News & Media

STS News, Fall 2018 -- In the last 10 years, much light has been shed on the function of high-reliability organizations. Most of the research has centered around groups in aviation, the military, and first responders. In this article, Dr. Paul Levy highlights useful ideas applicable in the cardiothoracic surgery arena. Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Paul S. Levy, MD, MBA, Chief of Surgical Services and Physician Operational Lead, Physician/Administrator Dyad NEA Baptist Memorial Hospital, Jonesboro, Ark. If you want to go fast, go alone. If you want to go far, go together. – African Proverb Having very challenging surgical cases is nothing new for cardiothoracic surgeons. We recently had one such case. I say “we” because most surgeons understand that surgery is a team sport. Teamwork is at the core of high performance and consistency. Good teams function as a whole—its members helping out where needed and stepping up when required. In our specialty, this behavior can save lives. But how are high-functioning teams put together? What role does leadership play in fostering teamwork? Answers to these key questions may depend on market size, program size, and administrative support, but never upon mere chance. The Importance of Leadership Team building is predicated upon a common vision. High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust. Leadership is the linchpin to team building. High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust. A strong leader encourages point-of-service stakeholder input and adaptation—a “can do” attitude. Ideal heart team members are self-starters, innovators, quick thinkers, and possess thick skin. A traditional command and control leadership style can stifle these important attributes. Strong leaders must be able to clearly articulate important team goals and identify educational gaps in teammates that are preventing them from accomplishing these goals. After filling educational gaps, leaders must trust their people and processes. Creating an environment promoting team camaraderie is the job of a surgeon leader and cannot be delegated to a manager. High-functioning and reliable teams have to feel that their leaders stand shoulder to shoulder with them. How to Strengthen Your Team Building a strong heart team has been a priority at our institution. The importance of teammate engagement has led to some impressive and sustainable dividends. Over the past 5 years, we have not only experienced decreased heart team staff turnover, but we also have cut our production costs significantly while increasing overall case volume. Additionally, our STS performance quality metrics have improved. How did we do it? We gave each team member a voice and showed them that we cared. Monthly heart team “get-togethers” serve to fill educational gaps and promote camaraderie. We begin each meeting with personal life catch-ups and then follow with talks regarding pertinent surgical topics, discuss the surgical “whats and whys” using videos, identify different surgical instruments, discuss anatomy, and end with an inspirational team-building video. This is our formula, and it works. I encourage you to give it a try at your institution. Alone or together, fast or far—it’s your choice. To view previous practice management columns, visit sts.org/practicemanagement.

STS News, Fall 2018 -- Three years into an R01 grant, researchers have made a number of discoveries that will help cardiothoracic surgeons improve patient outcomes after lung cancer surgery. In 2015, the Agency for Healthcare Research and Quality awarded STS nearly $1 million to study lung cancer survival, surgical approach, and resource use. The research team, led by Felix G. Fernandez, MD, MSc, from Emory University in Atlanta, has completed work on the first two aims; results from the third aim are expected in July 2019. “This research has leveraged two complementary national datasets to produce a unique cross-linked data infrastructure of individual patient clinical characteristics and longitudinal outcomes that could not otherwise be replicated,” said Dr. Fernandez. “Results from these studies have identified those patients at risk for poor long-term survival following lung cancer surgery and helped determine the optimal surgical strategies and associated costs in such patients.” Long-Term Survival The grant’s first aim was to develop a risk model for long-term survival following lung cancer resection. To accomplish this, the researchers linked data from the STS General Thoracic Surgery Database (GTSD) with Medicare claims data, which allowed for long-term follow-up on approximately 26,000 patients aged 65 or older who had undergone lung cancer resection. “The GTSD, as great as it is, is limited to 30-day clinical outcomes,” Dr. Fernandez said. “What really matters to patients, besides the safety of the surgery, is how long they are likely to live after surgery.” Following the data linkage, the researchers found that although mortality was 2.2% at 30 days, it increased to 2.6% at 90 days. In addition, 90-day mortality for sublobar and lobar resection was at least double that of the GTSD-reported mortality and also was higher for bilobectomy and pneumonectomy. “Results from these studies have identified those patients at risk for poor long-term survival following lung cancer surgery.” Felix G. Fernandez, MD, MSc Building upon these findings, the researchers then created a long-term survival model, which determined that cancer stage and a patient’s age are strong predictors of survival following lung cancer resection. This model also adjusts for other clinical variables in estimating predicted long-term survival. Results from this study can inform clinical practice by helping lung cancer patients understand their expected survival following surgery based on their unique characteristics. Other discoveries included: A center’s short-term outcomes didn’t necessarily correlate with its long-term results. Delirium, blood transfusion, reintubation, and pneumonia had a negative impact on survival 3-18 months after surgery, while sepsis and blood transfusion were associated with a greater risk of mortality after 18 months. Perioperative lobectomy outcomes for GTSD participants were superior to outcomes from non-GTSD participants. Surgical Approach and Resection Extent With work from the first aim completed, the team then started examining survival based on surgical approach, as well as the extent of lung resection in lung cancer patients.  Performing a comparative effectiveness analysis, the researchers found that minimally invasive surgical techniques for lung cancer resection did not lead to worse outcomes. “There had been prior data suggesting that perhaps a minimally invasive approach was inferior in terms of lymph node staging compared to a thoracotomy and that this could potentially adversely impact long-term survival,” Dr. Fernandez said. “This comparative effectiveness analysis, however, showed no difference in the two approaches.” Results from a similar study on outcomes for segmentectomy versus lobectomy for early stage lung cancer will be presented at the STS 55th Annual Meeting in January. Resource Use and Costs For the final aim of the project, the research team will compare resource use and costs according to surgical approach and extent of resection, but Dr. Fernandez said that there’s still a major query that needs to be addressed in future research. “We want to know how our care impacts patient quality of life through patient-reported outcomes,” he said. “That’s a big interest of mine and a potential future topic for a follow-up grant. We know how long patients live, what their complications are, and what the costs are. But what we really don’t know is what impact the therapies have on their quality of life.” For more information on this grant or other STS-led research projects, contact Robert Habib, Director of the STS Research Center.

