Inside Duke Medicine - September 2009 (vol. 18 No. 9)

VOLUME 18 NO. 9 n inside.dukemedicine.org n September 2009

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Transformative cancer center and hospital expansion to become reality Historic expansion to help meet demand, enhance training and research programs

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fter several years of strategic planning, and the successful achievement of state regulatory approvals, Duke Medicine has initiated the construction of major new facilities at the Duke University Medical Center. These new buildings—a comprehensive Cancer Center and a major expansion of Duke University Hospital’s critical care and surgery platforms (which will include state-ofthe-art imaging facilities) to be called Duke Medicine Pavilion—represent Duke’s commitment to continuing to meet the needs of patients in North Carolina and further enhance our teaching and research missions. “The decision to go forward with this project was ultimately driven by what we see as a fundamental responsibility to patients throughout North Carolina to increase our ability to meet the demand for the kind of evidence-based, quality care that Duke

is known for,” said Victor J. Dzau, M.D., chancellor for health affairs and CEO of the Duke University Health System. “We are already near, or at, capacity at Duke University Hospital and there is an acute need for more space in which to provide treatment to patients, facilitate important research activities and train the next generation of medical leaders.” That decision, said Dzau, was subjected to exhaustive analyses of projected patient need, financial feasibility and commitment to employees by the DUHS Board of Directors, Duke University Board of Trustees, School of Medicine faculty, Duke Medicine employees, and leaders throughout Duke Medicine. Furthermore, plans related to the new facilities were shared and discussed with a variety of community groups, community leaders and elected officials. see TRANSFORMATION, p.3

The new Cancer Center and Duke Medicine Pavilion will dramatically transform the medical center campus. ARTIST RENDERING courtesy of medical center and health system architect's office

Duke Medicine Pavilion Meeting pressing patient care needs

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New cancer center

Personalized care and pursuit of research

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uke Medicine’s new comprehensive Cancer Center will not only help address projections of steep increases in cancer incidence – both locally and regionally – in coming years, but it will also soon facilitate a never-before-seen synergy among one of the most talented oncology faculties in the country. “Almost any hospital or medical

center would say that they treat cancer, but there is a quality and sophistication of cancer care that can only be provided by specialists and subspecialists who have received specific training and focus all of their time – 24/7, every day – on continually refining clinical practice based on the latest in clinical research,” see CANCER CENTER, p.4

uke University Hospital, as it has for more than 75 years, continues to attract patients from near and far. So many patients now flock to DUH for top-notch care that the hospital is often full. The hospital saw its last major expansion—Duke North—in 1980 and is now in need of an expansion in order to meet increased patient need. So when the Duke Medicine Pavilion finally rises alongside it, DUH will get a major addition that will add 16 new operating suites and 160 critical care and intermediate care, or step-down, beds. Scheduled to be completed in 2013, the new building also will

provide a high-tech surgical platform in which Duke Medicine can advance its medical education programs, facilitate innovative research into

“Duke Medicine Pavilion will be critically important to our ability to meet surgical demand.“ — Danny O. Jacobs, M.D., MPH, Chair of Surgery

surgical techniques and treatments, and provide the necessary capacity to meet surgical demands. The Duke Medicine Pavilion, see PAVILION, p.2

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Historic advances for patients and research Victor J. Dzau, M.D. Chancellor for Health Affairs and CEO

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invite you to spend a few minutes with what I believe to be a historic issue of Inside Duke Medicine. The momentous decision to move forward with construction of a dedicated Cancer Center and major expansion of the surgery, imaging and critical care services at Duke University Hospital will position DUHS for success for many years to come.

As you will read, despite the fact that this project is characterized by the creation of two significant facilities, it is really about advancing our teaching and research missions VICTOR J. DZAU, M.D. and meeting the needs of our patients. Patient centric-

ity is what must define DUHS as an organization moving to the future. Of greater significance is the fact that we have managed to position ourselves to move forward with this project while keeping the interests of employees at the top of our priority list. Finally, I want to say just how pleased I am with the results of the recent Work Culture Survey (reported in the previous issue of Inside Duke

PAVILION, continued comprising approximately 580,000 square feet of space, will sit at the heart of the Duke University Medical Center. From top to bottom, it is being designed to most efficiently welcome and attend to Duke’s growing patient population. Patients and visitors will be greeted in an inviting light-filled lobby. Nearby, current plans call for a patient resource center that will feature a health library, and a large, modern imaging center will provide a central, state-of-the-art location for patients needing MRI, CT and nuclear medicine—improving care and reducing patient transport distances. On the third floor, a new intraoperative imaging system will allow access to the latest imaging tools right inside the new operating suites, allowing for an even higher level of surgical precision. These new surgical suites will be especially important to Duke’s mission of providing a rich and engaging learning experience for the more than 900 residents and fellows—including 200 focused on surgery—who make up one of the largest such surgery training programs in the United States. “Duke’s surgical faculty are respected nationally, and in many cases internationally, and the demand for both specialty and subspecialty procedures—as well as procedures often considered less complicated—is exhausting our current facility,” said Danny

Medicine). I am energized by the fact that the results suggest we are making significant progress on many fronts, but also recognize there are areas within the organization in which we still need to improve. I wish you all a great last few weeks of the summer and thank you again for all that you do to make Duke Medicine one of the premier academic medical centers in the United States. n

Just the facts: Duke Medicine Pavilion Cancer Center

Components: • 64 step-down or intermediate beds • 96 critical care beds • Approximately 16 operating rooms • Approximately 48 isolation rooms • New, major consolidated imaging suite

Duke Medicine Pavilion

Concourse

The Duke Medicine Pavilion and new Cancer Center will be linked by a multi-level, climate-controlled concourse allowing patients to move from Duke South all the way to Duke North. RENDERING courtesy DUHS Office of Facilities, Planning, Design and Construction

O. Jacobs, M.D., MPH, the David C. Sabiston Jr., Professor and Chair of the Department of Surgery. “The Duke Medicine Pavilion will be critically important to our ability to meet surgical demand and train the next generation of surgical leaders.” Floors six, seven and eight will feature four 24-bed intensive care units and two 32-bed intermediate/ step-down care units, with each room large enough to accommodate all the necessary clinical technology, as well as comfortable overnight space for a patient’s family member. “Duke Medicine Pavilion is

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being shaped by patient needs and input from patients, physicians, nurses, technologists and others,” said hospital CEO Kevin Sowers, MSN, RN, FAAN. They have participated and will continue to participate in interactive design sessions with architects and engineers, he said. For example, input from nurses inspired nurse break rooms that will have natural light and access to an outside area, extending Duke’s commitment—as seen in the courtyard project at DUH and the garden project at Duke Raleigh Hospital—to provide natural spaces to employees, patients

Inside Duke Medicine, the employee newspaper for the Duke University Health System, is published monthly by Duke Medicine News & Communications. Your comments, story ideas and photo contributions are always welcome and appreciated. Deadline for submissions is the 15th of each month.

