Physician Focus May 2010

How Christiana Care is using Facebook®, Twitter® and other social media to reach patients and professionals with news, podcasts, publications, blogs and events page A5

MAY 2010

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IN THIS ISSUE

A2 For outstanding work in fighting chronic kidney disease, Christiana Care’s Kidney Transplant Program has earned the National Kidney Foundation’s Bruce Zakheim, M.D., Memorial Legislative and Advocacy Award.

A3 Computerized Provider Order Entry is up and running at Christiana Care, thanks in part to the many physicians who helped to build and continue to provide input to improve the system.

PLUS: New medical genetics program

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New specialty maternity OR ■ IHI Open School offers online curriculum W W W. C H R I S T I A N A C A R E . O R G

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K i d n e y Tr a n s p l a n t P r o g r a m

Kidney transplant program wins award For outstanding work in fighting chronic kidney disease, Christiana Care’s Kidney Transplant Program has earned the National Kidney Foundation’s Bruce Zakheim, M.D., Memorial Legislative and Advocacy Award. The National Kidney Foundation serving the Delaware Valley (NKFDV) presented the award on March 6 at the 26th annual Kidney Ball in Philadelphia. The award honors Christiana Care for its leadership in patient education, support services and community outreach.

“REMARKABLE ACHIEVEMENT” Christiana Care and physicians from Nephrology Associates began the kidney transplant program in 2005. By October 2006, with a multidisciplinary team in place, the program opened officially—the first adult transplant program in the state. So far, the team has completed 51 kidney transplants. More than 300 patients are waiting for a kidney transplant and 800 have received evaluation for transplant.

“This award is a remarkable achievement for a young program,” says S. John Swanson, M.D., program chief. “Our leadership involves our neighbors, not just our patients. Advocacy and outreach are part of being at Christiana Care.”

The Christiana Care kidney transplant program has taken a leadership role in education and outreach, holding classes for patients with chronic kidney disease and their families in different parts of Delaware twice a year, reaching 150 to 200 people each time. The program also participates in health fairs and screenings throughout the state.

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.

A CHAMPION IN THE TRANSPLANT AND NEPHROLOGY COMMUNITIES Christiana Care “captures the true spirit of Dr. Zakheim’s efforts against chronic kidney disease by championing key issues in the transplant and nephrology communities with passion and quality leadership,” according to the National Kidney Foundation. Dr. Zakheim, a New Jersey nephrologist, was a leader in the region for caring for patients with chronic kidney disease.

“Christiana Care is grateful to the NKFDV for recognizing the outstanding care that our kidney transplant program brings to Delaware patients with chronic kidney disease,” says Virginia U. Collier, M.D., Hugh R. Sharp Jr. chair of the Department of Medicine.

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As the first adult program in the state Christiana Care’s Kidney Transplant Program so far has completed

51 kidney tranplants.

“EVERYONE CONTRIBUTES TO WHAT WE DO” Stephanie Gilibert, M.D., program medical director, says, “The entire practice is a multidisciplinary undertaking. Everyone contributes to what we do.”

In 2008, to raise community awareness of the disease and the need for organ donation, Christiana Care spearheaded Delaware’s first Kidney Walk. The walk was held again in 2009, and plans are underway for 2010’s walk.

To ensure all Delawareans have convenient access to excellent end-stage renal disease care, the program recently established a satellite clinic in Lewes, Del.

Christiana Hospital

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Computerized Provider Order Entry goes live at Christiana dedication and cooperation,” Dr. Steinberg says. “The doctors at Christiana Care are very special people.”

A forest of technical support staffers clad in green vests was on hand to provide launch-time guidance at both hospitals.

Members of the CPOE Steer and Leadership teams watch as Jim Piacentine, D.O., hospitalist, demonstrates CPOE using a mobile station.

Eight weeks after a successful launch at Wilmington Hospital, Computerized Provider Order Entry (CPOE) is up and running smoothly at Christiana Hospital.

Although the launch at Christiana on March 23 was much larger in scale, it was less complicated because many of the concerns had been worked out at Wilmington, says Terri Steinberg, M.D., MBA, chief medical information officer.

There were fewer systems issues—and a far higher level of confidence,” she says.

