Focus is published only once this month. The next issue will come out on April 8, 2010.
FOCUS Kidney Transplant Program wins honors John Swanson, M.D., FACS, chief, Christiana Care Kidney Transplant Program, and Stephanie Gilibert, M.D., Kidney Transplant Program medical director, accept the Bruce Zakheim, M.D., Memorial Legislative and Advocacy Award.
T Clinical News CREST study results
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Wilmington campus update
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Transformation Lab & Pathology automation improves processes 5 General News Great Place to Work: A look back at 2009-2010
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CPOE launch success bodes well for Christiana Hospital March 23 start-up
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Practical advice on quick healthy meals at home
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hree-and-a-half years ago, there was no kidney transplant program serving adults in Delaware. Today, 51 patients have received transplants at Christiana Care and the National Kidney Foundation has recognized our remarkable success.
Virginia U. Collier, M.D., Hugh R. Sharp Jr. Chair of the Department of Medicine.
Leadership in advocacy, outreach The program is honoring Christiana Care for its leadership in patient education and support services and in comFor its outstanding work in fighting munity outreach. Christiana Care “capchronic kidney disease, Christiana tures the true spirit of Zakheim’s Care’s Kidney Transplant Program has efforts against chronic kidney disease earned the National Kidney (CKD) by championing key issues in Foundation’s Bruce Zakheim, M.D., the transplant and nephrology commuMemorial Legislative and Advocacy nities with passion and quality leaderAward. The National Kidney Foundship.” Dr. Zakheim, a New Jersey ation serving the Delaware Valley nephrologist, was a leader in bringing (NKFDV) presented the award on excellent CKD care to the region. March 6 at the 26th annual Kidney Ball. “Our leadership involves our neigh“Christiana Care is grateful to the bors, not just our patients. Advocacy NKFDV for recognizing the outstand- and outreach are part of being at ing care that our kidney transplant Christiana Care,” says John Swanson, program brings to Delaware patients M.D., FACS, chief, Christiana Care with chronic kidney disease,” says Kidney Transplant Program. CONTINUED,
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From left, Emily Pruitt, RN, Laura Bishop, RD, Stephanie Gilibert, M.D., Gail Eastman, RN, Aline Stant, RN, MSN, S. John Swanson, M.D., Nadia Hellenga, Pharm.D., Helen Chang-Deguzman, M.D., Velma Scantlebury, M.D., Tom Gay, Geri LiBetti, RN, and Senior Social Worker II Eileen Edge.
“This award is a remarkable achievement for a young program.” In 2005, recognizing that adult Delaware end-stage renal disease patients had neither the same access to care nor the follow-up care and support systems that patients in other areas of the country had, Christiana Care and privately practicing nephrologists from Nephrology Associates began developing a transplant program. By October 2006, with a multidisciplinary team in place, the Christiana Care Kidney Transplant Program opened officially—the first adult transplant program in the state. Now, in addition to the 51 completed transplants, 308 patients are listed as waiting for kidney transplant and 800 have been evaluated for transplant.
meet monthly and are open to area patients transplanted in other hospitals. See listed patients regularly, ensuring that they are well and able to receive the transplant.
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On average, patients wait 52 months from being listed for transplant to receiving a transplant from a deceased donor. A living kidney donor allows the transplant to proceed without this waiting time. ‘Everyone contributes’ Stephanie Gilibert, M.D., Kidney Transplant Program medical director, says, “The entire practice is a multidisciplinary undertaking. Everyone in the center contributes to what we do.”
To ensure that all Delawareans have convenient access to excellent endstage renal disease care, the program But the program does much more than recently established a satellite clinic in transplants. Team members: Lewes. n Serve as a resource for area nephrolIn different parts of the state twice a ogy practices. year, the program holds a patient education symposium for CKD patients n Provide multidisciplinary care for transplant recipients and living kidney and their families, typically reaching donors before, during and after surgery. 150 to 200 people each time. The program participates in health fairs and n Offer patient support groups that CKD screenings throughout Delaware.
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In 2008, to raise community awareness of the disease and the need for organ donation, the Kidney Transplant Program spearheaded Delaware’s first Kidney Walk. The walk was held again in 2009, and plans are underway for 2010’s walk. Administrative Director of Renal and Transplant Services Geri LiBetti, RN, CCTC, sees Christiana Care’s support as a vital part of the program’s accomplishments. “Christiana Care has provided us with the opportunity to assemble a team of transplant professionals who share the common goal of providing excellent education and transplant care to all Delaware residents,” LiBetti says. Patients, dialysis units and physicians can call the Christiana Care Kidney Transplant Office for information and referrals at 302-623-3866.
It’s Magnetic! The efforts that helped earn the prestigious award from NKFDV reflect these “Forces of Magnetism” #10. Community and the health care organization “Our team works closely with the NKF and other community organizations to provide education and screenings.” #13. Interdisciplinary relationships “The multidisciplinary transplant team comprises surgeons, physicians, coordinators, social work, pharmacy, nutrition, medical assistants and clerical staff. Each member represents their discipline and accepts responsibility for their area of expertise.” Geri LiBetti, RN, CCTC Administrative director Renal and Transplant Services
Research resolves question of best treatment for blocked carotids in high-risk stroke patients
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hristiana Care physicians and surgeons now have more options in tailoring treatments for patients at risk for stroke.
enrolled patients in the CREST Trial,” says Tim Gardner, M.D., medical director of the Center for Heart & Vascular Health.
in the stenting group, 4.1 percent versus 2.3 percent, for the surgical group in the weeks following the procedure.
The overall safety and efficacy of the two procedures was largely the same with equal benefits “ The principal finding of CREST is that for both men and for the choice of treatment must be individuwomen, and for alized for each patient with carotid dispatients who had ease.” previously had a Tim Gardner, M.D., medical director stroke and for those Center for Heart & Vascular Health who had not.