No. of floors: 8 Square footage: 580,000 square feet Construction begins: Late fall 2009 Construction complete: 2013

Notable features: • Expanded patient resource center with health library • Interoperative surgical imaging • Multi-level, climate-controlled concourse • New employee areas with natural light • New café in pavilion will be convenient to Emergency Department. Sustainability features: • Green roof space • Use of sustainable building materials • Energy efficient mechanical systems • LEED Silver status targeted

and visitors. The Duke Medicine Pavilion will be in close proximity to the Cancer Center, another much-needed expansion to Duke’s ability to care for more and more patients. These two new facilities will be connected by a new climate-controlled concourse that will allow staff, patients and visitors to move more easily about the hospital

Contact us Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: [email protected]

see PAVILION, p.3

Staff Editor: Anton Zuiker Managing Editor: Mark Schreiner Science Editor: Kelly Malcom Designer: Vanessa DeJongh Inside Online Editors: Bill Stagg and Erin Pratt Copyright © 2009 Duke University Health System

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PAVILION, continued and clinic complex without ever being exposed to inclement weather and while still allowing easy access to the outdoors. “The Duke Medicine Pavilion and the new Cancer Center will allow Duke University Hospital to do more of what the Health System does best—delivering world-class care,” said William J. Fulkerson, Jr., M.D.,

senior vice president for clinical affairs. Faculty and staff elsewhere in the health system, as well as nearby and regional hospitals wanting to transfer patients, will also benefit from greater capacity at DUH. Planning and design work on the hospital expansion has been ongoing for several years, and this project is just the latest in a series of strategic DUHS investments across a wide portion of North Carolina.

“They will allow DUH to do more of what the Health System does best — delivering world-class care.“ — William J. Fulkerson, Jr., M.D., Sr. Vice President for Clinical Affairs

The hospital expansion and new Cancer Center follow significant renovations at Duke Raleigh Hospital,

TRANSFORMATION, cont. “The unanimous conclusion was that this project is necessary and consistent with our commitment to the people of North Carolina,” he said. The global economic and financial crisis demanded that DUHS examine—and reexamine—every element of this project in great detail, said Dzau. He and the health system senior management team are confident that efficient financial management over the last several years, as well as the positive financial performance within DUHS that has been driven by outstanding employee work and dedication, have put DUHS in a position to move forward with the expansion project. This plan was subjected to extensive scenario planning exercises that included some of the worst-case possibilities that could emerge from the current federal healthcare reform discussions. In each case it was determined that the new Cancer Center and hospital expansion would benefit the citizens of North Carolina and that DUHS could manage through the various scenarios. Construction will begin in mid-2010 with the Cancer Center, a seven-story, 267,000-square-foot facility that will consolidate outpatient cancer services from around the medical center into a single, multidisciplinary center. The new building, targeted to open in 2012, will connect to the existing Morris Cancer Clinic. “Duke is already a nationally and internationally recognized leader in the treatment and research of various cancers, and the creation of this multidisciplinary focal point for clinical care and clinical research programs will allow us to more comprehensively and efficiently meet the expected increase in demand for the care provided by our faculty and staff,” said William J. Fulkerson, Jr., M.D., senior vice

Preliminary construction begun earlier this year is creating a dedicated tunnel for the utilities that serve the medical center. Photo by bill stagg

Marcom and his fellow researchers, including colleagues at the Duke Institute for Genome Sciences and Policy (IGSP), are pioneering an approach to breast cancer treatment that is hoped will ultimately personalize chemotherapy strategies for each individual patient based on the genetic composition of a patient’s tumor. “The new Cancer Center will better facilitate how we educate patients about “This project is necessary and participation in clinical consistent with our commitment trials and, for those who elect to participate, to the people of North Carolina.“ provide a convenient, —Victor J. Dzau, M.D., Chancellor and CEO, DUHS patient-friendly venue in which they can receive care and follow up,” said Marcom. bringing together—in one space—the The architects and engineers who many specialty areas involved in have designed the Cancer Center have cancer care and research. listened to needs identified by patients, “Duke is fortunate to have many physicians, nurses and others. Their nationally respected leaders in various areas of cancer care and research, design for the building is rigorously patient-centered, with attention and I believe we have only scratched having been given to the physical and the surface in terms of how this colemotional needs of cancer patients. lective expertise can be tapped in Linking the Cancer Center to order to design better studies and the existing bed towers of Duke more fully interpret resulting data,” University Hospital will be the Duke said P. Kelly Marcom, M.D., breast Medicine Pavilion, an eight-story oncologist at Duke. president for clinical affairs. The Health System’s investment in a new Cancer Center is critically important, as projections currently call for double-digit increases in cancer rates in the Triangle and throughout the state over the next five years. The new facility is also expected to result in new synergies in treatment and research advances as a result of

the construction of the Duke Medicine Plaza for outpatient specialty care on the hospital campus in Raleigh, and the openings of Duke Medical Plazas in Morrisville, the Brier Creek community, north Raleigh and Knightdale. In Durham, a new 12-bed hospice facility and renovations of the Emergency Department at Durham Regional Hospital are similarly broadening the ways DUHS meets the needs of our ever-growing number of patients. n

