Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Oct. 14, 2011 Issue | Archived Issues

Lunch on Us

Annual Medical Staff Meeting is Oct. 24

Chief of Staff Scott Karlan, MD, will discuss the climate of change at the medical center and President and CEO Thomas M. Priselac will speak at the lunch meeting, which runs from 11:30 a.m. to 1:30 p.m. on Monday, Oct. 24, in Harvey Morse Auditorium.

The 2011 Pioneer in Medicine Award will be presented along with the Chief of Staff Award.

Annual Meeting of the Medical Staff (PDF)


P&T Committee Approvals Released

Pharmacy Focus

Click the PDF below to review the Pharmacy and Therapeutics Committee's September approvals.

P&T Decisions September 2011 (PDF)


Meetings and Events


Grand Rounds

Click here to view upcoming Grand Rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - October 2011 (PDF)

Progressive Care Units Go Live on Oct. 17

New Units will Accommodate Patients who are not Appropriate for ICU

To better serve our patients who are too sick for regular floor care but do not fit the criteria for ICU admission, Cedars-Sinai will be launching its new Progressive Care Units beginning Monday, Oct. 17.

» Read more

President's Perspective: Doing the Right Thing, in the Right Settings, with the Right Resources

Cedars-Sinai

As our nation moves toward a medical system that requires greater accountability across all care settings, Cedars-Sinai is engaged in a system-wide initiative that will enable us to stay ahead of the curve and continue to be a national role model in a rapidly changing healthcare environment.

» Read more

Next Phase of CS-Link Coming March 2

IP3 Launch Event Planned for Oct. 27

In support of Cedars-Sinai's "one patient, one record" vision, the implementation of our electronic health system, CS-Link™, continues. We are scheduled to go live the weekend of March 2, 2012, with Computerized Physician Order Management (CPOM) and physician documentation for clinical care notes, part of Inpatient Phase 3 (IP3).

» Read more

Register Now to Run for Her

Annual 5k Walk and Run is Nov. 13

Registration is now open for the seventh annual Run for Her® 5K Friendship Walk and Run on Sunday, Nov. 13. This event supports ovarian cancer research and awareness. To register, go to www.runforher.com.


» Read more

117 Honored by Circle of Friends in September

Cedars-Sinai

More than 100 people were honored by the Circle of Friends program in August, including 95 physicians. 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.

» Read more

Highlights from the Oct. 3 Meeting

MEC Update

The countdown to CS-Link™ and modifications to Medical Staff Rules and Regulations were among the topics at this month's Medical Executive Committee meeting.

» Read more

Two-thirds of Hepatitis C Patients Can See Cure in the Half the Time, New Study Finds

Research Corner

Treatment with a telaprevir-based combination regimen for hepatitis C - until now a chronic, destructive and difficult to manage disease - effectively can be shortened to six months in about two-thirds of patients, finds a new study recently published in the New England Journal of Medicine. Fred Poordad, MD, chief of Hepatology and Liver Transplantation at Cedars-Sinai, was senior author on the study.

» Read more

A Rosy Life after Toddler's 2nd Kidney Transplant

Cedars-Sinai

Mother who Donated Organ to Daughter will Ride on Rose Parade Float

Cedars-Sinai performed hundreds of organ transplants last year. But one family's remarkable journey stood out when it came time to select who would represent Cedars-Sinai's Comprehensive Transplant Center on the 2012 Donate Life Rose Parade float.

» Read more

Progressive Care Units Go Live on Oct. 17

New Units will Accommodate Patients who are not Appropriate for ICU

To better serve our patients who are too sick for regular floor care but do not fit the criteria for ICU admission, Cedars-Sinai will be launching its new Progressive Care Units beginning Monday, Oct. 17.

