January 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, January 2017 topics include:


Welcome

Happy New Year Everyone! We are starting the year off on a positive note with patient satisfaction continuing to improve at both sites (see fig. a below). I am excited to see what other positive impacts we can make in 2017. This year started with two departures; our very own Lorraine Greene, Medical Staff office, retired on January 13th after 43 years of service to UM UCH. Joy Hoover, AVP Planning and Business Intelligence, accepted the position of COO at University of California – Davis Veterinary School of Medicine. We will miss you both dearly and wish you the best in the next phase of your life.  I would like to extend a heartfelt thank you to Dr. Bloomfield for his service to our country on behalf of the organization; we are glad to have you home.  And finally, I would like to thank Dr. Gonze for serving as honorary chair for the upcoming Red Pump Ball. 

Coming online February 1st is an innovative technology called BioFire that will identify blood borne pathogens within hours of a positive blood culture; please read on to get the specifics. Unfortunately, we have had a challenging two quarters with regards to CAUTI and we have to right the ship quickly. Another challenge the organization faces is readmissions, particularly at HMH.  There is a negative revenue impact of $110,000 because we have not met the 11.85% reduction target (see fig. b below).  

Flu season is upon us. The Infection Prevention and Occupation Health departments are diligently monitoring the number of patients and team members diagnosed with the flu. As the numbers of flu positive patients increase we will undoubtedly face challenges with bed placements and staffing. We thank you in advance for your commitment. 

Remember, February kicks off capital budget request season. As each of you work with your administrative leads to decide what capital investments need to be made this season, think about your service line and what you need to succeed in the future. Not just 'keep the lights on' type material (which is important) but will not take us from good to great. We need innovative and disruptive ideas that will lead to a healthier Harford County community. Steve Jobs said it best: “Don’t be trapped by dogma – which is living with other people’s thinking." We can’t be comfortable with last year’s success. I am anxious to see what we come up with this season.

Thanks to everyone for your readership and positive feedback; it drives us each month to make it better. We have a packed eFocus and an embedded clue for a $20 Starbucks gift card.

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

fig. a


fig. b



Opioid Crisis 

When the 2017 Maryland General Assembly opened a couple of weeks ago, Governor Hogan, along with several other key leaders, began to prepare bills to address the state’s opioid crisis. As a part of this process, the Maryland Hospital Association requested hospitals to submit what they are already doing to mitigate the crisis to prevent redundancy. We submitted the following:

Opioid Abuse Response Efforts

With the high volume of opioid (and other drug) abuses in Harford County, University of Maryland Upper Chesapeake Health (UM UCH) has seen increased utilization of both Emergency Departments (ED) for addiction overdoses and stabilization.

  • Naloxone Dispensing Program
    • Since September of 2015, the ED’s have distributed over 200 kits to 130 patients. 
      • Of the 130 patients whom have received a kit, 58 revisited the ED, 28 of these revisits were related to a heroin overdose. 

  • Memorandum of Understanding (MOU) between the Harford County Sheriff’s Office (HCSO) and UMUCH from October 1, 2016 through September 30, 2021.  Per the memorandum UMUCH will provide HCSO within 48 hours after discharge of an individual treated for a suspected opioid related overdose at a UMUCH facility the following:
    • Date the individual was treated
    • Sex of the individual
    • Race of the individual
    • Age of the individual
    • City of residence for the individual
    • Suspected drug which caused the overdose

  • Worked closely with the Harford County Health Department who provide Peer Recovery Specialists, offering support and treatment options to patients on ALL inpatient units and the EDs at both hospitals.

  • One staff psychiatrist (an addiction expert), provides consults on the medical units and works with the Health Department.

  • The 24/7 hospital consultation service assesses referrals for addiction needs in addition to mental health needs and refers as necessary.

  • Ashley Addiction Treatment leases office space on the hospital campus to provide outpatient therapy and Intensive Outpatient Programming (IOP) to referrals from the hospital and community at-large.

  • Strongly supports accessing the Chesapeake Regional Information System for Patients (CRISP) to better monitoring prescribing patterns across providers.

On February 2, 2017, Dr. Angela Poppe Ries and Chaplain Allen Siegel will co-host a one hour Heroin/Opioid Misuse Forum for UM UCH Team Members. All Team Members are invited to come and share their thoughts, concerns, feelings and comments about the impact heroin and opioid abuse is having upon our Team Members.

