012, I gave a lecture entitled “ Tackling He was able to learn more about the complications Concussions: What’s the Hype?” at the Hasbro Chil- that some patients have with limb loss. Dr. Porter dren’s Hospital Pediatric Trauma Symposium. was featured Fall 2012 was busy for the Center. Besides seeing pain the Novem- tients at the Center, Dr. Jeff Feden has been the teams ber/December physician at Roger Williams 2012 edition University and the Physician of the Lifespan Medical Director/ Advisor to Diversity RWU’s Emergency Medical Newsletter  Technician Program. (pictured below) recogniz- Neha Raukar, MD Director, Division of Sports Medicine ing Veterans’ Day.  Visit us at http://www.thecenterforsportsmed.org/

DEPARTMENT OF EMERGENCY MEDICINE PAGE 9

EMS—LifePACT (continued from page 7) 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?

Gr and Rounds 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? This past year 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. 

Good Luck, University Emergency Medicine Foundation Kavita! In 2012, UEMF welcomed several new employees, reorganized and streamlined business operations. November 2012, Kavi- Kirsten Rounds has been named Senior Executive Administra- ta Babu, MD, bid fare- tive Director. Kirsten is located at Claverick. well to the Brown Uni- versity Department of Danielle Renzo has become the Director of Human Resources. Emergency Medicine. Danielle is located at Imperial. Jodi Remick will continue her role as Director of Revenue Oper- Dr. Babu is an Assistant Professor ations. Jodi is located at Whipple Street. of Emergency Medicine and Medi- cal Toxicology Fellowship Director Keith Neal is the Director of Finance and is located at Imperial. Additional space at University of Massachusetts Alison Zangari is now an HR Generalist located at Imperial. at Whipple Street Medical School General Hospital. Paul Marino is a new Data Analyst located at Claverick. Kavita completed her Toxicology Fellowship at UMass-Memorial Dennis Ferrante is a new Data Manager located at Claverick. Medical Center. For Kavita, this Michelle Lindros is a new Administrative Assistant located at Imperial. position was a great opportunity UEMF has expanded its office space at 125 Whipple Street, Providence. closer to home. Dr. Babu will con- The location will have business offices, as well as, physician offices. tinue to work per diem clinically at Welcome Catherine Cummings & Frank Overly to the UEMF Board of Directors. Anderson Emergency Center and Welcome back Matt Kopp for his 3rd term on the Board. Special thanks to Drs. The Miriam Hospital ED.  Sue Duffy & Dave Portelli for their service on the Board. 

DEPARTMENT OF EMERGENCY MEDICINE PAGE 10

Emergency Medicine Research 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 emergency department patients. This study has the potential to validate a screen that can then be used in pediatric 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 dehydration 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, entitled “VitalChest Signs: Pain A Quality Unit ImprovementMedical Director 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 documentation 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. 

593 Eddy Street, Claverick Resident Scholarly Development Fund 2, Providence, RI 02903 The Resident Scholarly Development Fund provides scholarships for Brown emergency medicine residents to carry out projects or training in the research or education realms. The fund was created in 2009 with an initial $5,000 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 contributions, 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

DEPARTMENT OF EMERGENCY MEDICINE PAGE 11

MedHost PhysDoc Roll Out 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 development 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.