Located on 5NE, 5NW, 6NE, 6NW and 6SE, the Progressive Care Units will feature enhanced nursing ratios and the ability to administer some medications that were previously restricted to the ICU. Patients admitted to these units will be remote- and bedside-monitored by RNs who are ACLS-certified and have received additional training in cardiovascular and pulmonary management. Remote monitoring will be provided from a centralized monitoring center on 5 North.

"We are launching these units to accommodate our patients’ needs while placing them in the most appropriate beds," said Glenn D. Braunstein, MD, vice president for Clinical Innovation. "We believe that patients and their family members will be more comfortable in these units, while receiving the enhanced care that they need, including point-of-care testing."

One example of a patient suitable for admission to a Progressive Care Unit rather than the ICU is a patient with end stage metastatic lung cancer, who is suffering from shortness of breath and placed on a continuous BiPAP.

The Progressive Care Units will feature non-teaching beds. The attending physicians will continue to have primary responsibility for the care of their patients. House physicians/Rapid Response Team Service will only provide emergency coverage for these patients.

For program information or general questions, please contact Dana Meyer, RN, BSN, MBA, director of Critical Care Services, at (310) 967-4344 or dana.meyer@cshs.org. For physician-specific or clinical questions, please contact Dani Hackner, MD, associate chair, Medicine and medical director, Care Management, at (310) 423-2760 or dani.hackner@cshs.org.

President's Perspective: Doing the Right Thing, in the Right Settings, with the Right Resources

Thomas M. Priselac
President and CEO

As our nation moves toward a medical system that requires greater accountability across all care settings, Cedars-Sinai is engaged in a system-wide initiative that will enable us to stay ahead of the curve and continue to be a national role model in a rapidly changing healthcare environment.

Hundreds of you are actively involved in the comprehensive, multi-year Cedars-Sinai Medicine initiative. Many clinical and operational changes have already been implemented, and there will be more - all designed to ensure that each of us consistently does the right thing for our patients, in the right settings, with the right resources.

We're developing best practices for a wide range of diseases and conditions to optimize outcomes and value for our patients. This involves conducting extensive research on nationwide best practices and performance measures - and placing almost everything we do in the clinical arena under a microscope to determine the most efficient way to provide the best care. We're examining every step of the healthcare delivery process, from prevention and ambulatory care to pre-admission, hospitalization and post-acute treatment.

This work is being done under the leadership of Glenn Braunstein, MD, Vice President for Clinical Innovation, by 20 multispecialty and multidisciplinary teams. They are exploring ways to take action before health problems become more difficult and expensive to solve, to improve coordination of care and ensure seamless transitions between levels of care, and to avoid unnecessary hospital admissions and patient days.

Our clinical best practice teams reflect the pluralistic structure of our medical staff - a key strength in our push toward integration of all members of the healthcare team. Each team is co-led by a faculty member and a private attending physician, and members include faculty, private and Cedars-Sinai Medical Group physicians, as well as nurses, pharmacists, physical therapists, occupational therapists, respiratory therapists, case managers and social workers, among others. A total of more than 300 individuals are now working on these teams, and this number will continue to grow as we expand the scope of the initiative to include more clinical conditions.

The teams are focusing on high-volume, typically short-stay surgical procedures such as hip and knee replacements and non-malignant gynecologic surgeries, as well as common medical conditions that lead to hospitalization, such as pneumonia and atrial fibrillation. Top priorities also include heart failure, chronic obstructive pulmonary disease, diabetes, sepsis, stroke, back pain, and the care of the frail patient, among other conditions. We're also examining how to provide the most appropriate and compassionate end-of-life care.

