//www.youtube.com/watch?v=fUoZUWfff5k

To work together effectively as practitioners in a 21^st Century health system students must learn together.  And, equally important, the coordinated, team approach to patient care that today’s students aspire to must be modeled across clinical settings where they will practice after graduation.

That was the overarching message of USF Health’s inaugural Interprofessional Education Day held Nov. 16 in the USF Marshall Student Center.

The event brought together more than 250 graduate students, faculty and deans from all USF Health colleges, along with alumni and Tampa Bay community partners, to discuss the advantages and challenges of preparing students for a future that includes greater use of interprofessional health services.

The inaugural IPE day was attended by students, faculty and deans from all four USF Health colleges, along with alumni and community partners.

Interprofessional education, or IPE, is the essence of the USF Health brand. As the region’s only academic medical center, USF Health is uniquely positioned to organize, integrate and focus the capabilities of many health disciplines on behalf of the Tampa Bay community.

“This day highlights the power of USF Health – with its colleges of medicine, nursing, public health, and pharmacy, school of physical therapy and rehabilitation sciences, as well as athletic training and physician assistant programs – to take the lead in how interprofessional health education can be implemented,” said Victoria L. Rich, PhD, RN, FAAN, senior associate vice president of USF Health and dean of the USF College of Nursing.

Dr. Rich co-chaired IPE Day with Jay Wolfson, DrPH, JD, associate vice president of health law, policy and safety at USF Health and distinguished service professor of public health, medicine and pharmacy. They planned the inaugural event with a committee comprised of faculty members from all four health colleges and a student representative.

USF College of Nursing Dean Victoria L. Rich, PhD, welcomes speaker Chad Epps, MD, executive director of healthcare simulation at the University of Tennessee Health Sciences, to the Oval Theater stage.

“By sharing knowledge and training together, we create an environment ready for creativity and innovation,” USF System President Judy Genshaft said in her welcoming remarks. “In patient care, as we better understand each other, we provide more thoughtful care when we work as one team. Many times a patient’s life depends on it, as there is no single person or specialization that can ever address all the complexities of a patient’s needs… Truly the team-based approach embraced here at USF represents the future of health care.”

Charles J. Lockwood, MD, MHCM, senior vice president for USF Health and dean of the Morsani College of Medicine, has championed improved patient care and outcomes through stronger interdisciplinary collaboration. In his introduction, he painted a picture of the national health care challenges creating an impetus for IPE – including mounting pressure to reduce unprecedented health care costs.

The U.S. spends more on health care – nearly 18 percent of its GDP – than any other developed country, and with largely worse health outcomes, Dr. Lockwood said. This has led to a health care system transitioning from fee-for-service (care based on volume of services provided) to a focus on reducing cost while improving quality of care, known as value-based care.

From left: Kevin Sneed, PharmD, dean of the USF College of Pharmacy; Jay Wolfson, DrPH, IPE Day co-chair; Scott Newell, MAS, IPE Day speaker; Charles Lockwood, MD, USF Health senior vice president and dean of the Morsani College of Medicine; Victoria Rich, PhD, dean of the College of Nursing and IPE Day co-chair; Donna Petersen, ScD, dean of the College of Public Health; and Chad Epps, MD, IPE Day speaker.

“The only way we can provide that type of care is together. It can’t possibly be accomplished by the doctor alone, or the nurse alone, or the pharmacist alone,” Dr. Lockwood said. “In order to have that very efficient, tightly knit health care delivery system, we must train together, practice together, and do research together.”

Medical errors are the third leading cause of deaths in the U.S. after heart disease and cancer, according to a Johns Hopkins patient safety analysis. “Not only is there an economic imperative for IPE, but also a moral and ethical imperative to ensure we maximize patient safety,” he added.

The morning program featured two national speakers. Both emphasized the important role that simulation-based interprofessional activities can play in reducing medical errors by teaching health professionals at all levels how to think and act as a mutually supportive, problem-solving team.

IPE Day speaker Scott Newell, standing, interacts with Frederick Slone, MD, (blue shirt), who has a teaching appointment with the MCOM Department of Medical Education.

In the first presentation, Scott Newell, a commercial pilot and paramedic turned health-care simulation educator, drew parallels and distinctions between aviation and health care teams and explained how team training with simulation and crew (crisis) resource management techniques are critical to more effective communication, improved safety and quality outcomes.  All human beings, no matter how well trained and competent, make mistakes – but many medical errors result from a chain of events that can usually be averted at several points, preventing the medical error from causing severe patient harm, Newell said.

The second presentation by Chad Epps, MD, executive director of health care simulation at the University of Tennessee Health Science Center and past president of the Society for Simulation in Healthcare, provided examples of how other academic institutions across the country are structuring their simulation-enhanced IPE.   Dr. Epps said IPE is not students from different health disciplines sitting alongside each another in the same classroom and learning in parallel, but rather “students in two or more professions learning about each other’s professional roles, learning how to communicate with one another, and learning to provide mutual support to other members of the team.”

An interprofessional team looks over their mission during the collaborative escape room exercise. From left:  Amy Schwartz, faculty member, College of Pharmacy, Zemelia Miller, student, Physician Assistant Program; Anne Marie Buford, student, School of Physical Therapy; Chris Chrosniak, student, College of Nursing; Andrew Armstrong, student, College of Nursing; Anna Torrens Armstrong, faculty member, College of Public Health; and Kanisha Jenkins, student, Athletic Training Program.

