April 2017

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Welcome to eFocus.  Our goal is to provide you with timely, informative and useful short summaries and links about UM UCH related news, issues, or events.  Feel free to contact us if you have news to share, story ideas or any other feedback. As always, your comments are welcome.

eFocus, April 2017 topics include:  


Welcome

The month of April just whipped by and we are knocking on the door to the month of May. Children are counting down to the end of school as we count down to the end of fiscal year 2017. We have had some successes and some challenges, but I could not be more excited with the many initiatives we are getting ready to implement.

During the last DL meeting, we delineated that the care we provide has four main pillars: Safe Care, Quality Care, Efficient Care and Empathic Care. Starting with Safe Care (see fig. 1), I would like to acknowledge  the efforts of our nursing team, CAUTI Team, Dr. Younus and everyone that contributes to our CAUTI initiative. As of April 26th, we have gone 75 days without a CAUTI at UM UCMC.  To quote Dr. Younus, “Sustained success is never an accident." We will celebrate our success when we get to 100 days.

Next, with regards to Quality Care (see fig. 2), we are installing the new CT scanner in the Emergency Department at UM UCMC that will give us the capability to perform Coronary CTA.  We will be able to achieve two things with this technology. We will have the ability to discharge those who present with chest pain and have intermediate risk factors for CAD. Even more importantly, we will be able to identify coronary lesions in patients and perform aggressive risk factor modification potentially preventing the need for a stent in their future. Take a look at the image from the New England Journal of Medicine that we have in our newsletter.

Efficient Care (see fig. 3) can be exemplified by the impressive decrease in our length of stay that has gone down month by month since our initial spike up in July-August 2016. This correlates to our improved staffing at night and a special kudos to Tonya Appleby, DNP, whose leadership has optimized our night staffing.

Finally, Empathic Care (see fig. 4) provides our patients a positive environment to aid them in their healing. The hospitalist group is implementing the Patient Callback program this month, an initiative proven by the Emergency Department to be effective in improving the patient experience. Enjoy this month’s eFocus and find the clue for two tickets to the upcoming Senator Bob Hooper House Hospice Regatta.             

Fermin Barrueto, Jr., M.D., M.B.A.
Senior Vice President/CMO
Medical Staff Affairs


fig. 1


fig. 2


fig. 3


fig. 4



Clinical Decision Support and Appropriate Use Criteria for Advanced Imaging Modalities

The passage of the Protecting Access to Medicare Act of 2014 (PAMA) mandates providers consult appropriate-use criteria through an approved clinical decision support software (CDS) when ordering CT, MR, NM, and PET procedures. The mandatory use of CDS is law and must be implemented for use by January 1, 2018 per CMS. The CDS software evaluates the order and reason for exam, analyzes the appropriateness of the test indication, and provides feedback to the referring provider.  The law requires the use of CDS software when ordering advanced imaging modality exams. If the software is not used, the exam cannot be billed. Compliance with the law directly affects the Imaging Department and organizational revenue.

CDS is a multi-disciplinary tool and for it to be effective, broad engagement across the system is necessary. Consultation of appropriate use criteria is required prior to ordering of advanced imaging exams in the physician office and hospital outpatient settings.

As a collaborative effort, the University of Maryland Medical System is building a Clinical Decision Support Oversight committee, steering committee, and various work groups to support this mandate and assure timely implementation into our various IT systems.  


Congestive Heart Failure (CHF) Program at UMUCH Comprehensive Care Center

CHF is a leading diagnosis for hospital admission in the US, with over 5 million patients diagnosed and treated for the condition and related comorbidities. Medicare guidelines have implemented penalties for readmissions within 30 days of discharge for several diagnoses and CHF is among these.  The UM UCH Comprehensive CARE Center is a transitional care program created to fill the gap of care from hospital discharge through community care and the CHF program is a component of this outpatient practice. It is comprised of a team of health care personnel, including a nurse practitioner, RN, and social worker, who work together with patients and their families utilizing education, support, and resource assistance to promote wellness, teach self-management, and decrease hospital readmissions. The CHF patient is identified in the hospital by a provider, case manager, or team member and a consultation is ordered. Upon discharge, an appointment at the CARE Center is made and the patient is seen weekly or bi-weekly through the 30-day time period, and then transitioned to primary and specialist providers. 

The program was launched approximately 12 months ago, and there has been great success toward achieving the goal of decreasing hospital readmissions.

Referrals to the CARE Center should include patients admitted for acute decompensated congestive heart failure, whether it be heart failure with preserved left ventricular function (HFpEF) or heart failure with reduced left ventricular function (HFrEF), newly diagnosed cardiomyopathy patients at risk for CHF, hypertensive heart disease, chronic CHF refractory to medical management, or those with poor support, lack of resources, or multiple chronic conditions on many medications. CARE center staff is available to discuss referrals and assist with care coordination if needed, and is in communication with the hospital case management team on a regular basis. 

