Focus: April 23, 2009

FOCUS

A publication for Christiana Care Health System physicians and employees April 23, 2009

Christiana Care’s next green initiative: Purchase wind-generated electricity

VO L U M E 2 0 , N U M B E R 7

Published every two weeks by Christiana Care Health System External Affairs P.O. Box 1668 Wilmington, DE 19899-1668 www.christianacare.org

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earching for greener energy, Christiana Care’s Facilities and Engineering team found one good answer blowing in the wind.

Starting Jan. 1, 2010, a wind farm being developed of Schuykill and Columbia counties of eastern Pennsylvania will supply much of our electricity.

Christiana Care signed a nine-year agreement with Iberdrola Renewables of Radnor, Pa., to purchase 40 million kilowatt hours of electricity annually from its Locust Ridge II wind farm.

That amount represents approximately 15 percent of the output of the new 102-megawatt, 51-turbine wind farm – enough electricity to power about 3,700 homes.

IN THIS ISSUE Clinical News order entry

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A look back at Education Week

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Paramedic training for police officers

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Teamwork tackles novovirus

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Publishing, Presentations Awards, Appointments

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General News Dr. Rizzo visits U.S. House of Representatives

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Steady supply of green electricity According to Bob Mulrooney, Christiana Care vice president for Facilities and Services, the Locust Ridge II wind farm will provide between 30 percent and 40 percent of Christiana Care’s annual electricity needs.

The deal assures a steady supply of pollution-free electricity. “You’re harnessing the power of wind to produce electricity,” says Mulrooney. “From an environmental standpoint, it’s a clean and renewable source.

Starting Jan. 1, 2010, Christiana Care will begin purchasing 30 to 40 percent of its annual electricity needs from Locust Ridge II wind farm in Pennsylvania.

Because we are a health care provider, it’s a natural fit for us,” Mulrooney says.

In addition to the environmental benefits, the deal provides cost benefits: Christiana Care’s electricity costs will remain unchanged during the nineyear contract.

CLINICAL NEWS

Computerized doctors’ orders will transform patient care New software will speed pace of filling prescriptions, improve patient safety In January 2010, a new, multimilliondollar software system that works with PowerChart, the electronic medical record system, will put Christiana Care in the forefront of hospitals in the United States.

According to a survey by the New England Journal of Medicine, only 17 percent of U.S. hospitals today have implemented computerized physician order entry (CPOE), lifesaving information technology.

“CPOE is an extraordinarily powerful tool for patient safety and a great step forward for Christiana Care,” says James Newman, M.D., chief medical officer.

Improving patient safety Submitting orders electronically reduces the risk of medical errors.

With CPOE, pharmacists, laboratory technicians and others who need to read the orders no longer have to question illegible handwriting and inconsistent medical abbreviations.

“The legibility issue dramatically improves with CPOE because we’re not dealing with handwriting from 300 or 400 physicians,” says Al Helmeczi, vice president for Pharmacy Services.

Saving time and costs The new system will also eliminate the need for transcribing orders and scanning doctors’ handwritten orders into the system before sending them to the pharmacy or lab.

Removing these steps in the process

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will improve overall order processing time, making ordered medications more readily available. And streamlining the process might lead to cost savings and give pharmacists more time to support direct patient-care activity.

Christiana Care’s Pharmacy Services fills about 1.5 million orders each year.

Increasing order efficiency At the heart of the new CPOE system will be 500 order sets, collections of orders physicians typically write for patients with particular diagnoses. To give patients with the same diagnosis the safest and most effective treatment, order sets use best medical practices to standardize patient care.

“When you deliver care that’s standardized, it’s safer and of higher quality,” says Senior Vice President for Quality and Patient Safety Sharon Anderson.

But the order sets don’t dictate to physicians how they should practice medicine. Rather, they provide what Chief Medical Information Officer Terri Steinberg, M.D., calls “ease of ordering.” The new system is “single click, fast and efficient,” she says.

Christiana Care’s new system, according to Dr. Steinberg.

“We’ve been able to look at what’s worked and what hasn’t worked at other hospitals,” she says.

Engaging physicians According to Dr. Newman, physicians who are using technology more and more in their practice resist this type of new technology less than they would have five years ago. He attributes physicians’ growing acceptance in part to the fact that they have been engaged in the planning process at Christiana Care.

Mary Jones Gant, MSN, RN, RRT, CS, a clinical specialist in Performance Improvement and part of the team implementing CPOE, says she has found physicians to be receptive.

“They are embracing the idea that this is going to improve patient care,” she says.

But no one believes that switching completely to CPOE is something that will happen without hard work.

Learning the system For the past year, about 100 Christiana Care physicians have been reviewing the 100 existing paper order sets and developing new ones. When CPOE launches in January, physicians will have access to about five times more order sets than most hospitals have.

Implementing the system

“There’s definitely a learning curve,” says Edmondo Robinson, M.D., MBA. “It probably took me a couple of weeks before I became fluent in using this system.” And he had substantial experience. Before joining Christiana Care, Dr. Robinson, a hospitalist, worked at three hospitals that used CPOE.

Watching health systems that have already implemented CPOE has been a real advantage for the designers of

But Dr. Robinson says he soon began to enjoy the new technology and con-

siders transformation to CPOE inevitable.

“The idea of doctors writing things on paper that involve the care of patients is a little bit ridiculous in this day and age,” he said. “I can’t imagine years from now doctors are going to be handwriting anything.”

Using a computer to write medical orders is part of morning rounds led by attending physician Edmondo Robinson, M.D., MBA (left). Residents with him, from left, are Linsey O’Donnell, D.O., Amanda Kijac, D.O, Chandrakala Kathiravan, MBBS, and Keala R. TeKolste, D.O.