STS News, Fall 2018 -- The schedule for the upcoming STS 55th Annual Meeting at the San Diego Convention Center has been reorganized to help attendees spend fewer days away from their patients—without sacrificing the dynamic, interactive experience that they’ve come to expect. “It will be an outstanding meeting, and if you’re not there, you’re going to miss out,” said STS President Keith S. Naunheim, MD. “It’s a meeting jam-packed with regard to new content; the present and future of cardiothoracic surgery will be on display.” Instead of the traditional Sunday through Wednesday schedule, the meeting will now be held Sunday through Tuesday. The meeting will kick off on Sunday morning with STS University followed by an opening plenary session, featuring the J. Maxwell Chamberlain Memorial Papers and the Thomas B. Ferguson Lecture by Laurie H. Glimcher, MD, President and CEO of the Dana-Farber Cancer Institute in Boston. Following the lecture, an Opening Reception will be held in the Exhibit Hall, and the President’s Reception—open to all attendees—will be at the historic Hotel del Coronado. Members of the Program Task Force selected abstracts and exciting invited talks for the Annual Meeting program. Monday’s program will include Dr. Naunheim’s Presidential Address, and Tuesday’s schedule will include the C. Walton Lillehei Lecture by Eric Topol, MD, a cardiologist and geneticist specializing in the use of artificial intelligence, “deep” data, and smart technology for individualized treatment approaches. Hot Topics in Each Subspecialty Sunday, Monday, and Tuesday also will feature an interesting selection of scientific abstracts and invited lectures that will appeal to every discipline and every member of the cardiothoracic surgery team. “For the adult cardiac surgery sessions, we’ll look at some familiar topics—aortic valve disease, mitral valve disease, and ischemia—but we’ll also be focusing on the minimally invasive approaches to treatment,” said Richard Lee, MD, Chair of the Workforce on Annual Meeting. The general thoracic surgery sessions will feature presentations on the esophagus, the mediastinum, and lung cancer, focusing on applications of new technology and therapies. “Some of the very exciting papers we’ve chosen are related to immunotherapy in the tumor microenvironment,” said Mara B. Antonoff, MD, a member of the Program Task Force. “In addition, there are some great papers looking at disparities in the receipt of certain treatments, such as adjuvant therapy and the proper operation, and opioid use is a very hot topic with a focus on the types of perioperative care and prescriptions for opioids that are being delivered.” Congenital heart surgeons can expect new information on hypoplastic left heart syndrome, heart transplantation, ventricular assist devices, and more. “We’ll look at the management of single-ventricle patients with failing hearts who are in need of mechanical circulatory support, as well as how to decide the timing of transplantation and optimization of donor selection in order to improve overall outcomes,” said Christian Pizarro, MD, a member of the Program Task Force. “Presentations also will focus on the overarching challenge of neurodevelopmental outcomes and shed important light on how to manage these patients.” “It’s a meeting jam-packed with regard to new content; the present and future of cardiothoracic surgery will be on display.” Keith S. Naunheim, MD Focus on Digitization In an effort to be more environmentally friendly, programs will no longer be printed. All attendees are highly encouraged to use the STS Meetings mobile app, which will be available for download in early December. “The app is actually outstanding. You can read abstracts, interact on social media, and look at the entire schedule,” Dr. Naunheim said. “The app lets you individualize your own curriculum, and you can even set it to remind you when you’re supposed to be somewhere.” In addition, all posters will now be electronic, allowing more abstracts to be included and offering greater flexibility for authors. Several monitors will be available in the convention center for attendees to view the posters. Coding Workshop, Tech-Con Kick Off Annual Meeting Immediately prior to the STS Annual Meeting, the Society will offer its annual Coding Workshop to provide surgeons, coders, and other billing professionals with the latest information about issues affecting reimbursement for their practices. The Coding Workshop will be held Friday and Saturday at the Marriott Marquis San Diego Marina, the headquarters hotel for the STS Annual Meeting. Also before the Annual Meeting, Tech-Con 2019 will be held at the San Diego Convention Center. See below for more information.  