To accommodate the day and evening shifts, two sessions will be held.

  • Pre-evening shift:     6:00 – 7:00 pm in the UM UCMC Chesapeake Room.
  • Post-day shift:           7:30 -  8:30 pm in the UM UCMC Chesapeake Room.

Any questions or comments regarding this forum, please contact either Dr. Angela Poppe Ries, ext. 2696, email APoppeRies@uchs.org, or Chaplain Allen Siegel, OFS, MA, BCC, CCISM, ext 1375 or email Asiegel1@uchs.org.

To read more about Opioid use in the US click here https://www.washingtonpost.com/news/wonk/wp/2016/12/13/where-opiates-killed-the-most-people-in-2015/?utm_term=.7f1d749f580c.

*If you're reading this, name three initiatives that UM UCH has implemented to combat the opioid crisis and send to fbarrueto@uchs.org. The first person with the correct answer will win a $20 Starbucks gift card.


Our Future: Transparency, Trust and Online Patient Reviews

After years of academic debate over the role and value of patient satisfaction scores and reviews of health care providers, Yelp, the online powerhouse of documenting customer satisfaction, is forcing the issue. A recent analysis used natural language processing tools to evaluate 17,000 Yelp reviews of 1352 hospitals and showed that they revealed information similar to that covered by 7 of the 11 categories of patient satisfaction included in HCAHPS, along with 12 categories not included in the HCAHPS, such as costs, billing, and scheduling.

Although this free and familiar platform can generate an impressive volume of feedback data, physicians do not always respond positively to the sudden exposure of sometimes negative reviews. Recent reports describe doctors and dentists who have felt compelled to post retaliatory and revealing responses that not only violate HIPAA, but also threaten to undermine the fundamental trust between patients and clinicians.

So what are the goals of transparency efforts regarding patient feedback? How can those aims best be achieved? Whose responsibility is it to provide and share these data? And what are the best media or venues for such sharing? Read more in “Transparency and Trust—Online Patient Reviews of Physicians.”


BioFire Notice

The UM UCH clinical laboratory will begin using the BioFire FilmArray beginning Feb. 1st to identify organisms in positive blood cultures and to identify several resistance genes (MRSA, VRE, and KPC). The BioFire FilmArray blood culture identification (BCID) panel is an automated in vitro diagnostic system that utilizes the nested multiplex polymerase chain reaction (nmPCR) and high resolution melting analysis to detect and identify multiple nucleic acid targets from clinical specimens.  It has the capability of reducing the time interval from the identification of a positive blood culture to identifying the causal organism to less than 2 hours at UCMC and, due to logistics, less than 6 hours at HMH.

The following caveats are important:

  • All results for BioFire will be found in the Lab-Serology Section on Meditech--NOT the Micro Section.
  • Sub-culturing of positive blood cultures is necessary to recover organisms for susceptibility testing and epidermal logical testing, to identify organisms in the blood culture that are not detected by the FilmArray BCID panel, and for species determination of some Staphylococci, Enterococci, Streptococci and Enterobacteriaceae that are not specifically identified by the FilmArray BCID panel assays.
  • A negative FilmArray BCID result does not exclude the possibility of blood stream infection. Negative test results may occur from an infection caused by an organism not detected by the panel. Test results may also be affected by concurrent anti-bacterial/anti-fungal therapy or levels of organism in the sample below the lumen of detection for the test. Negative results should not be used as the sole basis for diagnosis, treatment or other management decisions.
  • A “Not Detected” result for a resistance gene does not indicate susceptibility to a class of antibodies. For example, a “Not Detected” result for the KPC gene does not indicate susceptibility to carbapenems. Antimicrobial resistance can occur via multiple mechanisms. Subculturing is required for species identification and susceptibility of testing isolates.

If you have any questions, please call the lab at 443-643-1400.

V. Dixon King, Jr., MD
Chair, Department of Pathology

Meditech Screen Shots:

The BioFire Blood culture identification (BCID) panel results will display under Laboratory, under the Serology tab.

In order to see the complete individual report, click on the Date/Time header.

The BioFire has interpretative comment under DNA Polymerase Chain Reaction. Click on the bubble to expand.

Or click on Lab Report to see a full printed report.

If an organism is identified by the BioFire BCID panel, the organism will be updated in the blood culture results.

