Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF April 15, 2011 Issue | Archived Issues

Acetylcysteine Shortage, Benzocaine Product Risks

Pharmacy Focus

- Update to Fluoroquinolones Boxed Warning

- Shortage of Acetylcysteine 10% 100mg/ml Solution for Nebulization

- Benzocaine Topical Products: Risk of Methemoglobinemia

» Read more


Meetings and Events

Women and Ischemic Heart Disease Symposium
April 29

Annual Basketball Game
May 15

Clinical and Translational Research Workshop
Applications due June 1

» Read more


Grand Rounds

Click here to view upcoming Grand Rounds.

Bar Code Medication System Continues to Rollout

A new bar coding medication system will be rolled out to all Med/Surg units by Tuesday, April 19, following a successful pilot program on the 7SW Rehab unit.

ICUs, the NICU and Pediatrics are scheduled to start using the barcodes starting Tuesday, May 17. Women's Services and Thalians will start on Tuesday, June 21, completing the housewide rollout of the new wristbands.

» Read more

Physician Orders and Documentation on CS-Link Goes Live Oct. 15

Physicians will start using CS-Link™ for entering and managing their orders with the launch of Inpatient Phase 3 (IP3) on Oct. 15.

» Read more

Attendings Invited to Apply for Two MEC Positions

At the end of this year, two member-at-large positions will expire on the Medical Executive Committee. These spots are now open for election to Attending category members.  

» Read more

2 Minutes With ... M. Jonathon Solnik, M.D.

M. Jonathon Solnik, M.D.

M. Jonathon Solnik, M.D., is co-director of the Center for Minimally Invasive Gynecologic Surgery, acting director of the Division of Urogynecology and Pelvic Reconstructive Surgery, and an attending physician in the Department of Obstetrics and Gynecology at Cedars-Sinai.

» Read more

Added to the 'Circle'

March Circle of Friends Honorees Announced

Eighty-seven physicians were among the nearly 100 people honored by the Circle of Friends program this past month.

» Read more

Save the Date for the Great Debate on April 28

Mark your calendar for April 28 at 8 a.m. in ECC A-C as two Cedars-Sinai surgical residents compete for the Morgenstern Trophy, a cash prize and Cedars-Sinai immortality at the Eighth Annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition.

» Read more

New Paradigms in Vehicular Placement

Bloom M.D., Leo & Bialystock M.D., Nathan

The recent growth of our medical staff has led to a fascinating display of different parking techniques in the physician parking areas. While these varied techniques represent the rich diversity of our medical center, some of the medical staff have been unable to master or to appreciate them.

» Read more

Volume Surge Reflects Confidence in Cedars-Sinai

The surge in patient volume we've experienced since January has had a significant impact on medical staff and employees throughout the Medical Center – including not only those involved directly in patient care, but all of you whose support is crucial to providing high quality, compassionate care for our patients.

» Read more

Bar Code Medication System Continues to Rollout

A new bar coding medication system will be rolled out to all Med/Surg units by Tuesday, April 19, following a successful pilot program on the 7SW Rehab unit.

Under the new system, patients will be given an ID wristband with imprinted bar codes. Whenever medication is administered, nurses and respiratory therapists will first verify the patient's identity, then scan the bar codes on the patient's wristband with a scanner attached to the bedside Workstation on Wheels (WOW). Next, they will scan the medication itself. If the medication does not match the physician order in CS-Link™, system alerts will appear.

Pharmacy Services evaluated the entire inventory of medications stored at Cedars-Sinai, and developed processes to ensure that every dose has a bar code on it that is readable.

Nurses on 7 SW expressed enthusiasm for the new system, which was echoed by patients and family members on the Rehab unit, which began the pilot program on March 1.

"Patients and family members could not stop raving about how 'advanced' and 'what a great idea' this technology is," said Lauren Maggini-Miller, RN, MSN, who works on 7SW. "All the patients also voiced how impressed they were regarding the lengthy measures Cedars-Sinai takes to ensure patient safety."