Study examines emotional effects of breast cancer on relationships Research at the Helen F. Graham Cancer Center will provide an intimate look into the relationships of women with breast cancer and their partners, providing important insights on how couples can cope with stress and support one another.

University of Delaware and will involve 50 couples.

“Cancer affects not only the individual but her loved ones, as well,” says Scott Siegel, Ph.D., health psychologist. “By understanding these processes, we can be in a better position to offer meaningful help and counseling.”

In the study, each partner will register his or her feelings for 10 days using a Personal Digital Assistant (PDA), about the size of a cell phone. The partners will rate such factors as how much stress they have experienced that day, positive and negative emotions, level of connection and emotional intimacy, and how much support they have received or given their partners.

A two-year, $160,000 grant from the National Cancer Institute will fund a collaborative effort with the

Dr. Siegel says a cancer diagnosis can be so overwhelming that partners get caught up in their own stress and do

not support one another. Learning to manage those emotions can significantly improve the patient’s wellbeing, emotionally, socially and medically.

“Decades of research indicate that people who report more social support, including women with breast cancer, have better outcomes, in part because they are more compliant with their doctors,” he says. “They are more likely to complete all their treatments.”

That’s vital because advances in care are enabling patients to live longer and with a better quality of life.

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CLINICAL NEWS Heart Transplant Evaluation Program offers better logistics Only three months after receiving a new heart, William Wichess has a spring in his step again.

provided his risk stratification testing close to home.

room of the Heart Failure Program, where he greeted Cathy Johnson, RN.

New heart, new life

Wichess was 43 when he had his first heart attack, the same age his mother was when she died of cardiac arrest.

His father died of a heart attack at 58.

In the past 12 years, Wichess has been hospitalized more than a dozen times.

Wichess, 55, went on the transplant list in December 2008. On Jan. 7, he received a donor heart at the Hospital of the University of Pennsylvania, one of several regional transplant centers with which Christiana Care works to provide seamless coordination of care.

“My neighbor didn’t believe I had a heart transplant,” he tells her. “I have to show people my scar to convince them.”

“His heart was failing in every way,” says Mitchell Saltzberg, M.D., director of the Heart Failure Program.

“From the moment I woke up from the operation, I could feel the difference. I could feel that my new heart was working,” Wichess recalls. “Before, I couldn’t walk three feet without having to sit down.”

Until last summer, Wichess would have had to travel from his home in Newark to a regional center in Baltimore or Philadelphia to determine if he was candidate for a heart transplant. But Christiana Care’s Heart On a recent morning, the former Marine strode briskly into the waiting Transplant Evaluation Program

These days, Wichess is walking at least three miles a day and has started jogging. He spends time at Civil Engineering Associates in Middletown, where he is a partner.

Long-term care at home Because Christiana Care provides his long-term medical care, Wichess does not have to travel to Baltimore or Philadelphia for follow-up tests or evaluations. “Mr. Wichess is a true success story, an example of the way the system works.” Dr. Saltzberg says.

In 2007, about 30 patients from areas served by Christiana Care went to hospitals in Philadelphia or Baltimore for heart transplants. But that number represents only a fraction of the people with advanced heart failure evaluated at Christiana Care each year for possible transplant.

Most of these patients are treated with medications and never have to leave home. If a transplant will improve a patient’s chance of survival, however, staff coordinates care with regional transplant centers so patients spend as little time as possible away from their families and doctors.

Heart Failure Program Medical Director Mitch Saltzberg, M.D., listens to William Wichess’s new heart while his case manager, Cathy Johnson, RN, takes his pulse. Marine Corps veteran Wichess had a heart transplant Jan. 7 at the Hospital of the University of Pennsylvania and receives long-term care at Christiana Care’s Center for Heart and Vascular Health.

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Focus on Excellence – Best Practice Review Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly review important topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff to better articulate our safety practices during an unannounced survey.

PCA PUMPS Q. Who is authorized to activate the PCA dosing button?

A. The patient is to push the PCA button to receive pain medication. However, Registered Nurses in the Critical Care & Diagnostic Areas are also authorized to activate the dosing button only if the patient meets criteria.

Q. What criteria must be met in order for an RN in Critical Care & Diagnostic areas to activate the dosing button of a PCA? A. An RN in the Critical Care or Diagnostic Area can activate the button only if the following two criteria are met: 1. The button is out of reach for the patient.

2. The patient verbalizes that he or she is in pain and requests pain medication.

Q. If an RN is not available, is there ever an instance when a non-licensed employee can activate the dosing button?

A. No. The only other qualified person would be a physician. If neither is available, the patient’s primary care RN must be called to activate the dosing button.

To ask questions, contact the content expert: Gwen Ebbert, RN, SDS 733-3052. To reach the Safety Hotline, call SAFE (7233) from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further information is available in the Archives of Best Practices. From your portal, choose Focus on Excellence, Joint Commission

Diana Dickson-Witmer, M.D., associate medical director of the Christiana Care Breast Center at the Helen F. Graham Cancer Center, will join the American Society of Breast Disease’s (ASBD) Education Program Committee for a three-year term.

As a member of the Education Program Committee, Dr. DicksonWitmer joins a national panel of breast cancer experts to oversee the development of U.S. and international medical education programming that promotes multidisciplinary breast health care.

Aman U. Buzdar, M.D., professor of medicine at the University of Texas

M.D. Anderson Cancer Center, who chairs the committee, notes, “our goal is to ensure the highest quality medical education symposia and courses available to breast specialists in the United States.”

