American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Reflections from ACS Members

Erica Ludi, MD, Helps Strengthen Bolivian Trauma Systems

Erica Ludi, MDMy name is Erica Ludi, and I am a general surgery resident from Emory University currently doing a global surgery fellowship through the Northwestern Trauma and Surgical Initiative in Santa Cruz, Bolivia. I have been working in-country for about eight months now and the main focus of the fellowship is building surgical capacity and strengthening the trauma network. In conjunction with the Department of Health, I have been working to maintain and improve the trauma registry implemented at six hospitals, develop and teach a trauma first responder course for lay persons, write proposals to improve prehospital care, and implement a general surgery perioperative registry.

I have also been involved with the Emory global surgery resident committee that has drafted a proposal for incorporating a rural/global surgery track within the residency program, as well as organized movie nights and journal clubs. In medical school, I spent three months in Haiti for a one-month surgical service trip and a two-month trauma surveillance project. I am excited to be part of the RAS global surgery group to collaborate on projects, share resources and experiences (to not reinvent the wheel), and to find innovative solutions for working in low- and middle—income countries.
Looking forward to hearing everyone's #RASGlobalSurgery story and working together.

Erica Ludi, MD
General surgery resident, department of general surgery, Emory University
Global surgery fellow, department of trauma and critical care, Northwestern University

Dr. Ludi presenting

Dr. Erica Ludi is the 2018-2019 global surgery research fellow with the Northwestern Trauma and Surgical Initiative under the mentorship of Mamta Swaroop, MD, FACS, and Esteban Foianini, MD, FACS. Currently living in Santa Cruz, Bolivia, her work focuses on strengthening the local trauma system and building surgical capacity. In the first eight months of her fellowship, Dr. Ludi has conducted surgical capacity assessments, has maintained and improved the trauma registry implemented at six hospitals, executed a trauma first aid course for the lay community, solicited proposals for technologic advances in ambulance coordination, and implemented a general surgery perioperative registry.

To elaborate, as a means of eliminating duplicate work and improving the accuracy of the data collected in the trauma registry, Dr. Ludi has worked side-by-side with Department of Health leadership to develop an emergency department medical record form that incorporates trauma registry items. A government resolution mandating the use of this new form has passed, and there are plans to implement the form across all second and third level hospitals in April and May. She also adapted a course pioneered in Chicago, called TRUE Communities, to provide trauma first responder courses to the lay community. PRISA (Primera Respuesta Iniciada para la Seguridad de Accidentados), with didactic and practical elements, was first implemented in November 2018 and has already demonstrated improvements in participant confidence and first aid knowledge.Dr. Ludi is also collaborating with the Center for Regulation of Urgencies and Emergencies throughout the Department (CRUED) to strengthen capacity of the central command center, ambulance dispatch and coordination, and prehospital personnel training. Finally, she has translated the G4 Alliance (consortium of general surgeons, trauma surgeons, anesthesiologists, and obstetric-gynecologists worldwide) perioperative registry into Spanish and has implemented the registry at two hospitals. After preliminary analysis and provider feedback, the goal is to expand the registry to other hospitals and surgical sub-specialties.

In addition to the research and education projects, Dr. Ludi has had the opportunity to do some clinical volunteer work. She has helped with two general medicine campaigns provided by local rotary clubs. Furthermore, when the non-profit organization Healing the Children came to Santa Cruz to provide 51 cleft lip/palate operations to children, Dr. Ludi assisted intra- and peri-operatively. She is also working with the partner rotary club to develop a hospital-based cleft lip registry to advocate for more patient resources and develop family support groups. 
Lastly, Dr. Ludi was recently elected as the OGB GSWG Resident Education Liaison. Her responsibilities will include improving access to education-related resources in low-income settings, organizing the didactic and humanitarian skills courses at Clinical Congress, and reviewing Congress panel proposals.

Dr. Ludi plans to continue working in Santa Cruz through summer 2020 before returning to clinical residency at Emory University. Future directions of her work include partnering with the Bolivian Surgical Society to strengthen their academic journal and to promote the development of a Latin American women in surgery group. Follow her work and progress on Twitter (@vinylnvicrylgal) and on her blog.

Diane Haddad, MD, RAS-ACS Scholarship Winner, Attends the Summit

Diane Haddad, MDI had the honor of being a recipient of the RAS-ACS Resident Leadership Scholarship Award to attend the 2019 Leadership and Advocacy Summit in Washington, DC. Upon my arrival at the airport, I was filled with appreciation for the College for scheduling this summit during peak cherry blossom season! There was palpable energy around the city as surgeons gathered to take the stories and struggles of their patients to policy makers in Washington. 

The leadership summit took place over my first two days in Washington and was a reminder of the responsibility of surgeons to be leaders in their communities. The two days were filled with talks from surgeon leaders on topics such as leveraging technology to streamline administrative burdens, the importance of mentorship, and our responsibility to address injustice in our health systems. We were reminded of our responsibility to promote equity and our calling to protect the vulnerable. 

