DOM CONNECT:

In this month’s spotlight, we highlight the work of Jeeva Subramanian, MD, an associate professor of medicine and physician in General Internal Medicine.

Dr. Subramanian has worked in both inpatient and ambulatory settings throughout her career, but her passion lies in ambulatory medicine. In her spotlight, we highlight her work as a physician and current research projects, as well as her love for teaching and the community that she serves. 

Learn more about Dr. Subramanian by clicking the button below.

The eICU program at UMass Memorial Health is leading exciting new efforts to improve efficiency and patient outcomes in intensive care units across Central Massachusetts. Also known as the ICU telemedicine program, the eICU launched in 2006 and currently electronically monitors over 150 adult ICU beds at UMass Memorial Medical Center, Marlborough, Harrington, and HealthAlliance Hospital, the PACUs at UMMC, and ICU beds at non-UMass sites including Heywood, Milford Regional, and Tobey Hospital. Beds are monitored 24/7, from a remote support center, by attending intensive care physicians who are assisted by critical care nurse practitioners or physician assistants. The eICU is led by Bruce Greenberg, MD, MBA, interim medical director of the eICU and medical director of the Memorial CCU, critical care physician, and assistant professor of medicine in Pulmonary, Allergy, and Critical Care, and Eric Cucchi, MS, PA-C, director of eICU operations, critical care physician assistant, faculty in the Program in Digital Medicine, and instructor in the Tan Chingfen Graduate School of Nursing. The primary goals of the eICU include direct support of and interventions to help ICU patients in conjunction with the bedside providers, review and optimization of recently admitted patients, co-managing triage and patient flow, and providing population health outreach.  

One of their chief objectives is to enable clinicians to be as efficient and effective as possible. Because they are staffed with two to three clinicians each shift and they monitor over 150 patients, the eICU depends on electronic tools to help guide them and ensure that they are not missing critical issues. They utilize a specialized alerting and alarming system that helps them focus their attention on sicker or less stable patients that might be decompensating so that they can intervene. They have also developed handoff tools that facilitate communication from the bedside to the eICU and vice-versa, enabling easy communication among the teams. Innovative technology and tools used in the eICU are critical to the management and care of our ICU patients. 

For their most recent innovation, eICU leadership developed a clinical decision support tool within Epic that addresses about 25 patient metrics. Beginning in the summer of 2021, the metrics and particularly the supporting electronic medical record analytic logic were developed from the ground up. Dr. Greenberg and Mr. Cucchi sought input from physicians and critical care leaders, worked to match all the algorithms precisely with UMMMC clinical practice guidelines, and worked iteratively to optimize the tools. It took over a year to fully develop and validate the tool and in October 2022, under the leadership of Dr. Greenberg and the support and assistance of the Critical Care Committee and hospital quality leadership, the eICU began its implementation. Two ICUs were added each month until all UMMH Epic ICUs were on the system. The tool was developed and refined to align with how providers practice critical care at UMass and, with about 98% accuracy, is able to identify critical care patients that need at least one of the metrics addressed, whether by action or conversation and consideration. The eICU team has incorporated the tool deeply within the critical care workforce workflow including with both eICU and bedside providers.  

Currently, each morning during rounds, the bedside team is recommended to use a patient census view that incorporates the eICU population health recommendations as part of routine rounds. In the afternoon, the eICU clinical team will go through the report and review patient charts to evaluate whether items that are still flagged need further evaluation by the bedside team. If further evaluation is required, the eICU clinical team will reach out to the bedside team to have conversations about specific metrics which can then lead to actionable items and in turn improvements in patient care. Through decisions made from these types of conversations, preliminary data has shown that UMass is already starting to see a decrease in the amount of time that intervascular lines are in place. Initial data is also showing a downtrend in the duration of mechanical ventilation. More data are needed, but these preliminary results indicate that using this tool is having a significant impact on ICU patients. “I would say we’re justifiably proud of this effort,” said Dr. Greenberg. “It took a couple of years of work and rework to get fidelity so our rules and logic synchronize as close to perfect or, really, perfectly, with our established standards. It was a huge effort and an enormous amount of coding, mostly by Eric [Cucchi]. This tool may be among the most sophisticated of any Epic installation, certainly of anything we know of.” 