Society Executive Director Brooke Breslow adds, “The addition of Dr. Dickson-Witmer’s perspective, through her involvement with the Commission on Cancer and her leadership role in a multidisciplinary breast center, will help the Society fulfill its mission.”

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CLINICAL NEWS

Researchers, clinicians establish monthly stem cell working group Physicians, scientists conduct open forum to share and develop ideas

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Researchers and clinicians from Christiana Care, the University of Delaware, Nemours/Alfred I. duPont Hospital for Children and the Delaware Biotechnology Institute meet monthly at the UD as part of the Stem Cell Working Group.

ancer researchers led by Bruce Boman, M.D., Ph.D., director of Cancer Genetics & Stem Cell Biology at Christiana Care’s Helen F. Graham Cancer Center, meet monthly to share their knowledge and understanding of adult human stem cells.

The Stem Cell Working Group provides a forum for researchers and clinicians from Christiana Care, the University of Delaware, Nemours/Alfred I. duPont Hospital for Children and the Delaware Biotechnology Institute to discuss their work, listen to feedback from other scientists and collaborate on joint research projects.

They started meeting in January 2009 because, while a number of scientists at the member institutions were engaged in stem cell research, “there was no mechanism for people to interact and share their research,” Dr. Boman says. “Ultimately, what we want to do is translate stem-cell targeted therapies to clinical practice.”

Testing ideas “We’re trying to figure out problems inherent to cancer from a stem cell perspective,” says Robert Sikes, Ph.D., associate professor of biological sciunces at the University and associate director of the Center for Translational Cancer Research (CTCR). The CTCR is a research partnership that includes the Helen F. Graham Cancer Center, UD and Nemours. “We also want to know more about what regulates the

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normal behavior of stem cells—how they behave and grow,” Sikes says.

Testing one’s idea against an audience of fellow researchers can improve the quality of the work done at member institutions, Sikes adds.

“If you’re only going to live in your dark box, there’s never going to be any light shed on anything.”

Partners on grant applications Dr. Boman, who published innovative research for identifying colon stem cell markers in the New England Journal of Medicine April 15, 2009, says the new working group also should lead to more applications for joint research grants.

“The hope is this will enhance research within the region and bring in grant award dollars and philan-

thropic dollars and support from other sources,”Dr. Boman says.

Dr. Boman and Deni Galileo, Ph.D., another associate professor with UD’s department of biological sciences, are seeking a grant from the newly formed Delaware Health Sciences Alliance to fund joint research into what causes normal colon stem cells to mutate into colon cancer stem cells.

The Alliance is a new partnership that fosters closer research and clinical ties among Christiana Care, UD, Nemours and Thomas Jefferson University (see FOCUS April 9 issue cover story).

Dr. Boman says the Stem Cell Working Group also wants to expand membership to include representatives from area pharmaceutical and biotech companies, which have the capacity to develop lifesaving medications from the discoveries made in the lab.

Specialized cushions help hasten healing of pressure ulcers Nursing and Occupational Therapy are making major progress at improving patients’ skin integrity by using specialized seat cushions to fight hospitalacquired sacral pressure ulcers and tissue shearing.

“Seven to 33 percent of patients in acute care develop pressure ulcers, yet insurance no longer covers wounds acquired during hospital stays,” reports Patricia Poet, MOTR/L, OTD, Occupational Therapy supervisor and program coordinator.

Health systems now assume those costs, which the Institute of Healthcare Improvement estimates at $1.3 billion per year.

Promotes wound healing Christiana Hospital’s pulmonary step-down unit (3D) piloted the cushion last year, and now it is a systemwide program. In one example, a 48-year-old male achieved dramatic improvement of a 9 x4 cm, stage-II sacral wound.

Initially able to sit in a chair for only 30 minutes at a time, within three weeks of using the specialized, high-profile cushion he was able to sit for two hours at a time.

With two months, the wound shrank to 2 x 2 cm.

Cushions available systemwide Each nursing district maintains three to five reusable cushions.

Nearly 750 nursing, laundry, maintenance and rehabilitation services staff are trained in their care, use and maintenance. Five cushion styles enable nurses to meet individual patient needs. Wound ostomy nurses and occupational therapists are a resource for questions

or concerns.

“Kudos to our nurse managers for making this patient-focused project a priority,” says Staff Development Specialist Carmen Pal, RN, PCCN. “The cushions allow patients with

even stage III or IV wounds to get out of bed and promote wound healing.” For more information or questions, call Patricia Poet, MOTR/L, OTL or Claudine Wujcik, MS, OTR/L at 302-733-1071.

Therapeutic Notes The Joint Commission (JC) National Patient Safety Goal (NPSG) 3E aims to reduce the likelihood of patient harm when therapeutic (as opposed to prophylactic) anticoagulation is used. The NPSG, issued in 2007, introduced elements of performance and expectations of implementation to be met on a specified time line throughout 2008.

(with the exception of confirmed DVT or suspected/confirmed PE, in which case the baseline lab is ordered concurrent with administration of the first dose). Pharmacists and nurses reviewing warfarin orders are required to verify there is a current INR and to clinically evaluate the result prior to dispensing or administering the first dose.

The scope of the goals is broad, encompassing both inpatient and outpatient areas wherever unfractionated heparin, low-molecular weight heparin and warfarin are used.

Order sheet MD5605 is in use

To this end, two new tools have been developed: (1) a revised heparin preprinted order sheet that will be rolled out in June (MD5613), and (2) a comprehensive warfarin order sheet (MD5605). This article will introduce the warfarin order sheet and how it helps to meet NPSG 3E goals. In a later issue of FOCUS the revised heparin order sheet will be discussed.

