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Workshop 203. Leading Your Team through Crisis in GME: Caring, Character, and Practical Wisdom
No full textMedical education leaders such as program directors face myriad crises, from pandemics to natural disasters to resident substance use. Facing these crises is daunting and demanding. Managing crises in medical education often occurs through leadership teams, which may include associate program directors, program coordinators/program administrators, faculty, and chief residents. We will work from the personal stories of the speakers and participants to define the crises that GME leadership teams face. We will then discuss an evidence-based approach to optimizing leadership teams before a crisis and strategies for effective leadership during a crisis. Using group discussion and reflection exercises, we will share best practices for leading in current or future crises, highlighting the role that character traits play in leading through difficult times. The approach is grounded in the organizational psychology and business literature and can be easily applied to medical education. Participants will leave with 1) a framework for leading before, during, and after a crisis; 2) a list of resources for assessing their teams\u27 strengths and weaknesses; and 3) an action plan for strengthening their team now for the next crisis.
This presentation was about the book wherein Dr. Hamel authored a chapter titled Leading Through Crisis: Intimate Stories of Teamwork, Caring, And Character in Graduate Medical Education
Heart Matters: Strategies to Decrease Acute Myocardial Infarction Readmission
No full textBackground
Hospital readmissions after Acute Myocardial Infarction (AMI) are common and costly, with nearly one in six patients readmitted within 30 days. These admissions contribute significantly to healthcare expenses. Since 2012, hospitals have faced financial penalties for high 30-day readmission rates under the CMS Hospital Readmissions Reduction Program.
Purpose
The project aimed to identify gaps in the discharge process and implement strategies focused on nurse education, patient instruction, early follow-up appointments, follow-up calls, and transition-of-care planning to reduce AMI readmissions.
Implementation Strategies
All cardiac nurses were surveyed to assess current discharge practices. One-on-one education was provided using AHA guidelines and Epic system references. Post-intervention surveys evaluated improvements in knowledge and use of the teach-back method to enhance patient understanding.
Evidence based Recommendations
Patient Education
Education began during hospitalization and continued post-discharge. Nurses used the teach-back method along with printed materials, including discharge summaries, self-management plans, PCI instructions, and medication guides.
Follow-Up Appointments
Appointments with cardiologists or primary care providers were scheduled within 7–10 days post-discharge. Discharge staff coordinated these visits before patients left the hospital. Uninsured patients were referred to a VNA clinic for continuity of care.
Follow-Up Calls
Within 48–72 hours post-discharge, nurses conducted structured follow-up calls using a standard template to clarify instructions and address concerns. Calls helped identify and resolve issues early, preventing readmissions.
Transition of Care
All AMI patients were enrolled in cardiac rehabilitation before discharge and educated on the program’s benefits. Cardiac rehab supported recovery and encouraged adherence to treatment plans.
Results and Conclusion
Readmission rates dropped to 9.1% by September 2024, below the target of 9.74%. Structured discharge education, follow-up planning, and care coordination effectively reduced readmissions and improved patient outcomes
Awake fiberoptic intubation in a patient with radiated vocal cord squamous cell carcinoma (SCC) for an urgent femoral fracture repair
No full textIntroduction: Awake fiberoptic intubation (AFOI) is useful in managing patients with a known history of difficult airway including airway obstruction, masses or stenosis. The ideal method includes education, divided doses of sedation and analgesia as well as topical lidocaine to keep the patient both comfortable and compliant. Case Presentation: A 85 y/o F with a PMH of oxygen dependent COPD, CAD s/p PCI, poorly controlled HTN, SCC of the tongue and epiglottis with vocal involvement s/p radiation (last 3 months prior), diaphragmatic hernia, dementia, and sensorineural hearing loss with plans for THA due to instability. PE was Mallampati III with decreased TM distance and poor mouth opening. Of