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| Quarterly highlights from the Perioperative Surgical Services
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A Message from the Surgeon Chief
Dear colleagues,
Life is a paradoxical journey, presenting us with a constant interplay between the amazing and the awful. Our collective challenges over these past few years have weighted heavy on the scales. With a wary eye on the horizon, it is safe to say that we all seek a comforting sense of stability. In times like this, it is helpful to find your "home," your center, your neutral position. Take time to simply listen rather than react. Life is woven with threads of joy and sorrow, success and failure, elation and frustration. The breathtaking beauty of nature, the wonders of human achievements, and the moments of pure bliss fill our hearts with gratitude. Yet, life also confronts us with hardships, personal struggles, and the injustices that pervade our world. To navigate this dichotomy, we must embrace the entirety of our experiences, finding solace in acceptance and purpose in the face of adversity. We are fortunate to be situated closely to our noble purpose by trade. I encourage you to cultivate gratitude, resilience, and human connection to find your balance amidst the chaos. This practice will help us emerge stronger and more equipped to appreciate eachother no matter where we find ourselves on that spectrum at the moment.
Sincerely,
Jeff
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OR Renovation Updates
OR 12 and 13 are open after renovation. Stream Connect is operational.
OR 7 and 8 have started renovations
Karl Storz Stream Connect is an advanced technology designed for operating rooms that allows medical professionals to view and share high-quality images and videos in real time. It enables seamless communication and collaboration during surgical procedures. Read more HERE.
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Pediatric GI Lab Performs First EndoFlip
The Pediatric Endoscopy Lab performed their first EndoFlip on May 18th. Dr. Girish Hiremath, Victoria Bell, BSN, RN along with Trent Peters from Medtronic are pictured here performing the study. The procedure was a success in assisting with the diagnosis of the patient with Eosinophilic Esophagitis. EndoFLIP (endoluminal functional lumen imaging probe) is a newer, minimally invasive type of technology that can be used during endoscopy to measure the dimensions, movement, and pressure inside the esophagus. The equipment allows us to assess not only the distensibility, but also the presence of peristalsis. The advantage of performing EndoFLIP is that it allows an assessment of the motility of the esophagus while the patient is under anesthesia in a less-invasive way. Patients may need EndoFLIP to better evaluate and detect motility problems such as esophageal achalasia, swallowing difficulties, and eosinophilic esophagitis. It can assess esophageal diameter, effectiveness of certain treatments, and continued symptoms after fundoplication or myotomy. Read more HERE.
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| Welcome!
We've added several new members to the Periop family. CLICK to see who's-who.
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Advancement and Recognition
Perioperative team members are continuously advancing on their chosen career path.
CLICK to view staff and faculty advancements and achievements!
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Melissa Johnson, APRN, nominated for "Jerita Payne Advanced Practice Nurse"
Lauren Boston, MSN, RN, PNP-PC, NPD-BC, nominated for "Nancy Wells Nursing Research & Evidence-Based Practice"
Dr. Bevan Londergan, MD, nominated for "Friend of Nursing"
Tracy Warhoover, MSN, RN, CPNP, nominated for "Jerita Payne Advanced Practice Nurse"
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Great Catch, PATCH! Preoperative Assessment and Teaching for Children's Hospital Team (PATCH) is on top of it.
Successful Coordination at PATCH: Patient's Difficult Airway Identified by NP Leads to Proper Assessment and Preparedness, Ensuring Smooth Surgery and MRI
Walk-in Patient's Cardiac History Leads to Critical Hematology Consultation at PATCH, Uncovering Hemophilia Family History and Developing Hemostasis Plan
PATCH Intervention Reveals Medication Noncompliance and Critical Lab Abnormalities in Patient Scheduled for Posterior Spinal Fusion (PSF)
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Get to know the Pediatric Sedation Service
The Sedation team is comprised of four Medical Doctors with intensive care or Emergency medicine training and five Advanced Practice Registered Nurses with a long history of providing both deep and moderate sedation to our pediatric patients. The primary goal of the service is to provide safe, customized sedation for patients outside of the operating room for minor procedures, diagnostic tests, and imaging. We provide sedation throughout the hospital including locations in VCH3, Radiology, and DOT5. Examples of types of procedures we support include: Lumbar punctures, Bone marrow biopsies, EEG, Botox injections, ABR, ECHO, dressing changes, catheter insertions, and more. Please reach out to the team at 615-835-9999 pager, or 63358 if you have a patient you would like to have evaluated to be served by their team. This is important as we work to utilize our OR space for surgical procedures. Learn more HERE.