At the morning session wrap-up, Dr. Lockwood challenged faculty to develop an IPE curriculum that takes full advantage of USF Health’s state-of-the-art simulation resources as well as clinical opportunities with primary teaching hospital Tampa General Hospital and other community partners.

A lunchtime panel discussion, moderated by Dr. Wolfson, featured the deans of all four USF Heath colleges and other key leaders, and the IPE Day guest speakers.

The afternoon culminated with a fun, interactive escape room exercise – a spy game designed to build camaraderie and teamwork within the 15 interdisciplinary student groups participating.

From left, top row: USF System President Judy Genshaft and Dr. Rich with the winning USF Health student team Michael Woolard, College of Nursing; Tyler Mauzy, School of Physical Therapy; Daniel Segarra, Morsani College of Medicine, Dr. Emily Hall, a faculty member for the Athletic Training Program; Matt Allman, College of Public Health; and Dr. Lockwood. Bottom row with the winning trophy: students German Herrera Alzate (left), Physician Assistant Program, and Jennifer Willms, School of Physical Therapy. Not pictured: Lucinda Shaw, adjunct faculty member, College of Nursing.

What They Said: 

We’ve known that poor communication and system errors are major causes of preventable death in 1999 and here we are in 2018, and we still haven’t made a whole lot of advancements…  We have a tremendous opportunity to impact patient safety and change the way we deliver health care.

Speaker Chad Epps, MD, referring to the Institute of Medicine’s landmark report “To Err is Human” published in 1999

Dr. Epps: IPE activities created with shared, linked outcomes and objectives can improve patient safety and care. Interprofessional faculty development also has to be a priority for IPE to work.

One difference between the airline industry and health care is that when a pilot screws up, the first place he ends up is a smoking hole in the ground… In health care we still tend to bury our mistakes… How many of you have filed an incident report and never found out what happened with it?

Speaker Scott Newell, MAS, NREMTP, CHSE, talking about the motivating factors for the safety culture in aviation driving crew members to speak up when they see a potential error

***

Today’s IPE Day helps us think about how we can take our current IPE offerings to the next level. There is little doubt that if we use the energy and momentum generated at events like this, USF Health can become a model of IPE across the education continuum, and our patients and the community will be the better for it.

Bryan A. Bognar, MD, MPH, FACP, vice dean for educational affairs, USF Health, Morsani College of Medicine

The lunchtime panel discussion included deans and other key leaders from USF Health, and the two featured IPE Day speakers.

I am committed to working with the deans and their respective IPE experts to build the best interprofessional education experience possible for our students so they will graduate to become IPE champions in their future practice environment.

Haru Okuda, MD, FACEP, FSSH , USF Health’s first executive director of interprofessional education simulation programming and CAMLS executive director

***

Part of the reason to engage the practice community is to push the environment toward IPE. We hear from our graduates who are well trained (in interprofessionalism) that when they get out in the workforce sometimes they are told “We don’t do that here.”

Donna Petersen, ScD, USF Health senior associate vice president and dean of the USF College of Public Health, on the gap between enthusiasm for interprofessional learning and interprofessional practice

***

Today begins to define the culture of what USF Health will be moving forward. Every program will begin to define how they are part of massive health care-related changes… We’re asking for buy-in for IPE from everybody.

Kevin Sneed, PharmD, USF Health senior associate vice president and dean of the USF College of Pharmacy

Dr. Kevin Sneed comments during the panel discussion.

Research indicates that the effects of IPE for graduates do not not typically persist in the practice area. Partnering with employers and patients has the potential to address this “missing link,” with the goal of improving the quality and effectiveness of health care. We are committed to developing and sustaining these vital collaborative partnerships.

Laura Lee (Dolly) Swisher, PT, MDiv, PhD, FNAP, FAPTA, associate dean, USF Health Morsani College of Medicine, and director of the School of Physical Therapy & Rehabilitation Sciences

***

It was great to see the diversity of health disciplines represented within USF Health… This day helped broaden our ability to collaborate, be problem solvers, lean on people’s strengths to do the best we could to succeed in our mission.

Michael Woolard, third-year nurse anesthesia student and member of the winning team for the IPE Day escape room exercise

Alyssa Radel, (center) an athletic training student in the MCOM, reacts to an IPE Day speaker.

Students pick up the dossiers and burner phones their teams need to begin the IPE Day escape room exercise, which involved a mission to rescue their “kidnapped” leader (played by Dr. Charles Lockwood) from an evil robot (played by USF Health’s Joe Ford). The “mission” promoted collaboration and problem solving while encouraging the students to have fun.

Team leader Rohit Iyer (far right), a second-year medical student, works on a clue with fellow team members.

For one of the escape room activities, teams were asked to create a “spy tool.” Here, one team uses an Apple watch and the team leader’s bow tie to make a “bow-tie spy cam.”

-Video by Torie M. Doll and photos by Eric Younghans and Freddie Coleman, USF Health Communications and Marketing.  Jessica Samaniego, USF College of Nursing, also contributed photos to this story.

TAMPA, Fla. (May 24, 2018) – The USF Health Endoscopy & Surgery Center has earned accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC) – an achievement that distinguishes the ambulatory care center as one that meets or exceeds nationally-recognized standards for quality care.

More than 6,000 ambulatory health care organizations across the United States are accredited by AAAHC, a private, non-profit organization. That means these organizations have successfully completed an independent, external evaluation process, which determines they are delivering safe, high-quality care in the way they say they will. Not all ambulatory health care organizations seek accreditation, and not all undergoing the rigorous on-site survey process are granted accreditation.