Patient and family feedback has been overwhelmingly positive, and community physician/provider support has been consistent. For more information on the Comprehensive CARE Center contact the office at 443-643-2273.

Suzanne O’Keefe, MSN, CRNP


Collaborative Nurse Practitioner Clinical Training Program

UM UCH has partnered with the University of Maryland School of Nursing (SON) to secure grant funding for the development and implementation of a collaborative nurse practitioner (NP) clinical training program. This multi-year grant will provide funding to: 

  • build collaborations between education and practice that promotes patient centered care
  • provide an infrastructure to clinically train NP students at UM UCH
  • embed SON faculty in the clinical environment and develop clinical training rotations built upon their combined expertise
  • create a pipeline of expertly trained NPs for UM UCH, and 
  • ultimately implement a fellowship program for NPs at UM UCH.

Although not an exclusive agreement, UM UCH will preferentially host NP students from the University of Maryland SON to support this exciting and innovative collaboration. Please feel free to contact Shannon Idzik, DNP (idzik@son.umaryland.edu), Tonya Appleby, DNP (tappleby@uchs.org), or Stephanie Dinsmore (sdinsmore@uchs.org) for additional information regarding the grant or precepting NP students.


Coronary CTA and Population Health

You don't need to be a radiologist to read this picture. The arrows show both on Coronary CTA (on the right) and nuclear test how medical therapy reversed a lesion inside the coronary artery. A heart attack waiting to happen has gone away. With our Coronary CTA program, we will identify more of these patients who can get better with risk factor modification and prevent heart attacks. Truly a game changer for the community we serve.


'Excellence in Nursing' Recipients

Kudos to Dara James, Case Management, UM UCMC, and Jamie-Lee Thompson Hammer, Cardiovascular, UM HMH, who received accolades from Baltimore magazine’s 2017 ‘Excellence in Nursing’ survey. Dara and Jamie-Lee are featured in the May issue of the magazine along with 48 of the region’s top nurses. 


Grant Aims to Assist At-Risk Mothers and Newborns

The Upper Chesapeake Health Foundation is proud to announce a recent grant awarded from the Albert P. Close Foundation to support our local, at–risk mothers and infants born to mothers struggling with substance abuse. The “Hold Them Close” program at University of Maryland Upper Chesapeake Medical Center ensures a healthy start for these moms and their infants. 

As part of this partnership our goals are to:

  • Reduce the number of readmissions to the hospital for mom and baby
  • Provide resources to mother and baby to help baby reach developmental benchmarks
  • Reduce the incidence of SIDS deaths with NAS babies in Harford County

To learn more about the Albert P. Close Foundation and how you can support funding of this vital program please visit closefoundation.org.  You can also sponsor or join the upcoming fundraising event, "That's the Spirit," on May 19. Details below

*The first five individuals to email Dr. Barrueto at fbarrueto@uchs.org with the goals of the "Hold Them Close" program will be entered in a raffle to win two tickets to the Senator Bob Hooper House Hospice Regatta on June 3rd.


Physician Spotlight

Congratulations to Nkiruka Arene, MD, on her recent certification by the American Board of Physical Medicine and Rehabilitation (ABPMR) in Brain Injury Medicine. Dr Arene joins one of only 528 physicians nationwide to attain Board Certification in brain injury medicine (as of 2016), and one of only 8 in the state of Maryland. A specialist in stroke rehabilitation and pain management, Dr. Arene was already board certified by the ABPMR in physical medicine and rehabilitation. Brain injury medicine (BIM) is one of seven subspecialties. 

The subspecialty of BIM focuses on the prevention, evaluation, treatment, and rehabilitation of individuals with acquired brain injury, whether traumatic or non-traumatic. BIM physicians provide a high level of care for patients with brain injury and their families in both the hospital and the post-acute setting, and over the continuum of care to facilitate the process of recovery and improve medical and functional outcomes. This latest achievement underscores Dr. Arene's clinical strengths and highlights her dedication to providing excellence in health care.

Dr. Arene is the owner and medical director of the Wellspring Clinic, specializing in rehabilitation medicine as well as advanced pain management interventions, neuromodulation and medical management. She is also a musculoskeletal ultrasonographer with expertise in musculoskeletal disorders and treatments. Furthermore, she is one of the co-medical directors for the pain management program at UM UCH and one of the only pain management physicians that will see inpatient consults.