“Having this multi-disciplinary capability here will serve future patients well. The principal finding of CREST is that the choice of treatment must be individualized for each patient with carotid disease. Our cardiovascular specialists will be able to perform either traditional surgical carotid endarterectomy or carotid stenting using whichever treatment is most appropriate for the particular patient.”
However, when the investigators looked at the numbers of heart attacks and strokes, they found differences. The investigators found that there were more heart attacks in the CEA group, 2.3 percent compared to 1.1 percent in the stenting group; and more strokes
The trial was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, and led by investigators at Mayo Clinic, Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark.
The CREST study, a landmark clinical
trial that included patients at Christiana Care, showed that two medical procedures designed to prevent strokes are safe and effective for people at risk for stroke. One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) took place over a nine-year period at 117 centers in Canada and the United States, including Christiana Care’s Center for Heart & Vascular Health.
The 21st Annual Update in Cardiology conference on Feb. 27 in the John H. Ammon Medical Education Center attractIn the trial of 2,502 participants, carotid endarterectomy (CEA), a surgi- ed more than 220 health professionals. The concal procedure to clear blocked blood flow and considered the gold-standard ference featured presentations from Christiana prevention treatment, was compared Care Center for Heart & to carotid artery stenting (CAS), a Vascular Health physinewer and less invasive procedure cians and visiting guest that involves threading a stent and expanding a small protective device in speakers and covered clinical news, latest the artery to widen the blocked area emerging technology and capture any dislodged plaque. and research for the “Vascular surgeons along with intermanagement and treatventional cardiologists and radioloment of cardiovascular gists at the Center for Heart & disease. Vascular Health participated and
From left, Timothy J. Gardner, M.D., medical director, Center for Heart & Vascular Health, Andrew Doorey, M.D., program director, and William Weintraub, M.D., John H. Ammon Chair of Cardiology.
Janice Nevin, M.D.
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oin Christiana Care Health System and Hanover Presbyterian Church to learn how the $205 million expansion of Wilmington Hospital will transform the delivery of health care in our community. Janice Nevin, M.D., MPH, senior vice president/executive director Christiana Care - Wilmington Campus and associate chief medical officer, will
share the vision of the future of Wilmington Hospital, including an animation of the progression of the project. Following the formal presentation, light refreshments will be provided by Hanover Church. Members of the community will have a chance to talk about areas of mutual concern.
Janice Nevin, M.D., is responsible for all clinical activity and operations on the Wilmington campus and is helping to lead the transformative building project. She is the former chair of the Christiana Care Department of Family and Community Medicine, a featured columnist for the News Journals’ Tuesday health section, and she sees patients in the Family Medicine Center on the Wilmington campus.
Wilmington campus at a glance
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Resulting delays:
Bids are now coming in on fit-out work scheduled to start in April/May.
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The opening of Washington Street entrance—a prerequisite for excavation to begin Washington Street side of the project.* *Washington Street entrance reopened March 8.
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veryone in America is watching health care today. Increased oversight from the private sector, government and consumers is challenging us to transform how we deliver care. Christiana Care has accepted the challenge to make dramatic change. We are focusing on improving quality and safety, decreasing costs and building our financial strength to reinvest in our mission of care and service. Transformation does not occur in small, incremental steps. It comes about through breakthrough initiatives, radical thinking and big changes. It leads to dramatic improvements in patient safety and satisfaction, quality of care, clinical outcomes, employee engagement and value—all aspects of our Focus on Excellence diamond.
Pathology & Laboratory Medicine automation
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utomation and improved efficiency efforts have made the hospital environment safer for both patients and Pathology & Laboratory Medicine staff at Christiana Care hospital. Patients are safer thanks to reduced risk for misidentification. Staff is safer thanks to reduced biohazard risk due to minimal sample handling. Plus, added speed and efficiency has enabled the department to handle increasing demand and cut turnaround time. Compared with pre-initiative measurements:
n There are 138 fewer repeat tests performed each day, with a cost savings of $9,800 a year in test-related substances. n The average in-lab turnaround time for morning rounds decreased from 89 minutes in 2006 to 40 minutes in 2009.
Here’s how they did it: n Redesigned the central receiving area, placing work areas next to the pneumatic tube delivery system and closer to the automation line. n Introduced several new automated systems, including a robotic specimen transport system and lab automation system with two high-volume routine analyzers online.
Rewrote software to eliminate the need for redundant testing and unnecessary technologist intervention, such as issuing paper reports for normal results. n
A robotic transport system now helps Lab staff make sure the right specimens get to the right place, right on time.
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From good to great: People make the difference A look back at FY ‘09
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hristiana Care Health System is a Great Place to Work largely because of its employees and success in recruiting and retaining high-performing, committed and engaged team players at all levels. Our continued success depends on your efforts and we value your vital input to help ensure progress.
hospital by the American Nurses Credentialing Center for a four-year term starting Feb. 18, 2010. Recipient of the 2009 Beacon Award for Critical Care Excellence, one of only 35 hospitals nationwide and the first in Delaware to earn the honor.
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n Named a News Journal “Best in the Business” employer for the fifth consecutive year.