TWO PHASES HELPED ROLL-OUT Rolling out CPOE in two phases enabled Christiana Hospital to benefit from the experience gained

at Wilmington campus, says James Newman, M.D., Chief Medical Officer and Patient Safety Officer.

“Quite a few doctors had been trained at Wilmington and they brought a level of comfort and knowledge that they could share with their colleagues,” he says.

“The chairs of departments and leaders of the Medical-Dental Staff were also very visible and engaged and their presence was calming.”

Dr. Steinberg and Dr. Newman note that many physicians played an integral role in helping to build the system. Doctors will continue to provide input to improve the design. “It is tremendously impressive to witness the level of

CPOE is a dramatic step forward in improving patient safety and health care efficiency. Because orders are entered electronically, the system eliminates errors in deciphering doctors’ handwriting.

CPOE also reduces repeat tests and improves turnaround times for results. The technology provides such conveniences as “smart med” pick lists, with usual doses and methods of delivery.

“Providers have come to accept that CPOE is a reality— and a good thing for patients.”

JAMES NEWMAN, M.D. CHIEF MEDICAL OFFICER AND PATIENT SAFETY OFFICER

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Did you know

Specialized rehab is now available at the Helen F. Graham Cancer Center. Cancer patients now have a place to exercisethat and receive rehabilitation therapy at the “We quickly realized at Christiana Care

Helen F. Graham Cancer Center with the opening of a Specialty Rehabilitation, Inc. (SRI) facility in March.

we would get the very best doctors. Plus, I would be treated like a person, not a number.”

First in Delaware to offer specialized physical and occupational therapy for patients living with cancer, SRI provides rehabilitation services to post-mastectomy, gynecological, post-prostatectomy, head and neck and colorectal cancers. Therapy is also available to address debilitation and fatigue and to improve peripheral neuropathy resulting from chemotherapy.

For more information or to make a referral, call 302-709-3411 or visit www.specialtyrehabilitation.com

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Medical Genetics Program

Now medical genetics testing is closer to home Until now, adults in Delaware in need of genetic testing had to go to Philadelphia or Baltimore. But a new medical genetics program at Christiana Care will provide the only clinical genetic services in Delaware aimed at helping to improve the diagnosis, treatment and prevention of many diseases.

Bruce Boman, M.D., Ph.D., director, Cancer Genetics and Stem Cell Biology at the Helen F. Graham Cancer Center, says “medical genetics classically focused on prenatal, pediatric and cancer medicine, but today it is helping to save the lives of people who are at high risk for developing not only cancer, but many other diseases that have genetic components.“ The goal of the program is to develop an infrastructure to diagnose inherited disorders and to tailor treatments based on a patient’s genetic profile.

“The future of genetic medicine is looking at common and etiologically complex disorders, such as hypertension, coronary artery disease and depression,” says Louis Bartoshesky, M.D., MPH, chair, Department of Pediatrics and also medical director of Genetics and Newborn Screening for the Delaware Division of Public Health.

As this new area of pharmacogenomics matures new molecular genetics technologies will help to identify which drugs are most likely to help Louis Bartoshesky, M.D., MPH patients and least likely to cause a bad reaction, based on each patient’s genetic profile. For example “We expect [soon] to be able to draw blood, send it to the lab and learn that Antidepressant A would work better than Antidepressant B,” Dr. Bartoshesky says.

According to says Zohra Ali-Khan Catts, MS, CGC, director of the Cancer Genetic Counseling at Graham Cancer Center, in about 5 to 10 percent of cancers, May 2010 P H Y S I C I A N F O C U S

“Medical genetics...is helping

to save the lives of people who are at high risk for developing not only cancer, but many other diseases that have genetic components.“ BRUCE BOMAN, M.D., PH.D. director, Cancer Genetics and Stem Cell Biology at the Helen F. Graham Cancer Center

including breast, ovarian, colorectal, pancreatic, prostate and melanoma, inherited genetic mutations cause the disease. “When we know about a person’s risk factors, we can tailor strategies to help lessen the likelihood that cancer will develop. We can catch cancer early when it is most curable,” she says.

RESEARCHERS DISCOVER OTHER GENETIC LINKS Other diseases that result from mutations in a gene or pair of genes include some forms of muscular dystrophy, as well as Huntington’s disease, a degenerative neurological disease, and Marfan syndrome, a disorder of the connective tissues that can affect the heart, lungs and eyes. Through collaboration between Christiana Care’s Center for Heart & Vascular Health and the Helen F. Graham Cancer Center, researchers are discovering genetic links to many more conditions.

