American College of Emergency Physicians : Member

Society of American Emergency Medicine : Member

Medical Society of Delaware : Member

Delaware Academy of Medicine : Member

Visual outcomes after traumatic retrobulbar hemorrhage are not related to time or intraocular pressure

An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment

Immediate Stress Echocardiography for Low-Risk Chest Pain Patients in the Emergency Department: A Prospective Observational Cohort Study

High Single-dose Vancomycin Loading Is Not Associated With Increased Nephrotoxicity in Emergency Department Sepsis Patients

Predictors of a Top Performer During Emergency Medicine Residency

Residency can be an incredibly stressful part of the medical education experience. In a 2006 study of first-year residents – also called interns – researchers found 4% met criteria for being burnt out at the start of the year. That number was 55% by the end of the year.For the fourth episode of our “The Toughest Questions in Health Care” series we’re looking at a challenge that has plagued teaching hospitals – like ChristianaCare – for decades. Dr. Brian Levine, ChristianaCare Associate Chief Academic Officer and Designated Institutional Official, and Dr. Andrew Blake, a second-year emergency medicine resident at ChristianaCare,  tackle the question, "why are residents burnt out, and what can be done about it?"It's a conversation that takes us from the historical grind of residency to today's efforts in creating nurturing environments that still meet the high standards of medical training. We examine the fine line between the stress needed to forge competent physicians and the potential harm of overwhelming pressures.Mental Health in Health Care and Psychological First Aid with Katie Godfrey, PhDChristianaCare Residency Programs ChristianaCare Center for WorkLife WellbeingAmerican Medical Association - Inside Match Day 2024Thanks for listening and subscribing! Follow us on Facebook, Instagram, Twitter and LinkedIn.

The Toughest Questions in Health Care: Why Are Residents Burnt Out and What Can Be Done About It?

EMRA Antibiotic Guide, 19th Edition

Christiana Care Health System is one of the largest health care providers in the mid-Atlantic, serving all of Delaware and parts of PA, MD and NJ.

ChristianaCare

Brian Levine, an emergency doctor by training, is the associate chief academic officer and the designated institutional officer at ChristianaCare. 

Dr. Levine oversees more than 30 residency and fellowship programs at ChristianaCare and has spearheaded ChristianaCare’s significant authorship in the development of pocket-sized reference guides used globally by thousands of emergency residents each year. The guides, published by the Emergency Medicine Residents’ Association, provide guidance on antibiotic use, the treatment of orthopaedic injuries and administering EKGs, among other issues.

Antibiotic Stewardship

Undergraduate Medical Education

Emergency Medicine

Graduate Medical Education

Aeromedical Transport

Downloadable Photos of Dr. Brian Levine

ACEP Frontline: Antibiotic Education (2016)

ACEP Frontline: EMRA Antibiotic Guide (2018)

EMRA Cast: Antibiotic Stewardship (2019)

Brian Levine

Health care is about more than broken bones and blood pressure readings. Join For the Love of Health hosts Michael Chesney and Megan McGuriman every other Thursday for engaging conversations about fascinating treatments, innovative programs, groundbreaking research and cutting-edge technology. Learn how medical experts are creating health today and delivering the care of tomorrow.

For the Love of Health

taking-action-for-quality-improvement

Caregivers tackle real-world health care issues like hospital noise, appointment no-shows and waiting time in the Achieving Competency Today program

Associate Chief Academic Officer and Designated Institutional Official

Chief Learning Officer

Leadership Development

Healthcare Management

Medical Education

Internal Medicine

Clinical Effectiveness Officer of Ambulatory Care

Cardiac Telemetry

Sepsis

“Learning is a journey. It is continuous,” said nurse Hellen Okoth, MSN, CCRN, RN-BC, of the Transitional Surgical Unit. She was one of the learners on that journey through ChristianaCare’s professional development program Achieving Competency Today (ACT).

 ACT, a 12-week graduate-level program dedicated to health care improvement, will celebrate its 40th session in 2025. Some 1,000 caregivers have graduated from ACT and have tested some 140 innovative project ideas since the program’s launch in 2003.

On April 9, three ACT teams presented their quality improvement projects at the John H. Ammon Medical Education Center on ChristianaCare’s Newark campus.

 Interdisciplinary, experiential learning programs like ACT create a rich and dynamic learning environment,” said Tabassum Salam, M.D., MBA, FACP, chief learning officer for ChristianaCare.

“The emphasis on continuous improvement and real-world applications of the educational content sets our ACT graduates up for lifelong learning and repeated application of these new skills.”

The ACT course is a collaborative experience that brings together learners from diverse disciplines to tackle real-world health care challenges. Participants learn from health system leaders and gain a broad perspective on health care through coursework.

They work in teams to complete problem-solving projects from start to finish using the Plan-Do-Check-Act (PCDA) model of continuous improvement. Facilitators, who are experts in improvement science and team effectiveness, guide the teams through the process, ensuring that each project is meticulously planned and executed.