The prescriber can quickly and easily: ■ Order a baseline INR. ■ Initiate follow-up INR schedule.

■ Select from a number of dose methods specific to patient need and prescriber preference.

Required element of performance The primary requirements, with respect to warfarin, address the need for appropriate monitoring. A current baseline International Normalized Ratio (INR) is available for all patients starting or receiving warfarin therapy. A current INR is available and is used to monitor and adjust therapy.

Christiana Care requires an INR current to the present admission for all patients before warfarin therapy can commence

The preprinted order sheet streamlines warfarin dosing, ordering of the associated labs, and appropriate follow-up on a single sheet.

The Warfarin Therapy (MD5605) order sheet used to initiate therapy will improve patient care by: ■ Meeting NPSG 3E requirements for warfarin therapy.

■ Streamlining the process for prescribers, pharmacists and nurses.

■ Improving the clarity of orders and communication of the goals of therapy.

■ Preventing unnecessary delays in initiation of therapy.

Comments or questions should be directed to Medication Safety Specialist Dean A. Bennett, RPh, dbennett@ChristianaCare.org.

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E D U C AT I O N N E W S Scientific Paper Awards cap Education and Research Week

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he 2009 Scientific Paper Awards reception April 2 at the Ammon Education Center marked the close of Education and Research Week at Christiana Care.

President and CEO Robert Laskowski, M.D., welcomed about 150 honorees and guests, telling them: “Education at Christiana Care is key to our ability to serve our neighbors with excellence. I congratulate all of my fellow educators at Christiana Care for inspiring and leading our organization to excel.”

Vice President, Academic Affairs and Research Brian Little, M.D., Ph.D., observed that “True transformation comes about through willingness to learn and change.”

Leadership built on spirit “With the spirit shown by our educators and the promise of the Delaware Health Sciences Alliance, we can become a true model for educational innovation and leadership for our region and the country.”

Rosa M. Colon, Ph.D., vice president of System Learning, said “This year’s Education and Research week allowed us to come together as a multidisciplinary learning community to explore new ways to enhance how we learn, change our culture, and leverage learning technologies to enable transformation.”

Colon congratulated more than 800 individuals who participated in the weeklong events that included educational workshops, expos and learning needs surveys. “It is exciting and powerful for us all to connect like a big think tank to learn new ways to collaborate with each other and serve better our patients.”

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“Education at Christiana Care is key to our ability to serve our neighbors with excellence.”

– Robert J. Laskowski, M.D., MBA President and CEO, Christiana Care Here are some highlights of the 2009 Scientific Paper Awards: The Lewis B. Flynn Award and Best Fellow’s Paper went to cardiology fellows Vinay R. Hosmane, M.D., MPH, and Nowwar Mustafa, M.D., for their study of 98 patients at the Center for Heart and Vascular Health, published Feb. 3 in the Journal of the American College of Cardiology, which showed that patients resuscitated from cardiac arrest in the early stages of a heart attack have a good chance of survival and full neurological recovery following emergent coronary angiography.

The Paul Shaw Memorial Award wen to preliminary year Internal Medicine resident Omer Awan, M.D. for his case reports documenting the successful use of endovascular stents to repair abdominal aortic aneurysms in patients with unfavorable anatomies.

The Best Case Report went to MEDPEDS resident Cherilyn Hall, M.D., for diagnosing a case of dermatitis resulting from a four-year-old’s misadventures with a box of chocolate laxatives. Her case report is slated for publication in the Journal of Emergency Medicine.

The People’s Choice Award for Best Poster went to a Respiratory Care team led by Joel Brown II, BS, RRT. The poster illustrates how Virtual Education and Simulation Technology (VEST) can build both clinical competency and confidence at bedside.

Key educators and contributors recognized at the event included more than 45 volunteer educators for their dedication and outstanding service in facilitating learning programs in Nursing, Safety, and Quality, Team Training and System Learning; and program assistants who work with program directors to support residency training among Christiana Care’s many residency programs.

The Medical-Dental Staff Best Abstract Award went to Tequa SalehiRad, D.O., a MED-PEDS fourth-year resident, for her long-term study of children with perinatal HIV exposure.

Her study of electronic patient records See p. 17 for additional awards informaat Nemours/Alfred I. duPont Hospital tion from the 2009 Scientific Paper for Children, showed babies with Awards reception. maternal HIV exposure in the womb subsequently experienced more chaotic living conditions with more parental substance.

AAMC President Darrell Kirch, M.D., urges changing current culture of U.S. medical practice During a Health and Society Lecture Series and Grand Rounds presentation on April 1, one of medicine’s most innovative thinkers challenged his audience to commit to changing the way medicine is practiced in the U.S. Darrell G. Kirch, M.D., president and chief executive officer of the Association of American Medical Colleges, delivered “Can We Believe in Health Care ‘Change’?” to an audience of about 200 at the John H. Ammon Medical Education Center.

Capping off Christiana Care’s Education & Research Week, which concluded on April 2, Dr. Kirch’s talk was also broadcast to an audience at Wilmington.

Changing the culture Dr. Kirch says the current culture in which physicians work autonomously, without communicating with one another about their patients, needs to be replaced by a new patient-centered model built on collaboration “a culture in which we all teach and learn.”

According to Dr. Kirch,“We’ve got to have the courage to say ‘I am committed to trying to change the culture.’”

He is a psychiatrist and neuroscientist and former dean of the medical school at The Pennsylvania State University and CEO of the Milton S. Hershey Medical Center at Penn State,

Need more than just money and strategy To build revenue, he says, we need something more than money and strategy. “The answer is culture.”

Given the widespread dissatisfaction with the current system, change of some kind is inevitable, says Dr. Kirch.