Sharon Owen, director of the USF Health Endoscopy & Surgery Center

“When you see the certificate of accreditation, you know that AAAHC has closely examined our facility, procedures and outcomes,” said Sharon Owen, director of the USF Health Endoscopy & Surgery Center. “Going through the process challenged us to find better ways to serve our patients, and it is a constant reminder that our responsibility is to strive continuously to improve the quality of care and services we provide.”

Organizations seeking accreditation by AAAHC undergo an extensive self-assessment and on-site survey by the association’s expert surveyors – physicians, nurses, and administrators actively involved in ambulatory health care. Among the areas reviewed are patient rights, quality of care, quality management and improvement, clinical records and health information, infection prevention and control, and anesthesia, surgical and related services.

Located in the Morsani Center for Advanced Healthcare on the USF Tampa campus, the USF Health Endoscopy & Surgery Center is a state-of-the-art facility with five endoscopy and procedure suites, four fully-equipped and integrated operating rooms, and a 33-bed recovery room. The center’s experienced professionals are highly trained in orthopedics, ENT, ophthalmology, urology, gynecology, colorectal surgery, general surgery, breast oncology, plastic surgery, podiatry, and endoscopy.

For more information, visit health.usf.edu/doctors/asc. For scheduling or other questions, please call (813) 905-9956.

-Photos by Torie Doll, USF Health Communications and Marketing

Participants in the first full USF Health Graduate Medical Education program’s Patient Safety Workshop are searching a simulated patient room for as many safety hazards as possible.

In a standard hospital room lie dozens of potential dangers threatening the well-being of the patient.  It’s up to every member of the health care team to mitigate these dangers to ensure the safest environment possible.

USF Health’s Graduate Medical Education program hosted a Patient Safety Workshop on April 24 to help residents identify possible causes of patient care errors and learn how to effectively communicate those errors, as well as teach protocols and mechanisms that allow all members of the health care team to speak up.

“What this workshop is trying to emphasize is how to address these issues from a systems perspective while continuing the resident’s medical education,” said Cuc Mai, MD, assistant dean for the USF Health Morsani College of Medicine Graduate Medical Education program.  “At the end of the day, patient safety is the most important thing to a health care team.”

Yilmarie Rosado-Acevedo, MD, a pediatrics intern at the USF Morsani Center for Advanced Healthcare, notices an air-tube around a mannequin’s neck during the USF Health GME Patient Safety Workshop.

One highlight of the workshop was the simulated hospital room riddled with patient safety hazards the physicians had to identify.  Many were obvious, like the sharps sticking out of a biohazard disposal bin, and others required much more attention to identify, such as the patient not wearing non-slip socks and latex gloves mixed with non-latex gloves.  While a scenario like that is unlikely, the importance of being able to detect those hazards proved important to the participants.

“The workshop is a very important tool that will be a great help to all of us,” said Arash Naghavi, MD, a USF radiology oncology resident at Moffitt Cancer Center.  “You can never be too safe when it comes to patient safety.”

A patient’s call remote on the floor is a major safety issue in the patient room.

During the workshop, held at the USF Health Center for Advanced Medical Learning and Simulation, the group also discussed methods of effectively communicating patient safety events to hospital administration, patients and families.  When incidents that threaten patient safety get reported, they can be used to identify vulnerabilities within a system and are often drivers to change them, according to Dr. Mai.

To finish, the residents conducted a root cause analysis, often used to understand the causes of an adverse event and identify flaws in the system that can be fixed to prevent medical errors from happening again.  “This is about preventing future events, not blaming or punishing people for what happened,” Dr. Naghavi said.

This first full workshop, with 13 participants from residency training programs in internal medicine, neurosurgery, and radiation oncology, followed a successful pilot workshop in early April.  The Graduate Medical Education plans to schedule more throughout the year to train all incoming residents.

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

Reams of information helped him determine what college he would attend and which residency programs to apply for. Statistics help him know which medications are the most effective for his patients. And archived scientific literature helps him conduct his own research.

So Nishit Patel, MD, knows data is useful.

//www.youtube.com/watch?v=0RUukBCqBz8

But what he has come to discover in the few years since becoming a doctor is that big data will, in the very near future, help researchers find cures – big cures, like for cancer and Alzheimer’s.

Dr. Patel is a dermatologist for the USF Physicians Group and was recently named the chief medical information officer for data analytics for USF Health. In that role, he will work with USF Health Information Systems and USFPG leadership to oversee the business intelligence platform and ensure that data reported from the system is both meaningful and credible. In addition, he will help guide the expansion of the newly developed research data warehouse.

Pulling from such vast amounts of data will help the USFPG improve patient care, from streamlining how quickly a patient can get in to see a USF health care provider to – the ultimate goal – improving health outcomes.

***

Big data is more than collections of demographics and shopping patterns and political bents. In science, big data looks at the tiniest of details in an enormous sample size. Even cellular functions, mutations, secretions, and bindings can play out across the million-fold and reveal trends that, in smaller sample sizes, might seem like outliers and oddities.

Dr. Patel had his own ah-ha moment for just how impactful data can be for improving patient care. And it pushed him to start a dermatology clinic focused on a patient population in need of that expert care.

In his training, he had learned that organ transplant patients are at a much higher risk for developing skin cancer, but there is little research on how to significantly reduce this risk and little indication that the bulk of these patients are getting intensive, personalized dermatology care.

