MUSC: Bill Moran (BM), Jane Zapka - Medical Center Intranet

Aging Q3 2011 Spring Retreat 

Thursday, April 14, 2011 draft pi 

MINUTES 

Present: 

MUSC Faculty/Staff: Mary Adler, RN; Kim Davis, MD; Deborah DeWaay, MD; Keri Holmes-Maybank, MD; Rogs Kyle, MD; Bill Moran, MD; Justin 

Marsden; Fletcher Penney, MD; Paul Rousseau, MD; Kathy Wiley, MD; Brian Collins, MHA; Patty Iverson, MA; Neal Axon, MD; Elisha Brownfield, MD; 

Jay Brzezinski, MD; Leonard Lichtenstein, MD; Lynn Manfred, MD; Amy Thompson, PharmD; Julie Leal, PharmD; Don Fox, MD; Cara Litvin, MD; Patrick 

Mauldin, PhD; Tamela Sill, RN; Yumin Zhao, PhD; 

MUSC Residents: Sara Allen, MD; Andrew Schreiner, MD; Eddie Kilb, MD; Elton Chambers; Jon McGough 

USC Support Team: Darryl Wieland, PhD, Maureen Bumba, PhD 

Guest Speaker: Marcy Bolster, MD 

Topic Discussion Outcome 

(Recommendations and Actions) 

Welcome and Aging Dr. Moran welcomed all to the retreat and gave an 

Q3 Update 

overview of the agenda. He reviewed the results of 

the Resident Survey. 

Resident Panel Dr. Moran asked the residents present for their Dr. Davis liked the idea of the group 

reaction to the survey results and their input on ways detailing between clinics. 

to improve Aging Q3. There were many helpful Perhaps this can be discussed at the 

suggestions, mostly centering around 

next Executive Committee meeting. 

Detailing: 

PI will put on the agenda for April 

• Too busy to do detailing during clinic. 

21 meeting. 

• Do the detailing in the clinic in groups of 5-6 

and feed them lunch. 

• Keep residents from morning block and have 

afternoon residents come early to clinic and Dr. Brzezinski– Graph of survey 

detail all of them at once. 

results showed more success when 

• 

• 

If there is food, they will come. 

Do detailing in groups for 1 week straight. 

Probably would get 80-90% of residents that 

way. 

the ACOVE detailing message was 

more specific. Zero in on just 1 

aspect like was done in the Hospital 

Care and Transitions ACOVE. 

• Email residents 1 week in advance about their 

day for group detailing; page them that day. Amy Thompson– Next time we cycle 

through the ACOVEs, Med Use and 

Responsible 

Person(s) 

PI/Executive 

Committee 

Deadline Target 

Date 

4-28-11 

1

• Make group detailing mandatory 

• Detailing on wards is hard – so busy 

• Expand detailing to other services – 

cardiology is persistent about follow up. 

• Noon conferences are good 

Hospital Care & Transitions ACOVE: 

• On Discharge Summaries, didn’t need to 

detail more than once. Use a graded scale 

• Degree of complexity is different with each 

ACOVE 

End of Life ACOVE (EOL) 

• Spend time with Mary or Dr. Rousseau is best 

way to learn EOL 

• EOL - More comfortable with IP than OP 

because it is uncomfortable bringing up 

Advanced directives. 

• EOL booklet is good 

• EOL ACOVE has increased the frequency of 

having Advanced directives discussion with 

patients. 

• EOL follow up conversations (at another 

appointment) went well. 

• EOL – hard for new residents to do Advanced 

Directive discussion with patients because 

they don’t know them well. 

• Need a more visible place for Advanced 

Directives in IP chart. 

Resident and Patient Gifts 

• Liked the gifts for the patients like the 

exercise bands and medication bags 

• Suggested not giving the residents trinkets 

unless they are useful, like the stop watches. 

• Instead, feed us! 



MINUTES 

Safety will be more focused. 

Layer the skill or detailing message. 

Play Aging Q3 jeopardy on 3 

ACOVEs at a time. 

Put SOAP calculator on 8E and 8W. 

Is there a way to have SOAP 

calculation go directly into the 

notes section of pt. record? 

Patty will initiate conversation 

with? regarding placing hard copies 

of Adv. Directives in pt. charts or 

make scanned copies more visible. 

Discuss at Exec committee meeting. 

