System News by Penn Medicine

Volume 12

Issue 4

April 2013

SYSTEMnews CEO’s corner Ralph W. Muller

CEO, University of Pennsylvania Health System

As you probably know, Congress and President Obama were unable to come to an agreement that would have avoided the automatic spending cuts known as sequestration. Unless an agreement is reached soon, this will mean an $85 billion reduction in spending for the remainder of the federal fiscal year, which ends on September 30th. About half of that amount would come from a five percent across-the-board cut in discretionary domestic spending. The other half would come from an eight percent reduction in defense spending Medicaid is exempt from the sequestration cuts, but two-percent cuts in Medicare provider payments and fivepercent reductions in other federal health-care programs, including biomedical research, could soon begin to affect hospitals and health-care organizations nationwide. Naturally, we at Penn are not immune from the effects of such cuts and our hope is that they will be reversed. But if they aren’t, the quality of care that we provide to our patients will still remain exceptional. Because of careful planning and our continuing focus on using resources sensibly, we can weather the reductions triggered by sequestration. We’ve been working hard over the past several months to develop a strategy for addressing potential cutbacks such as the ones that have now been officially put into play. As a result — and because we’re a fiscally sound institution — the Health System is well prepared to continue delivering on its mission. Also, the Perelman School of Medicine will continue providing world-class training of future physicians, and faculty members will still perform high-caliber research that offers fresh hope to patients worldwide. To sustain our ability to address the ramifications of sequestration, we are fully invested in a two-track approach. First, we’ll continue to refine our short-term plan for ensuring that core activities continue in an uninterrupted manner and at a high level. Second, we’re working closely with our peer institutions and professional organizations to help Washington understand the potentially serious national consequences of the healthcare cuts.

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Inside The Envelopes, Please!............2 Rubenstein to Step Down.................................2 New Features Available at myPennMedicine..................2 From Pastels to PDA’s...............2 Penn Medicine@Work..............3 RoundtableFree Skin Cancer Screening......................3 Newsmakers..............................4 Shortakes...................................4 A Focus on Quality & Patient Safety.........................5 Another Title..............................5 Awards and Accolades.............6 SOM Ranked #2.........................6

Penn Orthopaedics

Expanding services to meet all musculoskeletal needs

“There’s one Penn Medicine. Now, there’s one Penn Orthopaedics.” That’s how L. Scott Levin, MD, chair of Orthopaedic Surgery, described the changes occurring in orthopaedics throughout the Health System. With the expansion of orthopaedic services at Pennsylvania Hospital, “we’re working towards a musculoskeletal product line that’s collaborative and multidepartmental.” Noting that both PAH and Penn Presbyterian will provide treatment in 10 orthopaedic specialties (see sidebar on page 2) — and that HUP will provide multiple orthopaedic services as well — he called it “bookends of care... east and west.” With its wide range of services, Penn orthopaedic surgeons can treat any musculoskeletal problem. But, beyond total joint replacement and other routine procedures, its patients are receiving cutting-edge treatments that are unique in the region.

Correcting Imbalances After a stroke or brain injury, a patient may experience a severe loss of movement. As neuro-orthopaedist Keith Baldwin, MD, explained, the signal going from the brain to a muscle gets scrambled. The result: Muscles don’t work as they should. That’s what happened to a woman who suffered a stroke at 48. By the time she came to see Baldwin two years later, she had developed a neuromuscular club foot which had left her unable to walk and in a wheelchair. “The stroke caused her foot to curve inward, with the toes pointing down,” he said. “A club foot is very difficult to walk on. In fact, it’s one of the most debilitating deformities.” A club foot generally results from a muscle imbalance — too much pull on one side and too little on the other. Such was the case with Baldwin’s patient. Correcting the imbalance involved making the overactive muscle relax and performing tendon transfers, which allowed the foot to straighten. “The patient is now able to walk almost totally without assistance.” This approach and others have helped many patients affected by spasticity, fixed muscle shortening, and loss of mobility which left them with problems such as stiff-knee gait, hip and knee deformities, and stiff

shoulder. One patient with a brain injury couldn’t throw a ball due to his arm “catching involuntarily.” Baldwin compared it to how a person’s leg jerks involuntarily when the doctor taps the knee. The patient had a simple goal: being able to throw a ball to his son. Baldwin lengthened the patient’s bicep, which weakened the muscle and eliminated the involuntary movement. “Now the triceps work the way they’re supposed to and he’s reached his goal. “We can’t fix a brain or spinal cord, but, by relaxing or redirecting a muscle or tendon, we can give the patient a better quality of life.”