ChristianaCare offers many professional development opportunities. Click here for careers and benefits. 

“The hands-on projects in ACT enable learners to innovate and test out solutions in settings that directly benefit patients, leading to better outcomes and a higher quality of care,” Salam said.

The three most recent teams presented improvement research that has the potential to expand beyond their pilot stage to other areas of the health system.

‘Hush! For the Love of Health’ In “Hush! For the Love of Health,” an interdisciplinary team worked to reduce noise levels on the Cardiovascular Critical Care Unit (CVCCC) at Christiana Hospital. Their goal was to decrease ambient noise levels by 10 decibels during the study period. Intensive care units often experience noise levels that can exceed 80 decibels. A quiet environment is 30 to 40 decibels.

 Members of the “Hush” project found creative ways to reduce noise on an intensive care unit.
Ambient noise refers to all sounds present in the background, which research shows can interfere with communication, concentration and comfort. In a hospital setting, these sounds may include alarms, conversations, announcement and pages and carts moving by.

The team looked for opportunities to safely reduce the number of alarms sounding. By collaborating with Philips technology company to lower alarm volumes and eliminate redundant alarms, they reduced the number of alarms sounding from 10,000 to 3,000 daily and successfully decreased noise levels by 13 decibels, exceeding their goal.

“It’s good for patients to have a quiet environment and it fights alarm fatigue for caregivers,” said Dylan Norris, a pre-medical student from the University of Delaware and participant in the ACT course.

‘Show Up and Show Out’ Reducing the no-show rate among patients in primary care practices improves health outcomes and conserves resources. In “Show Up and Show Out: Boosting Patient Attendance in Primary Care,” the project team aimed to reduce the incidence of no-show appointments at the Wilmington Adult Medicine (WAM) practice by 10%.

 The “Show Up and Show Out” project team used personalized communication outreach to patients to encourage keeping their primary care appointments.

“Our literature review showed that personal relationships with providers are one thing that can encourage people to attend appointments,” said team member Christi Karawan, MS, BSN, CCRN-CSC.

The key to their problem-solving strategy was using a secure messaging platform for automatic appointment reminders specifically for WAM that were personalized with the provider’s name and thanking the patients for letting WAM be a part of their healthcare team. Other steps on the road to success were signage around the practice encouraging patients to update their contact information and calls from office assistants and medical assistants to unconfirmed patients the day prior to their appointments.

The team achieved a 9.5% reduction in no-shows, just shy of their goal, over a two-week period.

An office assistant who participated in the pilot said, “Outreach has been helpful not only in getting people in but in getting people to reschedule or cancel. We can catch it before it becomes a no-show.”

‘Magnetic Efficiency’ To address delays in patient transport from MRI testing at Newark campus, an ACT team created a new communication workflow to directly connect patient escort dispatch to the MRI charge technician. The ACT team aimed to decrease patient wait times following MRI completion for stretcher transport back to patients rooms by 25% — and “a bold goal,” said one colleague — during the study period.

 The “Magnetic Efficiency” team identified a new workflow to get patients back to their hospital rooms faster after MRI testing.

Using Vocera wearable communications tools, the team created a thread for direct communication between Escort Dispatch caregivers and MRI charge technicians. Also, when an Escort transporter dropped off a patient for an MRI, the transporter asked MRI staff if any patients were ready to go back to their rooms. These changes in communication and empowerment consolidated transports and led to a 17% reduction in wait time during the two-week pilot.

“We don’t want people to work harder,” said team member Tim Kane, BSN, RN. “We wanted to avoid preventable delays.”

Both teams expressed satisfaction and improved communication with the new process and they expressed interest in continuing the process after the pilot ended.

Future forward The ACT course has a rich history, originating from a specific initiative piloted by the Robert Wood Johnson Foundation with ChristianaCare among the early adopters along with Harvard University, the University of Pennsylvania, Johns Hopkins University and Beth Israel Deaconess Medical Center.

 Through the years, ChristianaCare ACT team members have seen their projects live on both as permanent changes throughout the health system and, more personally, in their professional growth.

“I was able to enhance my creativity, organizational and problem-solving skills,” said Starr Lumpkin, a staff assistant who was on the “Hush” team. “This was a pivotal journey for me.”

ChristianaCare is growing its program to develop a pipeline for the next generation of health professionals, said Safety and Quality Education Specialist Claire Rudolph, MSM, CPHQ. “We have a varied group of learners and facilitators who are making an impact on health care quality, cost and safety.”

Dylan Norris was the first participant from a new partnership with the University of Delaware for pre-med students to get quality improvement experience.

“I have learned so much about what goes into a quality improvement project. Buy-in from the stakeholders is key in implementing any new project successfully,” she said. “I have also learned about the importance of the initial research that goes into creating a new project and how much pre-planning goes into it.”

Closing the event, Clinical Effectiveness Officer Christian Coletti, M.D., MHCDS, FACEP, FACP, called on the ACT graduates to use their newfound “superpowers” — “vision, seeing the future, catching something before it breaks.