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Congratulations to Keke Hinds, Support Specialist in the Post Anesthesia Care Unit, on being nominated for Athelete of the Year by Special Olympics Nashville! Keke's positive attitude, 100% effort, and never-ending support of others make her the perfect candidate.
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Celebrate Pride Month: Standing Together for LGBTQ+ Community
In these challenging times, it is crucial to show unwavering support for our LGBTQ+ friends. June is Pride Month—a time to honor the resilience, courage, and achievements of the LGBTQ+ community. Let us join hands to ensure that everyone feels safe, respected, and embraced for who they are.
To foster inclusivity and offer support, resources are available. The Vanderbilt Program for LGBTQ Health provides valuable assistance, while the P.R.I.D.E Employee Resource Group offers insights and direction for employees.
The Vanderbilt Program for LGBTQ Health is a major sponsor of the Franklin Pride and Nashville Pride Festivals. They will be at both events providing the onsite medical services.
In case you missed it, here is a special message from Dr. Jeff Balser, President and CEO, urging support for members of VUMC’s LGBTQ community. In this message, Dr. Balser stresses the importance of caring for each other as we care for others. “This is a time we all need to go the extra mile to assure a safe environment for our LGBTQ patients and employees.”. VIDEO MESSAGE.
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Communications Survey Winner Announced
Ashlee Blannett, RN in the Peds Cardiac Cath Lab is our winner for taking the Communications Survey! Ashlee won a $15 gift card for Suzie's Coffee Shop. Thanks for your participation!
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If you are interested in learning more about results from post-patient experience surveys, click HERE.
Thank you ALL for your continued dedication to our patients and families!
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Empowering Action through Data & Outreach: Unveiling the Story of Traumatic Injuries in Middle Tennessee; Relaunching BITZ Program
Stacey Pecenka, manager of the Trauma Injury Prevention program at Monroe Carell, wants you to know that data drives the mission and outreach helps to land it. "We need to understand the trends of traumatic injuries in Middle Tennessee. By carefully analyzing our Trauma Registry and RedCap surveys, we gain valuable insights into patients' backgrounds, injury locations, causes, and preventability. This data serves multiple purposes: it allows us to tailor our programs to meet the specific needs of our community, seek funding to improve safety measures, provide accurate statistics for media and educational purposes, and shape our program messaging and bedside injury prevention education. With this knowledge, we can make a significant impact in preventing injuries and keeping our community safe. Read more HERE.
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Dedicated Yoga Instructors Revive Stress Management Program for Healthcare Workers
Heather Larson, Lissa Wooten, and Stephanie Slinger's dedication to providing healthcare workers with a valuable stress management tool through yoga demonstrates their unwavering commitment to the well-being of their colleagues.
Describing the program as a slow flow vinyasa with a strong emphasis on breathing and relaxation, the sessions span approximately 45 minutes. Over time, the yoga classes have fostered a sense of community among regular attendees, creating a supportive and welcoming environment. As they continue their mission, these instructors are poised to make a lasting impact on the lives of healthcare professionals, promoting overall wellness and resilience in the face of demanding circumstances. Learn more about how this class came to be HERE.
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American College of Surgeons Trauma Center Verification Coming September 18-19
It is that time again for our American College of Surgeon’s Trauma Center Verification. The survey takes place on September 18th and 19th and is in a new virtual format where the documentation including patient charts are submitted well in advance. That means the surveyors will have more time available to speak to various trauma liaisons and staff members virtually. You will also see us touring the hospital with rolling iPads, to include the PACU and OR. In the past, the surveyors have asked about OR availability, staffing mixes, available equipment, and staff training. Please feel free to reach out to Amber Greeno if you have any follow-up questions. Read more about how to prepare for ACS Trauma Center Verification HERE.
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Click HERE for a closer view of the Vanderbilt Pediatric Surgery Surgical Site Infection Scorecard.
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Click HERE for a closer view of the Spinal Fusion Surgical Site Infection Scorecard.
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Nominate a colleague!
Submit a Safety Superhero nomination: CLICK or use QR code.