Helping to Regrow Cartilage Joint cartilage is the flexible connective tissue that coats the ends of bones to keep them moving against one another smoothly. According to James Carey, MD, director of the Penn Center for Advanced Cartilage Repair and Osteochondritis Dissecans Treatment, cartilage is 1000 times more slippery than ice! “That’s why we can take a million steps a year without a problem.” Unlike skin, cartilage cannot heal itself. Therefore, left untreated, tears get bigger and bigger, often leading to arthritis. Cartilage tears most frequently happen when the knee cap dislocates or there’s an injury to the anterior cruciate ligament. “It generally occurs in contact and collision sports,” Carey said, adding that year-round athletes are also more likely to develop osteochondritis dissecans (OCD), a rare — and often misdiagnosed — condition in which a fragment of bone and cartilage separates, causing pain, swelling and mechanical issues. While cartilage isn’t self-healing, certain procedures can help it regrow. But repairing cartilage is not easy. “It requires special training and there’s a steep learning curve,” Carey said. Plus there are specific rehab protocols for these patients. Procedures to repair cartilage differ according to the size of the tear. For example, in smaller defects in the cartilage, Carey uses microfracture, making small holes in the bone to stimulate cartilage growth. “It’s the most common procedure.” An autologous chondrocyte implantation fills a large defect with millions of cells grown from a small piece of the patient’s own cartilage. (continued on page 2)

Celebrating Art & Life.............. 6

The Envelopes, Please! Every March, Match Day occurs for thousands of medical students across the country. This annual event is the culmination of a process that began in the fall through the National Residency Matching Program, which helps pair graduating medical students across the country with the hospital or medical center of their choice. This year, 161 students from the Perelman School of Medicine (77 women and 84 men) gathered in Stemmler Hall in an emotion-filled ceremony to receive their “residency placement” envelopes and learn where they will spend the next few years receiving their advanced medical training. To read a first-person perspective of the process, read the blog of two Penn medical students (husband and wife Jon and Martha Kole) at http://news.pennmedicine.org/blog/. `` Kelly Quinley and her husband were clearly pleased with the outcome. Kelly matched in Emergency Medicine at Alameda County Medical Center in California.

New Features Available in myPennMedicine Since its debut in 2008, myPennMedicine, the Health System’s online healthmanagement tool, has provided over 100,000 patients with easy and secure access to their personal medical information, including lab and radiology results, as well as the ability to: • Renew a prescription • Send a secure message to their Care Team • Request an appointment Now, a new feature allows patients access to cardiology diagnostic test results, such as EKGs and echocardiograms, as well. In addition, a pilot currently underway will allow patients to schedule their own appointments online. If the pilot proves successful, this new feature will be rolled out to interested departments. So far, patient feedback about myPennMedicine has been glowing: “I think what you’re doing is a great idea.... I am 74 years old and I find the site very friendly. Please keep up the good work.” “I really enjoy being readily able to access my information online.... This site is easy to navigate and locate information.” “I love this website. As usual, Penn Medicine is pioneering health information access. What a great tool to keep the patient focused on maintaining their health.” If you haven’t already done so, it’s easy to sign up for myPennMedicine. Simply go to the Intranet home page and click on ‘myPennMedicine.’

Perelman SOM Ranked Among the Top Five Medical Schools in US For the 16th year in a row, the Perelman School of Medicine has ranked among the top five medical schools in the United States, according to an annual survey by U.S. News & World Report. In 2013, the School of Medicine was ranked #4 in the country. The Perelman School of Medicine also ranked among the nation’s top medical schools in five areas of specialty training, including a first place ranking in Pediatrics, Women’s Health (#3), Internal Medicine (#4), Drug/Alcohol Abuse (#5), and AIDS (#7). The annual medical school rankings are based on statistical indicators that measure the quality of a school’s faculty, research, and students.

Penn Orthopaedics Expanding services to meet all musculoskeletal needs

Avoiding total joint replacement is also the goal of another unique procedure offered at Penn Orthopaedics: Free Vascularized Fibular Graft (FVFG).

(continued from cover)

An osteochondral allograft transplantation, which uses cartilage and bone from a cadaver donor, is often “the last step before a knee replacement,” he said. “But, for a 20-year-old patient, that’s a new replacement every 10 years. We do everything to avoid metal and plastic.”

10 Orthopaedic Specialty Areas Penn Orthopaedics offers treatment in 10 specialty areas as well as same-day service. “You call with any musculoskeletal need and we’ll see you that day,” said L. Scott Levin, MD, department chair. “No exceptions.” • Foot and ankle

