Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Oct. 15, 2010 Issue | Archived Issues

Free Flu Shots Now Available

Free influenza vaccinations are now available to medical staff, including private physicians, in Employee Health Service (EHS) located in SSB-200. Appointments and walk-ins are welcome from 7 a.m. to 4 p.m. Monday through Friday.

Flu shot clinics are planned this month for ...

» Read more


Medication Shortage Update

Pharmacy Focus

Ascorbic Acid 500mg/ml 50ml injection vials ...

Furosemide, Bumetanide, Torsemide ...

Epinephrine 0.1mg/ml 10ml syringes ... 

» Read more


Printing Patient Results

Web/VS Tip of the Week

When you need to print patient results, use the "Print" icon at the right end of the silver banner across the top of the page.

» Read more


Meetings and Events

Arthur I. Johnson, M.D., Memorial Medical Student Reception
Oct. 19

"Divination and DNA: The Hazard, but Inevitability, of 'Divination' in Our New Genomics"
Oct. 20

Comprehensive Approach to the Treatment of Obesity
Oct. 22

» Read more

CS-Link™ IP2 Go-Live is one week away!

On Oct. 23, Cedars-Sinai will go live with the Inpatient Phase 2 of our electronic medical record, CS-Link™. With this go-live, nearly all nursing and clinical care documentation will be entered into CS-Link. Physicians will view key clinical information in Web/VS through a real-time interface with CS-Link, similar to how CareVue information is viewed today. At the same time, ICU physicians will begin to document and view patient data in CS-Link as CareVue is being retired.

» Read more

Lunch is on Us

Annual Medical Staff Meeting is Oct. 18

Chief of Staff Scott Karlan, M.D., will discuss the climate of change at the medical center and President and CEO Thomas M. Priselac will address healthcare reform at the lunch meeting, which runs from 11:30 a.m. to 1:30 p.m. on Monday, Oct. 18, in Harvey Morse Auditorium.

The 2010 Pioneer in Medicine Award will be presented along with the Chief of Staff Award.

Sarah Kilpatrick, M.D., Appointed OB/Gyn Chair

Sarah J. Kilpatrick, M.D., Ph.D., an expert in maternal-fetal medicine and women’s health, has been appointed chair of the Department of Obstetrics and Gynecology. She will start on Jan. 3, 2011.

» Read more

Physicians Continue Their Education

Mariko Ishimori, M.D., right, was one of a dozen aspiring clinical scientists who recently graduated from Cedars-Sinai’s Clinical Scholar Program.

The program is designed for medical residents, fellows and young faculty at Cedars-Sinai. 

» Read more

Patient Classification and Surgery (Procedure) Scheduling

In August 2010, Cedars Sinai instituted new processes and procedures with new clinical resources aimed at improving patient classification of surgery and procedure patients.

» Read more

Urgent but Routine After-Hours Imaging Studies

The S. Mark Taper Foundation Imaging Center offers walk-in slots for urgent, but routine imaging studies after normal business hours.

» Read more

Stroke Center Aces Survey

Cedars-Sinai’s Stroke Center has been recommended for recertification by The Joint Commission. The survey ended with the surveyor having zero requirements for improvement for the center.

» Read more

CS-Link™ IP2 Go-Live is one week away!

On Oct. 23, Cedars-Sinai will go live with the Inpatient Phase 2 of our electronic medical record, CS-Link™. With this go-live, nearly all nursing and clinical care documentation will be entered into CS-Link. Physicians will view key clinical information in Web/VS through a real-time interface with CS-Link, similar to how CareVue information is viewed today. At the same time, ICU physicians will begin to document and view patient data in CS-Link as CareVue is being retired.

