Team Member Spotlight: Dawn Bourne, DNP, RN, FNP-BC

Dawn Bourne, DNP, RN, FNP-BC

In addition to her day-to-day duties as a nurse practitioner in the Department of Family Medicine, Dawn Bourne plays an integral part in two UVAHS programs designed to enhance patient experience throughout treatment at the Medical Center and after discharge.

The first, the Ethics Consult Service at UVAMC, was a natural fit for Dawn to become involved with: Her research and dissertation as a DNP (Doctorate of Nursing Practice) student at UVA School of Nursing was on moral distress in primary care providers. “Ethical issues often arise in patient care when a provider knows the appropriate action to take, but is prevented from taking it because of something outside of their control,” explains Dawn.

As a branch of the Ethics Consult Service, the Moral Distress Consult Service addresses ethical issues that arise which are not specific to one patient. “We meet with the entire team,” says Dawn. “For example, we go to several ICUs on a regular basis and talk about issues that happen in the unit – we try to help troubleshoot what we have the power to change.”

In contrast, individual ethics consults most often involve specific cases and are noted in patient charts, with follow up like other consult services. The issues at hand are generally complex and emotionally charged, such as the withdrawal of life sustaining treatment and surrogate decision maker questions. The service is available 24 hours per day, 365 days per year thanks to the individuals who make up the on-call team: an interdisciplinary group made up of 8-10 consultants including physicians, nurses, a chaplain and social workers. “In many systems, the ethics committee is physician-only”, says Dawn. “It’s really important to UVA that this is an interdisciplinary team because everyone brings something to the table when it comes to these ethically, clinically and socially complex issues.”

Dawn also plays a vital role on the Family Medicine Transitional Care Management team, which follows patients after discharge. Within two days of their leaving the Medical Center, a patient is contacted by a RN Care Coordinator to review their case and tie up any loose ends in preparation for their follow-up visit. “This helps patients understand why their follow-up appointment is important, so they attend more often,” explains Dawn. She adds, “This is a truly collaborative effort because it has formed a more robust bridge between the inpatient and outpatient teams to address all aspects of patient care including social workers and clinical psychologists. There are many social determinants of health that having an interdisciplinary team helps address.”

The success of the team’s efforts are reflected in readmissions data: Between September 2016 and February 2017, 30-day all-cause readmissions were reduced from 31% to 6%.


Anesthesiology as Perioperative Care

Jacob Raphael, M.D.

Jacob Raphael, M.D.

When Dr. Jacob Raphael came to the United States from Israel after he completed his anesthesia training, he accepted a position with the UVA Department of Anesthesiology on what he considered to be a year-by-year basis; consistently re-evaluating the alignment of his goals and philosophy with those of the department and the UVA Health System. Twelve years later, Dr. Raphael remains proudly at UVA for a variety of reasons: in particular, the sense of collaboration across surgical teams, as well as the excellence of the other anesthesiologists and specialists with whom he considers himself extremely fortunate to work. “I looked for a place where the same physicians do pediatric and adult cardiac anesthesiology,” he says. “That kind of versatility keeps you sharp.”

A common misconception is that the sole purpose of anesthesiologists is to treat patients at the time of surgery. While this responsibility is vital, they also play an important role in many other aspects of patient care. “The anesthesiologist is really a perioperative physician,” says Dr. Raphael. “We are involved in cases from pre-op evaluation through discharge, and across a broad spectrum of patient needs including pain management and critical care.”

Department of Anesthesiology Chair Dr. George Rich points out that while anesthesiology isn’t typically considered to be a research-focused field, members of his team are involved in important research. One of the most significant issues currently being addressed is the reduction of opioid use for pain management. “We have been able to decrease opioid use by 40% in the last five years, using a number of different methods including regional nerve blocks, spinal narcotics as well as non-steroidal anti-inflammatories,” reports Dr. Rich. “This is something we are very proud of.” This achievement has been chronicled by news media including The Daily Progress and MD Magazine.

George Rich, M.D.

George Rich, M.D.

The emphasis on reducing opioid use is consistent with UVA Health System’s commitment to patient safety: a standout quality of this academic medical center. “In that respect, UVA is a much different environment than what I experienced in Israel, and from what I understand it also differs from most other health systems in the U.S.,” observes Dr. Raphael. “The reality of it is that we have very strict, careful safety regulations here at UVA.”

Another critical quality for outstanding care, according to Dr. Rich, is teamwork. “If you don’t function as a team, the patient outcomes are worse – many studies demonstrate this.” Dr. Raphael adds that the OR team is hardly limited to anesthesiologists and surgeons. “During any given surgery, there are likely residents, CRNAs (Certified Resident Nurse Anesthetists), the nursing team, the support team who sets up the room and brings equipment, and other players as well. When everybody embraces each other’s roles it leads to more success all around — and in the end that means improved patient outcomes and experience, which is our shared goal.”

This trend toward collaborative care, according to UVA Executive Vice President for Health Affairs Dr. Richard Shannon, is here to stay: “Team care is the model for the future. It clearly causes significant change in outcomes for patients,” he says.



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