• Joint replacement

• Spine

• General orthopaedics

• Neuro orthopaedics

• Sports medicine

• Hand and wrist

• Orthopaedic oncology

• Trauma and fracture care

• Shoulder and elbow

To learn more about Penn Orthopaedics, go to PennMedicine.org/orthopaedics

Giving New Life to Dead Bones

While most artificial hip joints in use today will last 10 to 20 years, for younger patients, the artificial hip joint — which replaces the natural hip bone with a metal ball and resurfaces the hip socket with a metal shell and plastic liner — still means a second surgery … or possibly a third. This was the situation facing a 26-year-old patient with bilateral osteonecrosis — also known as avascular necrosis, a condition that occurs when bones lose their blood supply. The patient, who was a law student when he started experiencing hip pain in 2011, pushed his pain to the back burner while he concentrated on studying for the Bar exam. Some time later, as the pain got worse, he sought help. But, by this time, an MRI showed that he had advanced beyond the point where typical therapeutic procedures would help. “I didn’t want to get an artificial joint that would wear out but my options were limited.” Then he heard about the FVFG, an alternative to total hip replacement that replaces the dying piece of bone in the hip with a segment from the fibula. “Once the blood vessels are connected, the hip is given a new blood supply that allows it to regenerate,” said Levin, the surgeon who performed the procedure. FVFG requires special training in both orthopaedics and microsurgery, a unique skill set that limits the number of hospitals capable of offering the procedure. In a few months, the patient will be able to walk, run and go back to his daily life. Although recovery from this procedure takes longer than the typical six weeks of a total hip replacement, the benefit of not undergoing multiple hip replacements over the course of a patient’s life greatly outweighs the extra time in rehab.

penn medicine

work

Annual Benefits Open Enrollment

April 15 – April 28 Open Enrollment is just around the corner! Now is the time to get a better understanding of the current benefits and what’s changing. And be sure to

Get Free Healthcare for 1 Year! Earn entry into a raffle for free healthcare for 2013-2014 when you complete the online Well-Being Assessment and record “Your Numbers” during Open Enrollment.

check out the many benefits of our Wellfocused Healthy Rewards program! Earned Premium Discount Extended to Covered Dependents (ages 18-26). You Must Take Action!

To earn the premium discount this year, all eligible dependents covered under a medical plan (ages 18-26) must not use tobacco or be enrolled in a tobacco cessation program by June 30, 2013. To receive the earned premium discount, you must certify to your tobacco use and then elect the tobacco user or non-user medical contribution. If you do not make an active election, you will default to the same benefits you had last year. However, the earned premium discount will not be applied and you will pay higher medical contributions of $25.00 per pay/$650 a year.

Quit Tobacco Use with the Help of Health Advocate

Enroll in Health Advocate’s free tobacco cessation program to set up your own plan to quit smoking or stop using other tobacco products with the help of a trained coach. This program allows you and your covered dependents 13 weeks of counseling, free nicotine replacement therapy (patch, gum, lozenge), and a $0 copay for over-the-counter NRT and prescription smoking cessation medications. Important: If you are a tobacco user, you must enroll in the UPHS tobacco cessation program by June 30, 2013 to receive the earned premium discount on your 2013 — 2014 medical contributions.

Know Your Numbers — It’s Free and May Save Your Life!

There is power in knowing your numbers: glucose, cholesterol (total, HDL, LDL), blood pressure and body mass index (BMI). They are important indicators of your health. When they are out of the normal range, it’s a signal that you could have a higher risk of developing certain diseases and conditions. UPHS medical plans cover preventive care like annual physicals and biometric screenings at 100%. Take action! If you haven’t done so recently, make an appointment today and know where you stand when it comes to your health. When you receive your results, enter your numbers into the Well-Being Assessment (see below) to see what you can do to be your healthiest.

Earn a $150 Healthy Credit & Participate in the NEW WellFocused Healthy Rewards Program

Wellfocused has several new programs that reward you for taking steps towards improving your health and well-being because the healthier you are, the more you can enjoy life and do your best. You can earn a $150 Healthy Credit when you complete the online Well-Being Assessment, Know Your Numbers (blood sugar, cholesterol — total, HDL, and LDL — blood pressure and BMI), have your biometric numbers fall with specific ranges, and/or take healthy actions through a new and expanded Wellfocused online platform. The new platform will be accessible through the HR & You website: www.uphshrandyou.com.

Toward a Tobacco Free Future

Recently, UPHS announced that, effective July 1, 2013, we will cease hiring tobacco users in our efforts to improve the overall health of our workforce while reducing health-care benefit costs. The response we’ve gotten from employees and from our community has been very positive. For current employees, UPHS will continue to provide free smoking cessation counseling and nicotine replacement therapy to support our staff and their families in eliminating the use of tobacco products. We know that employees might have questions about how this new policy affects them. Below are some Frequently Asked Questions (FAQ). For a larger list of FAQ — which includes additional details on how this policy affects those applying for positions at UPHS — visit www.pennmedicine.org/careers/working-at-penn-medicine/tobacco-free.html.

If you have additional questions that are not included in the FAQ below or online, email them to tobaccofree@uphs.upenn.edu

If you have additional questions that are not included in the FAQ below or online, email them to tobaccofree@uphs.upenn.edu.

How Does the Tobacco Free Policy Affect Current Employees? Will the Tobacco Free Hiring policy impact current UPHS employees? No. Current employees will be grandfathered — but employees who are tobacco users can expect to pay a higher premium on their health-care benefit if they are not actively enrolled in a smoking cessation program or nicotine replacement therapy.

Inherent in the mission of health-care organizations is healing the sick and cultivating healthier communities. So it does make sense that health-care organizations would be the first employers to move toward a tobacco free future — ending a habit that leads to disease, disability and premature death.