Check out the Department of EM Residency’s newly redesigned website: http:// EMRA brown.edu/academics/medical/about/departments/emergency-medicine/residency/ In October 2012, welcome-emergency-medicine-residency-alpert-medical-school. Special thanks to resi- Dr. Jordan Ce- dents Josh Jauregui, Dan Nelson & Yvonne Wang. leste was named President-elect of Upcoming International Speaker—In June 2013, The Depart- the Emergency ments of Emergency Medicine and Neurology will be co-sponsoring a Medicine Resi- Neuroscience lecturer Felix Schlachetzki, MD, PhD is a Professor of Neu- dents Associa- rology at the University of Regensburg in Germany and internationally recognized as an expert in his field. Dr. Schlachetzki is a well-published tion. Dr. Celeste researcher and is the Director of the Stroke Unit in the Department of will spend the coming year pre- Neurology. He will be giving a lecture “Prehospital Transcranial Ultra- paring an agenda for her Presi- sound and Recanalization in large Vessel Occlusions in Ischemic Stroke. dency and organizing the EMRA More information to come. committees. As President, she will be the primary spokesperson for Jessica Smith, MD - Receives the 2012 EMRA and represent EM resident interests on several national ACEP National Faculty Teaching Award boards. Congratulations to Dr. Jessica Smith on her 2012 ACEP National Faculty Teaching Brown EM Residency Clinical Award. She was presented the award at Pathological Case (CPC) Results ACEP’s Scientific Assembly in Denver, CO in October. Dr. Smith, an Assistant Professor The resident winner: of EM (Clinical), has been the Associate EM Residency Program Director Arlene Chung since 2009. Dr. Smith is well-known as an innovative medical educator The resident runner up: Jordan Celeste and consistently sets a high standard with her peers in bedside and The faculty winner: didactic teaching. She is an excel- Jeff Feden lent communicator committed to The faculty runner-up: giving our EM residents the best Ilse Jenouri clinical care experience and feed- The scores were very very close. back. Jessica energizes both resi- Drs. Chung and Feden will partici- dents and faculty, working with pate in the Regional semi-finals in both groups to find better teach- Atlanta in May. If they are unable to ing methods. Dr. Smith also pre- participate for any reason the run- sented a poster at ACEP’s assem- ners up will take their place.  bly.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 12

EM Peer-Reviewed Publications 2012

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 JChest, Nirenberg TD Pain, Lee C, Woolard Unit R, and LongabaughMedical R. DIAL: Directora 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 procedure-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.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 13

Brown EM at ACEP Dr. Raukar Named to Brown EM on the Our Brown EM department had excellent Institute of Medicine(IOM)’s Committee National Scene participation at the annual American Col- on Sports-Related Concussions in Youth lege of Emergency Physicians (ACEP) Scien- tific Assembly in October 2012 held in Den- Neha Raukar, MD was named to the IOM’s ver, Colorado. There were posters by Drs. Committee on Sports-Related Concussions in Megan Ranney & Kim Pringle; Drs. Jessica Youth by the Institute’s Board on Children, Smith, Brian Clyne, & David MacKenzie; Dr. Michelle Youth, and Families. This IOM committee is Daniel; and 2 posters from Dr. Lisa Merck. Dr. Bob sponsored by the Centers for Disease Control Tubbs presented 2 lectures “Don’t Blink: Plain Film Diag- and Prevention, Department of Defense, De- noses You Cannot Afford to partment of Education, Health Resources and Miss” and “Pitfalls inn Pediatric Services Administration, National Academies Chest and Abdominal Radiog- President’s Fund, National Athletic Trainers’ raphy”. The department host- Association, and National Institutes of Health. ed a reception at the Hyatt Regency at the Colo- The group will be studying sports-related rado Convention Center and invited all past concussions in youth using available litera- alumni of our program that was well attended.  ture and data on concussions. The group will be looking at causes; effectiveness of protective 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 further in depth research to the supporting agencies and some regulating government bodies.

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 physicians on real-life patient care scenarios with the aid of computerized mannequins portray- ing patients with symptoms. The LMSC records 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.

January 2013—Both Libby Nestor & Gary Bubly were predominantly featured on the Lifespan website for their significant awards. The LMSC was created to look like a real treatment area.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 14

