August 2016

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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, August 2016 topics include:



Welcome

This summer has whipped by and now we’re finishing up vacations and getting our kids acclimated to school once again.  Our first, revamped edition of eFocus had a great start with an open rate of over 37% in the first 48 hours.  Most e-publications of this kind are doing very well if they achieve an open rate above 24%, so we’re quite pleased! We’ve also expanded the viewership beyond our medical staff and have included department leaders. Please don’t hesitate to send me any suggestions regarding new content or format.

If you missed it, I included an embedded ‘code word’ in the last issue. The first five people to see it and email me with the word coffee received a $20 Starbucks gift card.  Congratulations goes out to:  Dr. Derek McCoy (Emergency Medicine), Dr. Jack Newman (Cardiology), Dr. Mark Gonze (Chair of Surgery/Vascular Surgery), Mark Lewis (CVI) and Dr. Tim Chizmar (Emergency Medicine). I wasn’t expecting my inbox to blow up with over 100 emails, but it was well worth it to hear from you. 

This month’s edition of eFocus has our traditional MEC and P&T updates, as well as the latest regarding Zika and Language of Caring program implementation.

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


URGENT: Prescription Update

A recent audit conducted by UMMS revealed that we were at risk for prescription diversion because of the use of prescription pads pulled from the Diebold machines on the nursing units. To reduce this risk, prescription pads will be removed from the Diebold machines as of October 1st. Providers will need to use the electronic scrips or their own supply of prescription pads. 


Quality Updates

Benefits of a culture of continuous improvement video: How Nebraska Methodist Health System keeps raising the performance bar

*There will a $20 gift card for the first person who emails fbarrueto@uchs.org with the last phrase of the video.*


MEC and P&T Summaries

D-dimer testing: We are switching to age adjusted cutoffs for pulmonary embolism.  For the full explanation please see below.

UMMS has decided to standardize sensitive D-dimer testing units as: ng/mL FEU.  This decision was based on specialist guidelines that include age-adjusted cut-off values for pulmonary embolism.

Best Practice Advice 4:  Clinicians should use age-adjusted d-dimer thresholds (age x 10 ng/mL rather than a generic 500 ng/mL) in patients older than 50 years to determine whether imaging is warranted.

Comments:

  • For age 50 years and below:  for the EXCLUSION of PE and DVT, the NEGATIVE PREDICTIVE VALUE (Cut Off Value) is 500 ng/mL FEU.
  • For age 51 and above:  for the EXCLUSION of PE and DVT, the NEGATIVE PREDICTIVE VALUE (Cut Off Value) is the age of the patient in years x 10 ng/mL FEU (Ex.  For a patient 38 years old the negative predictive value is 68 x 10 ng/mL FEU = 680 ng/mL FEU.
  • For the diagnosis of PE and DVT, the cut-off values or higher should ONLY be used in conjunction with standard imaging procedures and clinical data.
  • The normal population reference range is <19 to 540 ng/mL FEU.  DO NOT use this range for the diagnosis of PE or DVT.
  • Do NOT use D-dimer for PE or DVT diagnosis in patients with:  anticoagulant therapy for >24 hours, fibrinolytic therapy for previous 7 days, trauma or surgery within the previous 4 weeks, disseminated malignancies, aortic aneurysm, sepsis, severe infections, cirrhosis, or pregnancy.
  • Rare patients with DVT (mostly distal DVTs) may yield D-dimers below the cut-off values.

Standing Order Update:

The Chest Pain Standing Orders will now include a  new order: “Troponin I NOW; repeat in 3 hours."  The existing 12-lead EKG NOW order has been modified to include “… with interpretation by provider or intensivist; if initial results are non-diagnostic of MI, repeat 12-lead EKG every 30 minutes until chest pain resolves or serial EKG order is canceled by provider." These changes will go into effect on 9/6/16.

New or revised order sets: (these newly MEC-approved order sets will be available for use within next two months)

  • PCA IV and Adjunct
  • Rabies Vaccination – Outpatient
  • Sepsis Bundle – ICU
  • Sepsis Bundle – non-ICU
  • Syncope
  • Tracheostomy
  • Intra-Pleural Dornase/Alteplase
  • Rapid Sequence Intubation
  • Electrolyte Protocol ICU/IMC
  • Central Parenteral Nutrition – Adult
  • Influenza Vaccine Orders by Protocol (will begin Sept. 6)
  • Thoracic Surgery Postop – ICU/IMC
  • tPA Exclusion Criteria for Acute Ischemic Stroke
  • ED Intracerebral Hemorrhage
  • ED Subarachnoid Hemorrhage
  • Total Shoulder Replacement – postop
  • Orthopedic Surgery – general postop
  • Orthopedic Surgery – general admission

Infection Prevention 

The Infection Prevention Department is working closely with both the Harford County and the State Health Departments to ensure we have an appropriate response plan in place that aligns with Centers for Disease Control and Prevention Guidelines (CDC).