Who does this policy apply to? This policy applies to all UPHS employees, inclusive of physicians employed by the Health System, who begin employment on or after July 1, 2013. Due to the lengthy recruitment cycle of fellows and residents, the effective date for this policy is July 1, 2014, providing a full year notification to applicants. This policy does not apply to faculty and staff employed by the University or UPHS employees working exclusively in New Jersey.

If a current employee terminates employment with UPHS and then re-applies, will that person be subject to the new policy? Yes.

Why the focus on tobacco users? The health risks and related costs associated with tobacco use have caused UPHS to mobilize action for moving toward a tobacco free future by focusing on the health of its workforce while containing the escalating costs associated with tobacco use. The Center for Disease Control (CDC) provides evidence that smoking or second-hand smoke exposure contributes to 443,000 premature deaths annually and results in $193 billion in health-care costs and lost productivity. Is there documented evidence that ‘banning the hiring of tobacco users’ reduces overall health care costs? No longitudinal study provides demonstrable evidence that employers who cease hiring tobacco users reduce overall health-care costs. This is largely due to the fact that this type of employment practice has only been initiated in the past few years. One of the first to introduce the ‘tobacco free hiring’ policy was the Cleveland Clinic in 2007; the practice has contributed to an overall reduction in smoking rates in Cuyahoga County. Many others have followed since then, including Geisinger Health Care System, St. Luke’s, Baylor Health Care System, Humana, Massachusetts Hospital Association and many others throughout the country.

Will physicians be subject to the tobacco free hiring policy? All physicians who are employed by UPHS are subject to this policy — including residents, fellows and most CCA physicians. Faculty and staff who are employed by the University are not subject to this policy. Due to the recruitment cycle of residents and fellows, the effective date for policy implementation for this group of employees is July 1, 2014. Will residents of communities who have higher smoking rates be adversely impacted by this policy? Even surrounding communities that have a relatively high usage of tobacco products have far more non-tobacco users than tobacco users. We also are continuing our efforts to increase education on the impact of tobacco use in those communities with higher usage rates. The implementation of this policy does not adversely impact our recruitment efforts. We are committed to enforcing this policy while ensuring that our hiring rate in these communities does not decrease. What future bans will UPHS consider next? The University of Pennsylvania Health System is committed to a safe and healthy work environment and to promoting the health and well-being of its employees. Other than requiring future applicants to attest to not being a tobacco user, there are no specific plans to restrict employment for other conditions.

Penn Medicine

NEWSmakers / / / Colonoscopy Tied to Lower Risk of Advanced Cancer A new multidisciplinary study published in the Annals of Internal Medicine shows that people who have had a colonoscopy in the past decade are less likely to be diagnosed with advanced colon cancer than those who haven’t been screened recently. Researchers found less-invasive tests, known as sigmoidoscopies, were also tied to a lower risk of advanced tumors — but only those growing in one side of the colon. It’s still not clear what that means for cancer survival, according to Chyke Doubeni, MD, MPH, who led the new study. But while researchers wait for results from more controlled, long-term trials, the new report is more evidence that screening in general is beneficial, researchers said. “There’s a variety of screening tests for us to choose from,” Doubeni told Reuters Health. “This study doesn’t show that colonoscopy is the only test, but it does show that colonoscopy has the advantage in being able to see the right side [of the colon]… unlike sigmoidoscopy and fecal occult blood testing.” HealthDay news syndicate and Yahoo! News (via Myhealthnewsdaily. com) also covered the story, which was picked up by news outlets across the country.

/ / / Taking a Harder Look at Fracking and Health A coalition of academic researchers in the United States is preparing to shine a rigorous scientific light on the polarized and often emotional debate over whether using hydraulic fracturing to drill for natural gas is hazardous to human health. Some five years after the controversial combination of fracking and horizontal drilling in the gas-rich Marcellus Shale in Pennsylvania and surrounding states got under way, a team of toxicologists from Penn is leading a national effort to study the health effects of fracking. The Center of Excellence in Environmental Toxicology (CEET) has organized a working group with researchers at other top universities to investigate and analyze reports of nausea, headaches, breathing difficulties and other ills from people who live near natural gas drilling sites, compressor stations or wastewater pits. The aim is to bring academic discipline to the unresolved national debate. “There is an enormous amount of rhetoric on both sides,” said Trevor M. Penning, PhD, CEET director, in a New York Times blog. “We felt that because we are situated in Pennsylvania, we had a duty to get on top of what was known and what was not known.”