Clicking on the clipboard icon under Report will display the full report. Any organism identified by the BioFire BCID will have a comment under it indicating either "ID by BioFire BCID nucleic acid probe" or "ID by BioFire nucleic acid probe. Susceptibility pending."


National Women Physicians Day - February 3

In an effort to bring awareness and appreciation to women physicians in the field of medicine, Physician Moms Group (PMG) has declared February 3 to be National Women Physicians Day. It is also the birthday of Elizabeth Blackwell, who was the first woman to graduate from medical school in the United States from the Geneva Medical College in upstate New York in 1949.

PMG was founded in 2014 as a social, professional, and educational resource for a community of physicians who are also mothers. Its mission is to provide a platform for connecting like-minded individuals where they can share their medical expertise, seek and provide peer support, collaborate professionally, and build a collective voice to advocate for positive change in health care. In just over a year, the PMG network has grown to more than 48,000 physicians of all medical specialties. Membership spans the globe and is composed of certified physicians who graduated from medical school (M.D./D.O./M.B.B.S.).

The Founder and CEO of PMG, Dr. Hala Sabry, earned her degree from the New York College of Osteopathic Medicine in 2007. She is also the mother to three children who have been her motivation for finding a good work-life balance and her inspiration for the creation of PMG.


CAUTI Update

It takes a team to be green. Check out our latest CAUTI data below.



Flu Update

The CDC is reporting widespread flu activity in Maryland. If you are experiencing flu-like symptoms, please visit one of our ChoiceOne Urgent Care centers to receive a thorough exam and test for the flu. choiceoneuc.com

  • Fallston location 
    2315 Belair Road, Unit 1C
    443-966-3900
  • Aberdeen location (opens March 10)
    744 S. Philadelphia Blvd. (route 40)
    443-345-2650

PSA: Tackling the Stigma of Drug Addiction

Maryland Public Television, in partnership with the Maryland Department of Health and Mental Hygiene (DHMH), recently filmed several PSAs at UM UCMC that focus on the overdose issue that is so significant in many communities, including ours, across the state. Narrated by recently retired Baltimore Ravens linebacker, Zachary Orr, the spots will run throughout the month of February on MPT and the major television stations, primarily during local news times. Thank you to our team members on 1 West and the Emergency Department who assisted during the day-long filming.

You can view a 30-second PSA online at https://vimeo.com/199903314


MEC and P&T Summaries

The following items are from the MEC meeting held on Jan. 11th. 

  • ED Abscess Management Protocol
  • Revisions to Moderate/Procedural Sedation Record and Checklist
  • Hemoglobin A1C – possible overuse of test
  • Blood Culture Reflex Testing – Biofire
  • Biennial Review of Order Sets:
    • Duramorph, Post Injection
    • PCA Epidural Obstetric
    • PCI Epidural and Adjunct
    • PACU Pediatric Medication
    • PACU Adult Medications
    • ICD Pacemaker, pre-procedure
    • Cardiac Cath, post admission/observation
    • ICD Pacemaker, post procedure (no changes)
    • Phenytoin (no changes)
    • Fosphenytoin (no changes)
    • PED phenytoin (no changes)


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • 10th Annual Red Pump Ball 
    Benefitting the Heart and Vascular Institute at UM UCH
    Saturday, Feb. 4, 6 - 11 p.m.
    Water's Edge Events Center in Belcamp, MD

  • Foundations of Spinal Cord Injury Management: Creating a Solid Foundation for Rehabilitation
    Designed to provide rehabilitation practitioners with the fundamental tools to manage spinal cord injured patients. This course will give practitioners with limited or no spinal cord injury experience the basic tools to create a solid foundation for rehabilitation.
    Saturday, Mar. 18, 7:30 a.m. – 3:30 p.m.
    The Conference Center at Sheppard Pratt, 6501 N. Charles Street, Baltimore
    For more information and to register, visit umms.org/rehabconf

  • Red Dress Pink Ribbon: Keep it Moving!
    Exercise and increased activity can cut your chances for heart disease and breast cancer is also beneficial during treatment for either disease. Please share with your patients! Guests will enjoy a morning of fun and wellness. They can shop with our vendors, enjoy great exhibits, interactive activities, refreshments and much more. 
    Saturday, Feb. 18, 8 a.m. - 12 noon 
    Kaufman Cancer Center  
    Registration is required by calling 800-515-0044. Inclement weather date is 2/25; check umuch.org to confirm.

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