Throughout the health system, work groups, service line councils and committees are energetically seeking ways n Rated in Nursing Professionals to improve our work environment and Top 100 Hospitals to Work With. maintain our focus on excellence in n Continued recognition by US providing the best available care to News and World Report as one of our neighbors. America’s “Best Hospitals.” Employee Engagement Soon, all Christiana Care employees will be able to participate in the 2010 Employee Satisfaction and Engagement Survey conducted by the Gallup organization April 12-25. More than 7,000 employees—a system record 77 percent force—took part in the 2008 (most recent) survey. Previous survey results provide a frame of reference for our 2010 goals. For example, in 2008: Employees ranking Christiana Care at a best-possible 5 of 5 increased to 33 percent from 31 percent in 2006, placing Christiana Care at the 61st percentile of Gallup’s overall database. n
Christiana Care’s combined rating (4s and 5s) for employee satisfaction was a positive 78 percent. n
Christiana Care continues to be proud of the outstanding quality care our employees provide and the external recognition they receive. Recent highlights include: n
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Recognition as a Nursing Magnet ●
FOCUS March 11, 2010
bedside nurses. This fiscal year, through December 2009, an additional 454 new employees joined our health care team. The system-wide vacancy rate for all positions remains at or below 2 percent, consistently below the national average. As a sought-after employer, Christiana Care received more than 32,000 appli-
As a sought-after employer, Christiana Care received more than 32,000 applications in 2009.
Awarded the Department of Health and Human Resource’s 2009 Medal of Honor recognizing excellence in empathetic family care coupled with outstanding organ donation levels.
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Over the next five weeks, you’ll find detailed descriptions of important efforts on the portals: n
Recruitment & Retention March 9.
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Total Rewards - Week of March 15.
Health and Wellness - Week of March 22.
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Better and Easier - Week of March 29.
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Growth and Development - Week of April 5.
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Workforce Supply The recruitment and retention of a high-performing and engaged health care team at all levels is again a major accomplishment. Recruitment Christiana Care successfully hired 1,062 new employees this past fiscal year. Of these new hires, 166 were
cations in calendar year 2009. Targeted tactics and enhancements used to recruit our new team members include: n Internet sourcing with social media tools including Facebook, Twitter, LinkedIn and a new web 2.0 search engine optimization strategy n
College recruitment.
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Scholarships.
n Specialty training programs for new graduates. n Employment of students in nursing and allied health professions. n Special events, such as Career Night, Student Nurse Expo, and regional recruiting job fairs.
Retention Identifying the right fit for individuals within Christiana Care is a key goal of our retention strategy. Our success at retaining high-performing employees is evident by our low turnover rates, which exceed the health care industry benchmarks. Christiana Care’s fulltime current turnover is less than 6 percent and less than 4 percent for role model employees.
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s we continue our journey of making Christiana Care a Great Place to Work, consider how you would respond to the following employee engagement statements from our survey: “At work, my opinions seem to count.” Take advantage of opportunities to share opinions, provide feedback and express ideas that improve the health of our patients. Departments provide better patient care services when individuals actively and openly share suggestions for improvement. Sharing your opinions and ideas with your co-workers and your manager is a great way to provide valuable input. What can you do?
Learn about opportunities within your department and across the system to share your feedback and ideas. n
n Volunteer for committees and projects and actively participate as part of the team. n Volunteer for performance improvement initiatives or other opportunities outside normal job duties.
Express your opinions and ideas to individuals who have the ability to initiate positive change (your supervisor, your co-workers, etc). Take a solutions-oriented approach when sharing your ideas. n
n Be willing to identify opportunities for improvement and solicit ideas and opinions from colleagues within and outside of your department to maximize the impact of your idea.
Keep channels of communication open. Be willing to share feedback, and to receive it, as well. n
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Encourage others to share their opinions with you.
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Remember that your opinions matter.
“The mission or purpose of my company makes me feel my job is important.” As human beings, we like to feel as if we belong. Individual achievement is great; however, being part of something bigger gives us that sense of belonging. Each of us has different values; identifying how our own values relate to those of Christiana Care enables us to find a connection between the mission of the organization and our position, creating that unique sense of belonging.
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What can you do? Seek to understand how your individual role fits into the success of Christiana Care’s mission. n
n Find the common link between your own values and those of Christiana Care. n Identify opportunities to improve personal performance to support the mission through successful implementation of business goals. Your personal performance affects those we serve internally and externally, including and most importantly, our patients!
“My associates or fellow employees are committed to doing quality work.” The best work teams value and leverage each individual’s talents toward providing quality service and care to our patients. In order to place the needs of our patients first, cooperation among all departments is essential. To become a highly functioning work team, discuss with your colleagues and managers opportunities to improve the quality of the services your work team provides. Develop action plans to remove barriers that hinder your team’s ability to focus on excellence. What can you do? n Recognize co-workers within your department and supporting departments with paper or electronic diamonds when they are doing quality work. n Ask your manager to discuss job performance expectations at your next staff meeting. n Keep channels of communication open. Be willing to share constructive feedback, as well as receive feedback regarding performance opportunities. n Refer incidents of poor performance, including core value behaviors, to management for follow-up. Share with your manager the impact the performance is having on your ability to provide quality services, and follow-up with management if improvement is not seen.
Providing your feedback and suggestions allows you to contribute to achieving the organization’s mission. Valuing our colleagues and working together as a team contribute to making Christiana Care a Great Place to Work.
CPOE: The new way of doing business
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t has been relatively smooth sailing for Computerized Provided Order Entry, (CPOE) launched at Wilmington Hospital on Jan. 28 in a sea of green coats. “On the very first day, a few people actually said it was faster than paper,” says Terri Steinberg, M.D., MBA, chief medical information officer. “By Wednesday, the corner was turned and CPOE went from a novelty to a way of doing business.” One green jacket for every 3 doctors There was one tech support person—clad in an immediately identifiable green jacket—on board for every three doctors.