Overall, during the first week of the pilot go-live, the 7SW nursing staff had a 98 percent success rate of scanning their patients' wristbands correctly, and a 96 percent success rate of scanning the medications correctly.

"The most important benefit of this new system is increased patient safety," Maggini-Miller said. "This system inarguably adds another safeguard against medication errors."

ICUs, the NICU and Pediatrics are scheduled to start using the barcodes starting Tuesday, May 17. Women's Services and Thalians will start on Tuesday, June 21, completing the housewide rollout of the new wristbands.

Physician Orders and Documentation on CS-Link Goes Live Oct. 15

Physicians will start using CS-Link™ for entering and managing their orders with the launch of Inpatient Phase 3 (IP3) on Oct. 15.

Members of the medical staff were largely involved in choosing the go-live date for IP3, which includes:

  • Physician use of CS-Link for managing orders with electronic order entry and ongoing order management and/or medication reconciliation
  • Physician documentation of their clinical care notes in CS-Link; dictation for lengthier documentation needs may also be used (e.g., H&P, Discharge Summary, Operative Reports)

"The project team and the medical staff have a lot to do to prepare for go-live, but this effort is essential to assure that we are all comfortable with CS-Link after go-live," said Chief of Staff Scott Karlan, M.D., who is also co-chair of the Clinical Systems Informatics Committee.

These additions will also provide the best opportunity for improved patient safety at Cedars-Sinai.

Physician Involvement in New Functionality Design

CS-Link physician subject matter experts (SMEs) and champions will drive the development of clinical content for IP3 including:

  • Order Sets
  • Documentation Templates (e.g., SmartTools in CS-Link)
  • Preference Lists
  • Navigators
  • Reports

Members of the medical staff will review each of the above areas over the next several months to confirm content and usability.

Training

The current MD View Training will continue and be on-going. Computerized Physician Orders Management (CPOM) and Physician Documentation training will encompass a variety of training methods and settings that best meet the needs of all our providers. 

Where We Are Going

Cedars-Sinai is steadily moving forward on the path to “One Patient, One Record.” The CS-Link phased implementation approach continues with the current focus on CPOM and physician documentation while also expanding CS-Link functionality in a number of other key areas:

  • Obstetrics, Labor and Delivery services – physicians and nurses will chart in CS-Link only, where there is a tightly integrated workflow among the team
  • Dual monitors will be used for CS-Link and the Fetal Heart Monitoring system for a comprehensive view at the point of care for Obstetrics, Labor and Delivery services
  • A closed-loop medication administration process with the introduction of Bar Coded Medication Administration across the medical center (Med/Surg go live is Tuesday, April 19)
  • The Ambulatory portion of CS-Link used by Cedars-Sinai Medical Group is being enhanced through an optimization process to improve the workflow and usage
  • Scheduling, Registration and Ambulatory CS-Link is being offered for implementation in our private physician offices

Should you have any questions or comments about CS-Link activities for 2011, please reach out to the project team by contacting cshelp@cshs.org.

Attendings Invited to Apply for Two MEC Positions

At the end of this year, two member-at-large positions will expire on the Medical Executive Committee. These spots are now open for election to Attending category members.

A member-at-large represents the medical staff as a whole on MEC, rather than representing the department.

The eligibility requirements to be seated on the committee are listed on the following PDF.

MEC Membership Eligibility Requirements (PDF)

If you think you qualify, pick up a petition in the Medical Staff Office (North Tower, Plaza Level, Suite 2211) or print out a copy of the PDF below.

Official Petition (PDF)

Completed petitions are due to the Medical Staff Office by Friday, May 6.

2 Minutes With ... M. Jonathon Solnik, M.D.

M. Jonathon Solnik, M.D., is co-director of the Center for Minimally Invasive Gynecologic Surgery, acting director of the Division of Urogynecology and Pelvic Reconstructive Surgery, and an attending physician in the Department of Obstetrics and Gynecology at Cedars-Sinai.

If you weren't a physician, what would you be?
What I do is fairly creative, but I would do architecture and housing development — or anything that had a non-fixed schedule. I do better with less routine, and I like the process of design and building.