For details on how to register for the Annual Meeting, view the Registration & Housing brochure. Take Advantage of Early Bird Rates Register and reserve your housing for the STS 55th Annual Meeting at sts.org/annualmeeting. Early bird registration rates are good through November 19, 2018. Additionally, you must register by January 3, 2019, to reserve housing at the special Annual Meeting rates. Tech-Con 2019 and the STS 55th Annual Meeting require separate registration. TECH-CON ANNUAL MEETING Saturday, January 26 Sunday, January 27 - Tuesday, January 29 Registration includes access to: -Tech-Con educational sessions -Tech-Con exhibits Registration includes access to: -Annual Meeting educational sessions -Annual Meeting Exhibit Hall and Opening Reception -2019 Annual Meeting Online Tickets to attend STS University courses and the President’s Reception at the Hotel del Coronado (both on Sunday, January 27) require separate ticket purchases with Annual Meeting registration. The Society has engaged Experient as the only approved Official Registration and Housing Provider for the STS Annual Meeting. If you have questions about registration and/or housing, contact Experient at 800-424-5249 (toll free), 00-1-847-996-5829 (for international callers), or via email. Please be wary of any other companies ostensibly offering registration and/or housing assistance for the STS Annual Meeting. Such companies typically imply that they are working with STS, but in reality are unauthorized. Please inform the Meetings & Conventions Department if you are contacted by anyone other than Experient. Prepare for What’s Next at Tech-Con Stay ahead of the curve when it comes to cutting-edge developments in cardiothoracic surgery by attending Tech-Con, which will be held immediately prior to the Annual Meeting on Saturday, January 26. “Everyone should attend Tech-Con because the future isn’t just coming; the future is here,” said Melanie A. Edwards, MD, Co-Chair of the Tech-Con Task Force. “We will highlight ways that surgeons can prepare and incorporate these innovations into their own practice.” The adult cardiac sessions will explore advancements in ischemic disease, heart failure, atrial fibrillation surgery, and aortic and structural heart disease. Attendees at the general thoracic sessions can expect to learn about evolutions in lung and chest wall surgeries, as well as esophageal surgery. An expanded general session will feature a keynote lecture on the role of artificial intelligence in medical technology, as well as a 2018 year in review summary of major research, innovations, and new technology. The day will conclude with the popular Shark Tank presentations, in which inventors pitch their ideas to a panel of experts and the audience. Devices on deck for discussion include a leakproof aortic anastomosis stapler and a valveless pulsatile-flow ventricular assist device. Because information on new technologies provided by commercial interests will be included in Tech-Con, continuing medical education (CME) credit cannot be offered for this activity. Tech-Con registration is separate from Annual Meeting registration, so make sure to register for both at sts.org/annualmeeting.

Rep. Larry Bucshon, MD, a cardiothoracic surgeon, (third from left) spent time with Fly-In participants. STS News, Summer 2018 -- Twenty-four STS members made their voices heard at the most recent STS Legislative Fly-In, held June 11-12 in Washington, DC. After a dinner briefing on Monday evening, attendees spent Tuesday on Capitol Hill meeting with legislators and staff from 55 Congressional offices and urging action on five key priorities—increasing the cap on resident training slots, providing Qualified Clinical Data Registries such as the STS National Database with access to Medicare claims data, advancing research on women and lung cancer, enacting Medicare coverage of oral/dental care, and reauthorizing the Patient-Centered Outcomes Research Institute. First-time participant Thomas K. Varghese Jr., MD, MS said that while he had some initial hesitation, he ended up having a positive, impactful experience. Attendees networked at a briefing dinner the night before their Capitol Hill meetings. “Despite all the rhetoric and vitriol that we hear on television, the pleasant surprise I found was that there are a lot of very hard-working Americans on both sides of the aisle who share a commitment to enacting meaningful change,” he said. “At the end of the day, we all have the same goal of creating a healthier population and providing the best care for everyone throughout the country.” Dr. Varghese noted that cardiothoracic surgeons—as stewards of public health—are well-suited to become involved in advocacy efforts. “We’re on the front lines, so we see all the different factors that impact a patient’s health up close,” he said. “We need to build the relationships—even if we’re engaging with people who have different beliefs than we do—and have thoughtful discussions to find a common ground that can help the public at large.” Sen. Lamar Alexander (third from left) received the Society’s Legislator of the Year Award. Legislator of the Year During the Fly-In, STS presented Sen. Lamar Alexander (R-Tenn.) with the Legislator of the Year Award, celebrating his firm commitment to issues impacting cardiothoracic surgeons and their patients. In 2017, Sen. Alexander worked with Democratic leadership to advance policies supported by physicians. As Chairman of the Senate Committee on Health, Education, Labor, and Pensions, he collaborated with Sen. Patty Murray (D-Wash.) on a proposed plan to stabilize the Affordable Care Act’s insurance marketplaces. Sen. Alexander also helped spearhead the 21st Century Cures Act, which contained provisions to fund the National Institutes of Health, reduce opioid abuse, and advance medical research and development. It also included an STS-drafted definition about clinical registries. To see a video of the award presentation, visit the STS YouTube Channel at youtube.com/ThoracicSurgeons. To see more photos from the Fly-In, visit sts.org/fly-in. Read an exclusive Q&A with Sen. Lamar Alexander.