The U.S. devotes 16 percent of its gross domestic product to health care, far more than other industrialized countries. Yet, many patients are unable to find a primary care doctor or afford health insurance.

“Virtually everybody in America is unhappy about some aspect of health care,” Dr. Kirch says.

Focusing on patients and physicians The new culture needs to be not only more patient-focused, but also more accommodating to a new generation of physicians, whose personal and professional aspirations are different from those of earlier generations, Kirch says.

Rethinking education and the current dialogue He notes that a growing number of physicians will, at some point in their career, take a break from the practice of medicine in order to raise children or care for aging parents.

Creating a new culture will also

Darrell G. Kirch, M.D., president and chief executive officer of the Association of American Medical Colleges, spoke about transformative change in health care April 2 at the John H. Ammon Medical Education Center. require rethinking the traditional model of medical education in which students go in lockstep from premedical courses through their residency—an educational process Kirch called “the most discontinuous continuum that man ever invented.”

And inventing a health care model that reduces the disparities in how health care is dispensed in this country will also mean changing the current dialogue, Kirch says. “Are we willing to talk not about what we want but about what we’re willing to give up to create a more just system?”

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E D U C AT I O N N E W S

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n April 8, the largest group of graduates (25) completed the Achieving Competency Today (ACT): Health Care Quality, Cost, Systems, and Safety course. The 12-week, graduatelevel course teaches systems-based practices and collaborative team skills while promoting the learners’ role as advocates for quality and safety in patient care.

To-date, 120 Christiana Care nurses, residents, attending physicians, pharmacy residents and allied health professionals have taken the course.

Joining the graduates was Teri Foy, MEd, RRT, the seventh ACT course facilitator to complete the facilitator training program.

THE PROJECTS Still need that central line?

Talk about it!

This project was intended to decrease central line bloodstream infection (CLBSI) through raising team awareness of the need for daily assessment of the ongoing need for central venous catheters with prompt removal when deemed no longer necessary. Post intervention, 97 percent of the clinicians surveyed intend to evaluate on a daily basis whether a central line is still necessary.

Safety First: Increase near-miss reporting through education One team focused on increasing near-miss (also called ‘close calls’)

reporting through the Safety First Learning Report System as a way to identify system issues before they cause harm. Based on survey data that identified a lack of knowledge, the team created two education strategies: 1) an educational module for resident physicians, and 2) an interactive Webbased ‘frequently asked questions’ (FAQ) for all employees, which is now embedded within the current reporting system.

“Who ya gonna call?”: Reporting critical microbiology results for discharged patients In a small number of instances, identifying a licensed, responsible caregiver to contact when critical results are found after a patient is discharged is difficult. Our multi-disciplinary group found support from an unexpected source by following the ACT process. Our development of a secondary fail-safe mechanism gives the Microbiology Laboratory access to a source to help identify a caregiver who can receive the results and inform the patient that treatment may be needed.

An ounce of prevention . . .

The aim of the project was to increase rates of preventive health care delivery in the ambulatory setting with the introduction of a screening tool. Goals were to increase patient/physician dialogue about the role of prevention in health care and 10

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to provide an efficient means for physicians to quickly assess the preventive health status of each patient.

Most importantly, the tool provides an opportunity for the provider to initiate a collaborative partnership by inviting patients to be members of the health care team.

Physician assistants learn the ropes at Christiana Care

Web site shares resources Did you know that more than 70 physician assistants (PAs) work side by side with physicians in nearly every major specialty at Christiana Care?

MORE ACT INFORMATION The next ACT course begins on Sept. 16 and runs to Dec. 9, 2009. Applications—due by July 31—are available through the Academic Affairs Office, Christiana Hospital, Suite 2A00 or by e-mailing Theresa Fields, TFields@christianacare.org.

Like an extra pair of hands for our doctors, PAs improve both quality and continuity of patient care. And they assist with student and residency training as well as promote continuing professional education.

Certified PAs must be graduates of an accredited PA program and pass the national exam administered by the National Commission on Certification of Physician Assistants (NCCPA). To continue working, PAs must pass the exam again every six years.

Clinical rotations In their 50 weeks of clinical training, students from Hahnemann Hospital’s PA Program at Drexel University, the Philadelphia College of Osteopathic Medicine (PCOM) and Arcadia University do their clinical rotations and preceptorships at Christiana Care.

“Most of the 16 full-time and 8 part-time PAs in the Emergency Department rotated here as students,” says Will Paynter, PA-C, of Christiana Care’s Emergency Medicine Department.

Teaching During Education Week, March 30-April 2, Christiana Care’s Academic Affairs team recognized PAs for their roles as teachers and mentors in supporting excellence in academic medicine. “Doing the prep work to teach others helps me keep current with the knowledge and skills I need to deliver the highest level of care to our patients,” says Paynter, former PCOM faculty member.

In the Medical ICU, teaching mostly takes place in the context of managing patients. Students from area medical schools, including Jefferson Medical College, pair with one of two teams consisting of a PA, an attending physician and one or two upper-year residents and interns.

Chief Surgical PA Joe Allison, PA-C, says that in his department PAs are ideal teachers and mentors because

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GENERAL NEWS New clinic opens at DTCC in Wilmington Christiana Care’s Basic Health Ministry and Parish Nursing Program Christiana Care’s Basic Health Ministry and Parish Nursing Program is to be offered again in 2009. This program is sponsored as a collaborative effort between the Helen F. Graham Cancer Center at Christiana Care and Neumann College.

The vision of this program is to generate new ministries and thus promote healthy communities. It prepares registered nurses, licensed practical nurses and lay health ministers to begin ministering in their congregations using the curriculum developed by the International Parish Nurse Resource Center.

