Lessons in Nursing Leadership: Transition From Academic Medical Center to Community Practice

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

Download Full-text

Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.283 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 283-283

Author(s):

Jim Doolin ◽

Daniel Aaron Roberts ◽

Christina Cibotti ◽

Scott M Devlin ◽

Holly Dowling ◽

...

Keyword(s):

Median Time ◽

Medical Center ◽

Academic Medical Center ◽

Symptom Assessment ◽

Oral Chemotherapy ◽

Community Practice ◽

Financial Toxicity ◽

Online Tool ◽

Academic Medical ◽

Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

Download Full-text

Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00428.1 ◽

2017 ◽

Vol 9 (3) ◽

pp. 338-344 ◽

Cited By ~ 3

Author(s):

Kathryn E. Callahan ◽

Lindsay A. Wilson ◽

Juliessa M. Pavon ◽

James F. Lovato ◽

Hal H. Atkinson ◽

...

Keyword(s):

Internal Medicine ◽

Older Adults ◽

Medical Center ◽

Academic Medical Center ◽

Active Management ◽

Community Practice ◽

Chart Audit ◽

Geriatric Conditions ◽

Academic Medical ◽

Problem Lists

ABSTRACT Background Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experiences with older adults and competencies relevant to their care. Objective To explore patient demographics and the prevalence of common geriatric conditions in IM residents' continuity clinics. Methods We collected data on age and sex for all IM residents' active clinic patients during 2011–2012. Academic site continuity panels for 351 IM residents were drawn from 4 academic medical center sites. Common geriatric conditions, defined by Assessing Care of Vulnerable Elders measures and the American Geriatrics Society IM geriatrics competencies, were identified through International Classification of Disease, ninth edition, coded electronic problem lists for residents' patients aged 65 years and older and cross-checked by audit of 20% of patients' charts across 1 year. Results Patient panels for 351 IM residents (of a possible 411, 85%) were reviewed. Older adults made up 21% of patients in IM residents' panels (range, 14%–28%); patients ≥ 75 (8%) or 85 (2%) years old were relatively rare. Concordance between electronic problem lists and chart audit was poor for most core geriatric conditions. On chart audit, active management of core geriatric conditions was variable: for example, memory loss (10%–25%), falls/gait abnormality (26%–42%), and osteoporosis (11%–35%). Conclusions The IM residents' exposure to core geriatric conditions and management of older adults was variable across 4 academic medical center sites and often lower than anticipated in community practice.

Download Full-text