“We will have a combined database that offers unparalleled opportunities for research,” says William Weintraub, M.D., FACC, director of the Christiana Center for Outcomes Research and John H. Ammon Chair of Cardiology. Genetic testing can help to confirm such heart disorders as Brugada syndrome, which causes sudden cardiac arrest when the walls of the heart are abnormally thick.

Identifying inherited conditions also is important in preventing disease through medications and healthy habits. “Lifestyle and environment interact with genetics in ways that are still not well understood,” Dr. Weintraub says. “But we are learning more every day.”

Web Services

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Keep abreast of Christiana Care on Facebook, Twitter and other social media More than 175 million people use Facebook®. Last month, more than 23 million people downloaded a podcast. YouTube® users view a million videos every day. And up to 80 percent of Americans turn to the Internet to find health information.

As the number of social media users grows, Christiana Care is well positioned with a coordinated, flexible, strategy. “The fundamental concept of communicating online is that you need to put your voice where the people are,” says Shane Hoffman, Web services project manager for Christiana Care.

“People’s lives are filled with their own routine, surfing sites they’re comfortable with, creating their own channels of information. So that means putting our information where they are.”

FINDING MAINSTREAM AUDIENCES Christiana Care looks for sites that have a mainstream audience and provides tools for communicating with audiences in a variety of ways, Hoffman says.

“YouTube gives us the ability to showcase our videos. iTunes® allows users to download our women’s health podcasts and listen while they’re jogging. Flickr® is a place where people looking for photos can find them, but also where people who aren’t looking can stumble across them, including reporters and editors.”

Christiana Care was among a small number of hospitals doing social media when it got involved about a year ago. “We’ve really been on the leading edge of using social media as a health system,” Hoffman says.

In just a year, Christiana Care has more than a thousand followers on Twitter®. But large numbers of followers or comments isn’t the Web Services team’s goal.

GOAL IS PROVIDING GOOD INFORMATION “We’ve learned over the past year that there are almost as many social media experts in the world as people using social media. It’s all just communication, and each one of these sites is a tool,” Hoffman says. “We’re proud we have a thousand Twitter followers, but that’s not the goal. Our goal is to provide good information that helps people.”

Christiana Care’s Facebook page shares news, health tips, podcasts, presentations, access to physician blogs and invitations to events; sometimes, friends will start an online discussion about a post. Issuu®, a less-common site, lets users read, download and print Christiana Care publications. Twitter offers such tips as how to soothe a crying baby and when to seek help for chronic headaches.

THE STAGE IS SET As part of External Affairs, the Web Services team― Hoffman, Matt McCoy, graphics manager, and Director Scott Mash―works closely with other areas of the hospital to provide quality information for all its social media efforts.

“Before we had our online presence, it required a lot of planning. We’ve been really successful in setting the stage for the future in our ability to integrate all these tools and use each one for its best potential,” Hoffman says.

➾ If you are interested in or have an idea about how we could use Christiana Care’s social media presence to reach your patients or audience, or if you have already started, please contact Scott Mash at 302-327-3313. And don’t forget to follow us on Facebook, Twitter, Flickr, iTunes, YouTube and Issuu.

May 2010 P H Y S I C I A N F O C U S

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Christiana Hospital Labor & Delivery

New maternity OR equipped for multiple births and obese patients When Christiana Care planners began considering a fourth operating room in Labor & Delivery, they chose to invest in a larger, specially equipped facility to reflect two growing trends in the patient population— obesity and multiple births.

Now, extremely overweight women giving birth can have the family-centered maternity experience that Christiana Care is known for in the new bariatric operating room in Labor & Delivery at Christiana Hospital.

Possibly the first of its kind in the country, the stateof-the-art OR also is specially equipped to handle triplets.

MORE OPTIONS FOR C-SECTION Before it was added, the three existing ORs were scheduled for Caesarean sections more than 80 percent of the time, says L&D Medical Director Gregory DeMeo, D.O. “Now, there is much greater choice for doctors and their patients in scheduling Caesarean delivery,” he says. “We now have the ability to manage these patients in the safest, most appropriate manner,” Dr. DeMeo says. The OR has a lift to safely position large patients, as well as mothers with other special needs, such as paraplegia. The operating table is extra wide and can support up to 1,000 pounds—with fetal monitors and lights placed on booms.