STS News, Summer 2018 -- Investigators hoping to gain quick access to the high-quality data available in the STS National Database are in luck—the Society’s Participant User File (PUF) Research Program provides an affordable means of obtaining such data and examining important research questions. The PUF Program currently offers access to national de-identified data from all four components of the Database—the Adult Cardiac Surgery Database (ACSD), the General Thoracic Surgery Database (GTSD), the Congenital Heart Surgery Database, and—new—the Intermacs Database. Data are analyzed within investigators’ institutions, and pricing is based upon the volume of data requested. Currently, the program is available exclusively to STS National Database participants. Since the program’s inception in fall 2016, 52 submissions have been approved, resulting in 10 completed scientific abstracts or manuscripts so far, with many more in process. Bradley S. Taylor, MD decided to take advantage of the PUF Program because it was an easy and straightforward process. “Once we received the data, we had the abstract written in 2 weeks,” he said. Dr. Taylor’s abstract, which was presented at the Western Thoracic Surgical Association’s Annual Meeting in June, examined predictors of acute stroke after type A aortic dissection repair. The research used ACSD data on all acute type A aortic dissection repairs performed from July 2011 to July 2017. “The power and depth of this Database has only begun to be tapped, and the ease of this program and process has been enjoyable,” Dr. Taylor said. “I am impressed with the quality of the paper that we were able to write from our recent experience with the PUF Program.” “I find this program to be of tremendous value in disseminating scientific information from our most rigorous clinical registry.” Christina M. Vassileva, MD Malcolm M. DeCamp, MD had originally submitted a data request application via the STS Access & Publications (A&P) process. Although most A&P projects are funded by the Society, his project was approved with the caveat that his site would have had to cover the cost of analytics by the Duke Clinical Research Institute, which was prohibitive. When the PUF Program was launched, Dr. DeCamp changed the submission for his project, which required analysis of short-term outcomes for tracheal surgery, utilizing data from the GTSD on all patients aged 18 and older who underwent elective tracheal resection and reconstruction. The resulting abstract was presented at the STS Annual Meeting this past January. Dr. DeCamp offered advice for surgeons looking to apply to the PUF Program. “Understand the nuances of the Database—you may need data from different versions, and you’re limited to 30-day outcomes,” he said. “You’ll also need to ensure that you have a good biostatistical collaborator.” Christina M. Vassileva, MD found that a major advantage of the PUF Program was its speedy process. In her case, it took only a couple of weeks from when she submitted her proposal to when it was approved. Her research, which also was presented at the STS Annual Meeting in January, explored mitral valve repair versus replacement according to chordal preservation strategy for degenerative mitral valve disease in elderly patients. She used data from the ACSD on patients aged 70 and older who underwent either procedure. “I find this program to be of tremendous value in disseminating scientific information from our most rigorous clinical registry,” Dr. Vassileva said. “The process ran very efficiently, and scientific feedback was offered to facilitate quality research using STS National Database data.” Learn more and submit an application at sts.org/puf. If you have questions, contact Robert Habib, Director of the STS Research Center.

Submit Abstracts for the STS Annual Meeting Share your research with an international community of cardiothoracic surgery professionals. The Society is accepting scientific abstract submissions for its 55th Annual Meeting, to be held January 27–29, 2019, in San Diego, California. Abstracts and surgical videos may be submitted in the categories of adult cardiac surgery, congenital heart surgery, general thoracic surgery, basic science research, critical care, quality improvement, geriatrics, and cardiothoracic surgery education. Abstracts that address multidisciplinary approaches will be strong contenders for a Sunday program geared toward allied health. All accepted abstracts are published in the official Annual Meeting Abstract Book, and corresponding manuscripts are to be submitted for publication consideration in The Annals of Thoracic Surgery. Visit sts.org/abstracts to review the abstract submission instructions and policies and get started. The submission deadline is Friday, August 24—more than 2 months later than in previous years, helping to ensure that the educational program will feature the most up-to-date information in the specialty. Details about late-breaking abstract submissions will be provided later this year. If you have questions about abstract submission, contact the STS Education Department. Attendees will gain hands-on experience with the latest critical care technologies. Stay at the Forefront of Critical Care Advance your knowledge of cardiovascular and thoracic (CVT) critical care at the 15th Annual Multidisciplinary Cardiovascular and Thoracic Critical Care Conference, October 4-6 in Washington, DC. This 2.5-day conference was designed for the entire CVT critical care team and will cover the complex nature of CVT critical care, including the unique physiology, array of procedures, and potential complications pertaining to it. Leading experts will present new concepts, technologies, management protocols, and clinical experiences. “Patients undergoing cardiothoracic surgery today are older and more complex, so there’s an increased risk of complications,” said course co-director Nevin M. Katz, MD. “We’ve developed many new tools to meet these challenges, so it’s important for the entire team to come together and learn how to best deploy these strategies for their patients.” Some of the topics that will be covered at the conference include aortic emergencies, infections, extracorporeal membrane oxygenation, renal and gastrointestinal complications, respiratory support, neurologic issues, and coagulopathies. Speakers will include a wide-ranging group of multidisciplinary health care professionals, and attendees can look forward to panel discussions, abstract presentations, and hands-on breakout