/ / / Does Your Diet Influence How Well You Sleep? Poor sleeping habits can lead to overeating, but can unhealthy diets keep you up at night? Previous studies have linked a lack of sleep to overeating, but less is known about how diet influences sleep patterns. A group of Penn researchers investigated how diets correlated with sleep patterns. It turns out that people in different sleep categories also had distinct diet patterns. Short sleepers consumed the most calories, followed by normal sleepers, then very short sleepers. Long sleepers consumed the least calories. Normal sleepers, however, showed the highest food variety in their diets, and very short sleepers had the least variation in what they ate. A varied diet tends to be a marker for good health since it includes multiple sources of nutrients. “It reminds people that we have come to the point in our society where we recognize that our diet is important to our health. We don’t always act on it, but we recognize it,” study author Michael Grandner, PhD, instructor in psychiatry and member of the Center for Sleep and Circadian Neurobiology, said in an interview with TIME magazine. The research was also covered by the Huffington Post, The Dr. Oz Show, Philadelphia magazine, Prevention magazine, and Cosmopolitan.

/ / / Sequestration Projected to Hit Hard Within Philadelphia’s Biomedical Research Institutions A Philadelphia Inquirer story explored the projected impact of the federal sequestration on the area’s hospitals and medical schools, noting that Penn Medicine could lose an estimated $23 million a year from sequestration’s Medicare cuts, and National Institutes of Health research funding cuts could total at least $20 million. In the longer term, leaner funding makes it more difficult for researchers to build on scientific advances. As other countries, particularly China, increase science funding, the United States will find itself taking a diminished role, said Glen Gaulton, PhD, executive vice dean and chief scientific officer. Shaun O’Brien, a graduate student in Immunology, is also quoted in the story discussing the impact of dwindling funding on young scientists working to build their careers.

/ / / Do No Harm to Research Budgets J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine and executive vice president of the University of Pennsylvania for the Health System, authored an Op-Ed in The Philadelphia Inquirer calling on Congress to preserve federal support for biomedical research in the face of sequestration, which would cut up to 7.8 percent of the National Institutes of Health’s funding. “Cutting biomedical research,” he wrote, “will cripple one of our most promising economic engines, slow the pace of scientific discovery by dismantling research teams, abandon a generation of young scientists, and, most importantly, cost lives.”

/ / / Heart Health 2013 Penn Medicine physicians were featured in a multistory supplement on heart-health issues. Included in this special pull-out section which appeared in The Philadelphia Inquirer and Daily News:  Developing a New Medicine to Treat a Rare, but Deadly Condition A new medication, developed by Penn Medicine researchers, now exists to treat the rare condition, Homozygous Familial Hypercholesterolemia (HoFH), which affects 2,000 to 3,000 people in the U.S. and can lead to heart attacks and death, even in young adults. Daniel Rader, MD, chief of Translational Medicine and Human Genetics; Marina Cuchel, MD, PhD, research assistant professor of Medicine; and Emma Meagher, MD, associate professor of Medicine, were cited for their work in developing the medication.  The Hearty Way to Eat Heart-healthy eating is much easier said than done. Local experts discuss a dozen ways to simplify your every-day eating, to put you and your heart on the path to a long, lovely life together. Frances Burke, MS, RD, a clinical dietitian with Penn Medicine Preventive Cardiovascular Program, was quoted.  New Procedure Ensures Accuracy, Practicality in Handling Heart Attacks Fractional flow reserve dates to the mid-1990s, but has become more widely used in the past five years, not just because studies have found it effective, but because research is disputing the need to give stents to all patients. For the procedure, the physician inserts a catheter through the groin or wrist artery, injects X-ray dye into the coronary arteries and makes a film of the blood-flow pattern, showing the location and size of any blockages. Howard Herrmann, MD, director of Interventional Cardiology, was quoted discussing the procedure. • Procedure Can Now Zap Away Heart Problems with Ease The ability to locate and eliminate the electrical cause of a-fib has come a long way since the 1980s. Now, physicians have precise mapping and imaging technology, and minimally invasive ways of burning or freezing the misfiring cells. Francis Marchlinski, MD, professor of Medicine and director, Electrophysiology Program, was a featured expert in the article.

/ / / Governor Corbett at Penn Medicine to Sign Executive Order Creating Alzheimer’s Disease Committee Gov. Tom Corbett signed an Executive Order establishing the Pennsylvania Alzheimer’s Disease State Planning Committee. The committee will work to create a state plan to address the growing Alzheimer’s disease crisis in Pennsylvania. Over 400,000 Pennsylvanians are currently living with Alzheimer’s disease. Corbett signed the executive order at Penn’s Perelman School of Medicine, reported CBS3, Fox 29 and other outlets from across the state. Penn’s Alzheimer’s Disease Center is one of two Pennsylvania centers funded by the National Institutes of Health for advanced research in Alzheimer’s disease. Secretary of Aging Brian Duke will serve as the chairperson of the committee that will examine the needs and research the trends of Pennsylvania’s Alzheimer’s population. The committee will include representatives from various state agencies as well as those personally impacted by Alzheimer’s disease.