The Friday/Saturday weekend sessions are May 29-30, June 5-6 and June 12-13. Friday sessions are 4:30-9 p.m.

Saturday sessions are 8 a.m.-5 p.m.

they provide continuity for surgical PA students rotating through the program.

Continuing Medical Education Allison also sits on the PA Education Committee chaired by Michele Kelly, PA-C, that works with Academic Affairs to develop programs for an NCCPA-approved Category 1 Continuing Medical Education lecture series for all Christiana Care PAs. “The opportunity to be part of the educational process promotes performance excellence as well as longevity for our profession,” he adds.

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All sessions will be held at the Helen F. Graham Cancer Center.

Participants must attend all three weekend sessions to be eligible to receive continuing education contact hours. The cost for the program is $125 and is due with registration.

Scholarship funds are available.

Seating is limited.

For more information or to register, contact LaVaida Owens-White, RN, Christiana Care Health System Health Ministries Coordinator at 302-765-4557 or Nora Katurakes, RN, MSN, OCN, Christiana Care Health System Community Health Outreach Manager at 302-765-4161.

CHRISTIANA CARE’S COMPLIANCE HOTLINE Christiana Care’s Compliance Hotline can be used to report a violation of any regulation, law or legal requirement as it relates to billing or documentation.

The hotline will be answered 24 hours a day, seven days a week.

All reports go directly to Compliance Officer Ronald B. Sherman. Callers may remain anonymous.

The toll-free number is 877-REPORT-0 (877-737-6780).

To learn more about Corporate Compliance, review the Corporate Compliance Policy online or contact Sherman at 302-428-4503.

Christiana Care provides reproductive, mental health and referral services Education FIRST (Fostering Individual Responsibility Starting Today), a program partnering Christiana Care’s Center for Community Health and Delaware Technical and Community College, has opened a clinic at the college’s downtown Wilmington campus.

Christiana Care’s Center for Community Health provides reproductive health services, mental health counseling and navigation services.

Helping students stay focused on their education The National Campaign to Prevent Teen and Unplanned Pregnancy awarded Delaware Technical and Community College grant designed to help students focus on their education and avoid the additional responsibility of an unplanned pregnancy.

The grant for the $98,000, two-year project supports efforts to increase student awareness of the consequences of unplanned pregnancy, improve faculty and staff communication skills on the subject and provide free or low-cost counseling, referral and reproductive health services for students at the clinic.

Call Center for Community Health Manager Kathy Cannatelli at 302-4286557, for more information.

Unique program trains police as tactical paramedics When Sgt. Adam Ringle of the Wilmington Department of Police responded to a Delaware State Police request last year to assist during a bomb threat in Milford, State Police fortunate to have him.

Ringle is the first police officer in the history of the Wilmington Department of Police trained as a paramedic to provide emergency care to injured officers.

The Milford incident lasted 25 hours.

Weary bomb technicians dismantled eight dangerous pipe bombs that day.

While no one was injured, Ringle provided care to stressed technicians.

Thanks to Christiana Care, the Delaware State Police and the Wilmington Department of Police from left to right): John Madden, M.D.; Linda Laskowski Jones, RN, MS, ACNSwere able to create a first-of-its-kind BC, CEN; Karen Toulson, RN, MSN, CEN, NE-BC; Sgt. Adam Ringle, WPD, NREMT-P; Heather Orkis, NREMT-P, FTO; Carol Faedtke, RN, MJ, CFRN; Ross program in the state to train tactical paramedic police officers. The training Megargel, D.O. allows officers to respond quickly to Emergency, Trauma and Aeromedical Those receiving an award from high-level emergencies even when Services at Christiana Care. agency and police jurisdictions Christiana Care and their role: overlap.

“Together, we’ve established a model Ross Megargel, D.O., overall program In recognition of the program, several for ongoing training and support of supervisor. this initiative,” she says. physicians and staff members from John Madden, M.D., medical direcChristiana Care received a The Distinguished Community tion.

Distinguished Community Member Member Award nomination reads: Award from the Wilmington Police Brian Levine, M.D., medical direction.

“This agreement saves time and Department on March 31. resources, and demonstrates how law Linda Laskowski-Jones, RN, MS, “Our role was to help plan and overenforcement agencies and emergency vital hospital resources. see Sgt. Ringle’s education in conjunc- medical service agencies can work Carol A. Faedtke, RN, MJ, supervition with the Delaware Office of together to truly provide homeland sion.

Emergency Medical Services and the security the way it was intended.”

Heather Orkis, NREMT-P, FTO, field State Police,” says Linda Laskowski training supervision.

Jones, RN, MS, vice president of Karen Toulson, RN, MSN, ED rotations coordinator.

Congratulations to all!

April 23, 2009 FOCUS ● 13

Emergency Medicine team hosts SAEM Mid-Atlantic regional conference

T

he Christiana Care Department of Emergency Medicine showcased Christiana Care’s prowess in medical education and the facilities at the John H. Ammon Medical Education Center in sponsoring the Mid-Atlantic Regional Society for Academic Emergency Medicine (SAEM).

More than 160 attendees representing the Delaware Valley, Baltimore, Philadelphia, Louisiana State University Health Sciences Center, the Medical University of South Carolina and the University of California San Francisco, attended the 12th annual event.

Preconference activities included

ultrasound skills and advanced airway sessions, a roundtable discussion about medical education for medical students and a talk from Temple’s Joe Lex, M.D., on the assassinations of four U.S. presidents.

for Best in Session.

The conference featured 62 presentations—five Plenaries and 57 orals—in 10 breakout rooms. Keynote speaker Amal Mattu, M.D., from the University of Maryland, discussed “Becoming a Great Leader in Emergency Medicine.