sessions. “The ICU is the hub of patient care,” said course co-director Thomas E. MacGillivray, MD. “That’s where surgeons, advanced practice providers, nurses, pharmacists, respiratory therapists, perfusionists, and other consultants come together. The team-based approach is a central focus of this conference, and that’s why we’re encouraging all members of the team to attend.” View the full agenda and register for the meeting at sts.org/criticalcare. Early bird rates will expire after September 5. Register Your Team for AQO Meeting Registration and housing are now open for Advances in Quality & Outcomes: A Data Managers Meeting, September 26-28 in Hollywood, California. This popular annual event highlights what’s new with the STS National Database and offers valuable educational sessions on evidence-based practice to improve outcomes, as well as important networking opportunities. Two topics covered at this year’s meeting will be the specification upgrade for the General Thoracic Surgery Database (GTSD), which went into effect on July 1, as well as the specification upgrade for the Congenital Heart Surgery Database (CHSD), which will go into effect on January 1, 2019. The schedule also has been modified so that the GTSD and CHSD sessions will be held on different days, and the Adult Cardiac Surgery Database (ACSD) session will be Thursday afternoon and all day on Friday. During the Thursday ACSD session, a new breakout on “Using Data to Drive Quality” will include updates about the STS Intermacs Database.  The AQO conference is designed for data managers of all experience levels. Primary data contacts and new data managers are strongly encouraged to attend. Surgeons also are urged to consider attending the conference along with their data managers. Don’t forget—attendees will receive free access to AQO Online for sessions corresponding to their registration!  Register and reserve housing at sts.org/AQO. Secure your spot by Wednesday, August 29, for early bird pricing; after this date, registration fees will increase by $100. STS Has Presence at ASCVTS, ESTS Meetings President Keith S. Naunheim, MD and other STS leaders represented the Society recently at the annual meetings of two international cardiothoracic surgical societies. After attending The Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS) Annual Meeting in Moscow, Russia, Dr. Naunheim flew to Ljubljana, Slovenia, to attend the European Society of Thoracic Surgeons (ESTS) Annual Meeting. STS Treasurer Thomas E. MacGillivray, MD, Secretary Joseph F. Sabik III, MD, and Dr. Naunheim visited Moscow’s Red Square during the ASCVTS Annual Meeting.   ​ Gilbert Massard (ESTS President), Dr. Naunheim, Kostas Papagiannopoulos, MD (ESTS Past President), and Felix G. Fernandez, MD, MSc (Chair, STS Workforce on Research Development) exchanged ideas in Ljubljana at the ESTS Annual Meeting. Avoid Payment Cut by Reporting Quality Data through STS Cardiothoracic surgeons participating in the STS Adult Cardiac Surgery Database and—new for 2018—the STS General Thoracic Surgery Database can avoid a Medicare penalty by reporting their performance on specific quality measures to the Centers for Medicare & Medicaid Services’ Merit-Based Incentive Payment System (MIPS) through the Society. The MIPS program consists of four categories—Quality, Cost, Advancing Care Information, and Improvement Activities. Because the STS National Database has been designated a Qualified Clinical Data Registry for MIPS reporting in 2018, STS can report data to CMS on quality measures—14 for adult cardiac and eight for general thoracic—on behalf of surgeons who have signed a consent form. Eligible professionals who do not satisfactorily report at least six quality measures with 60% data completeness spanning the January 1–December 31, 2018 reporting period may be subject to a 5% negative payment adjustment in the 2020 Medicare Part B Fee Schedule. In addition, surgeons potentially could qualify for a small to moderate upward payment adjustment depending on performance and the number of measures and activities reported under MIPS.  Even surgeons whose hospitals are already reporting for them may benefit from reporting via the Society, as CMS will count the highest-scoring measures. A new consent form must be signed every year. The consent form must be submitted by Wednesday, October 31, 2018, and can be accessed at sts.org/MIPS-reporting. This service is free for STS members. If you have questions about MIPS quality reporting, contact Derek Steck, Contracts Manager, STS National Database. NQF Endorses Lobectomy Composite The National Quality Forum (NQF) has endorsed an additional STS composite score, bringing the Society’s total number of NQF-endorsed measures to 35, more than any other medical specialty society. The newly endorsed lobectomy for lung cancer composite score measure includes risk-adjusted mortality and major complications for patients undergoing this procedure. NQF endorsement is the gold standard for health care quality, and NQF-endorsed measures are recognized by the national health care community as “best in class,” evidence-based, and scientifically valid. NQF evaluates measures using four major criteria: importance to measure and report, scientific acceptability of measure properties, feasibility, and usability and use. Major health care purchasers and payers, including the Centers for Medicare & Medicaid Services, rely on NQF endorsement to ensure that measures are scientifically sound and meaningful. Learn more about the Society’s quality performance measures at sts.org/qualitymeasures or contact Mark Antman, Senior Manager, Quality Metrics and Initiatives. STS Offers Insights into MCS Devices Mechanical circulatory support (MCS) is an evolving treatment for heart failure patients. Held on May 11–12 in Rosemont, Illinois, the 2018 STS Intermacs Meeting provided more than 100 attendees with the latest updates on patient-reported outcomes, science, clinical trials, adverse events, and technologies related to FDA-approved MCS devices. Participants also learned about new initiatives and research opportunities related to the STS Intermacs Database. Check out photos of the engaging sessions, poster and networking reception, and award presentation at sts.org/intermacsphotos. Hands-On Experience Emphasized at Robotics Symposium, ECMO Course Robotic surgery is being widely incorporated into many general thoracic surgical practices. In view of this trend, the STS Symposium on Robotic Thoracic Surgery, held May 18-19 in Chicago, provided surgeons and their teams with a detailed overview of launching a successful robotics program within a hospital setting. In addition to lectures from well-known experts, there was plenty of time for participants to test their skills on several robots and simulators. Attendees at the STS/ELSO ECMO Management Symposium, held July 13-15 in Tampa, Florida, also received extensive hands-on experience. More than 60 attendees met with world class instructors to learn the latest in ECMO management.  