Celebrated Physician: Kevin Handy, MD

Meet Kevin Handy, MD

With the alarming rise in the abuse of prescription and non-prescription opioids dominating the headlines, many medical professionals may be at a loss to understand the full scope of the crisis, and what they can do about it.

Kevin Handy, MD, hopes to help provide some of those answers. An attending physician in both Critical Care Medicine and Anesthesiology at MedStar Washington Hospital Center, Dr. Handy has developed a lecture series, highlighting the opioid epidemic and alternative pain control regimens for critical care. Decreasing usage of opioids in general, specifically among the critical care population, would go a long way toward reducing opioid prescriptions upon discharge. He is also working on opioid reduction protocols specifically for the cardiac surgical patient population

Dr. Handy saw the extent of the epidemic firsthand in Boston, while performing his anesthesiology residency at Brigham and Women’s Hospital, and his critical care fellowship at Massachusetts General Hospital.

“It was truly surprising to find the problem isn’t limited to rural areas, but is widespread in cities as well,” he says. “The ICU is a gateway for addiction, so we have a big responsibility, when it comes to pain control drugs and sedatives.”

The Opioid Epidemic and ICU Cultural Shift 

As revising these practices may involve a major cultural shift in critical care for many longtime practitioners, Dr. Handy hopes to start delivering his lectures next spring, to interns at Georgetown University’s School of Medicine, where he received his own medical training.

“Teaching interns about opioids before they hit the floor, will help them build good habits at the outset of their careers,” he says.

It was during his own medical school rotations that Dr. Handy chose what some might consider as diametrically opposite specialties. But he’s found that anesthesia and critical care actually balance each other quite well.

In administering anesthesia, for example, “the 16-minute period before a procedure is very important, because the family is usually there, and you’re trying to gain their trust,” Dr. Handy explains. He adds that if a problem arises during surgery, it happens fast.

“You’re usually working by yourself, so addressing any problem is all up to you,” he says.

Critical care, on the other hand, involves more teamwork, with nurses, residents, technicians and others working together for each patient. As an attending physician, he must be able to delegate responsibilities, and trust that other members of the team understand what needs to be done.

“I also enjoy teaching,” Dr. Handy adds, “and there’s no better place to do that than the ICU.”

Outside the Hospital

Dr. Handy’s family life is likewise a study in balance. His wife, Natasja, is taking time off from her career as an attorney, to perform in stage shows around the area. The couple also has a 15-month-old son, Ben.

“We’re both from this area, so it’s great that we can see family regularly,” Dr. Handy says. Along with meeting up with his Dad for a round of golf, Dr. Handy also enjoys reading. And as one might expect, his choices alternate between fiction and non-fiction, “and always something non-medical,” he says with a laugh.

Celebrated Physician: Pamela Paufler, MD

Who is Dr. Paufler?

Many physicians have pursued other careers before entering medicine, but the path Pamela Paufler, MD took to becoming an attending Critical Care physician at MedStar Washington Hospital Center was, literally and figuratively, somewhat circuitous.

After earning an electrical engineering degree from MIT, the Charlotte, N.C., native began working in semiconductor development for a manufacturer of pacemaker and defibrillator products. Uncertain about making the field her career, Dr. Paufler happened upon a fortuitous opportunity to shadow some physicians, gaining some clarity about her future in the process.  

Why Choose Medicine?

“I decided I liked what they did better than what I was doing,” Dr. Paufler recalls. “As I’d planned to go back to school anyway, I took the prerequisite courses to get into medical school.”

Dr. Paufler earned a medical degree at the University of Minnesota Medical School, followed by a fellowship in Critical Care Medicine at Hennepin County Medical Center in Minneapolis, and another in Cardiovascular Surgery Critical Care at Johns Hopkins Hospital. As she pursued her training, the parallels between her once and future careers were evident.  

“Engineering and medicine are both about solving problems—what’s going on and why, and how to make it work better,” Dr. Paufler says. She adds that the sense of immediacy associated with treating some of the hospital’s sickest patients was likewise appealing.  

“I like the pace of doing a test, getting a result and using that information to make a change if needed,” she says.