More than 50 sets of twins and four sets of triplets have been delivered here since the OR opened in October of 2009.

NUMBERS INDICATED NEED FOR CHANGE Since the OR opened in October 2009, more than 50 sets of twins and four sets of triplets have come into the world there. The number of twin births increased 70 percent between 1980 and 2004. Births of triplets, quadruplets and more multiples quadrupled during that period. And 21 percent of expectant moms are morbidly obese, putting them at high risk for diabetes and hypertension.

“The room itself is large enough to accommodate all the extra pediatric staff that is present for multiple births so the parents aren’t separated from their children,” Dr. DeMeo says. “It is a beautiful place.”

A healthy dose of concern for patients NEW PARTNERSHIP BETWEEN VNA AND WALGREENS IMPROVES DIALOGUE Christiana Care Visiting Nurse Association (VNA) nurses want to be sure their patients are taking their medications correctly. So do the pharmacists who fill those prescriptions. When Walgreens approached VNA about partnering to find ways to help make patients safer, VNA recognized an opportunity to improve community health and prevent hospital readmissions, especially among the elderly.

VNA nurses and community-based pharmacists are forming a powerful alliance to transform home health care delivery through medication reconciliation, dialogue and education. Soon, they will join also with the Vial of Life, a national project that engages emergency medical technicians (EMTs) as yet another partner interested in sharing and benefitting from accurate health information for home health care patients.

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Vi r t u a l E d u c a t i o n a n d S i m u l a t i o n Tr a i n i n g

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High-tech mannequins simulate real injuries at training center Imagine a seven-room hospital where doctors gain a firm foundation in surgical techniques, handto-eye coordination and repetitive skills exercises—before they pick up a scalpel to operate on a real patient.

Christiana Care’s Virtual Education and Simulation Training (VEST) facility in the John H. Ammon Medical Education Center is one of only 106 member medical simulation centers in the U.S., according to the Society for Simulation in Health Care.

The 9,000-square-foot center has a working laparoscopy station with simulated tissues, an endoscopy/ bronchoscopy simulator, and 3D visualization software and display, with more than 100 task trainers.

Babies are born, injured adults and children rushed to the ED. Patients are intubated, have blood drawn and get IV drips in the trauma bay, intensive care unit, operating room and standardized patient rooms.

VEST Center Medical Director Glen Tinkoff, M.D., associate vice chair of Surgery, and Staff Development Specialist Pamela Woods, RN, teach resuscitation using a human patient simulator.

HIGH-FIDELITY PATIENT SIMULATORS The adult and pediatric highfidelity human patient simulators breathe, speak, blink their eyes and respond to stimuli. Controlled by computers to simulate various conditions, the manikins produce heartbeats, bowel sounds and blood pressure readings.

“We have an obligation to our community, our families and ourselves to provide a training environment that does not compromise patient safety,” says VEST Center Medical Director Glen Tinkoff, M.D. “Previously, the only way we could teach these skills was at the bedside.”

The facility is certified by the American College of Surgery as a Level II Educational Institute designated for providers of basic education enhancing patient safety through simulation.

Did you

know?

The Christiana Care chapter of the Institute for Healthcare Improvement (IHI) has earned more Open School basic certificates of completion than any other chapter in the world.

An online curriculum in quality improvement, the IHI Open School is a worldwide community of medical students, nursing students, physicians, nurses and other health care professionals afforded access to free curriculum about health care quality and safety.The IHI offers a certificate in performance improvement to those who complete all of their courses. There are more than 10,000 participants worldwide.

Christiana Care congratulates Matt Judd, D.O, our IHI Open School chapter leader and faculty advisors Patty Resnik, RRT, MBA, CPUR, Loretta Consiglio-Ward, RN, MSN, Charles L. Reese, M.D., and Lee Ann Riesenberg, Ph.D., RN, along with all colleagues who have earned certificates to date.

If you are interested in joining the chapter, contact Dr. Judd directly at 302-388-7941 or mjudd@christianacare.org.

Go to www.ihi.org for more information on the Open School.

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