The real work began the next day, which was packed with discussion on pressing public policy. We were briefed by expert panels on the issues impacting surgeons practicing across the United States. We learned about the challenges facing surgeons in the shift from fee-for-service reimbursement to value-based payments. Rewarding quality over quantity is better for our patients only if we can accurately measure and report both our costs and measures of high-value care.  Neither surgeons nor health policy experts are immune to the shock of unanticipated billing, when hospitals and provider groups are able to negotiate disparate contracts with insurance companies. This leads to catastrophic out-of-pocket costs for patients. The burden of documentation and specifically the requirements for prior authorization frustrate both patients and providers, who are subject to the scrutiny of an administrative review process that does little to improve the quality of care that is provided. The call for further research on injury prevention was championed along with the leverage of technology and policy efforts to understand the devastation of firearm injury and the epidemic of violence facing families, communities, and trauma centers. We left the summit prepared to take the stories of our communities and our patients to the people who made the laws of this land. 

Our meetings the next day took us to all corners of Capitol Hill to the offices of our state representatives in both the House and the Senate. We were welcomed into conference rooms as representatives of the College to share our concerns and questions. I was struck by the accessibility and authority we had as surgeons. The individuals introducing bills in committees that would directly impact the delivery of health care throughout the country were eager to hear the stories that our patients had entrusted to us. This experience reinforced the necessity of socially responsible engagement of surgeons in the public sphere, at both state and national levels. We have been given access by virtue of our white coats and skill set and with that comes responsibility to speak for those who do not have a voice.

Diane Haddad, MD   Diane Haddad Summit

Steven Stain, MD, FACS, Discusses the Importance of Local ACS Chapters

Steven Stain, MD, FACSMy introduction to the ACS came in 1988 through the ACS Southern California Chapter meeting, which was held at the Fess Parker Hotel in Santa Barbara, CA. I was a chief resident at Los Angeles County USC Medical Center at the time, and I presented my first paper, “Hepatic Trauma,” which was co-authored by my professors, Arthur J. Donovan, MD, FACS, and Albert E. Yellin, MD, FACS. The ACS Southern California Chapter is one of the largest chapters, but the experience of presenting papers myself at the meeting, and eventually watching my own residents present papers, became one of my most indelible impressions of the ACS.

While I was on the faculty at USC, we always tried to submit a paper to the local chapter meeting. A podium presentation gave you a rather good shot at publication in an excellent journal, and the meeting also was where you could reconnect with friends from across the chapter. Several of those individuals were from different institutions and become my supporters as I ascended through the College. Several close friends come to mind: Ron Tompkins, MD, FACS, from UCLA, and his wife, Suzie, who gave my oldest daughter her first swim suit when she was born; and Santa Barbara locals Ron Latimer, MD, FACS, and his wife, Beverly. At one of our chapter meetings in Santa Barbara, my wife, Hyacinth, and I met the Latimers. As a wedding gift, they sent us a beautiful set of antique champagne glasses.

Naturally, when I relocated to the Nashville, TN, I joined the local ACS chapter. It was different—several of the annual chapter meetings were held at state parks—but the meetings had a similar feel to those of the Southern California Chapter. The chapter hosted vibrant meetings with resident presentations and active members, and I was even introduced to the annual tradition of drinking moonshine. I was never quite certain who brought the moonshine, but you were expected to at least give it a try. More importantly, I met Richard Reiling, MD, FACS, who was at an exhibit table for the ACS Foundation. He introduced me to their philanthropy for the first time. As I have watched the ACS Tennessee Chapter grow and prosper, I am amazed by some of their successes, including the Tennessee Surgical Quality Collaborative, formed in May 2008 by Joe Cofer, MD, FACS, and others. The 10-hospital collaborative includes the ACS Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation.

My current chapter is the ACS New York Chapter, and it is spread over a large geographical area. While navigating this large territory can sometimes make it difficult to have annual meetings where residents assemble to present papers, this chapter has been deeply committed to advocacy on the behalf of surgeons and their patients. This year, the chapter will hold an annual Advocacy Day on April 30. On the same day, the Albany Medical Center Trauma Group will partner with the ACS New York Chapter to teach the Stop the Bleed® course to legislative staff. I have watched ACS Governors Arthur Cooper, MD, FACS, and Scot Glasberg, MD, FACS, expend tremendous energy working for issues important to surgeons and patients.

The ACS chapters are often the first connection residents and new Fellows have to the College. This year, one of the Executive Committee’s priorities is focused on strengthening local ACS chapters. Key to any chapter’s ability to complete initiatives is the number of members paying dues to the chapter. Under the direction of Member Services Pillar Lead Terry Buchmiller, MD, FACS, we will be initiating a competition to help ACS chapters increase their number of dues-paying members. We look forward to your participation in this important task as we continue to support the great work being done at the local level.