580,000-square-foot addition to DUH that will greatly expand DUH’s critical care and surgical capacity and house a large high-tech centralized medical imaging center. The Duke Medicine Pavilion, expected to begin construction in late 2010 or early 2011, is targeted to begin receiving patients in 2013. This facility will include 16 new operating suites that will feature state-of-the-art surgical technology, including MRI and CT imaging scanners. It will also include the creation of 160 muchneeded new state-of-the-art intensive care and intermediate care beds. Both the Cancer Center and Duke Medicine Pavilion, once completed, also will serve as high-tech training grounds for the more than 900 residents and fellows who train in Duke’s graduate medical education program—one of the largest in the country. Even prior to completion, the new buildings will have a more immediate local and regional impact. The more than $700 million in estimated project costs will translate to a significant positive boost to the Durham, Triangle and North Carolina economies. Project managers estimate that as many as 1,500 highly skilled construction workers may be needed during the approximately five-year construction phase. Ultimately, the project will provide an additional 1,000 permanent provider and staff jobs. However, it is critically important that this expansion project be viewed as something substantially more important than just the construction of new buildings. “It is first and always about people,” said Duke University Hospital CEO Kevin Sowers, MSN, RN, FAAN. “Most importantly, it’s about the patients we will serve there, the people who will work in these facilities, and how these buildings will help them do the excellent work they do every day.” n

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CANCER CENTER, continued said Victor J. Dzau, M.D., Chancellor for Health Affairs. “Providing this kind of highly specialized cancer care –ultimately in a facility that will optimize the patient experience – is just another way the Duke Medicine is serving our local, regional and statewide communities.” As for meeting the current and projected patient demands, the construction of this center cannot go quickly enough. Last year, Duke faculty and staff provided cancer treatment for many thousands of inpatient encounters, and hundreds of thousands of outpatient encounters. Many days now, more than 100 patients cycle through the Morris Cancer Clinic to receive chemotherapy treatments. At the same time, thousands of patients participate in the more than 700 research studies being conducted at Duke to explore therapeutic improvements in cancer care or to seek better understandings of a host of non-treatment-related cancer issues. As if this wasn’t enough, the latest projections from the North Carolina Department of Health predict a 14 percent growth in new cancer cases in the state between 2006 and 2011, and a 21 percent increase in new cancer cases in the Triangle during this same time period. “When you consider the rates at which various cancers continue to plague our society, we are compelled to create a space in which we can optimize the ability of our faculty and staff to fight these diseases,” said William J. Fulkerson, Jr., M.D., senior vice president for clinical affairs. “Projections for large increases in cancer cases in North Carolina over the next several years suggest our plans – as well as those by the University of North Carolina – will just meet the demand,” said Dzau. “I believe the clinical and research collaborations between UNC and Duke have the potential to turn the Triangle into one of the country’s epicenters for advancements in cancer care.” In addition to facilitating innovative research and providing important learning experiences for residents and fellows, the Cancer Center has been designed to improve the way patients experience their treatment of cancer, as well as address the emotional well being of patients and their families. “The new facility is all about improving the patient experience as well as improving faculty and staff efforts to understand, treat and fight cancer,” said

It’s about our patients, not about buildings William J. Fulkerson, Jr., M.D. Sr. Vice President for Clinical Affairs

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Carolyn Haines talks with her oncologist, Hope Uronis, M.D., MHS, during a routine examination. Photo courtesy Duke Cancer Center

Just the facts: Duke Cancer Center No. of floors: 7 Square footage: 267,000 square feet Construction begins: Fall 2009 Construction complete: 2012 Components: • 3 clinical floors • 140 clinical exam rooms • 75 infusion stations • Radiation oncology services • Imaging Notable features: • Consolidates cancer services into one location • New multidisciplinary team spaces • Concourse connection to Duke Medicine Pavilion Patient and family amenities: • Cancer patient boutique • Outdoor, rooftop terrace • Retail pharmacy • Patient resource center • Café

Kevin Sowers, MSN, RN, FAAN, Duke University Hospital CEO. “Our aim in designing the new Cancer Center was to create a healing environment that would benefit not only the patients coming here for treatment, but our employees, too.” Once completed in 2012, the new center will consolidate in one location all of Duke’s outpatient clinical cancer services, eliminating the current need for patients to move from one clinic to another depending on their treatment needs. Moreover, patients and their families will enjoy more space and accessibility, convenience and attention to their special needs. Marcia Williams knows what it’s like to need that attention. A Durham mother of four and grandmother to 14, she was first treated for breast cancer at Duke in 2005, and later underwent

surgery, chemotherapy, radiation and breast reconstruction. It wasn't easy, she said. “But my doctor really challenged me to fight for my life. Ultimately, I feel it was God who healed me, but I also feel that it was the knowledge of the doctors and the caliber of people at Duke who saved my life.” Patients like Williams and Duke Medicine staff were polled and then tracked to learn how patients move through the existing cancer clinics. Those results were incorporated into the new design in order to maximize efficiency and minimize patient wait times, provide support for patients and their caregivers, and produce a comfortable atmosphere for staff and patients alike. “It’s truly been a group effort by patients, staff and physicians to come up with ways to make the treatment experience for patients optimally convenient and pleasant,” said Sowers. Currently available patient services will be expanded in the new center and new additions will include a cancer patient boutique, a retail pharmacy, a cafe and a patient resource center with educational materials for families, caregivers and patients. Recognizing that patients and families are often required to spend many hours in the oncology clinics for treatment, architects have incorporated new features into the design to enhance the patient and visitor experience. “The outdoors will be brought in, taking advantage of the healing properties of the environment,” said Mark Greenspan, project manager for the expansion. “This includes large expanses of windows that allow sunlight in, as well as an outdoor rooftop see CANCER CENTER, p.5

his issue of Inside Duke Medicine is dedicated to providing you with information about the decision to move forward with construction of a new Cancer Center and a major expansion of Duke University Hospital. These projects support the three missions of Duke University Health System: patient care, research and education. As we move ahead with the planning and construction of these facilities, it will be important for us to continue our focus on patients and the quality of their WILLIAM J. FULKERSON, experience JR, M.D. with Duke Medicine. Our patients and their families come to us every day seeking medical help, frequently for serious, potentially life-threatening conditions. This is often the most vulnerable moment of their lives and they can be fearful and anxious.

