June 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, June 2017 topics include:  


Welcome

We have a very busy beginning of the fiscal year 2018. We start with the Clinical Decision Unit (CDU) go live on June 27, 2017. A major initiative to provide care for our patients efficiently both in the CDU and beyond the four walls of the hospital. Our Hospitalist NPs are leading the way with the triage provider pushing the right patient to the CDU, and the CDU NP getting that patient taken care of within 24 hours. Tonya Appleby and her team are geared up and ready to make this a great success for our patients.

Starting July 1, 2017 we have two big opioid initiatives mandated by the state. Every provider that needs a Controlled Dangerous Substances (CDS) in Maryland must register with CRISP and the Prescription Drug Monitoring Program (PDMP). The good news is, if you have Meditech access then you have been registered with CRISP and the PDMP. Special thanks to the great work that Rick Casteel, Stephen Prouse and the rest of their team have done with single sign on for CRISP. Everyone will have a CRISP button that will launch into the PDMP after you sign into Meditech. Also on July 1st, Medicaid prescribers of long acting opioids like methadone or fentanyl patches and prescriptions with  > 90 mg morphine-equivalents will require preauthorization. This will affect surgical patients and we will need to be aware of this new requirement. Check out this website for more information.

Last but certainly not least, we have the Coronary CTA program that will be up and running with Dr. Dave Rubin and Dr. Dipan Desai who are able to read these CT scans. With our new 256-slice CT scan up and running, we will go live July 10, 2017. Any patient with chest pain and a HEART score between 4-6 could be a candidate. 

Beginning with this issue of eFocus, you will also see a common thread in our FY 2018 issues that will mirror our Operating Plan (see below) structured around the four pillars of care: safe care, quality care, empathic care and efficient care. We are organized for success and love seeing the energy around these initiatives like our Hospital Acquired Infection Bundle (look for the HAI Counter in the Safety Update section below!) Enjoy your summer, my friends, and make sure you read every section of eFocus this month!

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


*The first five people to identify five organizational initiatives to drive success in FY18 and email them to [email protected] will be entered to win two tickets to an Ironbirds game.


Safety Update

  • The CAUTI Prevention team streamlined the ordering process for Indwelling Urinary Catheters (IUC) and related nursing documentation. These improvements support appropriate use of IUCs. Perineal/Sacral Wound with Incontinence is no longer an approved indication for an IUC. Data indicates that the risks associated with an IUC outweigh the benefits, while proper peri-care supports the healing of a sacral wound. Be on the lookout for additional enhancements to the IUC ordering process and decision support for the nurse-driven protocol. Additionally, two new nursing interventions to reduce CAUTIs have been implemented; a buddy system for IUC insertion (inserter/observer) and new peri-care cloths with colloidal silver. If you have questions, please speak to our Infection Prevention team. If you have documentation/ordering questions, please call extension 2763 (CPOE). Together we can be CAUTI free! 

  • As an organization we are striving to keep Hospital Acquired Infections (HAI) to a minimum. HAI Composite Score is an aggregate number of the maximum allowable quantity of Hospital Acquired Infections in FY18 and will be updated in eFocus monthly. The FY18 organizational target is 42 cases. The HAI cases to be monitored based on QBR definitions are: CAUTI, CLASBI, SSI (Colon, Hysterectomy), MRSA, C-Diff). Look for the counter like the one below.


Quality Updates

High-Risk Medication Cost Awareness ($) Pilot

To improve communication and increase fulfillment of newly prescribed medications, a pilot will begin August 1, 2017 to alert the care team of medications that historically have high out-of-pocket costs for selected high-risk diagnoses. A dollar sign ($) will be added to the end of select medications and will display on Meditech ordering screens, Medication Administration Record, and prescriptions and discharge instructions. Each dollar sign represents approximately $100 in out-of-pocket costs (i.e. $$=$200, $$$$>$400). The dollar sign should prompt the provider to consider if the patient can afford these out-of-pocket costs, consider an alternative medication, or refer to Case Management for additional resources. The pilot will begin initially with Lantus; other medications will be added as the pilot progresses.

Physician Ordering Screen:

Pharmacy Label:

MAR: 


Osteoporosis Screenings

The providers in Upper Chesapeake Orthopedic Specialty Group are treating not only the injury or illness, but the whole patient. In individuals greater than 50 years with a low impact trauma, the National Osteoporosis Foundation recommends a bone density scan and a work up for osteoporosis. The presence of one fracture resulting from a low impact trauma almost doubles the risk for future fractures. Over ½ of women and up to ¼ of men over age 50 will break a bone due to osteoporosis.

There is a national shortfall for recognition and treatment of osteoporosis after a fracture. The two most devastating fractures that most commonly occur and are a clinical diagnosis for osteoporosis are compression fractures of the spine and low trauma hip fractures. Any low trauma fracture other than toes, hand or head warrant an investigation for osteoporosis (especially in the senior population).