Our plan development has focused on assuring we have processes in place to appropriately:

  • screen, diagnose, and manage possible Zika cases
  • educate suspect cases about Zika transmission and prevention strategies
  • report suspect cases to local health authorities

Since Zika is not transmissible via casual person to person contact, there are no special precautions needed in health care settings when caring for suspect cases.

http://www.cdc.gov/zika/index.html


Language of Caring

We are excited to announce that we will soon begin implementing Language of Caring for Physicians, a program that helps physicians fine-tune the specific communication skills key to patient and family-centered care, the unparalleled patient experience, positive clinical outcomes and a more satisfying practice for physicians themselves.

The hospitalist program will be the initial focus, with others to follow. Stay tuned for more information.


Greeley Audit Kick-Off September

The goals of this engagement are to identify opportunities to improve the effectiveness of the medical staff in carrying out its functions, and to facilitate discussion and prioritization of recommended improvement opportunities. 

Scope and Approach will include:

  • Assessing the effectiveness of UM Upper Chesapeake Health’s organized medical staff (which is inclusive of the organization’s advanced practice professionals) in fulfilling its roles and responsibilities
  • Assessing the effectiveness of communication between the hospital and the medical staff
  • Offsite review and analysis of hospital-provided documents and data
  • Onsite interviews with medical staff leaders (medical staff officers, department chairs, and paid medical directors) and hospital administration
  • Preparation and presentation of the final report of findings and recommendations


Provider Survey Reminder

Our journey towards a Culture of Excellence depends on you! Participate in the medical staff survey and voice your opinion. Your answers to these survey questions will help guide us toward our goal of providing the finest care to every patient, every encounter, every day.

Instructions are provided in the survey packets that were recently mailed to your office. Results will be used by us to identify what we're doing well and to make plans for improvements where needed.

Take the survey and you'll be entered to win a pair of Baltimore Ravens tickets! 


In Case You Missed It

Student Debt and Doctors
A program designed to ease the student-debt burden of teachers, public defenders and other modestly paid workers in the public sector is also set to help thousands of physicians, many of whom work for nonprofit hospitals.

ChoiceOne Urgent Care Now Open in Fallston
UM UCH has entered into a joint venture partnership with ChoiceOne Urgent Care to open the first of several walk-in urgent care centers in Harford County. Located at 2315 Belair Road, Unit 1, the Fallston Center is open from 8 a.m. to 8 p.m. seven days a week, including holidays. This is beneficial to you, particularly if you are a primary care physician, as you can refer your patients during off hours and weekends. ChoiceOne will also provide you with appropriate information regarding your patients’ visits to the Center.  

ChoiceOne welcomes all ages and diagnoses and provides treatment for:

  • Colds, coughs and flu

  • Cuts and bruises

  • Earaches and infections

  • Minor broken bones

  • Burns, rashes and bites

  • Sprains and strains

  • Vomiting and diarrhea

  • Respiratory infections

  • Nausea and headaches

  • Eye injuries

  • Occupational health services

  • Travel vaccinations

  • Onsite medication dispensing

  • X-ray, EKG, labs, suturing, and IV hydration/antibiotics

Together, ChoiceOne and UM UCH will open other Harford County locations over the next two years.

Walk-ins are welcome, but patients can set their arrival time online using the ZipPASS scheduling system. Most insurance plans and private payment are accepted. 


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Cardiology Symposium 2016: The Cardiac Patient Across the Continuum of Care
This is your source for the most relevant information, best practices, and guidelines for the care of patients with cardiovascular disease. Join fellow primary care and emergency physicians, hospitalists, and cardiologists as well as nurse practitioners, physician assistants, nurses, and allied health professionals at the premier cardiology conference in Harford County.

Register online at uchcourseregistration.org/cardiology 

Saturday, Nov. 12, 7:30 a.m. to 4 p.m.
Water’s Edge Events Center
4687 Millennium Drive, Belcamp, MD

This live activity has been designated for a maximum of 7 AMA PRA Category 1 CME Credits.™

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 Conference: 12 Noon, Every Monday
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., Second 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