“I'm proud of the quality of service and compassion that we provide to our patients and their families every day.“ I believe the most important thing that any of us can do is to seek out opportunities – whether large or small – to make a difference in the lives of our patients and their loved ones. Each of us within Duke Medicine has the ability to directly, or indirectly, make a difference in the experience of a patient or family member. I’m proud of the quality of service and compassion that we provide to our patients and their families and visitors every day. As we kick off this historic expansion of Duke University Hospital, maintain your focus on providing each patient and family member with the best experience with Duke Medicine. n

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CANCER CENTER, continued garden terrace where chemotherapy patients can go while receiving their infusions. The center will also contain quiet healing spaces where people can go to meditate and reflect.” Clinical areas have been designed to ensure that exam rooms, pharmacy and CT, MRI, and PET imaging technologies will be located near each other, minimizing the need for patient transport during their visits, and improving the coordination of care. “The multidisciplinary team spaces and embedding of patient support resources will go a long way to improving the way we provide care,” said Tracy Gosselin, RN, associate chief nursing officer of oncology services. The Cancer Center will be connected via a new pedestrian concourse to the Duke Medicine Pavilion at Duke University Hospital. The Pavilion, expected to be completed in 2013, has been designed in such a way as to allow easy and seamless transport of patients requiring surgical and inpatient care services. The creation of

The Morris Cancer Clinic will stay open throughout the construction of the new Cancer Center. FILE PHOTO

the new operating suites in that DUH expansion is important, said Sowers, because many cancer patients require a surgical procedure before they enter into the outpatient environment. Similarly, Duke cancer researchers believe, the new Cancer Center will improve their ability to talk with

patients about clinical trials and answer any questions they might have related to their participation. “Delivering cancer care in the 21st century requires state-of-art, multidisciplinary care with access to cutting-edge clinical research. To accomplish this, today’s cancer center must have

everything you need in one location, where specialists and clinical researchers can work together to address patient needs,” said Jeffrey Crawford, M.D., associate director of clinical research in the Duke Comprehensive Cancer Center. With Duke’s increasingly connected system for patient electronic medical records, health system physicians who refer their patients to the Cancer Center will be able to closely follow their treatments. And those patients will be encouraged to become active participants in their care by utilizing the Duke HealthView portal to interact with their own real-time medical records, lab results and integrated scheduling. “The completion of this Cancer Center is critical for people throughout the state and the region,” said Fulkerson. “Unfortunately, everything points to cancer becoming an even greater healthcare challenge for many years to come, and our ability to continue to lead the charge in innovative treatments and research discoveries will be strengthened by this project.” n

Recognizing quality care DUHS receives nearly $250,000 in performance awards

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uke University Health System received nearly $250,000 from the federal Centers for Medicare & Medicaid Services (CMS) in a project that rewards hospitals for high quality care. Thanks to the coordinated teamwork of faculty physicians, nurses, technicians and others, Duke University Hospital was named a top performer and received eight monetary awards totaling $175,097. Similarly, teamwork by the entire staff allowed Durham Regional Hospital to be named a top improver and to receive six monetary awards totaling $51,740. Duke Raleigh Hospital, through efforts of employees there, was also named a top improver and received four monetary awards totaling $20,815. “These awards reflect Duke University Health System’s commitment to providing high quality clinical care to our patients,” says William J. Fulkerson, Jr, M.D., DUHS senior vice president for clinical affairs. “We are always looking for ways to improve on what we do, and these incentives

Duke University Hospital (left), Duke Raleigh Hospital (top) and Durham Regional Hospital each received performance awards for high-quality care. file photos

recognize our results.” The project, called the Hospital Quality Incentive Demonstration, was created four years ago by the Premier health care alliance and the CMS to determine whether economic incentives given to hospitals are effective at improving the quality of inpatient care. Approximately 250 hospitals voluntarily provide data to Premier,

which tracks performance and measures improvement in five clinical areas — heart attack, coronary artery bypass graft (CABG), heart failure, pneumonia, hip and knee replacements. More than 30 nationally defined, standardized, risk-adjusted measures representing process of care and patient outcomes are tracked to evaluate whether the care provided consistently

meets or exceeds accepted evidencebased practice standards. Duke University Health System received the following awards: • Duke University Hospital received a top performer award in heart attack care. • Duke University Hospital received top improvement awards in heart attack, CABG, and hip and knee replacements. • Durham Regional Hospital received a top improver award in heart failure while Duke Raleigh Hospital received a top improver award in hip and knee replacement. • Duke University Hospital and Durham Regional received attainment awards in heart attack, CABG, heart failure, hip and knee replacement and pneumonia. Duke Raleigh received attainment awards in heart attack, hip and knee replacement and pneumonia. “Programs like this serve as promising role models for future health care reform efforts by recognizing and providing rewards to hospitals that exceed national standards of care,” said Fulkerson. n

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Construction will span 4 years Detailed plans will expedite construction, minimize inconvenience

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onstruction of the new Duke Medicine Pavilion and the new ambulatory Cancer Center will take about four years to complete. To build the two structures and a connecting concourse, a force of highly-skilled construction workers will erect about 5,500 tons of structural steel, pour more than 23,000 cubic yards of concrete (enough to build more than 90 miles of sidewalk) and install about 3 acres of exterior glass. For months, architects, engineers and designers have been preparing designs and plans for how best to choreograph the construction while minimizing the impact of the work on patients, families, visitors

and employees. • To keep pedestrian traffic flowing, the walkway between Duke North and Duke Clinics will always be open, although there may be temporary interruptions when cranes or construction materials need to be moved. Flaggers and security personnel will help to keep everyone safe. • As for road traffic, a special entrance has been built off Erwin Road for construction vehicles and equipment, to limit their impact on Trent Drive and the Clinic Circle. Even so, the greatest disruption will be around the Clinic Circle, with the construction of roads, sidewalks and utilities there.