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Turner, Wellons Serve as Honorary Chairs at the Iroquois Steeplechase Benefiting the Monroe Carell Jr. Children's Hospital
The 83rd Running of the Iroquois Steeplechase was Saturday, May 13 at Percy Warner Park in Nashville. Representing Monroe Carell Jr. Children’s Hospital at Vanderbilt (pictured above) was Honorary Race Chair, Dr. Jay Wellons, President Dr. Meg Rush and Child Ambassador, Rivers DeLisle with his parents, Matthew and Jessica. Also pictured is winning jockey Danny Mullins and Molly Willis from Madaket Stables LLC. Over the last three decades, the Iroquois has raised more than $11 million for Monroe Carell.
The Iroquois Steeplechase in Nashville, Tennessee, serves as a vital annual event that benefits the Monroe Carell Jr. Children's Hospital at Vanderbilt. As one of the city's premier social and sporting traditions, the Steeplechase combines exhilarating horse racing with a charitable cause, raising significant funds to support the hospital's mission of providing exceptional healthcare to children. The event's proceeds contribute to cutting-edge research, innovative treatments, state-of-the-art facilities, and specialized care for children facing various medical conditions. By fostering community engagement and philanthropy, the Iroquois Steeplechase plays a crucial role in transforming the lives of countless young patients and their families, while also highlighting the power of unity and compassion in making a meaningful difference.
Below right, from left: Dr. John Thomas, Chief of Staff, Dr. Jay Wellons, Chief of Pediatric Neurosurgery, Dr. Jeffrey Upperman, Surgeon-In-Chief, and Chris Lee, Chief Operating Officer, Ambulatory Services.
Below left, from left: Dr. Melissa Wellons, Fair Wellons, Jay Wellons.
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OR Supply Cost Per Case Update
The Supply Cost Reduction Committee would like to bring your attention to the attached graphs showcasing our cost per case performance compared to the budgeted cost and the percentage over/under compared to budget. While we have been above budget, it is encouraging to note that our efforts have resulted in a declining trend since January. We achieved our goal in October and have been steadily progressing since then. We want to express our appreciation for your hard work and dedication, which has contributed to this positive trend. Your commitment to cost management and efficiency is commendable, and we encourage you to continue your efforts while maintaining our high standards of quality and service. Together, we will strive to align our costs with the budget and drive our organization towards financial success. Thank you for your outstanding work.
Sincerely,
The SCRC
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Supply Cost Reduction Program
Supply Cost Reduction work will continue in FY2023.
EPSi Cost Accounting Team has developed a Supply Cost Tableau dashboard to measure and track performance to expense goal and change in year over year costs .
The Supply Cost workgroup team was created to oversee this workstream consisting of Finance, Perioperative Services, and Surgeon Leadership.
The team has identified 3 areas with opportunity for improvement:
1) Surgeon Preference Card Review
2) Reduce Supply Wastage
3) Utilization of CPT codes with greatest opportunity
If interested in going through a review of your Service’s Supply Cost data and performance on the dashboard, please contact Dr. John Pope or Jeremy Willis.
Attention: The information transmitted with any links is intended solely for VUMC faculty and staff and may contain confidential and/or privileged material.
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2023 American Pediatric Surgical Association Conference Highlights
Our surgeons were busy this year at APSA! Highlights include Dr. Melissa Danko moderating a scientific plenary session, Dr. Monica Lopez leading an interactive session providing basic QI knowledge and practical applications, Dr. Irving Zamora presenting on innovations in pediatric robotic surgery, and Dr. Eunice Huang leading an APSA coaching project. Special recognition to Dr. Zamora for having a standing room only session on Robotic Pediatric Surgery!
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Nurse’s Week Poster Presentations
Stevie Crossland (below, left) – Empowering Nurse’s Journey to Create a Sensory Friendly Unit
Cory Smeltzer, Molly Napier, (bottom) & LeighAnn Chadwell (below, center) – FOCUSing on Family-Centered Care: Improving the Patient-Family Experience. Presented at American Society of PeriAnesthesia Nurses (ASPAN) Conference by LeighAnn Chadwell.
Lauren Boston, Raven Stafford, Kathleen Gobbell, Jill McCann-VanDokkum, & Elizabeth Schwartz (below, right) – Who’s Who in the PACU? Role Designation During Emergencies
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Service Spotlight: Unveiling the Latest Endeavors and Innovations
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Advanced Practice Registered Nursing
The PATCH team in Murfreesboro is now utilizing surveys that can be distributed via MHAV accounts to screen for ASC eligibility in our Murfreesboro location that are saved to EStar. This is leveraging technology to make our work more efficient and supports our APRNs to provide high quality screening.