Part of the go-live includes a cutover step, which requires CS-Link to be down for a period of time on Oct. 23 (approximately 11 a.m. to 11 p.m.) as we upgrade the system for use. Following are the key points for the CS-Link downtime that may impact medical staff members:

  • Web/VS will be updated with results for existing patients during the downtime. Clinical information for new patients will not be available in Web/VS and lab results will be returned to the charts on paper lab slips until the downtime is complete.
  • Plan to complete rounds early and write orders in time for them to be processed by 11 a.m. on Saturday, Oct. 23.
  • Nursing staff will revert to paper requisitions for procedure orders and pMAR for medication administration.
  • To improve efficiency during this downtime, discharge patients on Friday, Oct. 22, if possible.

During the go-live period, there will be ample support staff on the floors to assist with physicians’ CS-Link and Web/VS needs. They will be easily identifiable in burgundy polo shirts. Please be supportive of the nursing and other clinical care staff during this transition.

Also, the CS-Link “On-the-Spot” Learning Center is now live in the Medical Staff Lounge. The “On-the-Spot” Learning Center will be staffed with CS-Link project team personnel from 7 to 10 a.m. and 3 to 7 p.m. These individuals can answer questions that medical staff members have about CS-Link and the upcoming go-live. Please stop by the lounge (Plaza Level, South Tower, Room 2810) for snacks, beverages and CS-Link information.

Have additional questions? Please direct them to AskCSLink@cshs.org or a Physician Champion wearing a green “CS-Link MD Champion” hangtag. For CS-Link and Web/VS help, dial the MD Clinical Support Line (310) 423-2828 or look for MD Support Staff with an orange hangtag.

Top Considerations for IP2

 Click on the links below to read the top IP2 considerations for all physicians, ICU physicians, and OB/GYN physicians for the Oct. 23 go-live.

 

Top IP2 Considerations for Physicians

  1. Patient safety remains our top priority. We will have expanded clinical and technical support provided for all clinical users.
  2. Nursing and other clinical staff need your support as they learn the new system.
  3. Team lists and PPLs remain in Web/VS per current practice but will not transfer to CS-Link or vice versa. Physicians will need to manually update each list as they add patients to their service.
  4. Nursing and other clinical staff documentation (vital signs, I/O, therapy notes, etc.) will be available in Web/VS and can be accessed anytime, in any location.
  5. Web/VS will continue to allow you to do the following: sign dictations, sign telephone orders, team sign out report, team lists, etc.
  6. The medication reconciliation process will remain as it is today.
  7. Physicians will still use the paper chart for placing orders.
  8. The CareVue system used in the ICU will be retired. Physicians regularly using CareVue for physician documentation will use CS-Link.
  9. The system transition starts on Saturday, Oct. 23, at 11 a.m. Improve your efficiency by completing rounds before 11 a.m. on Saturday.
  10. CSMG and ED physicians using CS-Link will experience a new look and feel with the Epic 09 upgrade.

Top IP2 Considerations for ICU Physicians

  1. The CareVue system will no longer be used. Physicians regularly using CareVue for physician documentation will use CS-Link.
  2. Physicians can view the nursing and other clinical staff documentation, preferably in CS-Link. Physicians will continue to use Web/VS to sign dictations and telephone orders, and for team sign out report and team lists.
  3. Physicians can view the data remotely in Web/VS.
  4. Team lists and PPLs remain in Web/VS per current practice but will not transfer to CS-Link (or vice versa). Physicians will need to manually update each list as you add patients to your service or utilize the unit list.
  5. The synopsis activity provides an at-a-glance overview of the patient, condensing large volumes of data into a single window.
  6. Core Measure data can be viewed in the Shift Assessment Patient Summary Report. Patient Summary Accordion reports are dynamic and updated in real-time, based on the amount of data in the system for a given patient.
  7. Training is required to receive CS-Link access. For physicians using CareVue for documentation today, two hours of classroom training and two hours of workshop time are required.
  8. Physicians and house staff should only be documenting on ICU patients. You will be able to open two charts at one time. Ensure that you are always documenting on the proper chart by checking the patient header.
  9. Attending physicians will co-sign resident notes from the “notes activity” or the “InBasket.”