• As the project progresses, patients, visitors and employees will be kept informed about any important changes to traffic and pedestrian routes through direct messages, DukeHealth.org, Inside Duke Medicine and http://inside.dukemedicine.org. It will be exciting to see the buildings rise. First to go up will be parts of the new enclosed pedestrian concourse, and then the new ambulatory Cancer Center, followed by Duke Medicine Pavilion. The renderings on the facing page give a general idea of how the project is planned to progress. As with any construction project, details and timeframes are subject to change. n

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A timeline of construction Bell Building

Before work began – Spring 2009 This is computer rendering of the Clinic Circle area before construction began.

School of Nursing

The Bell Research Building, at the top and left of center, has now largely been demolished. The yellow line at the left represents the previous and existing pedestrian route between Duke North and the Duke Clinics.

Parking Garage 1

Duke Clinics

Duke Medicine Pavilion

Duke Medicine Pavilion Cancer Center

Cancer Center

Duke Medicine Pavilion Cancer Center

Early 2010

Early 2011

Early 2012

A few months into construction, much has changed. The Bell Building has been completely demolished, construction trailers have been installed near the Clinic Circle and crews are at work on the foundations of both the new Cancer Center and Duke Medicine Pavilion.

In the view, at the top left, the frame of the new Cancer Center is nearly complete. To the right of it, the site for Duke Medicine Pavilion is readied.

Here the new Cancer Center has its glass, metal and limestone skin, and is largely complete. To the right, workers have begun erecting the steel frame of Duke Medicine Pavilion.

Duke Medicine Pavilion Cancer Center

2013 – Almost Finished School of Nursing

With the buildings completed, the construction staging areas have been removed and replaced with new roads and sidewalks. The transformation of the medical center campus is nearly finished. Landscaping will complete the scene, giving the area a park-like setting. Patients and caregivers will begin using the buildings by year's end.

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Surgery chair reflects on new ORs Danny O. Jacobs, M.D., MPH, the David C. Sabiston Jr. Professor and Chair of the Department of Surgery, oversees one of Duke Medicine’s largest departments, and the one that will most directly interact with the new Duke Medicine Pavilion and its 16 new operating rooms. As chair of Surgery, you’re focused on inspiring Duke surgeons to provide the best patient care. How will you do that in the new building?

It’s really about the people we recruit. The expansion gives us an opportunity to support academic surgeons who understand that patient care is the top priority but who also want to be at the forefront of surgical technology, develop new procedures, or use existing procedures in innovative ways. If the surgeons danny o. jacobs, M.D. we recruit in the years ahead go on to help design new ways of treating patients and to improve health care processes, then I would be very pleased. So patients will continue to come first?

Of course, it’s always exciting to have a new building. However, from the beginning of our planning for this expansion, we wanted to ask how we could reorganize ourselves so that it’s easier for patients to come and see the provider they’re here to see and be treated in a facility that is state-of-the-art. How will these high-tech surgery spaces impact the department’s educational mission?

The new operating rooms will put us right on the modern edge of surgical therapies, particularly in our ability to perform certain minimally invasive surgical therapies. Duke University Hospital is a tertiary and quaternary care hospital; but, unlike at some other peer institutions, Duke surgeons also provide a strong primary and secondary surgical care program. At our hospital, you’ll see patients undergoing relatively common procedures such as appendectomies, gall bladder removals and hernia repair. But we also perform very complicated, high-end procedures like heart and lung transplants. This hospital expansion will provide a unique training opportunity for medical students, residents, and fellows alike. n

In HAFS renovations, DUH gets more room to operate T

he new Duke Medicine Pavilion that will open in 2013 will add 16 new high-tech operating suites to Duke University Hospital. But that’s not the only effort underway to increase the capacity of DUH to treat a growing patient population and provide state–of–the– art operating rooms. The Hospital Addition for Surgery and related renovation activities have been underway since 2006. This $73.7-million construction and renovation project, which is modernizing and expanding the operating room platform in DUH, is about to enter its third phase—that will see the opening of Duke’s first hybrid OR, a very large surgical suite with built-in heart imaging technologies. In the first phase of the project, an eight-story, 77,684–square-foot addition was tacked onto the south side of Duke North. It opened in June 2008, making room for the relocation of administrative offices and the creation of OR clinical infrastructure space to support OR operations. Phase one also included upgrades to the DUH roof and relocation of Life Flight’s helipad to the roof. In phase two, the vacated areas in the hospital were renovated into an expanded family–friendly waiting room and a pre-operative and post-anesthesia care unit (PACU). These spaces, unveiled in April, cater to surgical patients and their families, offering not only comfort but also improved privacy and functionality.

The Hospital Addition for Surgery, attached to the South side of Duke University Hospital, is part of a project to renovate and add larger, high–tech surgical OR suites. FILE PHOTO

“Enlarging the size of the ORs will enable Duke to better accommodate new technology and staffing levels that are becoming the standard for procedures performed at the hospital,” said Kevin Sowers, MSN, RN, chief executive officer of DUH. And in the middle of this row of new ORs, builders will also create an 870-square-foot hybrid OR, a first for DUH. A hybrid OR is a surgical suite with angiography imaging equipment that is mounted to the ceiling or floor—traditionally exclusive to cardiac catheterization and interventional radiology laboratories. This OR will also have all the appropriate surgical lighting, surgical table, equipment booms for endovascular equipment, ceilingmounted flat-panel “The hybrid OR is perceived as a ‘best monitors, anesthesia of both worlds’ environment by equipment, perfusion console, designated surgeons and interventionalists alike.“ sterile field, and other — Danny O. Jacobs, M.D., MPH, Chair of Surgery components found in typical OR suites. Now, phase three will add four “The hybrid OR is perceived as a new cardiac operating rooms and a ‘best of both worlds’ environment by new hybrid operating room, bringing surgeons and interventionalists alike,” the total ORs at DUH to 35. The said Danny O. Jacobs, M.D., MPH, extra ORs address the pressing need David C. Sabiston Jr. Professor and to provide timely care and improved Chair of the Department of Surgery. technology for our surgical teams. The “In a hybrid OR, it is possible to majority of the current ORs are at 95 transition from minimally invasive to percent utilization. open surgical procedures in emergent Each of the four additional rooms situations without transporting the will encompass up to 670 square patient from a procedural area like the feet—larger than the current ORs cath lab to an OR.” elsewhere on the floor, which average The specialized angiography system 450 square feet.