“The speed with which physicians have adapted has been impressive and amazing, a true reflection of their commitment.” Terry Steinberg, M.D., MBA Chief Medical Information Officer Still, there were bumps in the road. Some
providers were frustrated by the number of alerts that fired as they entered their orders. “We had our alert threshold set way too low,” Dr. Steinberg recalls. “So we jumped in and changed it.” Anand Panwalker, M.D., president of the Christiana Care Medical-Dental Staff, says he welcomes CPOE as a necessary step forward in patient care. The electronic system eliminates errors and delays created in deciphering handwriting, making patient care faster, more efficient and safer. Still, asking doctors to give up paper and embrace technology is a radical shift. “There was great anxiety,” Dr. Panwalker says, “and then a great sigh of relief.” A few days after the launch, he had his first real-time experience with CPOE when he entered several orders. “I needed a bit of help, but it was there, thanks to all those people with green coats,” he says. “There were a few broken violin strings in this orchestra—but they were quickly fixed.” Dr. Steinberg says frequent updates on CPOE’s status helped to mentally prepare doctors, nurses and pharmacists for the launch. “It was a low rumbling that got louder and louder,” she says. “People knew it was coming.” Doctors continue to provide feedback as to ways the system can be improved. “The speed with which physicians have adapted has been impressive and amazing, a true reflection of their commitment,” Dr. Steinberg says. “Every day gets better and better.”
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Nurse managers, hospitalists, residents play major role in successful launch
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olling out the Computerized Provider Order Entry system was a team effort with many helping hands. “Wilmington Hospital is a special place,” says Terri Steinberg, M.D., MBA, chief medical information officer. “There is a sense of family there.” Residents, who worked hard to troubleshoot the system, played a key role in the project’s success.
ing implementation when nurses sat side by side with physicians at the computer working to get orders entered. The success of CPOE implementation brought out the best in the physician-nurse relationship.” Dr. Steinberg also expressed appreciation for the support and dedication of Dr. Nevin. “She was in the hospital 24/7, bridging the technical and medical,” she says.
“They adapted to CPOE like a fish to water—and their help has been invaluable,” Dr Steinberg says. Department heads played a crucial role in preparing for the launch, organizing training sessions. Hospitalists also showed a willingness to embrace Hundreds of doctors helped to write order sets. change, providing insights and feedback on the “So many people gave so generously to make this system. transformational event a success,” Dr. Steinberg “The nurse managers also played a major role in says. our success,” says Janice Nevin, M.D., MPH, senCPOE rollout at Christiana Hospital ior vice president/executive director Christiana begins March 23. Care - Wilmington Campus and associate chief medical officer. “There were many moments durFrom left: Terri Steinberg, M.D., and Carolyn Zinner, project leader; Chuck Molloy, project leader and David Bercaw, M.D.; and Staff Development Specialist Kim Berl.
Exploring careers in health care event April 6
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re you or someone you know thinking about a career in health care? Are you working in health care and looking to advance your education or expand your career options? If so, come to Exploring Careers in Health Care on April 6, from 5-7:30 p.m., in the John H. Ammon Medical Education Center main auditorium on the Christiana Hospital campus. While this is not a recruitment event, you will have an opportunity to meet representatives from a host of health care fields. You’ll also get the chance to explore educational options from the local colleges and universities. Here are a few participating schools: n
Arcadia College.
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Delaware Technical & Community College.
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Delaware State University.
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Drexel University.
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Eastern University.
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Immaculata University.
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Neumann University.
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Wilmington University.
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University of Delaware.
If you have questions, call Dominic Kayatta at 302-327-5706.
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Welcome New Medical-Dental Staff
National Experts to speak at Delaware Health Sciences Alliance conference
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he Delaware Health Sciences Alliance (DHSA) will host its second Annual Research Conference at the John H. Ammon Medical Education Center on May 4. The conference will bring together academic and clinical researchers from Christiana Care Health System and Alliance partner institutions The University of Delaware, Thomas Jefferson University and Nemours / Alfred I. duPont Hospital for Children. The conference goal is to showcase DHSA joint programs and to explore new opportunities to enhance translational research collaborations. Dedicated breakout sessions will focus on cancer, cardiovascular health, neurosciences, rehabilitation sciences, bioinformatics, outcomes and community research. Keynote speaker John J. Nance, JD, author, broadcaster, consultant and lawyer, will present “Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care.” Michael Lauer, M.D., director of the Division of Cardiovascular Sciences at the National Heart, Lung and Blood Institute and the Ancel Keyes lecturer in preventative cardiology, will discuss The American Recovery and Reinvestment Act of 2009 and Comparative Effectiveness Research, which will improve health outcomes by developing and disseminating evidence-based information to patients, clinicians and other decision-makers. The full agenda and registration link for the DHSA Research Conference are available at www.delawarehsa.org/ conferences.php.
John J. Nance, JD
Michael Lauer, M.D.
Internal Medicine med students earn national distinction
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our fourth-year medical students serving internal medicine electives at Christiana Care had their abstracts accepted out of 250 submissions for the National American College of Physician’s (ACP) Annual Scientific Meeting in Toronto in April. An abstract by Kelly McGlaughlin, Jefferson Medical College (JMC) MS3, is a Top 10 Winner in the National ACP Student Clinical Vignette Abstract Competition and will be one of only 10 selected oral podium presentations. McGlaughlin’s abstract, “Propionibacterium Acnes: When Will You Grow Up?” was co-authored by mentor Anand Panwalker, M.D. An abstract by Richard Medford, JMC MS3, “Venous Thrombosis, Pulmonary Embolism and Factor VII Deficiency,” under the mentorship of Med-Peds Resident Mark Troiano, D.O., and attending Charles V. Roche, M.D., also will be presented as a poster finalist at
the national meeting. An abstract by Peter A. Burke Jr., of the Philadelphia College of Osteopathic Medicine and soon to be a Christiana Care Internal Medicine resident, “Diagnosis and Management of TTP/HUS in an HIV positive patient,” under the mentorship of medicine resident PGY3, David Aljadir, M.D., and intensivist, Tuhina Raman, M.D., will be on display as a poster finalist at the meeting. An abstract by Stefanie Golebiewski, JMC MS4, and mentor Michael Benninghoff, M.D., titled “β-agonist use and Lactic Acidosis” also earned distinction as a poster finalist and will be on view at the meeting. The top 10 were selected for podium presentations and given all-expense paid trips to the meeting. The next top 25 in each category are invited to present posters of their abstracts for judging and monetary prizes.