Late last year PATCH successfully launched an EPIC build that automatically notifies PATCH to William's Syndrome patients being scheduled for surgery. This allows the PATCH team to ensure all appropriate measures are in place prior to the day of service. We have recently begun to develop a very similar process for our patients with bleeding disorders in order to ensure hemostasis plans are in place and communicated effectively.
Cardiac Surgery
Inhaled Nitric Oxide Study: Our Pediatric Cardiac Surgeons are seeking insights into intraoperative brain and kidney injury with ongoing enrollment.
General Surgery
Dr. Zamora is a member of a national multi-institutional team evaluating an innovative method for laparoscopic common bile duct exploration.
Dr. Robinson and Danko’s team will be presenting at the ACS Quality & Safety Conference in July on GJ tube use in infants and children.
Dr. Robinson is an informaticist who is developing a more formal and robust relationship between MCJCHV Peds Surgery and the Department of Biomedical Informatics.
Surgical Quality Committee (SQC) continues to meet on a monthly basis. Goal is to transition to All-Surgery PIPS format in the coming months.
Data analytics to support SQC's work:
1) M&M eRepository for adverse surgical events has been launched across all subspecialties.
2) Return to OR/Readmissions Dashboard is live and undergoing validation across service lines.
Dr. Monica Lopez is orienting as new leader of the Surgical Outcomes for Kids (SOCKs) team. She is currently drafting a strategic plan, appointing an advisory committee, and assessing future sources of funding.
Neurosurgery
Enrolling Now: Prospective multi-center randomized trial for "Shunt vs. ETV/CPC." An Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization (ETV/CPC) is a treatment in which an endoscope is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain, with an addition of a of choroid plexus cauterization; only performed in infants. A cerebral shunt is a device permanently implanted inside the head and body to drain excess fluid away from the brain. They are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid (CSF).
Published: Journal of Neurosurgery: Pediatrics. 'Intrauterine closure of myelomeningocele defects with primary linear repair versus bipedicle fasciocutaneous flaps: a post-MOMS cohort study with long-term follow-up.' Findings indicate that patient with these wide lesions are still eligible for procedure when bipedal flaps are employed. Read the full paper HERE.
Volume and growth continue to increase in the Brachial Plexus Clinic under the direction of Dr. Izabela Galdyn, MD.
Orthopedic Surgery
Pediatric Orthopaedic Society Annual Meeting Hosts – Omni Nashville April 2023
- Largest meeting attendance ever.
- 7 podiums/posters by Vanderbilt faculty
- 2 papers accepted in the Basic Science Research Awards session (both by Dr
Schoenecker) session including Best Basic Science Paper – Dr Jonathan
Schoenecker, MD, PhD. (second year in a row)
- 1 paper in the Clinical Research Awards session, (Dr Jeffrey Martus)
- Dr. Craig Louer hosted the Peds Ortho Podcast from the meeting venue with
interviews of Scientific Session Moderators.
- Tracy Warhoover APN was installed as President of the Pediatric Orthopaedic
Practioners Society (POPS)
Spine Research
Registries:
- Setting Scoliosis Straight Surgeon Performance Program
- Pediatric Spine Foundation Registry
- VCH Pediatric Spine Registry
Ongoing Studies:
- Cast versus Bracing Trial for Infantile Idiopathic Scoliosis
- Magnetic Controlled versus Traditional Growing Rods
- Outcomes of Kyphectomy for Congenital Kyphosis in Spina Bifida
- Mobility after Spine fusion in Spina Bifida Patients
- Benefits of Halo Gravity Traction Prior to Growing Rod Implantation
- 20 year Experience of Growing Rod Lengthening without Intraoperative
Neuromonitoring
- Atlanto-Occipital Ligament Injury Score (AOLIS): A Novel Scoring System Predicts
Successful Treatment with Cervical Collar versus Rigid Fixation
- Halo-Vest Immobilization is an Alternative to Posterior Cervical Fusion in the
Treatment of Atlanto-Occipital Dissociation in Children
- Nasal Staph Decolonization Protocol to Reduce SSI
- Pain Service Co-Management with AIS ERAS
Manuscripts:
- Clinical Radiographic Outcomes Following Correction of Idiopathic Scoliosis in
Adolescents vs. Young Adulthood. (accepted)
- Flexibility-Tilt Agreement Best Predicts Shoulder Balance Following Posterior Spine
Fusion for Adolescent Idiopathic Scoliosis (submitted)
- Dispelling the Dogma: UIV of T5-6 can achieve similar correction and shoulder