Dr. Davis said the EPIC committee is 

looking at more policies regarding 

process for getting information into 

and out of the record. She will 

bring this issue up with that 

committee 

Patty will recommend this issue for 

the Exec Committee agenda 

PI will look 

into an Aging 

Q3 jeopardy 

game 

PI/JM will get 

SOAP on 

computers on 

wards 

PI/Executive 

Committee 

KD will 

discuss at 

EPIC 

committee 

PI/Executive 

Committee 

5-6-11 

4-25-11 

4-2128-11 

? 

4-2128-11 

2

Recap ACOVES 

Past – Screening & 

Prevention 

Past – Hospital Care 

& Transitions 

Dr. Brownfield gave an overview of the results of the 

Screening & Prevention ACOVE. 

In summary, 

• There appeared to be an increase in the rate 

of documentation on flu shots from same 

time last year. 

• dt shots and pneumovax documentation 

increased from previous 10 years of data. 

• This data shows the change in intent but 

there was not sufficient data to show 

increase in actual shots given. 

• Documentation of exercise showed there 

were 519/825 pts. documented to be healthy 

enough for exercise but only 77 patients were 

counseled or an Rx was written for exercise. 

• Pre-Post test data did not reflect the 

documentation in Practice Partner on several 

questions. 

Dr. Axon gave a summary of the Hospital Care & 

Transitions (HCT) ACOVE and reviewed some of the 

pre- and post-intervention results. 

• The key attributes of this ACOVE were to 

increase discharge summaries that are timely, 

clear, concise, and complete, and forward 

looking. 

• Referring Provider and Past history were 

present in the highest percentage of 

discharge summaries 

• HPI required the least amount of editing for 

content. 

• The percent of discharge summaries with 

allergy documentation was highest with top 

score and lowest with discharge medications. 

• On a 3 point scale, residents showed a 2.6 or 



MINUTES 

Ideas were shared about why this 

ACOVE was successful: 

• Tailored the detailing 

message to where the 

resident is. 

• More IP attending 

participated 

• Dr. Axon made detailing a 

specific assignment for the 

attending 

• Social pressure – Dr. Axon 

put the yellow sheet right in 

the attending hands and 

told them what to do 

• Dr. DeWaay – likes the 1 

week time frame to get it 

3

higher level of confidence in hospital care & 

transitions skill and knowledge areas. 

Present – End of Life Dr. Rousseau reported on the progress to date on the 

End of Life Care ACOVE. He has heard feedback from 

residents that suggests 

• They felt the role playing was valuable and 

some even liked it. 

• They feel they will do better after having 

done the role play when they are doing family 

meetings live with patients. 

• However, when he has inquired with 

residents about remembering the steps of 

communication, he has heard it is hard to 

remember to do it when they are leading a 

live meeting with patient/families. 

Mary Adler reported the she feels 

• Residents are compassionate and want to do 

the right thing. 

• They seem to know their patients well. 

• Always do the introductions and ask what 

the patient and family knows. 

• But then they give the update without 

synthesizing Patient/family’s understanding 

with the doctor’s update message. 



MINUTES 

done. 

Simple, specific, and short. 

Some concerns about the ACOVE: 

• “Attending fatigue” 

• Ratios are too tight in the 

clinic to go over discharge 

summaries. 

Suggestions – detail everyone at 

once in the clinic, like the residents 

suggested, instead of during clinic 

time. 

Discussion and suggestions from 

participants regarding the End of 

Life ACOVE: 

• Residents seem 

comfortable with the 

advanced directives 

discussion. 

• It is easier for them to have 

the conversation in the 

clinic than on the wards 

because they know their 

patients. 

• Some residents have 

reported they have 

increased having the 

Advanced directives 

discussion with patients. 

• It appears residents may 

still not be aware of what is 

in an Advanced Directives. 

• Need to get attending more 

on board with detailing. 

4

• They are often using medical info more than 

focusing on feelings and the emotional side of 

the news. 

Dr. Brownfield discussed estimating life expectancy 

and using the SOAP calculator 

• Consider life expectancy when having the 

conversation about advanced directives 

• Residents know about SOAP and like having it 

on the desk top. Having it on the detailing 

sheet is good too, for manual calculation 

• Preceptors have used SOAP with some 

residents who said their patient didn’t have 

advanced directives and the residents have 

often been surprised by the results. 

• SOAP is also good for stopping treatment in 

Cancer patients. 