To view more photos from the robotics course, visit sts.org/robotic-thoracic-photos. To view photos from the ECMO course, visit sts.org/ecmo-photos. Express Your Interest in STS Leadership Positions All members are invited to participate in the Society’s self-nomination process for standing committee and workforce appointments. Submissions will be accepted September 1–30. You will receive an email with further information on how to self-nominate. A full list of the Society’s standing committees and workforces can be found at sts.org/leadershipstructure. Leadership appointments are approved by the STS Executive Committee each year, usually during its December meeting. Leadership appointments for 2019–2020 will take effect immediately after the STS 55th Annual Meeting in San Diego, January 27–29, 2019. The majority of open positions are for 3-year terms, renewable on a one-time basis. If you have questions about the STS leadership structure or the self-nomination process, contact Grahame Rush, Associate Executive Director. Apply for TSF Awards Application submission is now open for a number of awards, fellowships, and scholarships from The Thoracic Surgery Foundation (TSF), the Society’s charitable arm. Funding is available for research programs, educational fellowships, leadership courses, and surgical outreach missions. Receiving a TSF award can be a springboard for your research career. Bo Yang, MD, PhD, an Assistant Professor of Cardiac Surgery at the University of Michigan, received a TSF Research Grant in 2015 for his work looking at the effect of a certain growth factor mutation on myocardin-dependent smooth muscle differentiation. The funding helped him generate sufficient preliminary data to earn a National Institutes of Health K08 award in 2016 and an R01 grant this year. “The TSF’s support was essential in helping me develop my academic career as a junior surgeon,” Dr. Yang said. Learn more at thoracicsurgeryfoundation.org/awards and submit your application by September 15. Foster the Next Generation of Cardiothoracic Surgeons Help support the future of the specialty by encouraging general surgery residents and medical students interested in cardiothoracic surgery to apply for a 2019 STS Looking to the Future Scholarship. Scholarship proceeds include complimentary registration for the STS 55th Annual Meeting and Tech-Con 2019 in San Diego, a 3-night stay at an STS-designated hotel, participation in exclusive events, an assigned mentor to help plan a schedule of educational programming and facilitate introductions, and reimbursement of up to $500 in related travel expenses.  If you know of a general surgery resident or medical student who may qualify for an LTTF scholarship, encourage him or her to apply. You also can offer to write a letter of recommendation on the applicant’s behalf. Application details will be available at sts.org/lttf in mid-August. For more information, contact Rachel Pebworth, Affiliate Manager, Awards and Operations. 2018 LTTF Scholarship recipients learned about the specialty at the STS Annual Meeting in Fort Lauderdale. Catch Up with the STS Podcast Listen to words of wisdom from STS leaders via the Society’s podcast, Surgical Hot Topics. In the latest episode, STS Director-at-Large Shanda H. Blackmon, MD, MPH provides 10 tips on how to attract more female candidates into the specialty. In addition, presidential addresses from the five most recent Past Presidents—Douglas E. Wood, MD David A. Fullerton, MD, Mark S. Allen, MD, Joseph E. Bavaria, MD, and Richard L. Prager, MD—are available. Stream episodes at sts.org/podcast; you also can subscribe through iTunes, Google Play, or wherever you get your podcasts. Member Disciplined for Ethical Violation The Society recently sent a letter of admonition to one of its members for violating Sections I.E and II.B of the STS Statement on the Physician Acting as an Expert Witness in the course of providing testimony in a malpractice case. The underlying litigation was based on the treatment of an adult patient who underwent repair of an aortic dissection and experienced complications involving femoral cannulation that ultimately led to part of the patient’s leg being amputated. Acting on the findings and recommendations of a Preliminary Review Panel, the Standards and Ethics Committee  found that the admonished member’s limited experience with adult aortic dissections at the time that the operation at issue took place did not qualify that member as sufficiently familiar with the relevant standards of care that governed adult aortic dissections and femoral cannulation “at the time of the alleged occurrence” (violation of Section I.E). The Committee also found that the admonished member failed to distinguish adequately between actual negligence and an unfortunate medical outcome, testifying unequivocally that the femoral cannula was kept in place for too long, that it could have safely been moved to the ascending aorta or the aortic arch, that it was negligent not to do so, and that the patient’s complications could have been avoided if it had been done. The Committee observed that aortic dissection repairs are complex procedures that involve a great many possible outcomes, and at the time of the operation, it would not have been uncommon for a patient to experience negative complications such as amputation, even if the procedure had been performed perfectly. Nevertheless, the Committee found the admonished member never acknowledged that the complications at issue in the litigation could have occurred as a result of medical uncertainty rather than negligence (violation of Statement II.B). The Society’s policy on disciplinary action describes admonition as “a written notification, warning, or serious rebuke.” The Committee’s action to admonish the member in question was reviewed and approved by the STS Executive Committee. Visit sts.org/ethics or contact Avidan Stern, STS Associate General Counsel, for additional information regarding this area of STS activity.