But surgical critical care is much more than dealing with black-and-white, if/then outcomes. There’s also the human aspect, working with family members who must often make difficult post-surgery decisions for patients unable to speak for themselves. As such, Dr. Paufler believes maintaining open lines of communication is critical.  

“It’s essential to explain treatment options and outcomes in plain terms, and empowering them to make good decisions with the patient’s best interests in mind,” she says. “We want them to know that whatever they decide, we’re rooting for them.”  

Dr Paufler’s dedication to helping residents and fellows understand the intricacies of surgical critical care was recognized after her first year at the Hospital Center with the Keystone Education Award for resident education. Now, she’s leading several quality and performance improvement initiatives at MedStar Heart & Vascular Institute’s Surgical Intensive Care Unit. 

Life Outside the Hospital

One constant in Dr. Paufler’s life is her love of competitive and offshore sailing, a sport she’s pursued since age 12. She also enjoys swimming and travel, with her most exotic adventure being a visit to the Galapagos Islands. “The wildlife is unbelievable,” she says. “Each island is better than the last.” 

Central Line-Associated Bloodstream Infection (CLABSI) FREE

CLABSI Free - A Quality & Safety Milestone 

This week, Unit 2G, a medical intensive care unit at MedStar Washington Hospital Center, achieved a major milestone: reaching two years without a Central Line-Associated Bloodstream Infection (CLABSI).

Central lines (catheters) are tubes that help patients get the medications or fluids they need and allow medical professional to draw blood for testing.  But they also present a particular risk for developing infections, because they are inserted into large veins in the neck, chest or groin.  While these lines are necessary, they must be monitored continuously and carefully.  Medical professionals have been working hard to reduce CLABSI rates in hospitals, and from 2008 to 2013, there was a 46% decrease in CLABSI in hospitals across the U.S., according to the Centers for Disease Control and Prevention (CDC).  Yet, an estimated 30,100 CLABSI cases still occur in U.S. hospitals each year.

How did the physicians and nurses on 2G keep CLABSI at bay for two years (and counting)?  They credit dedicated teamwork for their success. "The most important step is collaboration and communication between all team members,” notes Joshua Wansley, RN, a nurse leader on the unit. “Twice a week, nurse leaders and attending physicians check on every patient and assess if the central lines are still needed for that patient.”

In fact, nurse leaders take the extra step of reviewing central line records every day to verify that the line is needed. “The goal, of course, is that you only have lines in that are absolutely necessary," says Wansley. "That one extra review could show a line ready to be removed.  If it comes out, the risk is gone.”

Resource nurses -- the nurses who manage the workflow on a shift -- keep careful records of patients' central lines. Nurses are tested every year on their skills for changing the dressings around the central lines and other protective steps needed to keep patients safe.  “We also talk about it all the time, so we are all very aware of the current situation with central lines. Our goal is to go that extra mile  to protect the patients," Wansley concluded.

And at the Hospital Center, every patient unit posts its current record in a highly visible place for all to see.  Much like a construction site that records the number of days since its last employee injury, our patient units post the number of days since the last CLABSI.  Keeping it top of mind among every team member -- and among patients and families -- will help 2G and every other unit at the Center prevent these life-threatening infections.   

For Patients:  What You Can Do to Help Prevent CLABSI

Patients can also play a role in preventing CLABSI. The CDC suggests:

  • Speak up about any concerns so that those providing your care are reminded to follow the best prevention practices.
  • Ask your healthcare provider if the central line is absolutely necessary. If so, ask them to help you understand the need for it and how long it will be in place.
  • Pay attention to the bandage and the area around it. If the bandage comes off or if the bandage or area around it is wet or dirty, tell a healthcare providerright away.
  • Don’t get the central line or the central line insertion site wet.
  • Tell a healthcare provider if the area around the catheter is sore or red or if the patient has a fever or chills.
  • Avoid touching the tubing and do not let any visitors touch the catheter or tubing as well.
  • MOST IMPORTANTLY:  The single most important thing that everyone can do is wash their hands.  Everyone who comes into the room to visit or care for a patient with a central line must wash their hands—before and after they visit.  If you are a patient, speak up if you see someone who doesn't follow this very important rule.  If you are a family member or visitor, be mindful of the rule, follow it, and speak up if others don't. It's simple -- and effective.