/ / / Price for a New Hip? Many Hospitals Are Stumped Only 16 percent of U.S. hospitals were able to say how much a hip operation would cost a potential patient when asked, and those that answered quoted prices that differed by more than $100,000, a new study in JAMA Internal Medicine study found. Ezekiel Emanuel, MD, PhD, chair of Medical Ethics and Health Policy and vice provost for Global Initiatives, and Andrew Steinmetz, BA, research assistant to Emanuel, co-authored a commentary published with the new study, which was covered by news outlets including The New York Times, Bloomberg News, Reuters, and NBCNews.com. “It just points to the fact that most of us in the health system don’t have any idea what the costs really are,” Emanuel told Reuters. Often, only the hospital’s billing office knows how much a patient is actually charged for a procedure such as a hip replacement, researchers noted. Some of the variation in costs has to do with how hospitals factor in overhead to each patient’s bill, Emanuel said. And the cost of an actual hip prosthesis can vary four- or five-fold across the country, he added.

/ / / From ‘God-like’ to Team Huddle: Training Doctors for a New Health-Care Future Bill Hanson, MD, chief medical information officer and professor of Anesthesiology and Critical Care, was quoted in a Marketplace Radio story discussing the new era of physician training. Hanson discussed the Thomas Eakins painting, “The Agnew Clinic,” a copy of which hangs in the John Morgan Building, noting that the art embodies the god-like position doctors held for more than a century. “The central figure in medical care is that isolated one professorial figure in white. And everyone else around him is in shadow, or secondary to that fount of wisdom. Very, very different from what we are talking about today,” said Hanson. Brian Smith, MD, a Trauma and Surgical Critical Care fellow, was also featured, discussing the key role of teamwork in the new health-care era, for improving patient care, avoiding errors and reducing costs.

To reach the Penn Medicine news website, go to www.PennMedicine.org/news

A Focus on Quality & Patient Safety Thanks to our collective efforts, we have had another successful year of delivering safe, high-quality health care throughout UPHS. This year, there were 98 project submissions to the annual competition for the UPHS Quality and Patient Safety Awards. “Each year I am overwhelmed by the engagement and creativity that I see in these projects,” said PJ Brennan, MD, chief medical officer for UPHS and a senior VP. “I want to thank the teams for their hard work and dedication,” he continued. “I know that it is their effort that makes Penn Medicine one of America’s leaders in health care.” To see all the submissions, go to http://uphsxnet.uphs.upenn.edu/ceqi and click on ‘2012 Winnters & Submissions Quality & Patient Safety Awards.’

Quality & Patient Safety Award Winners

Operational Award Winners UPHS Discharge Follow-up Phone Calls Reduce Readmissions and After Hours Calls

• Debra Runyan, BS, • Jennifer E. McGarvey,

MSN, ACNP-BC

UPHS Educational and Electronic Medical Record Interventions to Decrease Opioids Dispensed at Discharge in the HUP and PPMC Emergency Departments

PAH Medication Reconciliation — Discharge Time Out

HUP

• Jeanmarie Perrone, MD • Hallam Gugelmann, MD,

MPH

• Angela Mills, MD • Lyudmila Garbovsky,

PharmD

PPMC

• Amanda Binkley, PharmD • Christopher Edwards, MD

MSN, ACNP-BC

• Kate McGill-Armento, APN • Neurosurgery Front Desk • Paul J. Marcotte, MD, • Clinical Coordinators FRCS (C) • Mid-Level Provider Staff

Process for HUP Outpatient MRI’s Requested via EPIC

MSN, RN • Patricia Flack, RN • Valerie Masci, RN • Elizabeth Ferkle, PharmD • AnnMarie Papa, DNP, RN • Steph Borkowski, RN, BSN • Chris Boedec, MD, MBA • Carmen Farrow, MD, MBA

• Eileen Maloney Wilensky,

HUP Improving the Scheduling

• JoAnne Ruggiero,

PAH Implementation of Environmental Services Room Monitoring Program

MT(ASCP), CIC • Carolyn Tobin, BS, BA • Derrick Hutton, BS • Simone Edwards, BS, BA • Ida Macri, BSN, RN, CIC

• Claire Stango, RN, CIC • Maria Vacca, BSN, RN,

CIC, PCCN

• John Stern, MD • Sherelyn Riddick

CPUP Sustainable Change in Childhood Immunization Rates

• Marian Lord Gardner,

MSN, RN, CPHQ

• Shawn Miles, MD • Frank Sites, MHA, RN • 6 Cathcart Nursing Staff

CPUP MacGregor Infectious Diseases Clinic — The Infectious Diseases Transitions Service

• Gerald O’Neill, MD • Peter Sananman, MD

• Antoinette Carey • Brooke McDonnell, MBA, ASQ CSSBB • Ann Della Porta • Scott Falk, MD • Beverly Farrar, RT • Regina O. Redfern, BBA, RT • Ann Costello • Veronica Fraser (R) (ARRT) • Patricia Remeis, MSN, RN • Scott Trerotola, MD • Sylvia Thompson • Diane Corrigan • Stephanie Wiley • John Kirby

PPMC Improving the PPMC Critical Values Notification Process

HUP Meeting the Measure: The

• Bunmi Ariyo, RN, BSN • Peter F. Cronholm, MD,

MSCE, FAAFP • Tanya Dougherty, PharmD, BCPS • Nahid Farhat, MD, MEd • Nasreen Ghazi, MD • Tia Hope • Stephanie Ishmael

