November 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, November 2016 topics include:


Welcome

By the time you start reading this month’s eFocus, we will have eaten our turkey around a table of family and friends. It is during Thanksgiving and other holidays that we should all take a small moment to thank those physicians, APCs, nurses and team members who work these shifts. Health care is demanding on a good day and the rate of change has been accelerating. All too often we worry about the next soft tissue infection or the next catheter associated UTI and forget to thank people for the sacrifices they make to work during nights, weekends and holidays.

We have another stellar performance from both Emergency Departments with regards to patient experience. UM HMH had an incredible 91st percentile ranking for its overall score during the month of September and both EDs have been amplifying their patient callback programs. Please take note of the graph in this issue that shows how much of a difference calling a patient and checking on his/her well-being after discharge improves the patient’s perception of their hospital experience.

Remember to look for the Books for Babies donation boxes located in multiple locations, including both cafeterias, physician lounges, Pediatrics and the Pediatric Emergency Department. We are looking for new board books to donate to families and promote reading to their newborns. 

And finally, congratulations to Dr. Nasrin Huq for winning a pair of Ravens tickets for completing the Healthstreams Provider Survey. Look closely in this issue of eFocus for your chance at winning tickets to this Sunday's (Dec. 4) game!

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


Patient Experience and Callbacks

Congratulations to the Emergency Departments at both of our hospitals. During the month of September, UM HMH achieved a composite score of 78, placing them in the 91st percentile, and UM UCMC achieved a composite score of 70. 

The chart below illustrates the difference between patients that received a callback and those that did not at UM UCMC. Look specifically at communication with nursing and docs question–out of this world! Database size is 2045 and these two questions are near or above the 90th percentile.

Callbacks

Cardio Oncology Program

Although necessary for cancer care, many of the drugs and treatment regimens used to fight cancer can also damage heart muscle.  Cardio oncology is the caring of patients with cancer who are either at risk for developing heart disease (due to their cancer treatment) or who are already suffering from the condition.

The combination of earlier cancer diagnosis, the increased use of traditional and new systemic treatments, and advances in cancer care over the last decade has lowered the cancer mortality rate, but has also led to more patients being diagnosed with cardiovascular disease. A patient’s quality of life and survival is deeply affected—whether he/she is faced with having short- or long-term co-morbidities or is now cancer free yet living with heart disease that may be attributed to the previous cancer treatment. 

Cardiovascular conditions that can result from cancer treatment include:

  • heart failure
  • arrhythmias
  • valvular disease
  • accelerated atherosclerosis
  • pericardial disease

The Kaufman Cancer Center (KCC) and the Heart and Vascular Institute has developed a Cardio Oncology Program designed to optimize cancer care in a multi-disciplinary setting that may help decrease the adverse cardiovascular effects that cancer treatment can cause. In collaboration with the KCC care team, Dipan Desai, DO and Mitika Maddula, MD of Upper Chesapeake Cardiology lead the new program.

The Cancer Center’s number one goal is always quality patient care for individuals with cancer. Thanks to this new program, we can help individuals prevent or minimize issues with heart disease, as well.

Stat: There are roughly 14.5 million people fighting and surviving cancer in the U.S. Fifty-one percent have died solely based on their cancer diagnosis or recurrence of the disease. However 33 percent passed from having cardiovascular disease caused by, or exacerbated by their cancer treatment.

 "Patients who are undergoing cancer treatment start with cancer care as the main focus but they may slowly morph primarily into cardiology patients over the long term.  This program gives us the opportunity to change cancer treatment before the damage becomes permanent or to initiate supportive therapies as the long term consequences of the chemotherapy treatment become apparent.”  - Mark Lewis, HVI

For patients on a number of the newer chemotherapy agents, a baseline echo with subsequent serial echoes are done to monitor for changes in ejection fraction and in strain measurements, which examine subclinical effects.  Patients who have, or who are at risk for heart disease or in whom the EF changes are seen are referred to the cardio-oncology clinic for cardiac consultation, during which clinical pathways are established. Patients are seen in the KCC’s multidisciplinary clinic every other Tuesday from 1 – 4 p.m. For more information or to refer a patient, please call 443-643-1956.

*If you're reading this...the first five people who respond to fbarrueto@uchs.org with the cardiovascular conditions that can result from cancer treatment will be entered in a raffle to win Ravens club level tickets to this Sunday's game (12/4). Good luck!


ChoiceOne Urgent Care

Many patients have faced the dilemma of where to seek care on a weekend or in the evening.  In the past, the default option for most was the Emergency Department at UM UCMC, regardless of whether their condition was an emergency or not. With the new partnership between UM UCH and ChoiceOne Urgent Care we are shifting that paradigm and encouraging patients to seek care for non-emergent conditions outside of the ED. Over the next several months there will be a marketing push to educate patients on what types of conditions they should go to the Emergency Department for and which ones can be handled at ChoiceOne Urgent Care. Patients being discharged from the ED will be provided with informational material and local Primary Care offices will also be given similar material. 