can be used before or after an open surgical procedure, to provide diagnostic imaging during a fully interventional procedure, or to support combined open and interventional procedures. Surgical procedures most likely to benefit from fixed angiography in the hybrid OR include procedures historically performed as open surgical procedures but that are now being transitioned to catheter-based and minimally invasive alternatives, such as abdominal or thoracic aortic aneurysms, aortic and mitral valve replacements and numerous endovascular surgical procedures such as peripheral stenting. Although the hybrid OR will primarily be used for vascular and cardiothoracic specialties, it also will be designed to accommodate the needs of any general surgery procedure in order to provide the greatest flexibility to meet patient needs, OR utilization and capacity, said Sowers. “The hybrid operating room is essential for promoting Duke’s signature service for cardiothoracic and vascular specialties,” said Jacobs. “Duke Hospital must be capable of offering patients every viable treatment option, and with this hybrid OR, patients will have access to the latest trends in minimally-invasive and catheter-based treatment options.” The new hybrid OR, scheduled for first use in April 2010, will also mean Duke will be eligible to participate in clinical trials testing innovative technology that may revolutionize cardiac valve repair and replacement using percutaneous catheter-based technology. n

Inside Duke Medicine

September 2009

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Day by day—watch the medical center transform

From now until the new Cancer Center and Duke Medicine Pavilion open in 2013, a webcam atop the School of Nursing will capture construction activity every five minutes so you can watch the medical center campus grow up before your eyes. In this panoramic photo montage, the Bell Building is being dismantled. Visit http://dukemedicine.org/construction to see the webcam snapshots. While you are there, you can also view a time-lapse slideshow of how construction will unfold over the next four years. Photo courtesy DUHS Office of Facilities Planning, Design and Construction

Visit http://dukemedicine.org/construction to see more webcam snapshots. pat i e n t sa f e t y

Improving the safety of patient handovers P

atients who must be moved from the OR to an ICU are at increased risk for adverse events because of their vulnerable medical conditions and the complexity of coordination and communication between various caregivers during the handover. A group of enterprising clinicians at the Durham VA have been working together to make the handover process run more smoothly.

“We recognized opportunities to provide safer care and help patients by doing our jobs more reliably and efficiently.“ —Jonathan Mark, M.D.

“As with so many problems in life, communication is the root cause of most difficulties that occur during patient handovers,” said Jonathan Mark, M.D., Professor of Anesthesiology at Duke, and Chief of Anesthesiology Service at the Durham VA. “We took this on because we recognized opportunities to provide safer care and help patients by doing

Atilio Barbeito M.D. and Jonathan Mark, M.D. demonstrate some of the activities and equipment that might be involved in a handover from the operating room to an ICU. Handovers can involve the coordinated effort of up to eight people in a complex case. Photo by mary jane gore

our jobs more reliably and more efficiently.” The Durham VA Patient Safety Center of Inquiry (PSCI) successfully renewed their grant from the VA National Center for Patient Safety, with funding through Oct. 1, 2011. The $600,000 grant will support their new project, “Designing a Safer OR to ICU Patient Handover.” The PSCI will be building on techniques they’ve developed which

utilize high fidelity medical simulation as a training tool for nurse-physician teams and physiologic and clinical monitoring of patients. Their goal is to re-engineer the OR to ICU transfer process and improve patient safety through the design and implementation of a standardized handover tool and a structured handover process. The PSCI is led by VA anesthesiologists Jonathan Mark, M.D., Becky Schroeder, M.D., and Atilio Barbeito,

M.D., and members of the Duke Human Simulation and Patient Safety Center, Jeff Taekman, M.D., Melanie Wright, Ph.D., and Noa Segall, Ph.D. The growing multidisciplinary research group includes a cardiothoracic surgeon (Zane Atkins, M.D.), VA informatics consultant (Sally Kellum RN, MSN), quality improvement nurse (Dawn Rogers, RN), consultants from the Duke Fuqua School of Business Center for Leadership and Ethics (Sim Sitkin, Ph.D. and James Emery, Ph.D.), and technical support staff (Gene Hobbs, Becky Perfect). The PSCI will be recruiting a Program Support Manager to operate and run the VA high fidelity medical simulator and manage day-to-day administration of the Durham PSCI activities. Responsibilities includes budgetary, personnel, communication, and workload coordination duties, as well as data collection, record management, assisting with IRB/R&D compliance regulations, administering surveys, obtaining informed consent from staff, and assisting with analytical observations of direct and simulated patient care activities. Any interested individuals should contact Drs. Mark or Schroeder. n