“In looking at skin cancer and solid organ transplant patients, this is an area where there is very little research currently that can help change how we take care those patients,” he said. “Patients who’ve had organ transplants are at very high risk compared to the average population for skin cancer. In fact, they can have a 65 times higher risk for squamous cell skin cancers. Right now our treatment paradigm is that we try to detect early, we try to do what we can in terms of prevention, but at the end of the day there are lots of patients in that transplant population experiencing 5, 10, 15 skin cancers a year.”

Seeing an opportunity to fix a problem, Dr. Patel worked with Tampa General Hospital’s transplant team to design a dermatology clinic specifically for transplant patients and part of the post-surgery care.

“There was an incredible need because transplant patients were not being optimally managed for skin cancer prevention, detection, and treatment,” he said. “By creating and building this clinic from the ground up, we had a chance to capture all these patients so that, as soon as they get their organ transplant, they are automatically seeing us in the dermatology clinic. We get a chance to sit down with them and talk in very frank language: this is what your risk is for skin cancer and you’ve survived a lot to get your organ transplant so let’s make sure that you don’t have a bad outcome because we didn’t catch or treat a skin cancer early enough.”

The result is that transplant patients, who already beat death by getting a transplant and are beating organ rejection, are now beating skin cancer. Since opening in October, he has seen 230 patients. At the 100^th patient mark, Dr. Patel said, they had discovered more than 50 squamous cell skin cancers, basal skin cancers, atypical moles and melanomas on those patients and destroyed countless pre-cancers.

Aside from these good statistics, it was a thank you from a patient that gave him a true feeling of success.

“Within the first few months of starting the clinic, a patient returned for a follow-up from a biopsy for a squamous cell skin cancer in his scalp,” he said. “As we were walking out of the room, he paused and said ‘Thank you so much for starting this clinic. If it wasn’t for this program I would have never gone to the dermatologist.’ It’s very likely that his skin cancer in the scalp would have continued to grow and potentially spread. But because of this program, we found that cancer, we’re treating that cancer, and his life expectancy won’t be adversely affected by it. That is more rewarding than anything else. That is the whole point.”

Data presented the trend that drove the vision for the clinic that improved patient outcomes.

***

In addition to being an assistant professor of medicine in the Department of Dermatology and Cutaneous Surgery, he is also associate program director for USF’s Dermatology residency program. So, he’s a teacher to new physicians, and he’s helping them learn from the start how to input data and use data to practice better medicine.

“My mentors tell me they used to practice medicine in a way that was eminence-based, meaning that when the person they trained under said ‘that’s how it’s done,’ well, that’s how it’s done,” he said.

“Well, over the past 10 years, especially over the past few years, there has been a shift from eminence-based to evidence-based. That is such a powerful change in terms of how we care for patients and to do that, of course, you have to have good evidence, which means you have to have good data. Look at where we have gone with transitioning from paper records to electronic medical records to really aggregating pools of different sources of data. We have this amazing opportunity in terms of the next few years to look at data in a completely different way than we have in the past.”

At USF Health, that means electronic health records, but also a soon to be released research data warehouse built by USF Health Information Systems.

“Here at USF Health, we are developing a really great research database as a resource for clinicians and researchers, whether they’re bench researchers, translational, or in clinical medicine, to very easily access a pool of data they’ve never had the opportunity to pull together before,” Dr. Patel said. “Providing tools like Epic or our data warehousing efforts means we are building the giant infrastructure and the toolkit for all of our researchers to use and to develop that next great drug, to treat severe disease, and design that next great prevention strategy. I’m really optimistic about where we’re going and I think we can continue to transform how we practice medicine and to do it in a smarter way than just how we’ve been trained.”

***

It seems to be all about data, but Dr. Patel is quick to note the constant need to stay focused on the patient. The data will help, but not at the cost of direct, focused care.

“In looking at the bigger picture of a patient’s entire medical record, or of every patient in an entire health care system like USF and the inpatient data with the integrated medical records data we have with Tampa General, you’re going to find trends that you would otherwise never even realize were there,” he said.

“That’s when the power of data improves patient care. The beauty is, by creating that infrastructure for experts to look at a huge aggregate pool of data from their lens and offer analyses together, we can really change how we’re doing things in the clinics and how we can take the best care of that patient in front of us right now.”

Story by Sarah Worth, photos and video by Sandra C. Roa, USF Health Communications.

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

//www.youtube.com/watch?v=N9sOG4qVSq4

Over and over again, Harry van Loveren, MD, walks through a surgery in his mind before actually cutting open the brain of his patient, perfecting every step and accounting for everything he will encounter, the expected and the unexpected.

Dr. van Loveren is chair of the Department of Neurosurgery in the USF Health Morsani College of Medicine, senior associate dean for Surgical Subspecialties at USF Health, and chief medical officer of the USF Physicians Group. Along with a brilliant mind and capable hands, his visualization technique has made him an accomplished and much sought after neurosurgeon.

Dr. Harry van Loveren.

“To prepare for the kind of operations I do you have to mentally do the operations a number of times before you walk into the operating room,” he said. “And you have to understand it all – the anatomy, the surgical instruments, the surgical techniques – so your mental experiments are valid, that what you see in your mind is what you will see in the patient’s head. That these things you see in your mind are true and that if it works in your mind it had better work in the operating room. And if I can’t see that in my mind’s eye, I go back to the (training) lab, go back to text books, and review videos and figure it out until I can create a paradigm in my mind where I complete the surgery successfully.”