If you had unlimited time to develop a new skill, what would it be?
General contracting and architectural design.

What drew you to your specialty?
As a medical student, I was drawn to issues surrounding reproductive health. I was drawn to the procedural and technical aspects of surgery, and so, here I am.

If you could choose again, would you choose the same specialty or another?
I feel very fortunate to consider what I do less like work and more like a calling because it really still is fun and gratifying.

What are your interests outside of work?
Spending time my wife and children, who are 4 and 5. But really, anything that requires being outdoors.

If you could spend the day doing one thing, what would it be?
Hang out with my family – preferably on or near the water. I love to sail.

Is there something or someplace you have never seen that you would like to see in the near future?
I am lucky in that I have been able to travel. My wife is South African and I'd love to visit this amazing place and see extended family I've not met before.

What did your father always tell you that you now have to admit was correct?
Work hard and play hard. He taught me to persevere by his own example.

Dr. Solnik can be reached at solnikm@cshs.org.

Added to the 'Circle'

March Circle of Friends Honorees Announced

Eighty-seven physicians were among the nearly 100 people honored by the Circle of Friends program this past month.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for a complete list of Circle of Friends honorees. Physicians who were honored are listed below. (* honored more than once)

Click here for more information about the program.

  • Neel Anand, M.D.*
  • Theodore B. Goldstein, M.D.*
  • John B. Andrews, M.D.*
  • Jeffrey R. Gramer, M.D.*
  • Mohammad A. Ansari, M.D.*
  • Antoine Hage, M.D.*
  • M. William Audeh, M.D.*
  • Solomon I. Hamburg, M.D.*
  • C. Noel Bairey-Merz, M.D.*
  • Jonathan Hausman, M.D.
  • Peyman Banooni, M.D.
  • Peyman Banooni, M.D.
  • Irene Barnett, M.D.*
  • Laith H. Jamil, M.D.*
  • Behnoud Beroukhim, M.D.
  • Stanley Jordan, M.D.*
  • Keith Black, M.D.*
  • Saibal Kar, M.D.*
  • Selvyn B. Bleifer, M.D
  • Stephen P. Kay, M.D.*
  • Glenn D. Braunstein, M.D.*
  • Ilan Kedan, M.D.*
  • Earl W. Brien, M.D.*
  • Ooana Khan, M.D.*
  • Philip Brooks, M.D.
  • Stuart H. Kuschner, M.D.
  • Christiane Michele Burnison, M.D.
  • Eric J. Ley, M.D.
  • John D. Carmichael, M.D*
  • John C. Liu, M.D.
  • Kirk Y. Chang, M.D.*
  • Simon K. Lo, M.D.*
  • Cheryl G. Charles, M.D.*
  • Joseph Loewy, M.D.*
  • Andrew Chuang, M.D.*
  • Zachary H. Lutsky, M.D.
  • Jason S. Cohen, M.D.*
  • Raj Makkar, M.D.*
  • Stephen Copen, M.D.*
  • Philomena McAndrew, M.D.*
  • Stephen R. Corday, M.D.*
  • Robert Jr. McKenna, M.D.*
  • Cheryl L. Dunnett, M.D.
  • Allan L. Metzger, M.D.*
  • Jeffrey H. Fair, M.D.
  • Peggy B. Miles, M.D.
  • David E. Fermelia, M.D.*
  • Rushabh J. Modi, M.D.
  • Greg Fontana, M.D.*
  • Christopher S. Ng, M.D.*
  • Andrew L. Freedman, M.D.
  • Roy D. Nini, M.D.*
  • Gerhard Fuchs, M.D.*
  • Adrian G. Ostrzega, M.D.*
  • Clark Fuller, M.D.*
  • Guy D. Paiement, M.D.*
  • Cyril Gaultier, M.D.*
  • Edward H. Phillips, M.D.*
  • Atara Geft, M.D.
  • Fred Poordad, M.D.*
  • Ivor L. Geft, M.D.*
  • Irving Posalski, M.D.
  • Stephen C. Rabin, M.D.
  • Jerrold H. Steiner, M.D.*
  • Paul A. Rudnick, M.D.*
  • Steven N. Sykes, M.D.
  • Stephen A. Sacks, M.D.*
  • Nicholas R. Szumski, M.D.*
  • Jay Schapira, M.D.*
  • Tram T. Tran, M.D.*
  • C. Andrew Schroeder, M.D.*
  • Alfredo Trento, M.D.*
  • Prediman K. Shah, M.D.*
  • Mark K. Urman, M.D.*
  • John Sherman, M.D.
  • Robert A. Vescio, M.D.*
  • Randolph Sherman, M.D.
  • Daniel J. Wallace, M.D.*
  • Khawar M. Siddique, M.D.*
  • Janet White, M.D.*
  • Robert J. Siegel, M.D.*
  • Edward Wolin, M.D.*
  • R. Kendrick "Ken" Slate, M.D.*
  • Heidi H. Wu, M.D.
  • Samuel J. Smith, M.D.
  • Clement Yang, M.D.*
  • Andrew Ira Spitzer, M.D.*
 