Dr. Arene has worked as a clinician and researcher in the area of brain injury, stroke rehabilitation and recovery. Prior to establishing the Wellspring Clinic for physical medicine and rehabilitation, she was assistant professor and medical director of the stroke rehabilitation program at the Johns Hopkins University School of Medicine and Hospital.

To learn more about other services provided at Wellspring Clinic, please visit our website, www.drarene.com.


MEC and P&T Summaries

The following items were approved during the MEC meeting held on April 12th.

  • Biofire: The Lab will have the capability to use Biofire for diagnosing meningitis/encephalitis. There will be reflex testing when the CSF results are WBC >5 or Protein >50.
  • Labor Induction Checklist  
  • Hemoglobin A1C Utilization Policy  
  • Reference Lab Change from Quest to ARUP
  • Restraints and Seclusion Policy   
  • Cardiac CTA Policy/Protocol Amendments:      
    • Emergency Department
    • Inpatient/Observation Patients
    • Scanner Process
    • Outpatient Physician Order Guidelines
    • Outpatient Imaging Prep and Recovery
  • Perioperative Cardiac Clearance policy  
  • Humulin R U500 Insulin Administration policy  
  • Exparel – approved for shoulder procedures
  • Order sets:
    • Order sets - without medication changes
      • Hip Fracture Admission 
      • PEG - Post Procedure, Inpatient
    • Order Sets – no major content changes 
      • Admission – ICU 
      • Admission/Transfer IMC 
      • Admission Med/Surg or Tele 
      • Rapid Response 
      • Pancreatitis
    • Order Sets – advancing from P&T Committee   
      • Humulin U 500 Insulin 
      • Thiamine Deficiency (Post Bariatric Surgery) 
      • Bariatric Postop Hydration – Outpatient 
      • Ortho Preop DOS 


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • Grand Rounds: Sepsis - A Pathopysiologic and Evidence Based Approach  
    Wednesday, May 10th, 4 p.m.   
    UM UCMC, Chesapeake Conference Center  

    Hosted by Kenneth E. Wood, D.O.  
    Professor of Medicine, UMMS   
    RSVP to Rosemary Baze by May 5 at 443-643-1573     

  • 4th Annual Amanda Hichkad CCA Celebration Walk: Annual community fundraising event that honors and memorializes family and friends in the fight against cancer, while supporting Cancer LifeNet at the Kaufman Cancer Center.
    Saturday, May 13th, 7:30 a.m. (day-of registration opens) and 8 a.m. (ceremonial program and walk begins) 
    Ripken Stadium, Aberdeen 

  • The Role of HPV in Malignancy
    Presented by V. Dixon King, Jr., M.D.
    Wednesday, May 17th, 7:30 a.m.
    Streett Conference Center (in the Kaufman Cancer Center)

  • That's the Spirit! An evening of of live music, great food, beer, wine and bourbon to support the "Hold Them Close" program at UM Upper Chesapeake Health.  
    Friday, May 19th, 6-10 p.m.   
    Rockfield Manor, 501 East Churchville Road, Bel Air  
    Sponsor Enrollment Form   

  • Senator Bob Hooper House Hospice Regatta: A magical evening that supports hospice care. Guests will enjoy the annual sailboat race, a delicious meal, live music, gaming wheels and live auctions. Contact The Foundation for more info at 443-643-3460.  
    Saturday, June 3rd, 5-10 p.m., next to Concord Point Lighthouse in Havre de Grace.

Standing Meetings

  • Pediatric Grand Rounds: Held the first Wednesday of every quarter (Jan., Apr., July, Oct.) from 7 - 8 p.m. Guest lecturers present different topics in pediatric medicine, including common dermatologic conditions, effects and management of obesity in children, pediatric head injuries, and more.  
  • Multidisciplinary Thoracic and General Conferences: 12 Noon, Alternates Every Thursday (e.g., Thoracic is 11/3, General is 11/10)
    UM UCMC, KCC Streett Conference Room
  • Multidisciplinary Breast Conference: 8 a.m., Every Tuesday
    Radiology/Oncology Conference Room
  • Pharmacy &Therapeutics (P & T) Committee: 7:30 a.m., Third Wednesday of each month
    UM UCMC Maryland Room 
  • Credentials Committee 7:30 - 9 a.m., Third Friday of each month
    UM UCMC, MSCR 
  • Medical Staff Leadership  8 - 9 a.m., Fourth Thursday of each month
    UM UCMC, Fallston Room/UM HMH, MSCR
  • Metabolic Bariatric Surgery Committee: 5 p.m., Quarterly, Wednesdays
    HMH MSCR and UCMC Fallston Rm
    Upcoming dates: March 15, June 21, Sept 20, Dec 20

  • Allied Health Practitioner Committee:8 – 9 a.m., Third Tuesday of each month
    UM UCMC, MSCR