How does someone decide to become a neurosurgeon? For Dr. van Loveren, it was because it’s considered the most difficult area of medicine and requires the longest amount of training.

“To be honest, I don’t know why other people go into neurosurgery but I know why a lot of us do – because we’re so egotistical and because we want to be the best,” he said. “As we’re going through medical school we look around and ask what would be the hardest thing I could do? What would be the biggest challenge? But I don’t think we’re the only ones who do that. For instance, look at people who go into the police force and say ‘I want to be on the SWAT team’ or go into the military and say ‘I want to be a Navy SEAL.’  There’s an element of that to becoming a neurosurgeon. We’re looking for the greatest challenge.”

Meeting that challenge has made him one of the most sought after neurosurgeons in Florida.

In fact, when he joined USF Health about 10 years ago, he set a goal for his Department to become the go-to neurosurgery department in Florida. Starting with only six neurosurgeons, he has built the Department to about 30 surgeons and nine PhDs, becoming a hub for the most complicated cases.

“My practice is a little bit unique,” he said. “It’s called complex cranial so I do the more complex side of brain operations and a lot of my practice is taking care of patients for other neurosurgeons in the state either for those things they don’t want to do or don’t feel they ought to be doing. That can be a bit of a lonely and frightening position to be in. But nobody wants to see any lack of confidence in us and we don’t really want to feel that lack of confidence.”

His other reason for choosing neurosurgery is because he saw it as the one specialty in which he would never stop learning.

“I chose it because it looked like my learning curve would go on forever,” he said. “When I looked at neurosurgery, I saw older neurosurgeons still making great contributions and the acquisition of experience is so valuable to neurosurgery. So the finish line is, wonderfully, always just beyond our reach.”

He admits, though, that the real reason he chose neurosurgery might truly be because he thinks “the brain is cool.”

“The brain is who we are, it’s what we think, it’s what we believe,” he said. “The ability to affect a person’s life by manipulating that organ is profound and extremely interesting. And we really get some insight into brain function when we’re operating on someone while they’re awake and speaking to you. And with certain stimulation you can bring back very specific old memories for the patient, you can play music, you can run videos. It’s all stored in the brain and you can recall it and make it come out for the patient.”

With a laugh, he added “It’s just a really satisfying career. You should try it sometime.”

By taking some of the most difficult brain surgery cases – the ones other neurosurgeons feel might be outside their scope and skill – Dr. van Loveren has built a solid reputation for helping some of the most vulnerable patients, those whose conditions might otherwise be deemed inoperable. That reputation is based on knowledge and surgical skill, but also involves his ability to relate to patients, to calm them and impart feelings of comfort, but also confidence.

“Taking care of patients, taking care of people, is what this is all about,” he said. “What I try to do is make people feel the way you might feel if you had a serious brain problem and your brother was a neurosurgeon. That kind of comfort level, that your brother is someone you know, someone you trust, someone who knows you, someone who cares about you, and everything your brother tells you will be the truth and the best for you. That’s my approach with patients. With the family and the patient there’s the ability and the need to walk in and say hello and reassure them that I see them, that I’m aware of and care about who they are and how afraid they are, that I’m fully focused on them, that I care. I let them know this is not just another case. And I let them know a little bit about myself, reveal my human side. I hope they gain some comfort from that interaction.”

All this intensity can make for only serious conversations but in chatting with Dr. van Loveren, you will quickly see other sides, including his love for skydiving. In fact, he admits that freefalling to the earth is the only activity he has found that lets him completely stop thinking about neurosurgery.

Photo courtesy of Harry van Loveren.

“Brain surgery is always with you,” he said. “You’re always thinking, wondering, analyzing, or performing surgery. You’re always being nudged by your wife walking down the beach and she says ‘where are you now?’ Which is one of the reasons I’m a skydiver. It is a profound break in concentration and lets me focus completely on something else. I’ve tried a lot of things, from golf to fishing, to be distracted. But I find that throwing the door open at 14,000 feet and getting out of the airplane, that’s when neurosurgery stops for a while.”

Photo courtesy of Harry van Loveren.

Story by Sarah Worth, photos and video by Sandra Roa and Mihaela Madsen, USF Health Office of Communications.

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

//www.youtube.com/watch?v=yV6Ah66l6RM

Karen Bruder, MD, FACOG, was straight out of her medical residency when she saw firsthand the impact data could have on improving patient safety. As an invited member of the patient safety committee at American Congress of Obstetricians and Gynecologists (ACOG), Dr. Bruder was privy to national trends for problems and part of the effort to implement change for improvement.

Today, she is extending that reach directly into the patient care settings at USF Health. As Executive Physician Champion for USF Health’s transition into the Epic electronic health records (EHR) system, Dr. Bruder is the lead for guiding every health care provider at USF Health into the new EHR system.

Dr. Karen Bruder

To understand the true impact of that role, you might first know that Epic is a national leader in EHR and the same system used by Tampa General Hospital, the primary teaching hospital for the USF Health Morsani College of Medicine. This transition means patients will no longer need to collect and transport their records as they go from one partner institution to the other.

But more than that, Epic will help USF’s health care teams see up-to-the-minute records of patients at both institutions. It’s that real-time data – giving as complete a picture as possible of every patient – that is Dr. Bruder’s true target because that component directly correlates to patient safety.