Save the Date for the Great Debate on April 28

Mark your calendar for April 28 at 8 a.m. in ECC A-C as two Cedars-Sinai surgical residents compete for the Morgenstern Trophy, a cash prize and Cedars-Sinai immortality at the Eighth Annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition.

This very popular event attracts a standing-room-only audience each year. The topic of this year's debate is "Industry and Medicine – Essential Partners or Unholy Alliance?"

"The judges are being impaneled. The combatants are in the midst of intense debate preparation," says Leo Gordon, M.D., coordinator of the Great Debates in Clinical Medicine Series. "The buzz is intensifying. Crowd control planning is underway. Arrive early. There will be audience voting. Festival seating rules apply and we begin promptly at 0800 hours."

For more information, please e-mail Dr. Gordon at Leo.Gordon@cshs.org.

New Paradigms in Vehicular Placement

Bloom M.D., Leo & Bialystock M.D., Nathan

The recent growth of our medical staff has led to a fascinating display of different parking techniques in the physician parking areas. While these varied techniques represent the rich diversity of our medical center, some of the medical staff have been unable to master or to appreciate them.

To address this problem the research department, in conjunction with the simulation laboratory, has designed a one-day, hands-on seminar of simulated physicians' parking lot training.

Utilizing state-of-the-art real-time video models, participants will utilize triple-chip, high-definition recreations of common parking problems in the physicians' lot.

Graded by difficulty, the parking simulations will sharpen the physician's skill for this most crucial aspect of daily life at our medical center.

After achieving the objectives of this seminar, the Cedars-Sinai physician will be qualified to:

    1. Negotiate the physicians' parking lot without injuring colleagues
    2. Safely park in close proximity to expensive motorcars
    3. Master the "back-in" technique without ruining the cars referred to in objective No. 2
    4. Master the three-point parking technique first described by Herbert Schillman, M.D., at the Cedars of Lebanon Hospital in 1958 (The Schillman slide)
    5. Avoid RFK's - retained foreign car keys
    6. Refine and utilize a gender-neutral approach to group observational parking activities
    7. Understand the effects of the “honk-beam-honk” sequence on the brainstem of the aging medical staff member
    8. Employ the Dorfman Deforming Dent (The D3) by learning to generate maximum focused impact on another vehicle by an opened driver's side door. The Dorfman Dent honors Dr. Edith Dorfman, the first woman to achieve attending level status at the Mount Sinai Home for the Incurables in 1926. By virtue of this event, she became the first woman to utilize a designated physician parking area for a motorized vehicle.
    9. Differentiate between the purchased auto, the leased auto and the owned free-and-clear auto
    10. Identify annoying bumper stickers that disrupt the compliance-mandated political neutrality of the medical center
    11. Master the “bumper-tap” technique of offline parking
    12. Understand the directional component and intent of large unidirectional painted floor arrows
    13. Perform the Samuelson Reverse-Forward-Reverse-Forward-Reverse- Forward Swing Maneuver. First utilized in 1964, this classic parking maneuver is named after Mitchell Samuelson, M.D., a noted Mount Sinai psychiatrist who wrote extensively on obsessive-compulsive disorders.
    14. Master the art of High Holy Day physician parking
    15. Recognize the etiology and standard of care treatment of 90048 gridlock by identifying the main causes of parking pass displacement
    16. Master tipping techniques for parking lot attendants
    17. Identify the holders of bogus handicapped signs
    18. Identify classic oil leak floor stain patterns with clinical correlation to make and model
    19. Master the Auerbach Angle (angular occupation of three spaces with one car) first employed by Melvin Auerbach, M.D., at the Mount Sinai Hospital in 1967).
    20. Master the arts of encasement and fixation of a colleague's vehicle
    21. Master the most recent halogen light-blinding techniques