The Science & Research Supplement to Inside Duke Medicine VOLUME 18 NO. 9

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inside.dukemedicine.org

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September 2009

C A N C E R T R EAT M E N T

Found in translation: Clinical trials to patient care D

uke, as one of the original nationally funded Comprehensive Cancer Centers, is renowned for its research, with more than 700 ongoing cancerrelated clinical trials. Patients who come to Duke for cancer care have the opportunity to participate in clinical trials designed to determine the latest and best treatment methods. These trials run the gamut, from studies using a patient’s DNA to determine the right drugs to use to examining how to address the psychological and spiritual experience during and after cancer treatment. In the genes “Clinical trials are fundamentally about improving patient care,” says P. Kelly Marcom, M.D., a breast oncologist. Cancer clinicians, like Amy Abernethy, M.D. (above left), are using innovative Marcom and other researchers afmethods to perform cutting-edge clinical trials. file photo filiated with the Institute for Genomic Science & Policy’s Clinical Genomics level of gene expression to rigorously identify the prognosis of early stage Studies Unit (CGSU), directed by understand prognosis and be able to lung cancer led by David Harpole; two Geoffrey Ginsburg, M.D., Ph.D. are guide therapy using that science.” Duke trials to guide chemotherapy in leading several studies examining the use of genomic signatures to help guide advanced lung cancer led by Gordana Whole person care Vlahovic, M.D. early stage lung cancer treatment. cancer, led by Neal Ready, Ph.D.,M.D.; While many clinical trials focus on difBecause chemotherapy drugs can national trials for guided therapy in have significant side effects, including ferent ways to attack cancer tumors, prostate cancer led by Phil Febbo, nausea, vomiting and weight loss, it is trials run by the Duke Cancer Care ReM.D.; and other trials expected in the important that the drugs be maximally search Program (DCCRP) are addressing near future. effective at shrinking a patient’s tumors. the experience of the whole patient, in a The Duke genomics group, said Until recently, doctors had little to field known as supportive oncology. Neal Ready, M.D., clinical director guide them in selecting a particular “Our aim is to help develop new of the CGSU, is putting a tremendous chemotherapeutic drug. ways to deliver treatment so that the amount of effort and resources to Models developed by IGSP patient experience is central, and also rigorously test their hypotheses of how researchers Joseph Nevins, Ph.D. and to deliver quality outcomes across all Anil Potti, M.D. may make it possible facets of cancer care,” to use genomic signatures, or patterns said program director “Our aim is to help develop new ways of genes within tumors, to help guide Amy Abernethy, M.D. to deliver treatment so that the patient physicians to the chemotherapeutic The DCCRP’s drug most likely to work for each research approach is experience is central.” individual patient and improve health four-pronged. The first — Amy Abernethy, M.D. outcomes in the process. involves the use of One of Marcom’s patients, Claire “eTablets,” tablet computers available to direct treatment. Weinberg, is participating in the in the clinic waiting rooms, through “It’s been a huge effort by a breast cancer trial. which patients record, with ease and multidisciplinary team of research “I just think it’s so incredible privacy, how they are feeling and to scientists, pathologists, lab technicians, what’s available—that doctors can be report symptoms such as pain, disorstatisticians, clinicians and clinical looking at tumors at the minuscule dered sleep, sexual concerns or other research nurses,” he said. “The team level of genetics and the genome,” problems that often accompany cancer meets on a regular basis to build the Weinberg said. and cancer treatment. infrastructure, informatics and logistics In addition to Marcom’s breast “Through the eTablet system, cancer genomics trial, there are ongoing of collecting tumor tissue so that we we realized that sexual distress was can study them on the most basic trials using genomic information to a substantial concern for nearly one

third of our breast and gastrointestinal cancer patients. So we brought together oncologists, nurses and psychologists to develop new ways to address sexual distress, a concern that wasn’t previously recognized or discussed,” said Abernethy. The eTablets also provide a mode for providing information and education to patients about their treatment and any of the concerns that may come to light after the survey. Next, the group is engaged in controlled clinical trials that examine cutting-edge methods for patients resistant to standard treatment for conditions such as severe neuropathic pain, nausea and dyspnea, or breathlessness, as well as the effect of spiritual support and palliative care on health outcomes. Third, the DCCRP is developing models of care to put proven care information into practice. They have partnered with a national organization called Pathfinders to study an innovative and promising model of comprehensive psychosocial care for people with cancer. “With personal advocates, patients are encouraged to develop coping mechanisms based on their own strengths to try to get back in the business of living fully despite having cancer,” said Abernethy. (View a video describing the Pathfinders program at http://cancer.duke.edu/dccrp/) Finally, the program is committed to constantly updating treatment guidelines and models of care as results from patient information and clinical trials are gathered. “The DCCRP is committed to real–time integration of data into models of care. We want our patients to be able to benefit from our research methods during the course of treatment,” commented Krista Rowe, RN, a research nurse. The newly announced Cancer Center will contain many of the patient– centered elements researched by the DCCRP, enhancing not only the patient experience but providing more space and resources for clinicians to deliver quality care. n

Inside Duke Medicine

September 2009

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w o r k in g @ d u k e

Giving campaign begins Sept. 7 Doing Good in the Neighborhood strengthens communities

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hen Duke University’s expanded employee contribution program was unveiled last year as “Doing Good in the Neighborhood,” Courtney Frankel was among the first to pledge a contribution. She chose to support local health care clinics through a regular payroll deduction “because I don’t like the thought of people not having access to adequate healthcare.” “I hadn’t given through Duke before,” said Frankel, a physical therapist at the Center for Living. “But I was struck by the variety of ways to give to the community directly.”

Free admission to Sept. 5 football opener Duke football kicks off its second season under coach David Cutcliffe on Sept. 5, and faculty and staff are invited to celebrate the 2009 opener as part of Duke Appreciation. Reserve free tickets to the game and celebration at http://goduke.com/employee or call (919) 681-8738. Tickets are limited to four per employee. The festivities, sponsored by Duke Athletics and Human Resources, begin at 4 p.m. at K-ville Quad, where employees and family members can enjoy a buffet meal, games, music and the “Blue Devil Alley” football team march to Wallace Wade Stadium before the 7 p.m. game against University of Richmond. “The support we received from the Duke community last year was simply outstanding,” Cutcliffe said. “Our fans play a vital role in creating a great home game atmosphere for our team, and we want Duke employees to be a huge part of that experience.”

“I know times are tough, but I'm actually looking forward to contributing

Doctor appointments a click away

more.“ — Courtney Frankel, PT Led by Phail Wynn Jr., Duke’s vice president of Durham and Regional Affairs, “Doing Good in the Neighborhood” invites faculty and staff to give directly to about 30 organizations and programs supported through the Duke-Durham Neighborhood Partnership and Duke’s Division of Community Health. The campaign also includes an option to contribute to United Way agencies. This year’s campaign begins Sept. 7 and runs through November. Last year, employees pledged more than $203,000 through the Doing Good in the Neighborhood campaign. Unlike many charities, the campaign does not deduct administrative fees from employee contributions before passing them to Duke-supported organizations in local neighborhoods. This allows 100 percent of employee contributions to flow to the community. Frankel’s pledge led her to other connections in the community like delivering groceries from the Durham Food Bank to the Walltown Neighborhood Ministries for their food distribution. “That experience introduced me to a Durham neighborhood I had never spent time in,” said Frankel, who lives in Durham. “And I saw how the programs are directly benefiting people in the community.” Betty Henderson, business manag-

■ ■ in brief

Make health care appointments with Duke physicians. Check lab report results. And pay medical bills. All of this is available through HealthView, the Duke Medicine patient information portal. Through HealthView, outpatients receive general lab and radiology reports within seven days of the report being finalized.