Visiting Professor— September 19, 2012—Ravi Morchi, MD James Adams, MD Assistant Clinical Professor, Health Sciences November 7th & 8th, 2012, The De- Director, Medical Screening Exam- partment of Emergency Medicine ination Program Harbor, UCLA Medical Center welcomed Dr. James Adams as our Presented: Visiting Professor. Dr. Adams is Pro- International Emergency Interven- fessor and Chair of the Department of tions in the Undifferentiated Medi- Emergency Medicine at the Feinberg cal Environment School of Medicine at Northwestern University and Northwestern Memo- October 17, 2012 - Frank J. Bia, MD rial Hospital. Dr. Adams is an expert Medical Director, AmeriCares Foundation Professor of Internal Medicine (Emeritus) in professionalism, communication, Yale University School of Medicine and health care policy. Presented “Disaster Relief, Cholera & the AmeriCares Model” & As our visiting professor, Dr. Adams participated in 2 days of “Fevers of Unknown Origin in the 21st Century” scheduled events. This included a moderated dinner discussion with Brown Emergency Medicine faculty, fellows, and December 19, 2012- residents on hot topics in academic EM. Dr. Adams present- Dr. Brian Zink ed 2 lectures—one on communication and another on Drug Presented Seeking Patients in the ED. He also participated in bedside The History of teaching rounds at the Emergency Medicine Rhode island Hospital An- derson Emergency Center, gave a faculty development workshop, and provided January 8, 2013—Nader Shaikh, MD one-on-one mini-mentoring Assistant Professor of Pediatrics sessions for faculty. The University of Pittsburgh School of Medicine Dr. Thom Chun coordinated a special Pediatric EM It was an honor and pleas- Grand Rounds in support of PECARN grant. ure for us to host one of the Dr. Shaikh presented “Diagnosis & Management of premiere leaders in emer- Urinary Tract Infections in Children” gency medicine as our visit- Dr. Shaikh is one of our PECARN partners. ing professor.

January 30, 2013—Tracy Sansone, MD Associate Professor, Educa- Thank you Dr. tion Director University of Adams.  San Francisco Health, Morsani College of Medi- cine Dr. Zink presented Presented: Dr. Adams with a Lecture 1: ““Generations at plaque commemo- Work” rating his visit at the Lecture 2: The Educational EM Faculty dinner. Balancing Act: Bedside teaching & Productivity”

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! 

DEPARTMENT OF EMERGENCY MEDICINE PAGE 15

Leo Kobayashi, MD & Frank Overly, MD Lifespan—Medical Simulation Center Co-Directors, RIHMSC In July 2012, we were simulation faculty has brought in a total of $4,650,000 excited to welcome Dr. from externally funded research grants and another Catherine Pettit as our $1,330,000 from courses, industry and hospital funded simulation fellow for AY projects. 2012-2013; we also have Dr. Timothy Babineau, President of Lifespan, Rhode another fellow lined up Island & The Miriam Hospitals, & Dr. Zink both spoke for AY 2013-2014. The about what Medical Simulation has meant to the simulation fellowship is growing and developing a rep- health system in Rhode Island. Dr. Babineau has offi- utation as one of the best in the country. cially changed the “Sim Center’s” name from the Rhode On November 29th, the Medical Simulation Center cel- Island Medical Simulation Center to the Lifespan Medi- ebrated 10 years of simulation. It was an opportunity cal Simulation Center. The Sim Center has been a great to reflect on the past decade and all of the simulation part of the Rhode Island Hospital history providing related accomplishments. Starting with the initial ef- training to a large number of medical personnel. Peter forts of Dr. Gregory Jay and Dr. Marc Shapiro, the simu- Snyder, PhD, Vice President of Research for Lifespan, lation center was born from the MedTeams project. Dr. also praised the Sim Center’s strides over the past dec- Ken Williams and the RIDI project served as the next ade. There were various “stations” that showcased as- significant stepping stone in the launching of the simu- pects of the Sim Center: History of the Simulation Cen- lation program. ter; OR based simulation and movie making capabili- ties; Meet SimMan, “A shocking experience”; Pediatric There have been many projects over the years– during Simulation, “Somebody help my baby”; High Quality the annual simulation center retreat, we took time to CPR, “Manikins giving us feedback; Task trainers, reflect on everything that has come from 10 years of “Practicing on body parts”; and The CLEAR Initiative. true teamwork and dedication toward high quality simulation-enhanced training courses, innovative research Finally, the simulation center staff and faculty came projects and simulation-related quality initiative pro- away from this 10 yr. anniversary with a refined mis- grams. When we tally the numbers, the center has sion statement, a new been busy; the simulation team has worked with over 5-year vision statement 16,893 participants and run over 5,664 sessions. Aca- and increased enthusi- demically, the center (and specifically the EM simula- asm to continue lead- tion faculty) have also been productive; 67 abstracts, ing the way in the field 54 publications (8 more have been submitted) and 96 of medical simulation. national and international invited presentations. The 