Special thanks is due to the planning committee and to all the moderators, abstract reviewers, research nurses and support staff at the Ammon Center.

Award-winning presentations made

by Christiana Care physicians included David Cook, M.D., for Best in Session and Best Resident Presentation, and Joel Schofer, M.D.,

Christiana Care residents shined brightly through participating in the oral sessions, volunteering to assist for the break-out sessions and taking visiting attendees on ED tours.

In addition, Christiana Care Emergency Medicine and the SAEM are grateful to Melissa Bollinger, manager, Emergency Medicine Research, and Sherrill Mullenix, Emergency Medicine executive assistant, for their commitment to making the meeting a success.

From left, Emergency Medicine Program Director Neil Jasani, M.D., Emergency Medicine Resident David T. Cook, M.D., Emergency Ultrasound Fellow Joel Schofer, M.D., and Emergency Medicine Associate Program Director Michael Breyer, M.D. , with SAEM awards.

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FOCUS April 23, 2009

W

hen the norovirus struck at Wilmington Hospital’s rehabilitation unit in mid-March, quick thinking helped stem the number of people sickened and enabled new patients to receive care quickly.

According to Sharon Kurfuerst, Ed.D, OTR/L, FAOTA administrative director of Rehabilitation Services, 11 patients and 19 staff were affected by the virus. “Within 48 hours we knew we had a problem,” she says.

The rehab unit closed to new admissions. Within 36 hours, the Nursing and therapy departments opened a temporary unit for new admissions on 6D at Christiana Hospital.

At Wilmington, patients who were ill or exposed to the virus remained on the unit. Nurses and therapists restricted visitors and provided “gown and glove” care to patients in their rooms.

Janice E. Nevin, M.D., MPH, senior vice president/executive director of Christiana Care Wilmington Campus, has high praise for the teamwork that took the event in stride.

“Everyone just rolled up their sleeves and did what was necessary to ensure patients were safe and received the rehabilitation services they required,” says Dr. Nevin. “In particular, our leadership team, including Nurse Manager Felisha Anderson, Sharon Kurfuerst, and Medical Director Kelly Eschbach, M.D., demonstrated the flexibility, teamwork and creativity required to run rehabilitation services at both hospitals.

“No one faltered,” says Penny Seiple, MSN, RN, NE-BC, FACHE, vice president of Patient Care Services, crediting interdisciplinary teamwork with ensuring their success. Physicians, nurses, therapists and case managers communicated away barriers.

“And the patients always came first,” Seiple says.

April 23, 2009 FOCUS

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Celebrate Administrative Professionals Week April 20-24. Please remember to tell the administrative professions in your department about your appreciation for all they do. All administrative professionals are invited to a special tea in their honor on Friday, April 24.

Please register on the portal Education Center.

National Medical Laboratory Professionals Week, celebrated April 19-25, recognizes the dedication of our lab professionals and calls attention to the role of medical lab professionals in patient care.

National Volunteer Week, April 19April 25, is a time to say a special “thank you” to some of our country’s most valuable assets–our volunteers.

This special week recognizes the generous contributions of more than 1,000 volunteers across our health system, from volunteers ranging in age from 14 (our Summer VolunTEEN Program) to well into their 90s,. Last fiscal year they donated more than 126,000 hours as compassionate listeners, helping with inhospital deliveries of flowers and mail; responding to patient needs, supporting departments with clerical skills, and much more.

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FOCUS April 23, 2009

A Celebration for End of Treatment at the Helen F. Graham Cancer Center takes place Tuesday, May 5, 6-7:30 p.m., in the Large Conference Room.

All patients who have finished cancer treatment are invited to attend and light refreshments will be served.

Presentations include mind, body and spirit wellness, challenges of life after treatment, fatigue management, symptom management, nutritional needs and library resources. RSVP by April 28 to 302-623-4700.

The 2nd annual Great Place to Work celebration during National Hospital week May 11-15 celebrate everyone who contributes to making Christiana Care a Great Place to Work. Systemwide events include: Team posters and essays contest – Showcase your unit or department with a poster to visually display how we live our core values and work together to make Christiana Care a Great Place to Work.

A $200 gift card will be awarded for top poster(s).

Essays – Show off your writing talent by describing the impact our core values have on creating a Great Place to Work. A $50 gift card will be awarded for top essay(s). In addition, all employees who vote online for their

favorite poster or essay will be entered into a drawing for prizes.

Our cafeterias will feature a special Key West/Caribbean menu at Christiana Hospital on May 12 and at Wilmington campus on May 13. Water ice will be served at varioius locations.

The Department of Medicine-sponsored 4th Annual Roger B. Thomas Memorial Lecture is May 28 at 8 a.m. at the Ammon Medical Education Center main auditorium. Lawrence Smith, M.D., chief medical officer at North Shore-LIJ Health System in Great Neck, N.Y., will present “Who’s in Charge?,” a lecture on the medical and cultural factors that cost physicians ownership of their patients’ care and offers strategies to counter this problem and improve patient safety, quality of care and satisfaction.

Free bus transportation to the Susan G. Komen Foundation Race for the Cure on Sunday, May 10, sponsored by Christiana Care Helen F. Graham Cancer Center and Delaware Breast Cancer Coalition. Bus departs from the Medical Arts Pavilion 2 promptly at 5:30 a.m. and from the Medical Arts Complex at Riverside at 5:45 a.m., and leaves the Philadelphia Museum of Art at 11 a.m., returning to Delaware by noon. Seating is limited. RSVP by May 6 to 302-765-4161.