“There’s one great benefit with Epic to patients, which they may or may not realize, and that is a reduction of medical error,” Dr. Bruder said. “A great deal of errors happen when information is transferred from one place to another. Epic gives us the ability to have one chart for one patient. No longer will we have to have one electronic record for the USF practices and one electronic record at Tampa General. Instead they will be all the same. With Epic, we now have access to their entire health record, particularly about medications, recommendations from other physicians, and abnormal test results. Now those issues can be immediately recognized and addressed.”

Epic offers a way to more closely track care across the entire USF Physicians Group and Tampa General, providing a constant watch for contradictions, contraindications, and uses of standardized care. This ongoing analysis goes beyond strong team-based care, Dr. Bruder said, and gives the opportunity to truly impact and improve care.

In addition to her title with the Epic transition, Dr. Bruder is also associate professor, director of the USF Division of General Obstetrics and Gynecology, medical director of the Genesis Women’s Center at Tampa General Healthpark, and chief of Ob/Gyn at Tampa General Hospital. She is also active in the Florida Perinatal Quality Collaborative, a state-wide initiative aiming to improve the quality of health care quality and patient safety for mothers and their babies.

Her day is full of patient care and teaching medical students and residents. The passion she has for her career is easily seen by those around her – she clearly loves her job.

“Being an obstetrician is the greatest job in the world,” she said. “We get to experience the power of women who are carrying their babies, protecting their babies, then bringing their babies into the world and starting a new family. Some of my days I spend in labor and delivery, delivering new babies, doing cesarean surgeries, teaching residents how to do those deliveries, working with the nursing staff. Some days I’m at the Genesis Clinic. Every day is a little bit different and that’s what keeps it fresh and exciting for me.

“But I’m definitely the student as well as the teacher. I learn things from patients every day. I learn things from students and residents and the nursing staff every day. The teaching aspect of it for me is continuous. And because of my interest in quality, I’m able to share that with the residents and students and bring them into those conversations. We actually start teaching students at the medical school level about medical error and patient safety and best practices so that when they come to their residencies, those concepts are already familiar to them.

And the basis of those lessons is rooted in standards.

“Patient safety is really about developing standards of care and looking at processes in detail so we can avoid medical error,” Dr. Bruder said. “That is sometimes difficult to achieve, because there are so many parts of what happens to a patient from day to day. A lot of people are involved, a lot of steps happen between the patient and doctor conversation, the doctor ordering a test, the patient having the test, and then interpreting those results. Everything comes full circle, but anywhere in that process there can be an error that can affect the care of the patient. So our job with patient safety and quality is to look at national standards of care and then examine our processes to be sure we’re following those standards of care, and then making changes, piece by piece, until there is very little room for human error. The electronic health record helps a great deal with that.”

Loving her job comes naturally to Dr. Bruder, who always knew she wanted to be a doctor. The fact that she can incorporate her pursuit of patient safety into that career is an added bonus.

“I went to medical school to become an obstetrician gynecologist,” she said. “I’m one of the fortunate doctors who knew what I wanted to do before I got to medical school. And I’ve never changed my mind. It’s always been a great choice for me and a real source of joy and pride in my life to be able to take care of patients and to teach residents and students.

“When I was a young physician, just out of residency, I was invited to join the inaugural patient safety committee at ACOG, our educating and professional body of obstetrics and gynecology. That’s when I became aware of the Institute of Medicine report that was issued in 2001 and all the patient safety issues that were occurring in the United States. And since that time, wherever I’ve practiced, I’ve been very aware of patient safety issues, quality of care, how important it is for everyone on the patient’s care team to work together.”

And that’s where Epic comes into play again for Dr. Bruder. But only to a point.

“With all this new technology we still need to remember as individual physicians and as a team of caregivers, the most important thing is to be kind to the patients,” she said. “It’s always about the patients. It’s always about how we matter in their lives, it’s always about improving their lives, and it’s always about having a connection between them and us.”

Photos and video by Sandra Roa, USF Health Communications

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

Neonatal intensive care units (NICU) have some of our most vulnerable patients, babies in need of expert critical care. Because every interaction, every touch, with these newborns must be precise, with little margin for error, these NICUs must be a paragon of optimum patient safety.

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Terri Ashmeade, MD, embraces every aspect of that realm. She is associate professor of pediatrics in the USF Health Morsani College of Medicine and medical director for the Jennifer Leigh Muma NICU at Tampa General Hospital. She is also the newly named Chief Quality Officer for USF Health. Her experience in NICUs and her active roles in defining best standards for patient safety helped pave the way for the new position, a job that aims to elevate quality care and patient safety across USF’s hospital partners and inpatient and outpatient facilities.

Dr. Terri Ashmeade directs the Muma NICU at TGH and leads patient safety for USF Health.

What defines a health care provider’s best approach to care, the one thing that ensures the best outcome for patients? Dr. Ashmeade boils it down to one word: data.

“In order to improve we need data,” said Dr. Ashmeade, adding that data rules in the Muma NICU environment. “Measurement is very important and we try to measure everything, from how long it took us to take a baby from the delivery room to the NICU to the temperature in the delivery room and how that temperature relates to the baby’s progress.

“As Chief Quality Officer, I’ll be able to help others understand our data, get the data they don’t have, understand it, use it to help us improve, and then measure our improvements along the way.”

Dr. Ashmeade said she realizes that patient safety can seem vague for a lot of us, a term that can bring to mind obvious scenarios of incorrect prescriptions and surgical procedures. But true patient safety is more than just preventing accidents.