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- Zink Appointed to Lifespan Board of Directors duced as needleless ways to reduce pain and anxiety. Lifespan reorganized and condensed its various Resources and programs were implemented for patients hospital Boards from Newport, Bradley, The Miriam, with autism and developmental disabilities including ac- and Rhode island Hospitals and the Lifespan Board cess to specialized toys and equipment to minimize the to be form one Lifespan Board of Directors. Dr. Bri- stress of a visit to the ED. Hasbro Artists worked to create an Zink was appointed to a 3 year term. The new Board will meet 8 times a year for extended meet- an art project cart and developed a volunteer program to ings.  bring art projects to children receiving care in the ED. 

DEPARTMENT OF EMERGENCY MEDICINE PAGE 16

RIH Anderson EC (Continued from page 3) International EM agement. Admitted patients from all Pods will be In September moved through this area whenever possible. 2012, Dr. Dave Overall, utilizing the E-Pod in this manner will ex- Bouslough partici- pedite the care of patients once they leave the pated in the Clin- Critical Care rooms, and make more beds availa- ton Global Initia- ble in the A, B and C-Pods for patients from the tive reception. triage areas. The topic was Health Resources A new area has been established primarily for the for Health. Dave care of low acuity patients, ESI 4-5. The team in met the Ministers this area also assists in expediting waiting pa- of Health for Libe- tients when possible. The B-Pod Procedure ria & Rwanda & Former President Bill Clinton. Rooms and surrounding area has been reorganized and equipped to promote the efficient In November 2012, IEM welcomed Joseph Novik, MD care of these patients. This area is now staffed as the inaugural Global Emergency Medicine Fellow. from 11 am to 11 pm. In addition to nursing and Dr. Novik received his MD from the University of Min- tech staff, an attending and midlevel coordinates nesota Medical School. Most recently he was the Asso- patient management. With the Procedure Room ciate Director of Emergency Ultrasound and Co- area in operation during peak hours, low acuity Fellowship Director of EUS at NYU/Bellevue Medical patients can be largely removed from the other Center. Dr. Novik’s fellowship is in partnership with clinical Pods. Moreover, the staffing in this area the Rwandan government. Dr. Novik will be staying in provides the department with more options Kigali, Rwanda for approximately 8 months. Brown is when the department experiences surges in pa- one of eleven universities participating with the Clin- tient arrivals. ton Foundation and Rwandan government to organ- ize medical education there. When Dr. Novik returns The preparation and planned adjustments assist to the US he will be presenting his experiences and us in continuing to deliver our standard of high research to our department. quality care and service. The support and resources committed by UEMF and our hospital In October, we hosted 2 physicians leaders has been implemented to the best ad- from Managua, Nicaragua. Dr. Mar- vantage of our patients and our teams that care tha Bendana Morales from the Roberto for them. It is our great teamwork and dedication Calderone Hospital and Dr. Rebeca to improvement every day that validates the Herrera Chavarria from the Lenin Fon- great confidence our hospital leaders have seca Hospital. Both hospitals are part- placed in us, and makes us central to the ad- nering with our IEM Division at Brown. vancement of Rhode Island Hospital. 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 Welcome Back, Dr. Mark Greve guests of honor at a dinner held their last night here. In November 2012, Dr. Mark Greve, Several of our Brown emergency medicine attendings Clinical Assistant Professor of Emer- recently left for Managua for a visit. They will be teach- gency Medicine, rejoined UEMF and ing a trauma course to emergency physicians and resi- the Department of Emergency Medi- dents at the Universidad Nacional Autónoma de Nica- cine as a clinical attending. ragua– Managua. The group has an overall goal of “Just when I thought I was out, they pull me back improving access and standards of care for the under- in.” (quote from the Godfather Part III)  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 Dr. Jay Baruch, Selim Content including critical care resuscitation Suner, & Leo Koba- and trauma in low-resource settings. We yashi all participated look forward to further developing the clini- in Lifespan/ RISD’s cal relationships in both areas of the world. Fall Symposium 2012.   Dave Bouslough, MD, Director, International EM

