Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Sept. 3, 2010 Issue | Archived Issues

Drug Substitutions Due to Shortages

Pharmacy Focus

Morphine injection nationwide shortage ...

Bumetanide (Bumex®) 1mg/4ml injection shortage ... 

» Read more


Inpatient Order Status

Web/VS Tip of the Week

Did you know that you can check the status of an inpatient order in Web/VS? The Orders section can be viewed by individual categories or all categories at once.

» Read more


Meetings and Events

High Holiday Services – Sept. 9, 17, 18

Leadership and Life Strategies: A New Mental Diet – Sept. 13

Ethics Noon Conference – Sept. 15

» Read more

CS-Link Inpatient Phase 2 to Launch on Oct. 23

On Oct. 23, Cedars-Sinai will launch the next CS-Link™ clinical application phase called Inpatient Phase 2 (IP2) and continue toward achieving the goal of "one patient, one record." » Read more

Get Creative, Win a Gift Card

The Chief of Staff Advisory Committee is sponsoring a contest for the best acronym that promotes safety at the medical center. First prize is a $200 gift card, second prize is a $100 gift card and third prize is a $50 gift card. Any Cedars-Sinai employee or medical staff member may enter.

» Read more

C-S Password Update

Good News … and a Warning

Having trouble remembering your first pet's name or where you attended grade school? You are not alone. In response to a request from medical staff leadership, the Cedars-Sinai password policy is being modified to make it easier for you to remember your password.

» Read more

New Intraoperative Consultation Suite Opens on 8 South

The Department of Pathology and Laboratory Medicine will provide consultations from a new 800-square-foot suite equipped with state-of-the-art workstations and technology phased in to deliver streaming video images right to the operating room. 

The Intraoperative Consultation suite is located on 8 South.

» Read more

STAT vs. Wet Readings for Imaging Studies

A plan has been developed with the Quality Improvement Committee to clarify requests for STAT and Wet Readings.

» Read more

CS-Link Inpatient Phase 2 to Launch on Oct. 23

On Oct. 23, Cedars-Sinai will launch the next CS-Link™ clinical application phase called Inpatient Phase 2 (IP2) and continue toward achieving the goal of "one patient, one record."

Cedars-Sinai Medical Group and Emergency Department physicians have already gone live with CS-Link.

Upon the IP2 go-live:

  • Most nursing and other clinical staff documentation will be completed in CS-Link and the paper chart will no longer be used to view most patient information.
  • Changes to nursing and other clinical care staff will be significant as most documentation will now be done in CS-Link.
  • Nursing documentation done in CS-Link will be viewable in Web/VS.
  • Physicians caring for patients on the wards will use Web/VS to view patient information and physician documentation.
  • In the ICUs, the CareVue system will be retired, and physicians will use CS-Link to view patient information and complete documentation.
  • All physician actionable items, such as telephone order signoffs, will remain in Web/VS.

Prior to and at go-live, there will be ample support for everyone affected by the go-live to enable a smooth transition. Training for physicians who will be using CS-Link for documentation will be scheduled in late September. In addition, some physicians who will be using CS-Link to view patient information, will receive CS-Link view training. Physician champions and super users have been identified to support and lead during this period of change. A detailed go-live plan which includes on-site support resources will also be in place.

Additional events have been planned to provide physicians with opportunities to view CS-Link and Web/VS enhancements, understand workflows, and ask questions.

Get Creative, Win a Gift Card

The Chief of Staff Advisory Committee is sponsoring a contest for the best acronym that promotes safety at the medical center. First prize is a $200 gift card, second prize is a $100 gift card and third prize is a $50 gift card. Any Cedars-Sinai employee or medical staff member may enter.

Following is a list of safety values proposed by committee:

  1. Safety first - as we strive to achieve healthcare excellence, patient safety is our first consideration.
  2. Shared responsibility– safety is a team endeavor.  
  3. Shared accountability – we are responsible for ourselves and for all team members.
  4. Silence unacceptable – We have a duty to intervene, and to ask questions as the first step.  It’s OK to be uncertain or wrong.
  5. No retribution – no one needs to fear speaking up.  The only acceptable response to being challenged is "thank you."

For example, the acronym CREEP meets all the requirements, but is somewhat negative:  

CREEP:  

  1. Complain whenever you’re upset
  2. Repeat the complaint if people ignore you
  3. Express yourself in a different manner, e.g., become passive-aggressive
  4. Escalate, begin screaming
  5. Punch someone

Here are some early entries, to stimulate your creative juices. Please note that the second and third examples include some values in order to form words. If at all possible, include only behaviors.