STS Past President (2009–2010) A “great friend” to the cardiothoracic surgery community passed away on May 21 at the age of 79. Gordon F. Murray, MD became the Society’s 44th President after having served for 5 years as STS Secretary during a time when the Society underwent significant changes, including its transition to a self-managed organization. Dr. Murray also was President of the Southern Thoracic Surgical Association from 1992 to 1993 and the Thoracic Surgery Directors Association from 1993 to 1994. Born in Michigan, Dr. Murray earned his medical degree from the University of Michigan. He completed surgical residencies at The Johns Hopkins Hospital and Massachusetts General Hospital. Following service in the United States Navy, he joined the faculty of the University of North Carolina, Chapel Hill, and eventually moved to West Virginia University, where he served as Chairman of the Department of Surgery, Chief of Cardiothoracic Surgery, Director of the Thoracic Residency Program, and Chief of Surgical Services. “Gordon served our specialty in so many ways—always with grace, dignity, and a smile,” said Douglas J. Mathisen, MD, STS Historian, who was the Society’s First Vice President when Dr. Murray was President. “He was the consummate Midwesterner—both feet firmly planted on the ground, overflowing with common sense, a strong sense of right and wrong, and always treated people respectfully—qualities that are not necessarily in overabundance these days. His friendship and good nature will be missed by all who knew him.” STS Past President Mark B. Orringer, MD was friends with Dr. Murray for 50 years, dating back to their days as residents at Johns Hopkins. “Throughout his lifetime of professional accomplishments, service to our specialty, and leadership positions, Gordon was characterized as a truly ‘good guy’—kind, respectful of others, and sensitive, with an engaging smile and great sense of humor,” Dr. Orringer said. “He was a tremendous advocate for resident education and curriculum development. Few others have demonstrated such consistent dedication to thoracic surgery. He was a wonderful and dear friend.” In his 2010 Presidential Address, Dr. Murray described the transformation occurring in cardiothoracic surgery training and emphasized the need to allow ample time for developing the maturity of reflection and judgment on which quality patient care rests. “All of the concepts of quality patient care I have emphasized this morning: comprehensive, compassionate, continuity, communication, coordination, [and] competency depend on the thoughtful acquisition and application of such judgment,” he said. “Good judgment is critical to the fundamental success of our unrivaled profession’s clinical and educational missions.”