DEPARTMENT OF EMERGENCY MEDICINE PAGE 17

In the Spotlight—Media November 2012—Dr. Jason Hack was quoted in an article in the Providence Dr. Douchebag—The Most Read EM Article in 2012 Journal Fake Drugs, Real Danger. Medscape and WebMD recently carried a list of the top 10 most read articles by emergency medicine physicians. The Laura McPeake, MD was interviewed article that topped the list at number one was Dr. Jay Baruch’s and featured on Channel 10 regarding story Dr. Douchebag—A Tale of the Emergency Department widespread flu on 1/4/13.  which was published in the Hastings Center Report. 11/28/12—Dr. Esther Choo September 2012—Adam Levine was fea- On January 3rd, was featured tured in the Providence Business News in- Dr. Brian Zink on the Lifespan cluding an inter- was interviewed website regard- view regarding by Kristen Gour- ing a study on his International lay for WRNI, RI Adult Entertain- EM work and his public radio, ment Workers award given by regarding the & the benefits the Global EM usual surge in of health care Academy of flu patients in intervention. SAEM.  the EDs. Dr. Choo was the PI on the Study.  WNRI Interview: RI Hospital ER chief: 1/22/13—RIH EM physician Megan 1/10/13—Frantz Gibbs, M.D., was fea- “There has to be a better way.” Ranney, M.D, MPH., wrote a com- tured on Channel 10pm news in a story mentary in response to a recently about the flu season and the high volume December 2012—Dr. Brian Zink was inter- published paper on the use of Twit- viewed by Kristin Gourlay for NPR regard- ter as a vital tool to disseminate pub- of patients many hospitals are seeing. ing the problem of substance abusers fre- lic health information. quent need of emergency services focus- In the Journal of Resuscitation, Dr. Todd Seigel, MD appears in a starring role ing on visits to emergency departments Ranney challenged the paper and in the Video Tour of the Stroke Unit. It and what is being done to help provide a encouraged further study as provid- appears in the October issue of Lifelines. better way to care for this group of pa- ers of care need to respond to social tients. media appropriately in disseminat- ing information. Dr. Ranney’s com-

mentary was highlighted in Provi- Suner Talking: The Injury Prevention Center was all over the dence Business News on January Selim Suner, MD was featured on news in September 2012. IPC/Kohl’s Cares – 28, 2012 in an article entitled “More www.Brown.edu on the anniversary of Kids on the Go Car Seat Safety Program ad- Study Needed to Measure Twitter’s September 11, 2001. Health Impact”. vertising campaign hit all outlets: WebMD, He was also interviewed on WRNI the Yahoo, Facebook, RIPTA buses, radio, & the On January 26, Dr. Ranney was in- local NPR regarding the Rhode Islanders HCH homepage.  terviewed on WPRO-AM regarding who helped who in the disaster’s after- the use of Twitter as a public health math. In August 2012, Lifespan’s Lifelines, Online communication tool. January 2013, Dr. Suner was interviewed newsletter, featured articles regarding the reac- & featured on Lifespan.org with Q&A regarding the flu & how to limit your creditation of the Chest Pain Center at RIH with 8/12 -Tracy Madsen, MD & exposure. quotes from Dr. Anthony Napoli. Also featured the Women’s Health in in online edition an interview with Dr. Dina Emergency Care Fellowship Morrissey from the Injury Prevention Center. was featured in the AWAEM Lynn Sweeney, MD was  Newsletter. interviewed and featured In August, Dr. Dina Morrissey was featured on on the front page of the the Rhode Show with Cardi’s Furniture discuss- January 2013, Dr. Dina Providence Journal Au- ing car seat safety. Morrissey was featured gust 10th regarding Pro- in a public service video ject CLEAR. The story was on the Lifespan website called “Practicing Better for preventing scalding Bedside Manners”. injuries at bath time. 