MINUTES 

• BM asked the group if they 

felt the end of life 

discussions were too 

difficult for the 1 st and 2 nd 

year residents. 

o Mary Adler said she 

feels it is more of a 

matter of emotional 

intelligence then 

the year of the 

resident. 

o Nurses are better at 

explaining – they 

have the time. 

• Dr. Moran said he was 

nervous about this ACOVE 

but feels it is going very 

smoothly. 

Ideas surfaced about how to sustain 

this ACOVE: 

• Cards about steps of 

communication are good 

but they will get lost 

• Combine cards into 1 

booklet or put on 

“Maxwell” or something 

like that. 

• Need to find a way to make 

the advanced directives 

easier to find in the patient 

chart and Practice Partner. 

• Put the card on the Aging 

Q3 website 

5

Planning Future 

ACOVES: Pain 

Management 

Planning Future 

ACOVES: 

Osteoporosis 

Dr. Kyle reported that the Pain Management ACOVE 

work group has begun planning. He provided the 

audience with a very thorough lecture on pain 

management including: 

• Different types of pain 

• Different treatments 

• Drugs 

• Side effects 

• Published evidence based medicine on pain 

The working group is planning to focus on how to 

assess for pain and start pain treatment in IP and how 

to get patients off pain drugs in OP. Elders are less 

likely to take narcotics. However there is 

comparatively little data and serious drug-drug 

interaction and polypharmacy issues to consider. 

Dr. Brzezinski reported that the Osteoporosis ACOVE 

work group has begun planning. He explained the 

quality indicators tentatively chosen for the ACOVE: 

• How to screen 

• Who to treat 

• FRAX tool – ACOVE skill and pre/post 

• Complications of treatment 



MINUTES 

• Put Aging Q3 cards on the 

hospitalist curriculum. 

• Do the training each year 

with new residents led by 

senior residents 

• Add to intake checklist 

• Print nursing intake notes 

and attach to the front of 

patient charts. 

The FRAX tool can be put on desk 

tops. 

Many felt that Vitamin D & Calcium 

should be included as a detailing 

JM will look 

into getting 

FRAX on 

desktops 

JB will bring 

up these 

5/31/11 

4/19/11 

6

Awards: Resident of 

the Year 

Awards: Faculty and 

Staff 

Keynote Speaker: 

Marcy Bolster, MD 

He stated there is not much data on Vitamin D and 

Calcium treatment even though IOM recommends it. 

He was not planning to include the following topics 

into his ACOVE and asked the audience for input: 

• Vitamin D & Calcium 

• Men 

• Secondary work-up 

• Exercise 

• Pathophysiology of bone disease. 

Nominations for Aging Q3 Resident of the Year 

included: 

• Amanda Overstreet 

• Leah Clanton 

• Lauren Angotti 

• Abby Gass 

Dr. Moran presented a comical award presentation 

for faculty and staff 

Dr. Mary Bolster was the keynote speaker after 

dinner. She spoke on “Osteoporosis and Bone 

Health: Postmenopausal Women.” 



MINUTES 

point. Even though there isn’t 

much data to support it, it is 

commonly believed as appropriate 

clinical treatment for women. 

Dr. DeWaay shared that residents 

are weak in the pathophysiology of 

pain and feels it should be included. 

Others felt it is too big of a topic for 

detailing but it could be included in 

the lecture. 

Dr. Brownfield asked if Osteopenia 

and Osteoporosis was going to be 

included, what drug, what t score, 

and how long to treat. 

NNH and NNT will be included on 

the pre/post and in the lecture. 

The audience voted and chose 

Leah Clanton and Lauren 

Angotti. Dr. Clanton has 

participated in retreats and is 

on the EOL work group. Dr. 

Angotti has participated in 

retreats. 

Both are enthusiastic and 

support the efforts of Aging Q3. 

points at the 

next 

Osteoporosis 

WG meeting 

PI will make 

the 

certificates 

and look into 

a reward. 

4/29/11 

7

Retreat Survey The meeting ended and the participants completed 

evaluations 

Adjourn The conference meeting ended at 8:00pm 

Draft Submitted by PI 4_18_11 



MINUTES 

Patty & Justin will compile survey 

results for next retreat planning. 

PI/JM 4/21/11 - done 

8

MUSC: Bill Moran (BM), Jane Zapka - Medical Center Intranet

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