note, she underwent AFOI in 01/2024 for biopsy of SCC. After obtaining consent and education for the procedure, a small dose of midazolam was given for relaxation. We then performed AFO evaluation in the pre-operative area. The vocal cords were visualized. In the operating room, AFOI proceeded with divided doses of midazolam and antihypertensives. Our initial pass with the fiberoptic was unsuccessful. The second attempt with an anterior approach led to successful visualization of the cords and passage of a 5.0 ETT. The surgery was completed uneventfully, and the patient was extubated to a simple face mask without any issues. Conclusion: In anticipated difficult airways, thorough preoperative airway evaluation and visualization are critical in determining the optimal intubation strategy. In AFOI compliance is essential, requiring proper explanation and expectations including possible post operative intubation. Judicious doses of sedation and analgesia are important adjuncts to success in AFOI. Based on patient factors, appropriate medication selection—such as midazolam for anxiolysis—ensures adequate sedation while preserving spontaneous respiration. Analgesia selection, such as viscous lidocaine and solution via an atomizer, allows us to avoid medications that could disrupt spontaneous respiration. 1. Wong J, et al. (2019) Singapore Med J 60(3):110-118 2. Tsukamoto M, et al. (2018) J Dent Anesth Pain Med 18(5):301-30
SGLT-2 inhibitor-induced euglycemic diabetic ketoacidosis: A case report
No full textIntroduction: Euglycemic diabetic ketoacidosis (eDKA) is a rare but potentially life-threatening complication of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, such as empagliflozin (Jardiance). The incidence of eDKA is rising with increasing use of SGLT-2 inhibitors. Unlike traditional DKA, eDKA is characterized by significant ketoacidosis with normal to only mildly elevated blood glucose levels, making it a diagnostic challenge. The mechanisms underlying eDKA include increased glucagon secretion, enhanced lipolysis, and reduced insulin secretion, all of which promote ketogenesis despite euglycemia. Surgery, prolonged fasting, and critical illness further exacerbate this metabolic state. Here, we present a case of a 79-year-old female with type 2 diabetes mellitus (T2DM) who developed eDKA following preoperative use of empagliflozin and underwent urgent surgery for a femoral fracture. This case highlights the importance of recognizing eDKA in perioperative patients on SGLT-2 inhibitors and underscores the need for early diagnosis and aggressive management. Case Presentation: A 79-year-old female with a history of type 2 diabetes mellitus (T2DM) presented to the ED after a mechanical fall, reporting right hip pain. She had last taken empagliflozin the day prior. Found to have a subtrochanteric femur fracture, she underwent urgent intramedullary nailing under general anesthesia. Intraoperative baseline arterial blood gas (ABG) revealed a pH of 7.09, bicarbonate 11, pCOâ‚‚ 37, glucose 173 mg/dL, potassium 4.3, lactic acid 1.6, and an anion gap (AG) of 27. Given concern for eDKA, she received aggressive IV fluid boluses, 100 mEq bicarbonate and 500 cc albumin. Subsequent ABG improved to pH 7.24, pCOâ‚‚ 33, bicarbonate 14, glucose 159 mg/dL, potassium 3.9, and AG 21. Postoperatively, the patient was transferred to the ICU. Urinalysis revealed ketonuria, and serum beta-hydroxybutyrate was elevated at 4.6 mmol/L. She was treated with IV fluids, D5W and an insulin infusion, with progressive closure of the anion gap over three days. Her metabolic status improved, and she was transferred to acute inpatient rehabilitation. Conclusion: While SGLT-2 inhibitors offer significant benefits for patients with T2DM, this case emphasizes their potential to precipitate eDKA in the perioperative setting. Delayed recognition of eDKA can lead to worsening acidosis and metabolic instability, which may adversely impact surgical and postoperative outcomes. Clinicians should maintain a high index of suspicion for eDKA in patients taking SGLT-2 inhibitors, especially in those undergoing surgery or experiencing physiologic stress. Early identification, prompt initiation of fluid resuscitation, insulin therapy, and close hemodynamic monitoring are crucial for successful management. This case also reinforces the importance of holding SGLT-2 inhibitors in the perioperative period for at least 3 days prior to surgery to mitigate the risk of eDKA. 1. Erica Chow et al. (2023) 11: e003666. 2. Plewa, M. C. (2023). Euglycemic diabetic ketoacidosis. StatPearls 3. Nasa, Prashant et al. (2021) World Journal of Diabetes 12: 514-523