Top IP2 Considerations for OB/Gyn Physicians

  1. As of Oct. 5, the L&D and MFCU areas went live with the eMAR (electronic medication administration record).
  2. As of Oct. 5, pharmacy now enters medication orders for selected L&D and MFCU patients.
  3. For L&D and MFCU patients, WatchChild will continue to be used for fetal monitoring.
  4. For L&D and MFCU patients, the titrations of Pitocin and Magnesium Sulfate will continue to be completed in WatchChild. Documentation of a new bag being hung will be documented in the CS-Link eMAR.
  5. On Oct. 23, nursing documentation will be in CS-Link for patients in the Post Partum Unit and Nursery units.
  6. Physicians will be able to view all Post Partum and Nursery patient clinical documentation in Web/VS.
  7. OB/Gyn physicians will use multiple systems to view patient data on Oct. 23 depending on where the patient is located (L&D, MFCU, or PP).
  8. On Oct. 23, for the L&D and MFCU patients, OB/Gyn physicians will use WatchChild and Web/VS to view patient data. Physician documentation and orders will remain on the paper chart.
  9. On Oct. 23, for the Post Partum and Nursery patients, OB/Gyn physicians will use Web/VS to view results and nursing notes, and paper for physician orders and documentation.
  10. Order entry remains on paper.

Lunch is on Us

Sarah Kilpatrick, M.D., Appointed OB/Gyn Chair

Sarah J. Kilpatrick, M.D., Ph.D., an expert in maternal-fetal medicine and women’s health, has been appointed chair of the Department of Obstetrics and Gynecology. She will begin at Cedars-Sinai on Jan. 3, 2011.

Dr. Kilpatrick currently heads the Department of Obstetrics and Gynecology at the University of Illinois at Chicago and is vice dean of the university's College of Medicine. During her 11-year tenure at the university, she led major clinical, research, academic and administrative initiatives, focusing on those that brought together different medical specialties and health science disciplines, including nursing, pharmacy and public health.

As vice dean for the medical school, she has been instrumental in improving clinical service, recruiting faculty, strategic planning and enhancing philanthropy to the medical school. Dr. Kilpatrick led efforts that enhanced the quality of patient care, improved the educational program, and strengthened the medical center's community relationships. Prior to joining the university in 1999, she served on the faculty of U.C. San Francisco medical school.

Dr. Kilpatrick's specialties include high-risk pregnancy and pre-term delivery, as well as medical complications of pregnancy. Her research interests are clinical obstetrics, including maternal morbidity and mortality, as well as preterm birth management and outcomes.

Dr. Kilpatrick received her medical degree from Tulane University and a Ph.D. in biopsychology from the University of Chicago. She completed her graduate medical training at U.C. San Francisco.

The nationwide search was led by Noel Bairey-Merz, M.D., director of the Women's Heart Center and director of Cedars-Sinai's Preventive and Rehabilitative Cardiac Center, and an interdepartmental committee. Phillip Brooks, M.D., a member of the medical staff since 1964, has been serving as the department’s interim chair for the past several months.

Physicians Continue Their Education

Mariko Ishimori, M.D., right, was one of a dozen aspiring clinical scientists who recently graduated from Cedars-Sinai’s Clinical Scholar Program.

The program is designed for medical residents, fellows and young faculty at Cedars-Sinai. It includes a part-time curriculum in translational medicine and clinical research and concludes with an optional second year of full-time research under the supervision of an experienced mentor.

There are roughly 40 scholars enrolled in the program at a given time.

The program is directed at preparing the physicians for successful NIH and other research grant applications. Dr. Ishimori, Odelia Cooper, M.D., and Shervin Rabizadeh, M.D., have all received National Institutes of Health funding to date.

Patient Classification and Surgery (Procedure) Scheduling

In August 2010, Cedars Sinai instituted new processes and procedures with new clinical resources aimed at improving patient classification of surgery and procedure patients.