Ongoing adjustments to the tool can be made in accordance with stakeholder feedback or changes in clinical practice guidelines. “A great thing about this tool is that the eICU owns it fully, so as clinical practice guidelines change we can make changes on the fly and have new or revised metrics out on the front line very quickly without having to rely on a vendor to build the tool for us,” said Mr. Cucchi. 

Beyond its use in the eICU at UMass, Dr. Greenberg and Mr. Cucchi envision this tool will be exportable to other institutions. While specifics will vary from institution to institution because of differences in how Epic is set up at each individual site, the concept is transferrable. They are currently preparing a paper to share their findings with the national and international communities. More immediately, many aspects of this tool can be exported for use with non-ICU patients at UMass for relevant metrics. Current discussions with the anticoagulation group are ongoing to explore how to implement DVT algorithms into their acute care workflows and there are validation efforts going on in that area. The eICU team has also had conversations about exporting their nutrition support decision logic for the hospital nutritionists. 

This incredible effort by the eICU and multiple other supporting groups has made a significant impact on the workflow of eICU providers and bedside teams. Ultimately, this tool improves efficiency and allows caregivers to offer more effective care to ICU patients. The benefit of this tool has already been seen and more data will likely continue to reveal the overall impact to those who are cared for in the UMMH ICUs that they serve. 

In this month’s Fellow Spotlight, we feature Catherine Fiore, MD, a third-year fellow in Pulmonary, Allergy, and Critical Care Medicine, from Essex Fells, New Jersey. We recently caught up with Dr. Fiore to learn more about her work, why she chose UMass, and more.  

What are your clinical and research interests? 

My clinical interests reside in the growing field of interventional pulmonary, the teaching of safe and effective procedures, mentorship, and medical education. 

Why did you choose UMass for your fellowship? 

I completed my internal medicine residency here. The people who work here and in the pulmonary department have always been supportive and kind. Growing and learning within the department is a joy and I have fostered mentors I hope to keep throughout my career. Also, I couldn't live in Worcester and leave after Polar Park was built! 

Where is your favorite place to travel for vacation and why? 

I enjoy exploring the national parks. During residency and fellowship, I was able to make it to The Smoky Mountains, Yosemite, the Grand Canyon, and most recently Acadia. The next trip is to Glacier in the fall! 

What music or podcasts do you like to listen to? 

Recently I was able to see one of my favorite bands, The Lumineers, at the Boston Calling Festival. I also spend most of my time listening to a variety of podcasts including, They Daily, Normal Gossip, and This Podcast Will Kill You, to name a few. 

In this month’s Resident Spotlight, we feature Wyatt DeLomba, MD, an upcoming third-year Internal Medicine resident, from Cranston, Rhode Island. We recently caught up with Dr. DeLomba to learn more about his clinical and research interests, hobbies, and loyalty to his home state’s PawSox (no WooSox games for Dr. DeLomba!). 

What are your clinical and research interests? 

As a future hospitalist, I have an interest in gaining a deeper understanding of all organ systems and am always grateful to rotate with various specialty services. My clinical interests include medical education, and I am grateful to be taking part in the medical education track here at UMass in its first year of inception. I am working on a longitudinal project to make teaching resources more accessible and portable for residents through the shared hard drive. I also have an interest in medical simulation and improving interdisciplinary communication and am working with the Project Rescue research group to deliver mock code simulations here at UMass. 

What makes UMass a great place for your residency? 

UMass sees a wide variety of complex patients with many comorbidities, ensuring that we are well prepared for our careers as attendings, and Benedict adult primary care clinic has provided exceptional exposure to outpatient medicine across all socioeconomic classes. It is encouraging to see that the UMass system is rapidly expanding both in clinical sites and its research center. Above all, our program director and APDs are incredibly invested in our personal success and wellness, our teaching attendings care about our education and continue to serve as our mentors, and my co-residents are some of the most supportive friends I could have hoped to work with. As a medical student, I struggled quite a lot in choosing a specialty. My experience at UMass has confirmed without a doubt that internal medicine was right for me. 

Favorite hobby? 

To stay physically active, I prefer running, weightlifting, and racquet sports such as tennis, squash, and racquetball. I find great reward in gardening and sharing cuttings of my plants with others, and more recently have become interested in bonsai. As the son of two artists, I have a deep appreciation for the arts, and I occasionally practice glassblowing. I also play piano and percussion. I love watching so-bad-it’s-good movies (recommendations please) and enjoy playing board and video games (I coordinate the board game club here at UMass). 