“The most obvious forms of patient safety are what we hear in the news – a patient has an operation on the wrong body part or a patient gets a medication they weren’t prescribed,” Dr. Ashmeade said. “But there are many more subtle things that can go wrong. People who come into a hospital and get an infection related to a catheter or the overuse of medical treatments and X-rays, for example. It’s the more subtle things we do for patients, or don’t do for patients, that we need to pay attention to.”

Nurses and residents review daily progress of babies in the Muma NICU with Dr. Ashmeade.

Enhanced training for resident physicians and incorporating safety into the medical school curriculum are a couple of the ways Dr. Ashmeade aims to fill the pipeline with health care providers who are proficient in patient safety, which will improve patient outcomes.

“When I was a medical student we rarely heard the words ‘patient safety’,” she said. “We all assumed the care we were delivering was safe and thought that, if we were smart and if we were careful, all our patients would get the best care possible. But since then we’ve learned that, even with the best effort and the best intentions, we’re human beings and we can make mistakes and we can miss things. Learning about the science of patient safety and the science of quality improvement will help move us to the next level. At USF Health, we will train our medical students, nursing students, pharmacy students and public health students from the beginning so it becomes part of their everyday work and not something that’s an extra or an additional task. It has to be engrained.”

Building teams that center their efforts round safety will likely be the most effective approach. But that comes with a caveat: humans are reluctant to change habits and assume they already have good practices. And that’s where data steps in again.

“It’s hard to be measured; it can be shocking at first,” Dr. Ashmeade said. “Sometimes we have difficulty believing the numbers. So, my job will be to make sure I have the numbers right so people can trust them and use them effectively to improve. The first step is getting used to measuring our performance and being OK with ‘this is where I am’ whether we’re at the top or middle or bottom. Knowing where you are on that scale is critical, and data drives that.”

There are many tools for building that data, but Dr. Ashmeade noted that USF Health’s transition to Epic electronic health record system will be instrumental in tracking true improvement.

“With our EPIC implementation, we’ll be able to pull good data out,” she said. “I’ve used Epic for a long time at Tampa General so I know it’s a good system and will help us move forward in terms of collecting information on our patients, monitoring and tracking their progress and helping us improve safety across the board.”

Good data is what sparked Dr. Ashmeade’s drive for optimum patient safety and care, like that found in the NICU.

“When I became medical director of the NICU, it was the first time I really felt driven to understand what types of outcomes my patients were having,” she said. “And for the first time I had data I could look at that compared our performance to that of other similar neonatal units across the country and across the world. When I looked at those numbers, I saw that we were doing OK but weren’t at the top yet. That’s when I started training in quality improvement and patient safety to learn the techniques I could implement in the NICU to make changes that could get us to the top.”

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The delivery room and NICU at TGH are more than sources of data for Dr. Ashmeade. They are daily reminders for why she is so ambitious for the best patient outcomes possible.

“Patient safety is a huge part of neonatology, especially in that delivery room when there are so many things that have to happen within in a very short period of time,” she said.

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“We’re more like an orchestrated event or a dance. Before we go into a delivery we have what we call a huddle and decide who is going to do what in the room. Who is going make sure the baby is warm, who is going make sure the baby is breathing, who is going make sure the baby’s heart rate is appropriate. So when we get to the delivery room, we’re ready to go. We have specific places where we’re supposed to stand. There are specific communication strategies we use in those critical periods of the baby’s delivery. We don’t talk much, but when there is communication it’s very directed and specific so we are sure those specific steps take place at 30 seconds, at one minute, at one minute 30 seconds after birth. It’s really exciting when it all comes together but the fact is that it must all come together. It has to, for the baby’s sake.”

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“The best things happen to me every day,” she said. “I get to be present when babies are born. I get to be present for their first breath. I get to help them along, fragile babies, sick babies who might not make it, help them along their path. And then I have the pleasure of seeing their mom and dad, who weren’t sure if they we going to be able to take their baby home, actually take their baby home. I have the best job in the world.”

Photos and multimedia story by Sandra C. Roa, USF Health Office of Communications.

Despite countless hours of prevention training for healthcare professionals, urinary tract infections (UTIs) remain a big problem in nearly every hospital in the country.

To help curb, and even reduce, the prevalence of UTIs, USF Health students took the initiative and set up a training session for fellow students to teach on the proper way to insert a Foley catheter.

The aim of the effort: to instill early on a habit of prevention and improved patient safety, prior to entering the hospital workplace.

Attending the Foley catheter training is Peter Silverman, first-year medical student.

The Foley training session, which was held in the USF Health Center for Advanced Clinical Learning last month, is the first of many types of self-training exercises to be hosted by the USF Health Healthcare Improvement Group (HIG), an interprofessional student organization dedicated to developing a culture of healthcare quality improvement and maximizing patient safety.

Established last Spring, the USF HIG is a chapter of the Institute for Healthcare Improvement (IHI) and currently includes students from the USF Colleges of Medicine, Nursing and Public Health. The interdisciplinary group was started primarily to develop a culture of change for improving patient safety and providing training to advance healthcare quality improvement, said Neil Manimala, a first-year medical student and a co-president for the USF HIG along with Anthony Desantis.

“HIG is committed to not only improving patient safety through specific projects but also changing the culture of healthcare to one of true quality improvement and teamwork rather than blame, liability, and total practitioner isolation,” Manimala said.