Publishing, presentations, appointments, awards Publishing Lionel Malebranche, M.D., published a personal account of what he witnessed in his native country ofHaiti in the aftermath of the Jan. 12 earthquake. Dr. Malebranche saw the devastation of Port-au-Prince and great human suffering. Read his account in the Feb. 18 issue of the Annals of Internal Medicine, the publication of the American College of Physicians, or online at www.annals.org. Robert Witt, M.D., published an article titled “Surgery After Cocaine Ingestion,” in Ear Nose and Throat Journal, 2010;89(2):E14 David A. Paul, M.D., Amy Mackley, RNC, et al., published “Thyroid function in term and late preterm infants with respiratory distress in relation to severity of illness,” in Thyroid, February, 2010. Robert Abel Jr., M.D., has published a novel, Lethal Hindsight, a medical thriller about an ophthalmologist who stumbles on an international plot. It’s available online at www.xlibris.com.
Robert Abel Jr., M.D., has published a a pictorial children's book, Lumi's Book of Eyes, available at www.wastelandpress.net Presenting
Appointments, Awards Lee Ann Riesenberg, Ph.D., RN, was named to the editorial board of the American Journal of Medical Quality in October 2009.
James Gill, M.D., presented:
VNA CEO and President Lynn C. Jones has been appointed a member n “Using Centricity Encounter Forms to Improve Quality of Care for Chronic of the American Hospital Association (AHA) Governing Council for Long Diseases in Primary Care” at the 2009 Term Care, Rehabilitation and Home AAFP Conference on Practice Health Care, beginning a three-year Improvement: Constructing the Medical Home, in Kansas City, Mo., in term in March. November 2009. Michael Kalina, D.O., FACOS, earned the Leadership Development n “Impact of an EMR-based Intervention on Diagnosis & Follow-up Workshop scholarship from the Eastern Association for the Surgery of of Depression” at the 2009 NAPCRG Trauma. Dr. Kalina completed the Meeting in Montreal, in November first of three workshops, Part 1 at the 2009. January 2010 conference in Arizona. Bikash Bose, M.D., FACS, FICS, FAHA, et al., presented an oral digital Sherry Mars, BSN, RN-BC, patient care coordinator and staff developposter titled "tceMEP Monitoring Improves Detection of Iatrogenic Nerve ment specialist on the ACE Unit at Wilmington Hospital received a bachRoot Injury During Cervical and elor of science degree in Nursing Lumbar Spine Surgery" at the 26th Annual Meeting of the Spine Section of from Immaculata. the AANS/CNS in Orlando, Feb. 18-20.
CALL FOR ENTRIES COMMENDATION FOR EXCELLENCE AWARD 2010
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ominations are being sought for the 10th Commendation for Excellence Award. This award, established by the Medical-Dental Staff, honors physicians who have made exceptional contributions to the community through their clinical, scholarly, educational or humanitarian activities.
bers may nominate an eligible person for the award.
Dawn Gies at dgies@christianacare.org.
The physician or dentist selected by Requirements the Awards Committee is endorsed by n A letter outlining the reasons for the the Medical Executive Committee. nomination. This year’s Commendation for n The Qualifications of the nominee. Excellence Award recipient will be announced at the Medical-Dental Staff n The nominee’s CV, if available. Annual Event. Please help recognize the outstanding Current and former members of the contributions that physicians make to For more information about the Medical-Dental Staff are eligible to be our community. Reply with your nom- Commendation for Excellence Award, nominated. Medical-Dental Staff mem- ination by May 28, 2010 via e-mail to please call 302-733-1049.
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Two from Christiana Care earn HIV Consortium awards
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oyce Bunkley, RN, primary care nurse at the HIV Program Lancaster Avenue site, will receive the Guardian Angel Award, recognizing an individual for efforts to help improve the daily lives of people living with HIV/AIDS. Lisa Phillips, M.D., will receive the Ryan White Award, recognizing an individual in the medical profession who is dedicated to the health and well being of people living with HIV disease. They will receive the awards on April 17 at the annual Delaware HIV Consortium WOW evening gala— Delaware’s largest HIV/AIDS fundraiser—at the Clarion Hotel’s Belle and Augusta Grille Restaurant, 1612 N. DuPont Highway, New Castle. For information, call John Hinkson, coordinator of communications and special events at the Delaware HIV Consortium, 302-654-5471 or visit www.delawarehiv.org.
Avon Foundation supports breast cancer awareness
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hristiana Care’s Community Outreach at the Helen F. Graham Cancer Center received a $50,000 one-year grant from the Avon Foundation Breast Care Fund for its breast cancer awareness programs that increase awareness of the lifesaving benefits of early detection of breast cancer. The program has received funding from the Avon Foundation for Women for the Ninth consecutive year in recognition of its excellence. Christiana Care’s Community Outreach breast health programs educate Delaware women and refer them to low-cost or free mammograms and clinical breast exams in their own communities. This vital outreach program works with other agencies such as federally qualified health centers, senior centers, sisters on a mission and the local avon sales representatives. Since January 2002, the Helping Hands for Breast Health at Christiana Care has assisted with screening more than 7,000 women. Each year, the program focuses its efforts on reaching more women who need assistance while sending reminders to those screened the previous year. Last year, more than 20,000 women were informed about the importance of early detection of breast cancer through health fairs, blocked screenings for seniors, education programs and distribution of breast health education materials. In addition, screening reminders were mailed to 855 individuals, 300 women were enrolled in the program, 951 were referred for mammograms and clinical breast exams, and 12 breast cancers were found. For more information on Helping Hands for Breast Health at Christiana Care, call Nora Katurakes at 302-623-4628.