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 video supports patient centered care and how the whole health care system needs to collaborate on system wide goals to optimize quality care.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 18

EM Toxicology Alyson McGregor, MD Director, WHEC Dr. Hack was liberally quoted in a front page article on Synthetic Cannabinoids in the Provi- The Women’s Health in Emergency Care dence Journal on November 18th. Division (WHEC) has been moving forward. Dr. Hack along with Dr Jordan Celeste and On the research front we are working with Dr. Elena Kapilevich gave an invited lec- national collaborations to produce two Jason Hack, MD ture on “Bath Salts” to Providence Center Peer-Reviewed Lectures (PERLs) for Academic Emer- Director of Toxicology practitioner in October. They have also gency Medicine in support of the 2014 Consensus been invited to give an additional bath salts lecture to the Conference on Gender Specific Emergency Medicine PC and also to Child Protective Services in the coming Research. They will focus on both the aspects of Gen- month. der Specific research methods with showcasing updat- Dr. Hack was appointed to the Pharmacy and Therapeutics ed articles in emergency medicine while the second committee for RIH and TMH. one will present clinical knowledge and skills to bring to the bedside of caring for patients in the emergency Libby Nestor, MD— Recipient of the department. We will be filming in SAEM 2013 so stay Rhode Island Hospital Hamolsky Award tuned! Our educational program continues to grow. We are actively working on curriculum development in sup- EM Physician and Clinical Pro- port of our fellowship missions. We also have had na- fessor, Dr. Elizabeth Nestor, tional interest in the WHEC elective and enjoy show- received the Rhode Island casing our wonderful division and department to out- Hospital 2012 Milton Ha- side rotators who have expressed an interest in wom- molsky Outstanding Physician en’s health. Award. This award was presented to Dr. Nestor in a cere- Dr. McGregor was also invited to the offices of Nation- mony following the RIH Medi- al Board of Medical Examiners (NBME) along with oth- cal Staff Annual meeting on er physicians from the Sex and Gender Women’s January 23, 2012. The award is presented by the RIH Health Collaborative (www.sgwhc.org) to review medical staff to a member who leads by example as a medical school board testing for sensitivity and accura- role model and has made exceptional contributions to cy in gender-specific medicine. This was a wonderful medicine, medical education and research. Dr. Nestor opportunity to contribute to the advancement of this was given the honor for her outstanding of clinical care, science into medical school curricular. impeccable ethics, and never failing dedication to edu- Look for us at SAEM 2013 this year. We will be moder- cating medical students and residents; as well as mentor- ating two Didactics entitled: Mining the Hidden Sci- ing juniorDrs. EM Hackfaculty. and Babu, Division of Medical Toxicolo- ence in Your Emergency Medicine Research: Gender- Libby’s firstgy, careerhave beenwas asvery an hardordained at work Episcopal and as minis- produc-Specific Study Design and Analysis with Guest Present- ter. Shetive then as decidedever! to follow her father’s footsteps ers: Roger Lewis, MD, Deborah Diercks, MD, and Da- and becomeDr. Kavita a doctor. Babu servedLibby joinedas the ourcourse emergency director for vid Wright, MD. Followed by Top 5 Plays of the Day: medicinethe group Prescription in 1994. OpioidShe has Misusebeen recognized Academy, fora na- How Gender-Specific Medicine Impacts Men’s Health with Guest Panel Speakers: Basmah Safdar MD, Neha her commitmenttional conference to medical educationproduced andby clinicalthe ACMT care in with several Department of EM awards including 2006, Raukar MD, Federico E. Vaca MD, Nina Gentile MD March. The evaluations were overwhelmingly Teaching Recognition; 2008, Teaching Excellence; 2010 and David C. Portelli, MD. positive, and ACMT hopes to repeat this course in & 2012, Jacek Franaszek Faculty Teaching Award; and the future. Moving forward for 2013, Alyson 2008, UEMF/ DEM Outstanding Physician Award. Libby will be assuming the role of Divi- was also Dr.named Babu the also Rhode presented Island Medicala collection Women’s of her As- prac- sion Director of WHEC and Es- sociationtice-changing “Women Physician moments of the in Year”a Departmental in 2008. Resi- Grand ther Choo will be the Associate dents andRounds, medical called students “Lessons consistently Learned rank from Libby the in Pre- Director. This will give Esther the top ofscription the group Opioid for Academy.”teaching and mentoring. Dr. some much needed time to focus Nestor was also elected Employee of the Month during Dr. Joshua Jauregui, was selected from a highly on her research projects. As al- 2012 by the EM Staff in the Anderson Emergency Cen- ways, if you have any interest in competitive field of applicants to win the Medical ter. Drs. Zink and Hamolsky both spoke and presented examining your area of research the award. with a gender perspective – con- There was an overwhelming social media response on tact us! Facebook when her award win was posted. Libby’s re- Dr. Fowler shared her research on sponse was “All I can say is, the EM is a big department, "Adolescent Sexual Risk Behavior and we’re all friends.” Such modesty!  Determinants in Liberia“ on 09/11/2012.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 19