Patient classification is a significant compliance issue for Medicare as well as MediCal and other insurance carriers. Over the past year, various governmental audit agencies have focused on the hospital community and this topic of patient classification.

Hospitals are at great risk if found to be non-compliant with their regulations.
In response to this ongoing oversight, Cedars Sinai has taken steps to further improve the proper identification of patient class.

Ultimately, patients are classified as Inpatients or Outpatients for the purposes of billing and reporting. Within that overriding structure, procedure patients are scheduled as either "AM Admits," which is considered inpatient; "In-house," which is considered inpatient; or "outpatient procedure," which is outpatient in SIS and CS-Link™. As of the beginning of August, the option of "23 hour" was removed as it was not a true patient classification and confusing to users. Moreover, patients cannot be scheduled as "observation," but may become so after a procedure if they need to be evaluated for potential inpatient admission and with an appropriate physician order.

Case management has instituted a pre-review and post-review of all scheduled procedures for the appropriate assignment of patient class. Additionally, specific "patient classification department guides" were developed for non-OR procedural areas like the cath lab, interventional radiology and GI labs. Case managers are always available to assist with the proper determination of patient class.

Please note, the distinction of patient class is very important to hospital compliance, but does not change the care you need and desire to provide your patients. We appreciate your ongoing support of our endeavors in this area and welcome feedback on how we can further improve our process making it smoother for you and your patients.

For more information, please contact Gretchen Case, director of Compliance and Revenue Integrity, at gretchen.case@cshs.org or (323) 866-8940.

Urgent but Routine After-Hours Imaging Studies

The S. Mark Taper Foundation Imaging Center offers walk-in slots for urgent, but routine imaging studies after normal business hours.

If an urgent, but routine outpatient imaging study is needed after scheduling closes at 6 p.m., you can still request it until 9 p.m. Monday through Friday and until 7 p.m. on Saturday.

How?

To request a study after hours, please call (310) 423-8000 and press 1 for scheduling. If authorization is obtained (for PPO patients), then a study can be performed on a walk-in basis. PPO authorization is usually not required for ultrasound, vascular ultrasound and X-ray. 

Please fax the written order to our Command Center, at (310) 423-1516 or have the patient bring the written order and present it at the time of registration. If the fax or original written order is not received, the test cannot be performed.

When?

A patient must arrive at the center by 9 p.m. Monday through Friday and before 7 p.m. on Saturday and Sunday. After these times, outpatient registration is closed and the S. Mark Taper Foundation Imaging Center doors are locked.

Which studies?

The following routine, outpatient walk-in studies can be performed on an urgent basis:

  • CT
  • MRI
  • Ultrasound
  • Vascular Ultrasound
  • X-ray

This service does not include mammography, nuclear medicine, nuclear cardiology or interventional radiology.

If an outpatient requires an imaging scan after hours and it is a medical emergency, the patient should be directed to the Ruth and Harry Roman Emergency Department.

Stroke Center Aces Survey

Cedars-Sinai’s Stroke Center has been recommended for recertification by The Joint Commission. 

The survey ended with the surveyor having zero requirements for improvement for the center.

"It was evident from the outset that our team was well prepared to highlight all that had been done since our initial certification," said Bryan Croft, vice president, service line operations. "Among many things, the surveyor highlighted our MD/Clinical/Administrative Leadership, our processes for quality improvement, our outreach to the community, and our 'passion to do what is best for our patients.'"

In addition, the Stroke Team will be awarded a Gold Plus Award by the American Heart Association. A presentation is planned for 3:15 p.m. on Nov. 10 at 3:15 p.m. in the Board Room.

The Gold Plus Award is an advanced level of recognition that allows hospitals to be acknowledged for their compliance of the Quality Measures within the Get with the Guidelines-Stroke Program. This is an optional award that a hospital may choose to pursue if they are collecting Quality Measures and would like to be recognized for their efforts.