Joyce Bunkley, RN
Lisa Phillips, M.D.
Education Week April 6-9 events schedule Unless otherwise noted, all events are in the John H. Ammon Medical Education Building. Tuesday, April 6 9-10:30 a.m., Loretta Consiglio-Ward, RN, MSN, and Lee Ann Reisenberg, Ph.D., present “Adult Learning Principles / Learning Preferences, rooms 4-6. 11 a.m.-noon, Glenn Tinkoff, M.D., Simulation presentation, rooms 4-6. Noon-1 p.m., Guest speaker Rebecca Phillips, M.D., vice president, Education & Training, Cincinnati Children's Hospital Medical Center, presents “Educator's Strategy” rooms 4-6. 1-2 p.m., Simulation Presentation, Glenn Tinkoff, M.D., Wilmington Hospital Conference Center. 2-3 p.m., Simulation: Nursing Education, Katie Muther, RN, Wilmington Hospital Conference Center. 3-4 p.m., Simulation: Code Blue, AnnMarie Baker, RN, Wilmington Hospital Conference Center. Wednesday, April 7 7-8 a.m., Surgical Grand Rounds, Julie G. Nyquist, M.D., Professor of Clinical Pediatrics, University of Southern California, Main Auditorium. 8:30-10 a.m. Physicians Assistant Conference, back auditorium. 9-11 a.m., Federal regulations affecting Christiana Care research, rooms 11-12. 9-10:30 a.m., Loretta Consiglio-Ward, RN, MSN, and Lee Ann Reisenberg, RN, Ph.D., present “Adult Learning Principles/Learning Preferences,” Wilmington Hospital Conference Center. 11 a.m.-noon, Jerry Brannen and Rosa Colon-Kolacko, Ph.D., present “Learning Measurement Strategy and Evaluation Methodology,” rooms 11-12. 10:30-noon, Chris Lepine/ Trevor Clark present “Instructional Design,” Wilmington Hospital Conference Center.
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Upcoming events The 13th Annual Medicine Ball, sponsored by the Junior Board of Christiana Care, on Friday, April 23, 7-11 p.m., at the Wilmington Country Club. Proceeds support scholarships and continuing education for nursing and allied health professions at Christiana Care. E-mail jgoldston@christianacare.org for more information or to be added to the invitation list.
The 2010 Christiana Care Delaware Marathon Running Festival Sunday, May 16, Tubman Garrett Riverfront Park, Wilmington, includes Delaware’s oldest and largest certified road-running marathon, a certified half-marathon and a four-person team relay marathon. See www.delawaremarathon.org. A portion of the proceeds benefits the Center for Heart & Vascular Health.
Center for Comprehensive Behavioral Health Open House, Wednesday, March 24, 4-6 p.m., 201 W. 14th St., Wilmington. For information, call 4282962.
The 14th Annual Diabetes Update, Saturday, March 20, 7:30 a.m.-4 p.m., at the John H. Ammon Medical Education Center for physicians, RNs, NPs, dieticians, physician assistants, ophthalmologists and others. Fee: $70, $35 for students and emeritus. Register online and download a program under Events & Classes on physician, nursing and physician office staff portals.
The "Lucky 7" Evening in Monte Carlo, hosted by the Friends of the Helen F. Graham Cancer Center, Friday, May 14 in the Gold Ballroom at the Hotel du Pont, 11th and Market streets, Wilmington. Proceeds support the Center for Translational Cancer Research and the Cancer Special Needs Fund at the Helen F. Graham Cancer Center. E-mail jgoldston@christianacare.org for more information or to be added to the invitation list.
Noon-1 p.m., Lee A. Learman, M.D., Ph.D., present OB/GYN Grand Rounds, “Learning and Teaching Strategies, OR Professionalism,” Women’s & Children’s Services Building, rooms 1926/1927. Noon-1 p.m., Michelle Biros, M.D., presents Emergency Medicine Grand Rounds, room 1100, main hospital. 1-2 p.m., Katie Muther presents Simulation: Nursing Education. rooms 11-12. 2:30-4 p.m. Chris Lepine and Trevor Clark present “Instructional Design,” rooms 1112. Thursday, April 8 8-9 a.m., Medical Grand Rounds, Guest Lecturer Thomas J. Nasca M.D., MACP,
Trauma Program hosts the 10th ThinkFirst 5K and 1KChildren’s Fun Run on April 15 to support community injury prevention efforts. Register at www.races2run.com.
Dean of Jefferson Medical College, main auditorium. 9:30-12:30 p.m., Guest Speaker Brent Schlenker, presents “Education Strategies and Trends,” main auditorium. 1-2:30 p.m. Guest Speaker: Karen Barley, Corporate University, presents “Becoming a Learning Institute,” Karen Barley, Corporate University, rooms 11-12. 2:30-4 p.m., Ann-Marie Baker presents, Simulation: Code Blue, Ann-Marie Baker, RN, rooms 11-12 5-8 p.m., Reception, Main Auditiorium. Friday, April 9 9-10:30 a.m., Wendy Wintersgill presents “Preparing Your Poster Presentation,” rooms 11-12.