• Heather Klusaritz, MSW,

PhD

• Stella Mulbah, RN, BSN • Richard Neill, MD • Giang Nguyen, MD, MPH,

MSCE, FAAFP

• Craig Ruffin • Steven Smith, MBA

CCA Delancey Medical Associates — Bridging the Gap Between Hospital and Home

Perioperative Beta-Blocker Surgical Care Improvement Project • Sara Keller, MD, MPH • Danielle Ciuffetelli, PharmD • Anne Norris, MD • Janet Hines, MD • Jennifer Myers, MD • Bernadette Allison, RN • Eileen Hollen, NP • Susan Hansen-Flaschen, NP • Danielle Grant

• Colleen Mattioni, RN • Ann Marie Morris, RN • Nancy Celmins, RN • Scott Falk, MD • Nicole Hoke, CCNS • Jaime Gray, PharmD • Todd Miano, PharmD • Staci Oppleman, MSW • John Salmon, CPHIMS

• Rebecca Stamm, CCNS • Bea Travisano, RN • Julie Carl, CRNP • Marie Fisher, CNS • Meera Gupta, MD • Laura Haynes, PharmD • Andrew Silverman, RN • Kirsten Smith, ACNS • Latesha Colbert, CRNP

• Alex Rosen, AB • Rebecca Schwartz, BS • Rose DiMarco, BS • Dan Timko, PharmD • Amy Graziani, PharmD • Jennifer Lukaszewicz,

PharmD

• Kristen Zeitler, PharmD

CCA Penn Medicine at Gibbsboro — Improving Breast and Colon Cancer Screening Rates Through Team-Based EMR Initiatives

• Bo Jian, MD • Michael Atweh, MBA,

MHA • Roxan Reynolds, MBA, MT(ASCP) • Robert Adkins, BS, MT(ASCP) • Patricia O’Brien, RN, MSN

• Kimberly Pavan, MSN,

CRNP

• Denise Gilanelli, RN,

BSN, MS

• Kimberly Volpe, BS,

MT(ASCP)

• Karen Belfi, RN, MSN • Adam McMullen, BS,

MLS(ASCP)

PAH Code Cart Standardization and Management

• Lisa Marsella, MA • Gary Dorshimer, MD • Rosemary Kearney, MD • William Duffy, MD

• Edward Wu, MD • Christine McCusker, CRNP • JoAnn Grugan

Penn Home Care Penn Care at Home & Penn E-lert — Efficient Telehealth Monitoring Using a Collaborative Team Approach

PPMC Fast Track Extubation

Guidelines for Select Cardiac Surgery Patients @ PPMC SICU

• Beverly Alexander • Renee Biggs • Shawn Brown • Monica Clark

• Jacob Gutsche, MD • Joseph DiMartino, RN,

MSN • Mary Ann Jones, RN, MSN • Kim Volpe, BS, MT, ASCP • Bryan Fagan, RN, BSN • Jeanne Lavelle, RN, BSN

• Jackie Skodzinski, RN,

BSN

• Roseann Rapa, MS, RRT • Jeanmarie Salonia,

• Penney Rothmaller • Jeffrey Tokazewski, MD • Rosemarie Villamayor, MD • Suzanne Y. Brown, MS,

Penn Home Care Penn Home Infusion Therapy — Reducing Hospitalizations Secondary to IV Vancomycin Adverse Events

PharmD

• Amy McGovern, RN, CCRN R.Ph. • Dominic Mignone, CPhT • Dennis Kaighn Constan, • Kevin Pinder PharmD, BCPS • Roslyn Betsill, CPhT • Patrick J. Donnelly, RN, • James Robinson MS, CCRN • William Randolph • Dennis Gibson • Charles Kennedy • Margaret Markunas, MBA, • Ross Weisberg CNMT

• Janet Bryant, MSN, RN • Margaret Mullen-Fortino, MSN, RN • Laura Herron, BSN, RN • Mary Anne Daley, MSN, RN • Melissa O’Connor, PhD, MBA, RN, COS-C • Mary Louise Dempsey, • Penn E-lert Data BSN, RN • Joan Doyle, MBA, MSN, RN Coordinators: – Nicole Coles-Williams • David Horowitz, MD – Marcee Dougherty • Benjamin A. Kohl, MD – Jackie McConnell

• Judith O’Donnell, MD • Danielle Hafetz, RN,

BSN, CIC

• Kris Zborowski, PharmD • Anne Norris, MD • Jennifer Savon, MS, BSN,

RN, CHPN

• Kathleen Harple, RN, MSN • Mary Beth Ruckelshaus,

PharmD

• Jay Winters, PharmD

AWARDS AND ACCOLADES PPMC Ranks Among

100 Top Hospitals For the second consecutive year, Penn Presbyterian Medical Center has ranked among the nation’s top 100 hospitals, according to the annual study by Truven Health Analytics, formerly the Healthcare business of Thomson Reuters. The study identifies the 100 Top Hospitals based on their overall organizational performance in 10 areas including mortality, patient safety, patient satisfaction, adherence to clinical standards of care, and readmission rates for acute myocardial infarction (heart attack), heart failure, and pneumonia. Penn Presbyterian was recognized in the category of Major Teaching Hospitals and is one of only two in the state of Pennsylvania to be included in the new study. In October, Truven Health also named Penn Presbyterian one of the 50 Top Cardiovascular Hospitals in the nation. “Being listed among the top 100 hospitals is further proof of Penn Presbyterian’s positive impact to the community and our dedication to providing the highest-quality patient care,” said Michele Volpe, executive director and CEO.