Favorite thing to do in Worcester/Worcester area?  

My husband and I are always looking for new and interesting restaurants in Worcester. We particularly love spending time with friends at Worcester Public Market, Redemption Rock, and Free Play. I have been boycotting the WooSox because they were stolen from the Rhode Island PawSox, but maybe I’ll go someday. 

Roberto Caricchio Launches Lupus Center at UMass Chan  

Roberto Caricchio, MD, the Myles J. McDonough Chair in Rheumatology, professor of medicine, and chief of the Division of Rheumatology, recently launched the Lupus Center at UMass Chan, a new research and clinical care center in collaboration with UMass Memorial Health.

Along with Elena Gkrouzman, MD, assistant professor of medicine in the Division of Rheumatology, Dr. Caricchio and his colleagues aim to focus on several areas of investigation, including subclinical infections as triggers of lupus and its flares, the utilization of artificial intelligence to investigate clinical data of lupus patients, and identifying predictors of flares or early signs of lupus disease. 

Lauren Feld Discusses Her Passion for Workforce Equity

Lauren Feld, MD, assistant professor of medicine in the Division of Gastroenterology, was recently featured in UMass Chan’s UpNext! diversity and inclusion newsletter. Here, Dr. Feld explains her role in workforce equity in the Department of Medicine and why she is passionate about ensuring that everyone across the training spectrum in medicine is supported. 

Melissa Fischer Receives Manning Prize for Teaching Excellence

Melissa Fischer, MD, MEd, professor of medicine in the Division of General Internal Medicine, and vice provost for Interprofessional and Instructional Innovation, was recently awarded the 2023 Manning Prize for Excellence in Teaching. The Manning Prize, which is awarded to faculty who excel in teaching and service, was given to five University of Massachusetts faculty members across the university system.

Katherine Cooper Receives 2023 Emerging Liver Scholar Award 

Katherine Cooper, MD, a rising PGY2 internal medicine resident, was recently awarded a 2023 Emerging Liver Scholar Award from the American Association for the Study of Liver Diseases (AASLD).

This highly competitive award is designed to promote the study of hepatology among outstanding residents who have the potential for a career in academic medicine and may be interested in choosing adult or pediatric gastroenterology, hepatology, hepatopathology, surgery, or GI radiology with an emphasis on hepatobiliary imaging as their career focus. 

The Department of Medicine Grand Rounds series continued over the past few months, with presentations from Kimberly Fisher, MD, associate professor of medicine, in the Division of Pulmonary, Allergy, and Critical Care Medicine and Health Systems Science, titled "Communicating with Patients About Vaccination: What Works to Increase Uptake?", and from Elie Sternberg, MD, Milford Regional Medical Center, Lisa Demko, Baystate Health, Kimi Kobayashi, MD, MBA, SFHM, UMass Memorial Medical Center, and Nitin Trivedi, MD, DM, FACE, FACP, Saint Vincent Hospital, titled "Quality Improvement and Patient Safety Best Practices."

The Department of Medicine also held its Resident and Fellow Poster Day and Graduation Grand Rounds ceremony for graduating residents. We thank all those who attended this year's Grand Rounds presentations and look forward to welcoming everyone back in the fall.

Interested in watching our Grand Rounds presentations? Click on the links below.

June 15 - Graduation Grand Rounds Ceremony - No Recording Available 

June 8 - Grander Rounds: Quality Improvement and Patient Safety Best Practices 

June 1 - Grand Rounds: Communicating with Patients About Vaccination: What

Works to Increase Uptake?

Congratulations to the following faculty on their recent appointments and promotions:

Appointments

Poorva Bindal, MD

Hematology and Oncology

Assistant Professor

Shaylin Cersosimo, MD, MPH

Community Internal Medicine

Assistant Professor

Michael Kalfopoulos, MD

Hospital Medicine

Assistant Professor

Alan Mullen, MD, PhD

Gastroenterology

Professor

Promotions

Hanna Ahmed, MD, MPH

Cardiovascular Medicine

Associate Professor

Eyad Hamoudeh, MD

Endocrinology, Diabetes, and Metabolism

Associate Professor