“It’s not a glitch in the matrix,” he said. “You are the most important people at the bedside – hearing the alarms going off or the stretchers piling up. Work to identify problems and move toward solutions in your own microenvironments. Pass on your powers with reckless abandon.”


Taking ACT-ion for Quality Improvement

the-road-to-treating-substance-use-disorder-starts-in-the-primary-care-office

Innovative ChristianaCare program pairs early intervention and with resident education in addiction

Chair, Department of Family and Community Medicine; Physician Executive, Complex Primary Care and Community Medicine

Health Equity

Family Medicine

Faculty Development

Residency Training

Chronic Disease Management

For a groundbreaking offering in the treatment of substance use disorders, ChristianaCare’s Family Medicine residency program team received a Wellness Hero Award in the 2024 Delaware Lt. Governor’s Wellness Leadership Challenge.

ChristianaCare was recognized for creating “a comprehensive program designed to address the pressing need for behavioral health services in Delaware.”

 ChristianaCare’s Family Medicine residency established a substance use disorder treatment program in 2020 to identify and provide targeted substance abuse treatment to patients in need and, importantly, to train future providers in the specific and unique issues that patients with addiction often face in primary care settings.

“The purpose,” said James LaRosa, M.D., associate residency program director, “is to create an eager and competent workforce of providers ready to help this population.” LaRosa, an alumnus of ChristianaCare’s Family Medicine residency, is also lead for the Family Medicine substance use disorder treatment program.

 “James was intentionally recruited to our program to carry the torch for this important work,” said Erin Kavanaugh, M.D., FAAFP, chair of Family and Community Medicine.

“He has taken the program and department to new heights, particularly in terms of grant-funded work and educational opportunities, all anchored in dedication to comprehensive patient care and improved outcomes.”

“Family medicine practitioners take a holistic approach so patients receive personalized and consistent care for better health and well-being for them and their communities,” said Anna Filip, M.D., FAAFP, director of the residency program. “With opportunities like the substance use disorder treatment program, we are preparing the next generation of doctors to treat the whole person.”

At the 2024 presentation, then-Lt. Gov. Bethany Hall-Long praised the program for “its impact on closing the gaps in treatment capacity for those with substance use disorders” and “taking measurable steps to expand access to care in our community.”

The primary goal of the program is to support patients through withdrawal, LaRosa said. Patients identified for the program via ChristianaCare’s hospitals and emergency departments are connected with the Family Medicine Department to open the door to primary care. The program also provides vital social supports for these patients through the robust ChristianaCare network.

“We utilize the services of our in-house social work, behavioral health and case management teams to help provide wraparound services to a population where those things are as crucial as the medical care,” LaRosa said.

 Third-year resident Deanna Gorgei, D.O., said she chose ChristianaCare’s Family Medicine residency for its “forward-thinking and innovative leadership” who support residents in exploring their interests in the field. One of her interests in addiction medicine.

“Not only are residents like me getting this experience in how to treat different substance use disorders, but we’ve also gained exposure on how to set up a program like this,” she said.

“It’s been a huge part of my training and has shaped my interest going forward.”

Family medicine provides an especially effective setting to treat substance use disorders, in part because its providers are qualified to identify and treat comorbid conditions like hepatitis as well as a host of other illnesses and injuries.

“Since starting the program,” said LaRosa, “we have stabilized multiple patients’ chronic medical conditions, identified and treated a patient with bladder cancer, and cured 26 cases of hepatitis C.”

Combining care for substance use disorder with primary care, said Gorgei, is appealing for residents and fosters better patient experience and outcomes. “I like being able to have both opportunities,” she said. “It’s so beneficial to have addiction medicine rotate with routine primary care, because it is primary care.”





The Road to Treating Substance Use Disorder Starts in the Primary Care Office

On June 17, ChristianaCare welcomed 105 new residents and fellows into 27 training programs during their long coat ceremony, a rite of passage for medical students, signifying their entrance into the medical profession. Our new residents and fellows are joining us from a wide variety of states across the county including California, Florida, Texas, and we even have some native Delawareans! We are excited for this new generation of caregivers to join us as they embark on their new journey. To learn more about our residency and fellowship programs, visit our website: https://residency.christianacare.org/.

Welcome, ChristianaCare Residents!

Residency can be an incredibly stressful part of the medical education experience. In a 2006 study of first-year residents – also called interns – researchers found 4% met criteria for being burnt out at the start of the year. That number was 55% by the end of the year.

For the fourth episode of our “The Toughest Questions in Health Care” series we’re looking at a challenge that has plagued teaching hospitals – like ChristianaCare – for decades. Dr. Brian Levine, ChristianaCare Associate Chief Academic Officer and Designated Institutional Official, and Dr. Andrew Blake, a second-year emergency medicine resident at ChristianaCare,  tackle the question, "why are residents burnt out, and what can be done about it?"

For more information visit https://christianacare.org/us/en/wellness/podcast

Select Inquiry Type