The Implantable Cardioverter Defibrillator (ICD) Support Group Series for those who have or plan to receive an ICD, next two presentations include: “Exercising with ICDs and Pacemakers,” with Tim Parosky, Exercise Physiologist for Cardiac Rehabilitation at Christiana Care Tuesday, May 12, 2009 6-7:30 p.m.

“Eating Heart Healthy,” with Danielle Jerome, Registered Dietitian at Christiana Care’s Eugene du Pont Preventive Medicine & Rehabilitation Institute Tuesday, June 9, 6-7:30 p.m.

Light refreshments provided. Call 800693-CARE (2273) or 302-623-CARE (2273).

Publishing

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Medical/Dental Staff Clinical Award

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Best Dental Paper Award

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Best Oral Maxilliofacial Surgery Abstract Award

“Thrombopoietin in Infants Born to Mothers with Preeclampsia Compared to Those with IUGR,” by Tiffany LaBella, M.D., Amy Mackley, RNC, Kelly Zook, M.D., Steven McKenzie, M.D., Ph.D., and David A. Paul, M.D. “White Matter Magnetic Resonance Spectroscopy (MRS) of Extremely Low Birth Weight (ELBW) Infants is Similar to Term Infants,” by Erlita P. Gadin, M.D., David A. Paul, M.D., Amy Mackley, RNC, James C. Galloway, Ph.D., Kert F Anzilotti, M.D., and Karl Steiner, Ph.D., “Is A Small Platelet Mass Associated with Intraventricular Hemorrhage in Very Low Birth Weight Neonates?” by Jody L. Kohut, D.O., Amy Mackley, RNC, and David A. Paul, M.D. “The Allusion of the Best Interest Principle” was presented by Kirsitie Marcello, M.D., Amy Mackley, RNC, John L. Stefano, M.D. They also presented it at the Association of Perioperative Registered Nurses’ 56th Congress, March 17 in Chicago.

April 23, 2009 FOCUS

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The Junior Board of Christiana Care’s annual Medicine Ball traditionally supports nursing and allied health education scholarships, among numerous other programs.

lease support them with your gift today. It will make a difference in the lives of thousands of patients treated every day.

Contribute by May 8 to support the scholarships and help put Medicine Ball fundraising over the $1 million mark!

Send your tax-deductible gift to support nursing and allied health scholarships today to:

Gold Friends

AstraZeneca Betty and Jim Coker in memory of Dr. I. Lewis Chipman, Sr. Endo Pharmaceuticals

Silver The Glenmede Trust Company Mason Building Group, Inc. Wilmington Trust Company

Bronze Rocco & Mary Abessinio c/o Abessinio Family Foundation Action Coffee Bancroft Construction Co. Bayada Nurses DuPont Five Star Senior Living Peter D. Furness Electric Co. Vincent N. Greggo Hatzel & Buehler, Inc. Helen F. Graham Cancer Center Lankford SYSCO LBI Properties Peninsula United Methodist Homes PNC Bank Skanska USA Building

Pewter Ameriprise Financial Services Blood Bank of Delmarva Cavan Construction Co. Christiana Care Center for Heart & Vascular Health Conner Strong Companies East Coast Erectors W. L. Gore & Associates Lincoln Financial Group Marvin & Palmer Associates MedAssets Mid-Atlantic Realty Company Mitchell Associates Nason Construction Patterson Schwartz Real Estate Sentinel Self Storage Smith Barney, Randall L. Renneisen Spinnaker Medical, LLC Synthes Spine Talley Brothers Young Conaway Stargatt & Taylor, LLP

Associates Graphic Services B’s Shuttle Service Bassett, Brosius & Dawson Chandler Funeral Homes & Crematory Craft-Way Kitchens Doctors for Emergency Service Elkton Florist Financial House, Cliff Berg First State Women’s Care, P.A. Greenhills Salon/DK Spa Gunnip & Company, LLP Hardcastle’s Newark Gallery Kerns Brothers Tree Service & Landscaping Newspaper Support Services The Old Lamplighter Parkowski, Guerke & Swayze, P.A. Pratt Insurance Leo Raisis, M.D. Robert Layton Reed Trilogy Salon and Day Spa Valero-DE City Refinery Wohlsen Construction Co.

In-Kind Contributors The Inn at Montchanin Village Sherif Zaki Salon and The Oasis Spa Total Wine & More

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Albert Rizzo, M.D., testifies before Congress on toll taken by chronic lung diseases Albert Rizzo, M.D., chief of the section of Pulmonary and Critical Care Medicine at Christiana Care, testified in March before the U.S .House of Representatives’ Labor, Health & Human Services, Education and Related Agencies’ Appropriations Subcommittee.

As the Speaker of the American Lung Association’s Nationwide Assembly, Dr. Rizzo presented the health organization’s recommendations for public health and research funding.

He explained that many lung diseases are chronic and place a huge burden in both human suffering and medical care costs on our nation. He stressed the need for a “renewed commitment to medical research” not only for lung disease, but also across the entire National Institutes of Health. He also recommended sustained funding in prevention and wellness as a way to further reduce the toll of chronic lung diseases.

Dr. Rizzo is a long-time volunteer for the American Lung Association. His term as Speaker for their Nationwide Assembly runs through June.

External Affiars P.O. Box 1668 Wilmington, DE 19899-1668 www.christianacare.org

Albert Rizzo, M.D., section chief of Pulmonary and Critical Care Medicine at Christiana Care, testified As the Speaker of the American Lung Association’s Nationwide Assembly in March before a congressional subcommittee about the burden of chronic lung disease on our nation.

PRSRT STD U.S. POSTAGE PAID WILMINGTON DE PERMIT NO. 357