Physician-Author offers prescription for preserving humanity
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n a time often ruled by technology, physicians should not forsake some of the most powerful tools in medicine: their ears, eyes and hands. That was the message of best selling author Abraham Verghese, M.D., professor for the theory and practice of medicine at the Stanford University School of Medicine. Dr. Verghese spoke at Hotel du Pont on Sunday, March 7 as part of Christiana Care’s Health and Society Lecture series. The title of his address was “The Art of Medicine in a Technological Era.” Preserving humanity in medicine “The healing part still requires the doctor’s presence,” said Dr. Verghese. Bob Laskowski, M.D., Christiana Care president and CEO, introduced Dr. Verghese and stressed the personal touch is an integral element in providing care. “It is critical that we preserve the humanity involved in medicine,” said Dr. Laskowski. Dr. Verghese discussed the iconic painting “The Doctor,” painted in 1887 by Sir Luke Fildes, a Scotish artist. The canvas depicts a sick child, sleeping on a makeshift bed of two chairs pushed together. In the background are the parents, a stoic father standing by the mother, her head bowed in prayer. In the center is the doctor, hand on chin, intently observing the child. Technology creates an ‘iPatient’ But the painting isn’t about the physician. “It’s about the patient,” said Dr. Verghese. Making the patient the center of care is still the priority. But in an era of dazzling technology, doctors should not rely solely on images to determine
the course of treatment, in essence creating what Dr. Verghese calls the “iPatient.” “The iPatient gets fabulous care,” he said. “But very often the patient in the bed wonders who is in charge.” In a question-andanswer session, doctors in the audience raised the topic of “mindful meditation” and dialogue with colleagues, which a recent study at the University of Rochester reports can reduce physician burnout. Dr. Verghese agreed that doctors are under considerable stress in a fee-forservice system that includes multiple responsibilities and the distraction of paperwork. Listen to the patient Dr. Verghese said it is essential to educate the next generation of physicians on thorough physical examinations instead of relying on information obtained through technology. He said sloppy history taking also is a major contributor to missed or inaccurate diagnoses. It all comes down to listening to the patient. “I’m a big believer in anecdote-based medicine,” he said. Dr. Verghese is the author of several
Abraham Verghese, M.D., (left) spoke and later signed copies of his works at the Hotel du Pont March 7 as part of the Health and Society Lecture Series championed by Robert J. Laskowski, M.D., MBA, Christiana Care Health System President and CEO (right).
best sellers, including Cutting for Stone, a novel set in Ethiopia, where he grew up; My Own Country : A Doctor's Story, a memoir of his work with patients in rural Tennessee during the early days of the HIV epidemic; and The Tennis Partner: A Story of Friendship and Loss, chronicling the addiction of a medical resident who was his friend and tennis partner.
Randall Gaboriault to lead IT team
Jay Moorhead Sharon Kurfuerst named director appointed to Del Tech of Communications advisory committee
Jay Moorhead
Randall Gaboriault
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andy Gaboriault joined Christiana Care Health System in February as vice president and chief information officer (CIO) from Teleflex Inc., a multi-billion dollar, global medical device leader in Limerick, Pa., where Randy spent more than 12 years leading global teams for IT, logistics, operational excellence, and strategic sourcing. He volunteers for the non-profit Board of Directors for NPower Pennsylvania and Delaware, and also serves as a board director for the Community Performing Arts Center at the Pennsylvania Institute of Technology. “I am very excited to lead the Information Technology transformation at Christiana Care, through the renovation of health care,” Gaboriault says. “IT is the intersection point for people, process and technology, and the CIO is the wide angle lens on the organization. My time will be allocated between, the future, (Where are we going?) today (“managing the railroad”) and talent development (building the team to deliver excellence).” 16
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ay Moorhead joined Christiana Care in January as director of Communications, reporting to the senior vice president of External Affairs, Michele A. Schiavoni. Moorhead is responsible for all internal brand management, media relations, government relations, employee and physician communications, including FOCUS and the employee portal. “I have great respect for the activities and efforts that take place throughout our organization every day,” says Moorhead. “I look forward to helping get out the many positive stories that distinguish Christiana Care.” Moorhead has more than 25 years of experience in health care marketing and communications, most recently as head of his own marketing/communication business. He previously served as vice president of marketing and communications for Coventry Health Care, based in Bethesda, Md.
Sharon Kurfuerst, Ed.D, OTR/L
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haron Kurfuerst, Ed.D, OTR/L, FAOTA, administrative director of Rehabilitation Services, is serving on the advisory committee for Delaware Technical & Community College’s Physical Therapy Assistant (PTA) program. “I want to reach out to students who will soon be looking for jobs and offer them opportunities to learn about Christiana Care,” Kurfuerst says. To improve the connection between the Del Tech PTA program and Rehabilitation Services at Christiana Care, Kurfuerst has invited PTA students and faculty to participate in in-services on clinical documentation at Christiana and Wilmington hospitals, and plan more collaboration between Del Tech and Christiana Care. “We’re thrilled to have Sharon help us shape and enhance our curriculum to ensure students are successful in their desired career path,” says Del Tech PTA Program Director Doug Husienga, MPT.
A biometric screening and HRA could save your life John C. Smith, information technology project leader, discovered early warning signs of diabetes and hypertension during his HRA.
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ammy Johnson is rarely ill.
So she wasn’t concerned about her physical well-being when she reported for her biometrics evaluation as part of her Health Risk Assessment. Johnson, an applications analyst, was thinking about the $15 discount on her benefits contributions that she would save each pay period.
“I knew my family history and that my cholesterol was high—but I didn’t know how high,” he says. “When I learned that I also was pre-diabetic and prehypertensive, it was a complete surprise.” Tammy Johnson
She was stunned to learn that her blood pressure was dangerously high, reading 180/103, putting her at risk of stroke. Within the hour, Johnson was whisked from her job at Reads Way in New Castle to the employee health center at Christiana Hospital, where she was put in touch with her primary care provider. Johnson’s doctor prescribed a regimen of walking, as well as a low-sodium, low-fat, caffeinefree diet. Within a month, her blood pressure reading was down to 125/77, within the normal range. “An HRA not only saves you money,” she says. “It can save your life.” Johnson, 49, is the mother of seven children. She says she has always felt comfortable looking after others. “I am now learning to care for myself,” she says. “It’s something I have to do.”