CCC:

  1. Communicate – Discuss relevant considerations in an organized manner.  Speak up about any concerns.
  2. Confirm – if there is disagreement, reach consensus with team members.
  3. Consult – if disagreements can’t be resolved, go up the chain of command as appropriate.

SWISS:

  1. Safety first - as we strive to achieve healthcare excellence, patient safety is our first consideration.
  2. Without retribution – Patient safety is non-punitive.
  3. In-flight etiquette – the only acceptable response to being challenged is "thank you".  
  4. Shared responsibility and accountability – safety is a team endeavor.  We are responsible for ourselves and for all team members.
  5. Speak up – We have a duty to intervene, and to ask questions is the first step.  It’s OK to be uncertain or wrong.

STARE:

  1. Safety first
  2. Teamwork – shared responsibility and accountability
  3. Ask questions – Speak Up
  4. Retribution unacceptable
  5. Etiquette – Say Thank You

Send your entries to ChiefOfStaff@cshs.org by Thursday, Sept. 30. The winner will be announced in early October.

C-S Password Update

Good News … and a Warning

Having trouble remembering your first pet's name or where you attended grade school? You are not alone.

In response to a request from medical staff leadership, the Cedars-Sinai password policy is being modified to make it easier for you to remember your password.

Currently, your Web/VS password must be changed every six months. In addition, different software programs require different passwords. Studies show that too much complexity leads people to write down their computer passwords, thus reducing security.

Therefore, by the end of this year, your Web/VS password will no longer expire after six months, and you will be able to keep the same password as long as you like. In addition, by early spring, the medical center will have a unified system so that a single password will give you access to most Cedars-Sinai software.

"I must also relay a warning," said Scott Karlan, M.D., Chief of Staff. "Based on recent security violations, it is suspected that more than a few physicians have shared their passwords with members of their office staff. If you are one of these physicians, please change your password IMMEDIATELY. Next, have each member of your office staff who needs access to Cedars-Sinai records apply for their own password. You are responsible if a member of your staff accesses confidential records using your password."

Federal and state laws carry potential penalties up to $250,000 for individuals who inappropriately access confidential patient records.

"In addition to breaches of confidentiality, once CS-Link™ is fully implemented early next year, your password could be used to order narcotics or other drugs," Dr. Karlan said. “Please take this seriously.”

The Boston Globe article - "Please do not change your password"

New Intraoperative Consultation Suite Opens on 8 South

The Department of Pathology and Laboratory Medicine will provide consultations from a new 800-square-foot suite equipped with state-of-the-art workstations and technology phased in to deliver streaming video images right to the operating room.

The Intraoperative Consultation suite, located on the 8th floor of the South Tower, processed its first specimen on Aug. 20 – the culmination of five years of planning and construction. Cedars-Sinai’s Intraoperative Consultation Service, staffed by the Department of Pathology and Laboratory Medicine, provides more than 3,600 consultations for surgical services each year. The new facility is a centralized modern laboratory replacing multiple small laboratory facilities tucked into operating room areas.

“Our new consultation suite is an important tool to aid us in providing our clinician colleagues and their patients the highest quality subspecialty experience,” said Mahul B. Amin, M.D., chair of the Department of Pathology and Laboratory Medicine. “The suite will also be instrumental in our efforts to create a campus-wide biorepository accrual facility.”

The suite is equipped with multiple workstations for macroscopic examination, prosection and tissue selection; cryostats with the ability to handle multiple specimens arriving to the lab at once; and multiple dual-headed microscopes. In addition, the suite will allow for streaming video images to be sent to operating rooms that are wired. Static images can be captured and posted to off-site subspecialists. Subspecialty pathologists will be available for real-time consultation, also.

The suite will support the department’s commitment to developing a campus-wide biospecimen accrual facility. One of the suite’s workstations is dedicated to this mission, with the ability to “snap freeze” tissue for optimum preservation for molecular and scientific analyses.

For questions about the new suite, please contact Vladimir Kazarov, Anatomic Pathology manager, at (310) 423-4739.

A view of the microscopic work stations with streaming video monitors.

STAT vs. Wet Readings for Imaging Studies

A plan has been developed with the Quality Improvement Committee to clarify requests for STAT and Wet Readings.

STATs apply to the performance of the examination and Wet Readings apply to the interpretation. Ordering a study as a STAT will result in it being performed more quickly (as indicated below), but that will not generate a wet reading unless specifically requested.

Exam Performance "STAT":

  • The study will be performed within four hours.

Exam Interpretation "Wet Read":

  • The interpretation will occur within two hours of the performance of the study. The interpretation will be called to whoever is designated on the request form. If no person is designated, the report will be called to the ordering physician.

Exam Performance and Interpretation "STAT Wet Read":

  • For both a quick exam and a quick report, order both a STAT and Wet Read.