St. Geme Named CHOP Physician-in-Chief & Chair of Pediatrics Joseph W. St. Geme, III, M.D., has been named physician-in-chief of The Children’s Hospital of Philadelphia and chair of Pediatrics at the Perelman School of Medicine, effective July 1, 2013. St. Geme comes to Philadelphia from Duke University where he has served since 2005 as the chairman of Pediatrics and chief medical officer of Duke’s Children’s Hospital. An internationally known and respected researcher, St. Geme has focused his efforts on studying host-pathogen interactions involving pathogenic bacteria, aiming to identify targets for novel antimicrobials and to facilitate vaccine development. The primary emphasis of his laboratory has been Haemophilus influenzae, a leading cause of childhood morbidity and mortality worldwide.

Lance Becker, MD, director of the Center for Resuscitation Science, received the American Heart Association’s 2012 Award for Lifetime Achievement in Cardiac Resuscitation Science. Becker has played key roles in the dissemination of automated external defibrillators into the public arena, expanding the science of CPR quality and developing a resuscitation training program. His research interests extend across the basic science laboratory from animal models of resuscitation into human therapies such as novel methods of therapeutic hypothermia induction and the use of cardiac bypass following cardiac arrest. Jeffrey S. Berns, MD of Renal, Electrolyte, and Hypertension was named president-elect of the National Kidney Foundation, Inc. The NKF is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease. Garret FitzGerald, MD, chair of Pharmacology and director of the Institute for Translational Medicine & Therapeutics, is the 2013 recipient of the Scheele Award. The Swedish Academy of Pharmaceutical Sciences bestows the award on prominent scientists in the field of drug research and development to commemorate the skills and achievements of the famous Swedish chemist and pharmacist Carl Wilhelm Scheele. Jason Karlawish, MD, associate director of the Penn Memory Center, will serve as the inaugural director of the Penn Neurodegenerative Disease Ethics and Policy Program. This program will support research, education, and training to identify and address the ethical and policy implications of advances in the diagnosis and treatment of neurodegenerative diseases and work toward forming best practices for how these advances can be successfully translated into clinical practice.

(continued from cover) Sequestration is taking place in the middle of a slowly recovering economy, continuing uncertainty surrounding health-care reform, rising costs, and lower reimbursement rates. But, in spite of these difficulties, we will maintain our commitment to improving the well-being of our patients and community while making our health system even stronger for the future. These are dynamic times for Penn Medicine, and the pace will only get faster. Expanding opportunities await us and we won’t be diverted by short-term crises. We recognize that events such as sequestration are part of what it means to be a major health-care organization in a highly complex macro-environment. The contributions that each of you makes every day enable us to withstand such major external challenges, and for that I am grateful. Your resourcefulness and commitment to efficiency have helped create the conditions of fiscal strength that will allow us to absorb sequestration with little noticeable impact. I know that you will continue to be vigilant in seeking out ways to do more with less. Working together, I am confident that we will come out of this process an even stronger institution.

Systemnews

Victoria Rich, PhD, chief nurse executive, UPMC, received the 2013 Prism Diversity Award from the American Organization of Nurse Executives. The award recognizes an individual’s efforts to promote diversity within the nursing workforce and to enhance understanding of diversity issues through events or activities within a health-care facility or within the community. Since coming to HUP in 2002, Rich has created and cultivated globally recognized diversity systems that have become a model for health-care organizations.

Editorial Staff:

Donald Silberberg, MD, was appointed editor-in-chief of World Neurology, a newsletter published by the World Federation of Neurology and distributed to neurologists worldwide.

Administration:

Celebrating Art & Life Ken Zaret of Cell and Developmental Biology was one of 21 artists who won a ‘Best of Show’ in A Celebration of Art and Life. Judges received more than 450 submissions for the exhibition, which honors Bernett Johnson, Jr., MD, HUP’s former senior medical officer who was also an accomplished artist. “The exhibition if a blessing for both patients and staff,” said CEO Ralph Muller.

CEO’s corner

Sally Sapega, M.A. Editor Trissy Harding Graphic Design

Susan E. Phillips Senior Vice President, Public Affairs

Let Us Hear From You: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 Please feel free to share your thoughts and ideas for improving System News! E-mail the editor at sally.sapega@uphs.upenn.edu.