If the seminar participant passes the post-test, a special challenge awaits – a simulation of The Borenstein Blockade – the successful simultaneous blockage of four vehicles by one locked vehicle.

Named after Phillip Borenstein, M.D., the first physician to park at the Cedars-Sinai Medical Center in 1976, the Borenstein Blockade has been recreated as a 3-D interactive computer model for the final presentation at the seminar.

Physicians who successfully complete the seminar post-test will receive a complimentary copy of Bagels and Locks – The Definitive Guide to Parking at the Cedars-Sinai Medical Center.

Early registration is encouraged. Lunch will be provided by the Automobile Club. This seminar is generously supported by Sunset Auto Body.

Sunset Auto Body has no financial disclosures to make or conflict of interest to report.

Parking is unavailable.

Volume Surge Reflects Confidence in Cedars-Sinai

April 2011

Thomas M. Priselac
President and CEO

The surge in patient volume we've experienced since January has had a significant impact on medical staff and employees throughout the Medical Center – including not only those involved directly in patient care, but all of you whose support is crucial to providing high quality, compassionate care for our patients. Many of you have taken on extra hours and additional duties during this period, and I appreciate how hard you've been working to make sure our patients' needs are met.

We've determined that this surge is not related to flu season, nor is it being experienced as much by other hospitals in the area. It appears to be primarily a result of Cedars-Sinai's growing reputation for delivering the best care in a number of specialized areas. I believe it's also a sign that our initiatives to improve quality and safety, the strength of our medical staff, as well as the growth of our Medical Delivery Network, are making a difference in the number of patients who choose to come to Cedars-Sinai.

While it's rewarding to see a high level of confidence in the care we provide, a sustained surge presents challenges that call for long-term as well as short-term solutions. Our first priority is to be prepared to respond immediately when patient volume reaches a certain level. We closely monitor our census and move quickly to hire more nurses on a temporary basis and expand units to inpatient care when we experience a surge. Other short-term solutions include making temporary adjustments in the Emergency Department to create room for more patients and working with physicians to encourage safe and appropriate discharges before 11 a.m. We also rely on many of you to continue to pitch in wherever the need is greatest.

While addressing immediate needs, we're exploring long-term solutions. For example, we're analyzing the Medical Center's bed capacity to determine how we can accommodate more patients. Meanwhile, a construction project to expand our Emergency Department bed capacity is now underway. We're also looking into other ways to increase our capacity, including improving patient flow from the ED to the floors, increasing the efficiency of our discharge process and making ancillary services available around the clock.

I'm very impressed by the level of dedication that has been evident throughout the Medical Center at all hours of the day and night during this period of unusually high patient volume. Our clinical, support and management staff have worked closely together in many ways that demonstrate a deep commitment to our institution's core values. When we say patients come first, we mean it. It's not surprising that Cedars-Sinai is the preferred destination for a growing number of patients. The degree to which our core values are expressed every day results in a special brand of quality care that sets Cedars-Sinai apart in this region and attracts patients from other parts of the nation and the world.

One of our greatest strengths as an institution is an openness to new ideas. When we're facing challenges, we depend on everyone to look for solutions and share insights or suggestions. Please let me know if you have any thoughts about how we can respond more effectively to surges in patient volume. Thank you for your flexibility during the past few months and, especially, for your determination to do whatever it takes to maintain the highest standards in patient care.