At ChoiceOne patients can also receive bridge care between their visit in the ED and when they can be seen in their Primary Care’s office or by the specialist they are being referred to. Additionally, if patients need minor follow-up care from the ED (suture removal, recheck of abscess or cellulitis, recheck of elevated blood pressure, etc.) ChoiceOne can manage this follow up in a much more cost effective environment than having the patient return to the hospital. Every patient’s medical record will be shared back with the Primary Care Provider the same day he/she is seen at ChoiceOne.  ChoiceOne does NOT offer Primary Care services and as such will be an extension of your practice, not a competitor.

ChoiceOne Urgent Care Centers are fully accredited by the Urgent Care Association of America. They participate in a rigorous monthly medical Quality Assurance Program that ensures that they are offering the highest level of care with a focus on evidence based treatments.

For more information, visit http://umuch.org/programs/urgent-care-choiceone.


In Case You Missed It

In order to offer associates a faster, more convenient way to access the most up-to-date research, journals, and best practices, UM UCH & UM HMH are subscribing to Wolters Kluwer's Ovid resources. Ovid is an online service that offers access to peer-reviewed journals, ebooks, databases and evidence-based clinical research.

All employees have access to OvidMD, Ovid MEDLINE, over 30 Clinical Journals such as Hypertension, Stroke, Circulation, OB/GYN, Annals of Surgery, Critical Care Medicine, 46 Nursing Journals such as AJN, JONA, Nursing, Nursing Research and the Joanna Briggs Institute, EBP databases including Cochrane Collaboration & ACP Journal Reviews, New England Journal of Medicine, JAMA, over 70 Nursing eBooks and over 40 Primary Clinical ebooks.

Ovid Clinician Access links to journals and articles in the user's specialty, as well as a clinical search database, which searches UpToDate, MEDLINE, clinical guidelines, A-Z-Drugs, PubMed, and more. OvidMD provides quick access to the most current clinical research to support point-of-care decisions, tracks your research to deliver CME.

UM Upper Chesapeake Health worked with Ovid to develop user-friendly onsite access to these resources, without requiring a login or password.  Resources can be found on the Intranet under Resources and also on the Nursing Portal. The attachment provides links to access information remotely, from home. Access is also available via the OvidToday® iPad app.


Infection Prevention Update

Help Prevent Healthcare-Associated Infections: We all play a major role in preventing central line-associated bloodstream infections (CLABSIs). Please refer to this handy chart and print as a reminder for your team.

CLABSI


MEC and P&T Summaries

The following items are from MEC meeting on 11/9/16.  

  • Lactate critical value change:  ≥ 2
  • Heart Score
  • CURB 65
  • Order Sets:
    • FEES
    • tPA Exclusion Criteria
    • Chemotherapy order sets

Quality Updates

  • What is MACRA (Medicare Access and CHIP Reauthorization Act) of 2015? 
  • In the midst of an unprecedented "change management experience," the AHA's top quality executive wants leaders to take a page from other industries that must successfully manage high-risk processes. Read more in 'Let Hospital Staff Lead Quality Improvement Effort'

Safety Update

Maryland Prescription Drug Monitoring Program Registration
As you may know, recent state legislation made changes to the Maryland Prescription Drug Monitoring Program (PDMP), an important clinical tool administered by the Department of Health and Mental Hygiene and made available through the CRISP Query Portal. HB 437 (Chapter 147, 2016), the bill that became effective Oct 1, 2016, requires that all CDS prescribers and pharmacists licensed in Maryland are to be registered with the PDMP by July 1, 2017.  

In order to obtain your unique PDMP Registration Code, please visit the link at https://crisphealth.force.com/crispregkeydata, and enter your personal DEA and license number. If you have trouble accessing the PDMP, please contact CRISP at 1-877-95-CRISP or support@crisphealth.org

Glucometer Regulations
College of American Pathologists (CAP) regulations require that manufacturer recommendations be followed when running Laboratory tests.  Nova is the manufacturer of the glucometers that are in use at both UM HMH and UM UCMC. Nova has stated that patients with decreased peripheral blood flow cannot be tested for glucose with a glucose meter using a capillary sample (i.e. obtained by finger stick) as this may not reflect the true physiological state of the patient.  Only fresh whole blood or whole blood (arterial or venous) collected in lithium heparin syringes or blood collection tubes can be used on the glucometer strips. Examples of conditions with decreased peripheral blood flow include, but are not limited to:

  • Severe hypotension and shock
    - One vasopressor OR
    - Systolic blood pressure <90 mm Hg (unless <90 mm Hg is normal baseline)
  • Severe dehydration and hyper-osmolar-hyperglycemia (with or without Ketosis)
  • Hypothermia <36°C
  • Severe edema (3+ pitting), or cyanosis in fingers

Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

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., Second Wednesday of each month
    UM UCMC Maryland Room 
  • Credentials Committee7:30 - 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