July 3, 2019

Fellow’s Corner

Dr. Paul Herman

Dr. Paul Herman, a fourth-year resident at Johns Hopkins Department of Emergency Medicine, will be pursuing further training in geriatric emergency medicine (GEM) as part of his Focused Advanced Specialized Training Opportunities (FAST) program. The FAST curriculum offers senior residents at Johns Hopkins the chance to achieve advanced and individualized training within a specific area of emergency medicine. Dr. Herman, with an emerging interest in GEM, will spend the year expanding his knowledge of GEM as well as developing a number of GEM programs and initiatives.

As part of his longitudinal curriculum plan, Dr. Herman will spend time rotating with the various inpatient and outpatient clinical geriatric teams at Johns Hopkins Bayview Medical Center (BMC). These include the inpatient geriatric consult service, house call program as well as the inpatient medical behavior unit which specializes in the care of older adults with dementia and delirium. Finally, Dr. Herman will take advantage of a number of didactic opportunities to include a national conference in palliative care as well as a local leadership course focused on process improvement. 

Throughout the course of the year, Dr. Herman will be spearheading two distinct GEM initiatives at BMC.  The first of which is helping to prepare BMC for geriatric emergency department accreditation from the American College of Emergency Physicians. As part of this process, Dr. Herman will also be conducting a quality improvement project aimed at improving provider identification, prevention and treatment of delirium among older adults seen in the ED. Specifically, Dr. Herman hopes to gather an understanding of local practice patterns and knowledge of delirium among emergency medicine providers (EMPs) via survey as well as reviewing practice patterns via electronic medical record (EMR) data abstraction. Following this, Dr. Herman plans to implement a unique delirium prevention/treatment intervention.

This specific intervention will capitalize on an interactive order set algorithm, built into the Epic medical records system, which has been used to help guide providers in the care of patients with specific conditions at BMC. The repository of evidence- based guidelines within this system include dozens of acute (and chronic) conditions encountered by EMPs however geriatric specific guidelines are lacking. Using the aforementioned survey results and EMR data abstractions, Dr. Herman will build a specific Geriatric Delirium guideline to be accessed and used in real-time by EMP at BMC. Post-guideline development and implementation surveys of practice and prescribing patterns will also be reviewed.

Dr. Herman completed his undergraduate work at the University of California, Los Angeles, with a master’s in neuroscience from Université Claude Bernard Lyon 1 and his medical degree from Brown University. He is currently completing his residency training at Johns Hopkins Department of Emergency Medicine with a career goal of helping to develop further local and national programs within GEM.