Physician Assistant Diane Davis, left, weighs 6-year old Brian Parada Rives during a check-up at the Lyon Park clinic in Durham. FILE PHOTO

How to Give • Pledge packets are being distributed to employees through campus mail. Review the material and submit a paper pledge form. • Faculty and staff may also visit http:// www.community.duke.edu to make a donation. • Find volunteer opportunities at http:// www.community.duke.edu

er at Duke’s Center for International Studies, had a similar experience. “I’ve worked at Duke for 29 years, but never felt connected to the neighborhoods near campus,” she said. That changed when she received a monthly e-mail of volunteer op-

portunities from the campaign. Soon, she found herself participating in a neighborhood clean-up in Walltown. “I feel Duke needs to do as much as possible in these neighborhoods, and I’m glad to help,” Henderson said. Henderson and Frankel hope Duke employees join them in this year’s campaign by donating time or money to improve the lives of people living in and around Durham. “I know times are tough,” Frankel said, “but I’m actually looking forward to contributing more.” Henderson agreed. “I never know when I’ll be the one needing help,” she said. “It creates a good foundation in your life if you give to others while you can.” n

“Patients appreciate the transparency and efficiency that HealthView provides, and the physicians like the way HealthView empowers their patients to be more involved in managing their own health care,” said John Anderson, M.D., chief medical officer of Duke Primary Care. More than 100,000 patients are already signed up, and creating an account is easy. Enroll at http://healthview.dukehealth.org

Duke among ‘2009 Great Colleges to Work For’ For the second year in a row, the Chronicle of Higher Education has named Duke University a “Great College to Work For.” In the Chronicle’s July issue, Duke was recognized for best practices and policies in 14 categories ranging from compensation and benefits to confidence in senior leadership and healthy faculty-administration relationships. Duke was also selected for the publication's “Honor Roll” as one of the top 10 institutions of its size. The announcement included a profile on Duke’s professional development programs featuring Duke staff and faculty. Read the article at http://hr.duke.edu

Inside Duke Medicine

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September 2009

h e a l t h y l ivin g

Duke Run/Walk Club begins new season A

s the summer comes to a close, Stan Mirrett, technical director of the clinical labs for the Department of Molecular Genetics and Microbiology, and his wife Penny know it’s time to lace up their running shoes for an annual tradition of camaraderie and fitness. “My wife and I have been participating in the Run/Walk Club since its inception in 2002. We have seen the program grow and look forward to getting back on the trail — it’s nice to know that we will get in an hour of exercise at least twice a week during the 12-week session,” he said. Duke employees looking to get outside and into a fitness routine can sign up now for the fall session of the Run/Walk Club organized by LIVE FOR LIFE, Duke’s employee wellness program. The free 12-week program runs Aug. 24 to Nov. 11 and offers a social atmosphere where anyone from beginners to pros can get fresh air and exercise. Groups meet from 5:30 to 6:30 p.m. Monday and Wednesday at the East Campus track or the Al Buehler Trail on West Campus, near the Washington Duke Inn. Beginner walkers also meet at the Durham Regional Hospital employee entrance at 5 p.m. Monday and Wednesday. In addition to weekly meetings, the Run/ Walk Club also hosts several free workshops over the course of their seasonal program. This fall, workshops will teach participants about how to gauge body fat, use yoga to improve running and walking, and Zumba, a dancing exercise set to Latin music and rhythms. By signing up for the Run/Walk Club, employees also can earn LIVE FOR LIFE dollars, which are used toward buying a range of gadgets and services — from a pedometer or iPod to chair message minutes. “People from all fitness and interest levels join and over the course of the program, you can’t help but notice the transformation that takes place — no matter from where they start,” said Heather Spicer, a health fitness specialist with LIVE FOR LIFE. “The Run/Walk Club provides a structure that helps people challenge themselves, set goals and reap the benefits of getting in better shape and making new friends.” Register for the Run/Walk Club at http://www. hr.duke.edu/runwalk/ n

Duke Medicine employees will be moving their feet this fall in the Run/Walk Club and at two annual fundraising events. FILE PHOTO

Put your new walking feet to the test at these events: American Lung Association Walk on Sept. 19

Start!Triangle Heart Walk on Sept. 27

Lacing up your walking shoes in also a good way to help fight air pollution and asthma, chronic obstructive pulmonary disease COPD and more than 70 other lung diseases.

Duke Medicine is sponsoring the American Heart Association’s 2009 Start!Triangle Heart Walk on Sun, Sept. 27 at the RBC Center in Raleigh. The walk raises funds to combat the U.S.’s number one and number three killers—heart disease and stroke.

William Fulkerson, M.D., senior vice president for clinical affairs, once again invites employees to join him in support of healthy air and healthy lungs. Form your teams and mark your calendars for the 8th Annual Healthy Lungs & Air Walk to be held Sat., Sept. 19 on the Centennial Campus of North Carolina State University in Raleigh. Money raised with the 3.2-mile walk will support the American Lung Association on behalf of Duke University Hospital. To get involved, contact the chairs for this year's event: Joe Jackson (660-4280), Suzy Johnson (668-3466) and Sarah Woodard (684-5680), or register online at http://www.lungnc.org/

Employees are invited to join Victor J . Dzau, M.D., chancellor for health affairs and CEO of DUHS, and team captains from across the health system to don a Duke Medicine t-shirt and walk with the Duke Medicine Heart Walk Team. Last year, nearly 800 employees and their families —and some canine friends —walked with the Duke team. Register for the walk at http://www.starttriangle.org/ To sign up as a team captain, e-mail erica.lind@heart. org, or contact one of the following Duke Medicine Heart Walk co-chairs with any questions you may have: Wanda Bride at [email protected] or 681-7242, or Leatrice Short at [email protected]. edu or 419-5505.

More expansion coverage

Watch the future unfold

Next issue

Learn more about the Duke Medicine Pavilion and Cancer Center construction project at http://inside. dukemedicine.org

View a time-lapse slideshow of how construction at the medical center will unfold over the next four years, at http://inside.dukemedicine.org

The next print edition will appear Oct. 1. The deadline for submissions for that issue is Sept. 15.