Robert A. Wynbrandt, Executive Director & General Counsel STS News, Summer 2018 -- On April 29 in San Diego, the Society conducted its 14th annual leadership orientation, which featured both surgeon leaders and our staff management team and addressed all aspects of STS structure and operations. This year’s production was particularly geared toward those cardiothoracic surgeons and allied health care professionals who were new to STS governance, and we had a packed house. Don’t worry; this column will not be a condensed version of STS Orientation 101 for the masses. It is, however, dedicated to the STS core value of teamwork, which is a topic that I annually emphasize in the “STS governance” portion of the program. The thesis of my presentation, in which I implore a group of energized volunteers to “Respect the Bus,” is that we are a complex organism (the bus), fraught with opportunity for inefficiencies and friction absent an exceptionally high degree of communication, especially between our volunteer leadership and staff, i.e., the partnership engine that makes this organizational bus run. When I was hired in 2002, as the Society ushered in its “era of self-management,” one of my primary objectives, supported by Mark Orringer, Bill Baumgartner, Gordon Murray, and Robert Guyton (all ultimately STS Presidents), was to reorient the Society’s staff from what had been perceived as a “silo” mentality and help create a culture of interdependence. This task of building a culture of “we” among professionals of any type is inherently difficult—particularly when you are dealing with high achievers who aim to do great things for an organization and be recognized for their contributions; it requires constant reinforcement. There is undoubtedly a parallel dynamic in the world of cardiothoracic surgery, where the surgeon is the quintessential captain of the operating room ship—where the proverbial buck stops and a deep sense of personal responsibility for the procedure and the patient’s outcome is paramount. And yet it is undeniable that these past 16 years have evidenced a growing respect for, and acknowledgement of, the entire team—in hospitals and surgical groups throughout the world. This enhanced appreciation for the team is mirrored in the operations of your society. Our organizational culture of “we” transcends international boundaries. The STS focus on “team” has never been more pronounced, touching all three prongs of our mission to “enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research and advocacy.” A recent and important example that many of you are aware of through our various e-publications occurred in the advocacy arena on July 25, when STS Past President Joe Bavaria led a group of cardiothoracic surgeons and cardiologists, representing STS, the American Association for Thoracic Surgery, the American College of Cardiology, and the Society for Cardiovascular Angiography and Interventions, i.e., the organizational personification of the heart team, in presenting testimony before a Medicare Evidence Development & Coverage Advisory Committee panel regarding the balancing of access and patient safety interests in the federal regulation of TAVR procedures. In education, the interdisciplinary team is now featured in an ever-growing segment of our portfolio, e.g., at our recently completed ECMO and robotics courses, as well as our upcoming critical care conference, and of course at the ever-popular AQO meeting, our annual educational program solely devoted to the STS National Database. And speaking of AQO, the team is a growing focus of our National Database, where we expanded our scope earlier this year to incorporate the heart team dependent INTERMACS® registry; this extends to our PUF initiative, which allows cardiothoracic surgeons and their research scientist colleagues to pursue the STS research mission by mining the STS National Database for new discoveries that will take us to the holy grail: the highest quality patient care. And lest we forget, our organizational culture of “we” transcends international boundaries, as the Society collaborates with a growing number of organizations outside the United States to conduct and endorse educational offerings for the specialty throughout the world; keep an eye on www.sts.org for details. I’ve been reflecting a lot about all dimensions of our STS team since April 29, also the date on which I announced to our Board of Directors that I will be stepping down as the Society’s Executive Director & General Counsel in March of next year. (And in that  regard, please be assured that a committee already has been formed to conduct a search for my successor; our retention of a search firm tasked with assisting that committee likely will have been completed by the time that you read this column; and the search process will be in full gear before the fall 2018 edition of STS News hits your inboxes and desks.) That team concept was brought home eloquently by our President, Keith Naunheim, at the conclusion of the April 29 orientation session in San Diego. Perhaps unconsciously channeling Sister Sledge and the theme song of the 1979 world champion Pittsburgh Pirates, Keith closed with a reference to the Society as a family: the ultimate culture of “we.” With that as a fundamental cornerstone of our organizational DNA, as reflected in our stated core values and brought to life as we execute on all facets of our mission, the Society and the specialty that it is designed to reflect and serve are both on a great path for the future.

STS News, Summer 2018 -- Most cardiothoracic surgical practices have converted, are converting, or will convert from paper medical records to electronic health records (EHRs). The benefits of an EHR system include transparency, improved documentation and communication, reduced omissions, improved reporting, remote access to records, and increased collections. The improved documentation is reflected in both better legibility and content of notes. Transparency and communication impact care teams spanning both the inpatient and outpatient areas, as well as referring physicians and patients. The ability to customize and optimize the EHR to your practice is a powerful tool. Many teams decide to standardize their documentation. You can build templates that ensure you capture all relevant clinical data and succinctly communicate with referring providers. You also can capitalize on discrete fields to capture data required for database reporting and billing requirements. As more EHR systems offer the option of releasing notes to patients, you can establish protocols for how you want those notes to look. Although standardization can be time-consuming, especially if you have many stakeholders and require consensus for practice changes, it is a worthwhile investment that can really pay off. The benefits of an EHR system include transparency, improved documentation and communication, reduced omissions, improved reporting, remote access to records, and increased collections. The transition to electronic records is not without its challenges, however. Staff members tend to require “staged learning.” They need to be trained and allowed to use the EHR system, with subsequent ongoing training to evolve their electronic documentation and streamline their work. This implementation requires time, resources for ongoing evaluation, and a lot of patience. Another challenge is downtime. Paper charts never have downtime, but EHRs do. Generally, the frequency of downtime is not a significant issue, but you will need to develop procedures that accommodate downtime. One very important aspect to consider when implementing an EHR is exam room setup. Some feel an EHR reduces patient interaction by putting the physician’s focus more on the computer than on the person in the exam room. This perception can be minimized by paying close attention to where the physician and the patient will be seated in the exam room, as well as ensuring that templates are in place so that the physician can complete the required fields quickly. As with any transition, there will be challenges moving from paper records to an EHR. What you can count on needing is patience, time, and resources to build the system, to continually train your staff, and to tweak the setup. What you can expect in return are practice improvements that help with efficiency, communication, documentation, and reporting.