balance with less blood loss than T2-T4 in select patients (submitted)
Podium Presentations:
- Clinical Radiographic Outcomes Following Correction of Idiopathic Scoliosis in
Adolescents vs. Young Adulthood. (SRS 37 Annual Meeting , Fall 2022, POSNA
Annual Meeting April 2023))
- Traditional Growing Rod Lengthening Without Intraoperative Neuromonitoring: 20-
year Experience with no Neurologic Deficits (SRS 38th Annual meeting, Fall 2023)
General Peds Ortho Research:
Ongoing Studies:
- Multicenter Randomized controlled Trial of Local Anesthetic Options for Heel Cord
Tenotomy in IndiClubfoot RCT
- Rapid Recovery Protocol following ORIF of Tibial Tubercle Fractures
- RIMN for tibia shaft fractures in skeletally immature adolescents
- Activity Monitoring after Wrist / Forearm Fractures
- Trends in Operative Mgmt of Peds Femur Fxs in ABOS Part II Candidates
- Nonoperative Tx of Adolescent PCL Tears
- ABOS PRISM Sport Cohort Outcome Registry (SCORE)
- Isolated and Combined Adolescent MCL Tears- 1 enrolled
- Growth Disturbance after Ped/Adolescent ACLR
- Outcomes of open vs closed reduction of T3 SCH fxs
- Risk Factors for Delayed Union of LE Derotation Osteotomies
- Outcomes of Femoral shaft fractures age 1-5
- Dr. Craig Lauer continues to host Pediatric Orthopedics Podcast. Listen HERE.
Otolaryngology
Ear, Nose, & Throat (ENT) Biorepository now operational!
Grant-Funded Projects: Exploring Unilateral Vocal Fold Movement Impairment and Cholesteatoma in Neurologic Patients
Jason Parks, MD, investigating Vascular Biology in Aerodigestive Conditions
Dr. Frank Virgin Collaborating on Quality-Care Pathways and Clinical Practice Guidelines
Bark Tank now accepting ideas to present to a selection of VUMC internal experts to assess for funding and scalability. Contact Dr. Wootten with inquiries.
Innovation Summit is accepting submissions for presentation. This is a creative venue to share innovative ideas and foster collaboration among services.
In Progress: App for surgery for patients to self-schedule. SBAR phase complete.
Coming Soon: Surgeons & Techs Fair at the OSIC Innovation Summit: Showcasing In-House Instruments and Supplies for Interdisciplinary Collaboration
Green Zone Expansion: Inclusive Perioperative support for all ages at Vanderbilt Children's Surgery Center (VCSC) in Murfreesboro
Dr. Ryan Belcher is actively engaged in global health initiatives. He is a founding member of the Vanderbilt Collaborative for Global Health Equity and has authored a published paper on pediatric otolaryngology in the context of global health. He is currently working on a journal article evaluating pediatric otolaryngology outcomes in Guatemala and has contributed to an evidence-based approach to pediatric otolaryngology in developing countries.
CADET Aerodigestive Clinic: Excelling in Treating TEFEA, Tracheomalacia, and Esophageal Conditions, Guided by Dr. Robinson & Dr. Zamora
Plastic Surgery
FaceIT/Photo app software was debuted at three national meetings. There are 36 potential customers interested in adopting it. New feature: The app will subtract background from any anatomical parts in the frame.
Research Grant: "Human Craniosyntosis Atlas" using neuroimaging data and baseline full genome sequencing.
Research: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) for Craniosyntos to launch in October.
Urology
Urology Surgeons present four abstracts at American Urological Association's 2023 Annual Meeting, Fellow wins Best Poster.
Dr. Douglass Clayton & Dr. Irving Zamora collaborating on 3-D Imaging for complex reconstruction patients.
Re-Launched: Congenital Urinary Tract and Bowel Anomalies program lead by Dr. Eunice Huang.
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What's Next: Diversity, Equity, & Inclusion
This resource guide is intended to help you deepen your knowledge of the roots of injustice and inequity and learn about antiracism efforts. These resources will be regularly updated. Feel free to share with your family, friends and colleagues.
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In The News...
Discoveries in Medicine
VUMC Reporter
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Suggestion Box
This newsletter is for you! We want to keep you updated on relevant information for pediatric surgical services. Please offer feedback or suggestions, such as content additions, areas of focus, and ideas that relate to at least one of our Pillar Goals: People, Service, Quality, Innovation, Growth & Finance. We are also looking for contructive solutions to challenges within the Perioperative space.
Your feedback will help us improve.
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