Our team can help reduce the number of individuals returning to our hospital with a repeat hip fracture or other osteoporotic fracture with appropriate recognition and awareness of osteoporosis as well as early treatment and intervention. It is reported that 50% of osteoporosis-related repeat fractures can be prevented with appropriate treatment.  University of Maryland Upper Chesapeake Orthopaedic Specialty group has appointments available for patients to be evaluated for osteoporosis. Please call 443-643-3130 and schedule an appointment with Ben Diffenderfer, PA-C.    


Efficiency Update

ARUP Reference Lab Transition

As UM UCH continues to enhance its services to our providers and community, we are excited to announce the transition of our reference lab work from Quest to ARUP Laboratories. ARUP is a national, independent clinical and anatomic reference laboratory enterprise of the University of Utah. It maintains a dual role as both a national reference laboratory that specializes in esoteric testing and a full-service laboratory for the University of Utah Hospital and Clinics, providing ARUP with a unique blend of reference and hospital laboratory management experience. Rather than competing with UMMS for physician office business, ARUP offers education and consultative support to assist UMMS in improving diagnostics, streamlining operations, and reducing total cost-of-care. A commonality shared between ARUP and UMMS is to keep testing as close to the patient as possible. In light of this, they will help UMMS insource testing and apply real-time data analytics to monitor send-out testing and expenditures. Below is a brief summary of ARUP’s services:

  • ARUP performs 99.5% of UMMS’s testing in one central location, operating 24 hours a day, 7 days a week, decreasing turnaround times.
  • Over 90 Medical Experts are available to UMMS, through ARUPs pathologist-on-call program, for clinical consultation to complement our in-house expertise.  Access to Live Personnel through a single phone number (800) 522-2787, 24 hours per day, 7 days a week, 365 days a year.
  • More than 50% of the nation’s university medical centers, pediatric hospitals and teaching hospitals choose ARUP. 

UM UCH's transition from Quest to ARUP occurred on June 26, 2017. Baltimore Washington Medical Center converted to ARUP over a month ago, with other UMMS hospitals going live over the coming months. We anticipate this transition with go seamlessly, as our laboratory leadership and personnel have been working closely with ARUP for months to ensure a smoot rollout. Should you have any questions regarding this transition, please feel free to contact the UCMC Main Lab at 443-643-1400.


Empathy Updates

Patient Experience

Congratulations to the physicians on the improvement in patient experience scores (see below). The hospitalist team has implemented several new initiatives over the last year including a new rounding model, Language of Caring training, and patient call-backs.  

 

Friends and Neighbors Helping Friends and Neighbors

June has been an amazing month thanks to our dedicated volunteers, donors, and community partners generously supporting the community health care mission of UM UCH. Both the annual Amanda Hichkad CCA Celebration Walk at Ripken Stadium and the 18th annual Senator Bob Hooper House Hospice Regatta were held on Saturday, June 3. Together, these two events hosted 2,000 guests and raised $250,000 in support of Cancer LifeNet at the Kaufman Cancer Cancer and hospice care for residents in need at the Senator Bob Hooper House (more specifically, 500 nights of care will be provided free of charge to patients in their final stages of life at the Hooper House)! Thanks to all for helping us make a difference right here in our community.


Mobile Fingerprinting at UCMC

UM UCH will have a mobile unit at UM UCMC (Medical Staff Lounge – Ground Level) to complete the fingerprinting required for renewal of your state medical license on the following dates:

  • Monday, July 10th from 8 a.m.- 1 p.m.
  • Wednesday, July 19th from 2 p.m. – 6 p.m.
  • Wednesday August 16th from 8 a.m.- 1 p.m.

Appointments must be scheduled by clicking the following link: https://app.acuityscheduling.com/schedule.php?owner=13853761

You must bring the following with you to your scheduled appointment:

  • Fee $55 (payable by CASH, or credit card info can be obtained and charged back to office)
  • Valid State or Federal ID
  • LIVESCAN Preregistration form 

Please contact Katie McCardell or the Medical Staff office at 443-643-1550 with any questions. 


Nominate a 'Top Doctor': Deadline Approaching

Baltimore magazine is preparing a feature on the region’s best physicians, based on peer polling, and they need your help. This is historically one of the best-read features (and most sought-after back issues) of Baltimore. Please visit baltimoremagazine.com/about/top-doctors-survey and nominate your peer physicians in various specialties, other than yourself, to whom you would send a member of your own family for treatment. 

MEC and P&T Summaries

The following items were approved during the MEC meeting held on June 14th.


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • 40th Emergency Care Symposium, Hosted by UM UCH 
    Friday, July 14, 6-11:30 p.m., Richlin Ballroom in Edgewood 
    David Gatz, MD, UMMS emergency medicine physician, will present "Buzz Killers: The Dangerous New Street Drugs You Need to Know About" 

    Buffet dinner, including crabs, will follow program.

    *Advanced registration is required by calling 800-515-0044 by July 8, 2017. The event is FREE to attend; however, if you register and do not attend you will be responsible for the cost of food and beverage as set by the Richlin ($38.50 per person).

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