Jay Baruch, MD Foundry of Arts & Humanities in Emergency Medicine (FAHEM) Medical humanities was especial- students spent the afternoon en- ly busy the latter part of 2012. gaging with different modes of cre- The 3rd year of The Creative ative thinking, and integrated the- Medicine Series was kicked off by se methods with clinical care. artist and arts educator Alexa Workshops included music, dance, Miller, co-creator of Training the sculpture, acting, art at the RISD Eye program at Harvard Medical museum, medical illustration, and School. Her talk was titled "Museum Rounds: even acting and horsemanship. What Art Can Teach Future Doctors." The We've had a growing collaboration with the RISD second event welcomed Brown professors, dancers Museum, including a fascinating project lead by our and choreographers Rachel Balaban and Julie own EM resident Bonnie Marr that explores the use Strandberg, as well as students involved in their of museums to improve our understanding and grant funded project at Brown examining dance treatment of pain. We are mentoring several medi- and patients suffering from Parkinson's Disease. The cal students and EM residents, and are receiving highlight of this special evening was the presence inquiries from residents from other Brown pro- of several patients with Parkinson's who drove up grams. We have been excited by the number of from South County in terrible weather. medical students who have expressed interest in the In September 2012, we had the pleasure of co- medical humanities and bioethics scholarly concen- hosting an event with the Division of Women's tration. Health in Emergency Care. We sponsored a delight- We are looking forward to an exciting spring semes- ful evening at the medical school with physician/ ter. We will co-sponsor the AMSA Writer's Institute writer Maggie Kozol. The presentation, "Doctors Sto- in Virginia at end of January for medical students ries: Shaping the Healthcare Narrative," lead to a from around the country. Locally, Liz Tobin Tyler, wonderful discussion. JD, MA, our spring Bray Visiting Scholar/Artist, will In the fall, the first Bray Visiting Scholar/Artist, Deb give a series of three seminars at the medical school: Salem Smith, playwright-in-residence at Trinity Rep, "Patient's Professionals and Policy: Narratives of taught a playwriting class at Trinity Rep that includ- Health and Justice. The Creative Medicine Series will ed Alpert medical students and Brown/Trinity Rep continue with two speakers in the spring. MFA students. They presented their work in a public More information can be found on the recently event on December 13, titled, "Operating Theater: A launched Program in Clinical Arts and Humanities reading of collaborative works from Brown/Trinity website, and the Foundry in Arts and Humanities in MFA Actors and Alpert Medical Students." Emergency Medicine website. They are both works- The second year of Integrated Clinical Arts took in-progress.  place at the medical school on December 7. Medical

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.

Dr. Jay Baruch (left) is pictured with guest physician/writer Maggie Kozol and Dr. Alyson McGregor. The The Department of EM will be welcoming David Bachrach in Foundry of Arts & Humanities co- April 25, 2013. Mr. Bachrach, Physician-Executive Coach, will be sponsored Dr. Kozol’s presentation conducting a faculty development session entitled “How to Ef- “Doctors’ Stories” with the division of Women’s Health in Emergency Care. fectively Manage People” from 4p-8p.

DEPARTMENT OF EMERGENCY MEDICINE PAGE 20

TMH ED (continued on page 3) 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 during 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 additional 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 projects 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.

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 development, 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 program at [email protected].

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 improve understanding of The Alpert Medical School of Brown University’s Department and treatments for trau- of Emergency Medicine is hosting this year’s New England matic brain injuries and Regional SAEM Meeting. We look forward to having our EM other neurological emer- colleagues from all over New England joining us in Provi- gencies. dence April 17, 2013.

DEPARTMENT OF EMERGENCY MEDICINE