John C. Smith Smith, 52, keeps his cholesterol count in check through medication. He has reduced his risk for diabetes and hypertension by curbing his intake of sweets and fats. One simple and immediate change is banishing cheese from his diet, eliminating both fat and calories. Instead of a glass of red wine in the evening, Smith now unwinds with a cup of green tea. He uses computer software to help keep him on track, entering the calories of foods he eats throughout the day. “I focus on calorie intake versus how many calories I burn,” he says. “If I have calories left over, I can treat myself with a light beer, which only has 104 calories.” Five days a week, Smith devotes 30 minutes to working out on the elliptical machine, melting a cool 400 calories. He also lifts free weights to keep in shape. “I feel fortunate that I learned I was at risk before I developed full-blown diabetes or high blood pressure,” he says. “That’s the beauty of an HRA.”
Cafeteria menus offer tasty foods, lower fat, salt and calories
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he image of bland hospital cafeteria food is just a stereotype today, especially as compared with Christiana Care’s Wilmington and Christiana hospitals, where the food is not only tastier now, but healthier than ever before. Over the past few months, the chef has implemented menus designed to maintain sound health. The caloric content of entrées has been reduced by at least 100 calories.
Fat, sodium and calories all lowered “The executive chef has lowered the fat, sodium and calories while keeping the items flavorful. We’re also increasing the use of highfiber side dishes and promoting the reduction of red meat entrées,” says Maureen SimpsonWhite, corporate director, Food and Nutrition Services. “Our two new Combi ovens [that combine steam and convection cooking] will help us make healthier food, too.” Other healthful measures include posting the nutritional value of menu items, eliminating the use of milk produced with bovine growth hormone and using only natural chicken. Most recently, the cafeteria became trans fat-free. And food is easier to purchase than ever: The Christiana and Wilmington cafeterias now accept credit cards. 18
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Keep healthy foods around for quick meals
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ustling home after a busy day, it can be hard to warm up to the thought of cooking dinner. Instead of calling out for pizza, why not create something quick, easy and tasty in your very own kitchen? But before you don your apron, put on your thinking cap. Success starts with shopping list Your recipe for success starts with a shopping list. Stock your pantry with nonperishable staples such as rice, low-fat canned chicken broth, canned tomatoes, pasta, beans and tuna packed in water. Keep veggie burgers and bags of mixed vegetables at the ready in the freezer—and a few lowfat frozen dinners for those evenings when you have just enough time and energy to program the microwave. In the fridge, maintain a supply of fresh fruits and vegetables, including lettuce, carrots and bell peppers. Buy pre-packaged egg whites, no-fat milk and reduced-fat cheeses. (Experiment with leftovers—perhaps chicken and broccoli or shrimp and peas—and whip up a yummy omelet.)
Serve up vegetarian chili in the time it takes to add peppers, onions and spices to a few cans of tomatoes and pinto beans. Or steam frozen veggies with rice. Add leftover chicken, vegetables and noodles or rice to canned broth for a hurry-up version of homemade soup. And you can make a main course out of a salad in a snap by adding canned tuna or salmon and sliced, hard-boiled eggs. Experiment with light alternatives It’s fine to turn to such pantry pals as spaghetti and a jar of marinara sauce. But instead of prepared macaroni and cheese, experiment with a light alternative, blending cubes of reduced-fat cheese and no-fat milk with the noodles. For variety, add a handful of frozen peas to the boiling water.
Still have a yen for pizza? You can make your own version at home withWith the ingredients at hand and a out tossing dough for delivery. Make few simple recipes under your belt individual mini pizzas by spreading you will find you are much less likely tomato sauce on bagels, pita bread, to pile on calories—and empty your tortillas, French bread or even English wallet—with prepared and takeout muffins. Sprinkle grated cheese on top food. Think nutritious—and delicious. and heat under the broiler or in a So hold the fast food burgers and fries. toaster oven.
Focus on Excellence – Best Practice Review – March 2010 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. Dating and timing medical record entries Q. Do all Medical Record entries have to be dated and timed? A. YES, all medical record entries must be dated, timed and signed. Q. Why is dating and timing medical record entries important? A. Proper documentation for the date and time for medical record entries: Facilitates collaborative planning of patient care, treatment and services to achieve optimal outcomes and continuity of care among health care providers.
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Establishes when an order was given, and when an activity, intervention, treatment or procedure occurred or is to take place.
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Establishes a baseline for future actions or assessments and establishes a timeline of events.
Q. How should chart documentation be dated and timed? A. Documentation is to be recorded legibly, dated, timed and signed. See example below of correctly dated and timed documentations:
To ask questions, contact the content expert: Kathy Kozak, RN, 733-1697. 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 on the portals in the Archives of Best Practices. From your portal, choose Focus on Excellence, Joint Commission Readiness, Ongoing Strategies, Educational Strategies, Monthly Q&A.
Labrador rescued from pond finds a permanent home New master named the pooch ‘Graham’
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he young male labrador that nearly drowned in early February in the frozen pond behind the Helen F. Graham Cancer Center was adopted by one of his rescuers, Christiana Care Life Safety Specialist Lisa Carr. Carr, who along with Christiana Care Constables Cpl. Rick White, Cpl. Murray, Patient Guide Richard Stout and Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, says she was hooked on the pooch from the time they were trying warm him after getting him out of the bond. “His teeth were chattering and we just kind of bonded,” Carr says.
From left, Safety Specialist Lisa Carr, Cpl. Rick White and Cpl. Murray with a frisky Graham revisit the scene of the dog’s close call.