The USF HIG was founded primarily by Trevor Lewis, along with Jennifer Bruno, Christopher Centonze, Christopher Childs, Melinda Fang, Ian Mark, Keith O’Brien, Alexandra Printz, and Bruna Zanolini, all of whom are now second-year medical students.

Although currently including only medical, nursing and public health students, HIG is looking to include all USF Health professional students, Manimala said.

“We are currently working together with nursing students and public health but would like to expand the scope of our student involvement to the rest of USF Health, as well,” he said.

HIG began as an extension of the Morsani College of Medicine’s scholarly concentration called Health Systems Engineering. Within that, the group connected with the IHI in order to tap into the national group’s online training series called IHI Open School for Health Professions, which includes multiple patient safety training modules. USF students expanded on-site sessions for the modules to include concurrent training sessions with panels of experts, typically USF faculty, who spoke and led team discussions.

The localized focus has helped the group broaden its reach beyond those interested only in the modules and resulting certificate and helped reinforce concepts by seeing real-world applications by invited faculty with interests and experience in patient safety and quality improvement.

Ever-increasing interest in the modules and training sessions has meant looking ahead for the new group.

“We are looking to expand this training facilitation to the Northwestern University Patient Safety Education Program,” Manimala said.  “And we hope to one day integrate these patient safety education efforts into the formal health professional student curriculum. Besides these projects, members are constantly brainstorming for new ideas on how to improve the healthcare system.”

The hands-on Foley catheter exercise was just one example of how the group aims to facilitate change.

“At this event, students taught each other how to insert Foley catheters into plastic models and to also brainstorm on how to create procedural checklists,” Manimala said. “This exercise is part of a larger long-term student-led project to educate MS-III’s entering their clerkships on safe and effective Foley catheter insertion to avoid UTIs. And the aim is to offer other types of sessions for different procedures. These types of sessions help us train to become leaders in the area of patient safety and healthcare improvement.”

Prepping for training is Neil Patel (MS1).

Inserting a Foley catheter are, from left, Samson Lu (MS1), Daniel Myers (MS1), Viktor Flores (MS1).

At the first Foley catheter training event were, from left, front row, Melinda Fang (MS2), Jennifer Bruno (MS2), Yilmarie Rosado (MS1), Bruna Zanolini (MS2), Viktor Flores (MS1), Kathryn Dean (MS1), Aaron Block (MS4). Back row, Neil Manimala (MS1), Neil Patel (MS1), Emelia Hammond (fourth-year nursing student), Derek Djavaherian (MS1), Anthony Desantis (MS1), Christopher Centonze (MS2).

Story by Sarah Worth, USF Health Office of Communications

Photos by Neil Manimala, first-year medical student, USF Health Morsani College of Medicine

It started as a routine takeoff for US Airways Flight 1549.

But everything changed so fast.

Just after takeoff, Capt. Jeff Skiles, the plane’s co-pilot, caught a glimpse of movement and looked up.

“It was a big flock of geese, too close to maneuver around,” he said Friday, at the grand opening ceremonies for the USF Health Center for Advanced Medical Learning and Simulation.

In an instant, birds were hitting the plane, and some were sucked into the engines.

Skiles just had time to think aboutstarting to assess the damage when the engines went quiet. All he heard was the sound of the wind.

“The shock of the situation made me feel as if my head had swollen,” he said. “I saw the world through a fog.”

But Skiles’ next actions had nothing to do with fog – and everything to do with training.

Capt. Jeffrey Skiles, the co-pilot of US Airways Flight 1549 "Miracle on the Hudson," was a featured speaker at the opening of the USF Health Center for Advanced Medical Learning and Simulation.

Capt. Skiles grabbed his emergency procedures manual and flipped to the page for dual engine failure. Skiles began stepping through emergency procedures as his pilot, Capt. Chesley Sullenberger, took over flying the plane.

What happened is history. The pair landed the plane safely in the river. Every passenger on the plane survived. They became “the Miracle on the Hudson.”

But Capt. Skiles shrugs off such descriptions.

“Many people want to call me a hero or credit a miracle,” he said. “But this is not a story of individual achievement. This is a story of organizational change and safety awareness.”

And this is why Capt. Skiles was at CAMLS the day that it opened.

“We think that we can learn a lot from him,” said Dr. Stephen Klasko, dean of the USF Health Morsani College of Medicine. “Pilots know that practice and teamwork pay off in a crisis.”

CAMLS will collaborate with aviation safety experts to apply their lessons to the medical field, Dr. Klasko said. Those lessons include heavy use of simulators as learning tools and a focus on finding common errors and teaching how they can be corrected rather than blaming individuals for errors.

Skiles thinks CAMLS can teach those same lessons to health professionals.

“This is going to be an extremely valuable institution for the medical community,” he said.

“I’m here because of all the decades of developments in safety systems that allowed Sully and I to be successful in our moment of crisis,” Skiles said.

The Miracle on the Hudson is all about simulation and training and procedures that prepare pilots to handle the worst.

“Even in a moment of extreme stress and confusion, the training of decades came to the surface and we knew what to do,” Skiles said. “It was an event that we had practiced and prepared for our entire lives.”

The ultimate proof of that preparation:  Skiles and Sullenberger saved lives by working as a smoothly functioning team.

Even though they had just met that morning.

Capt. Skiles flips through his aviation emergency procedures manual while being interviewed by Lisa Greene of USF Health Communications.