Thanks to our Cedars-Sinai Medicine team members' hard work and innovative thinking, we've already begun getting results. For example:

  • Quality improvements and shorter hospital stays often go hand in hand, and this is what we're seeing in a number of areas where we've implemented best practices. We measure length of stay (LOS) by an index comparing actual days to the expected hospital stay for various conditions. Ideally, the LOS index will be 1 (indicating that actual days in the hospital match the expected number) - or less. Our LOS index has been declining for a number of conditions. For example, it is now below 1 for non-malignant gynecologic surgery and for total joint replacement. This reflects a recent 10 percent drop in the LOS index for each condition.
  • We launched "Code Sepsis" on September 19 to test new best practices for rapid response to sepsis, the leading preventable cause of death in hospitals nationwide. Under our new protocol, when sepsis is suspected, blood cultures will be drawn immediately and antibiotics administered within an hour of recognizing the condition.
  • A new protocol in the Emergency Department has reduced hospital admissions for atrial fibrillation. We formalized our processes for assessing patients with A Fib symptoms so we can more effectively identify those who have a complex cardiac problem and need to be hospitalized vs. those at low or intermediate risk who can be placed on observation status.
  • The number of births induced before 39 weeks without a specific medical reason has been as high as 10 to 15 percent at Cedars-Sinai, while the best-performing hospitals have a rate of 6 percent or less. Working cooperatively with our obstetricians, we've reduced non-medically indicated early deliveries to less than 4 percent.

Another crucial part of Cedars-Sinai Medicine is an educational process that involves sharing information with our medical staff from a software program called Crimson, which is used by leading academic medical centers around the country as a tool to help physicians evaluate their own clinical efficiency and effectiveness. Since we introduced this system in August, our MD advisors have been meeting one-on-one with physicians to show them their patient severity-adjusted inpatient clinical performance in comparison to their Cedars-Sinai colleagues on a variety of parameters.

Having access to this information will lead to valuable insights about how changes in practice can make a difference in quality and cost. Like so many other aspects of Cedars-Sinai Medicine, review of Crimson data by our physicians will be an ongoing process.

The Cedars-Sinai Medicine initiative calls for a level of introspection and transformation that isn't easy for individuals or organizations. Based on our long track record of adapting and succeeding during times of change, I have confidence in our ability to meet today's challenges in ways that will be emulated by other healthcare institutions nationwide.

Thanks for doing your part to improve quality, efficiency and effectiveness. You can learn more about Cedars-Sinai Medicine through periodic updates in Pulse, and I'll continue to discuss our priorities and progress in future President's Perspective messages as well.

Together, we will continuously build on the strengths that have made Cedars-Sinai a leading nonprofit academic medical center, giving patients from our community and other parts of the nation and the world a growing number of reasons to count on us for the healthcare they need.

Click here to read past President's Perspective columns on Cedars-Sinai's Intranet.

Next Phase of CS-Link Coming March 2

IP3 Launch Event Planned for Oct. 27

In support of Cedars-Sinai's "one patient, one record" vision, the implementation of our electronic health system, CS-Link™, continues. We are scheduled to go live the weekend of March 2, 2012, with Computerized Physician Order Management (CPOM) and physician documentation for clinical care notes, part of Inpatient Phase 3 (IP3).

This go-live affects all inpatient care areas and enables all physicians and staff to be connected for the first time via a single integrated system. In the areas where CS-Link has been implemented (e.g. ED, nursing), "we have seen many benefits including improved efficiency and communication among caregivers, as well as improvement with some patient care quality and safety issues," said Chief Medical Information Officer Paul Silka, MD.

To celebrate our CS-Link achievements to date and officially kick-off the Phase 3 implementation, everyone is invited to the CS-Link Inpatient Phase 3 launch event from 10 a.m. to 4 p.m., on Thursday, Oct. 27, outside on the Plaza.

Register Now to Run for Her

Event Details

  • What: 7th annual Run for Her® 5k Run and Friendship Walk
  • When: Sunday, Nov. 13, 2011
  • Where: Pan Pacific Park
  • Time: 9 a.m. - noon

Register now at www.runforher.com.

Check out some helpful new features:

  • Share Tools Download avatars, badges, posters, screensavers, bumper stickers and more!

Keep up to date with run for her, research updates and more through social media:

117 Honored by Circle of Friends in September

More than 100 people were honored by the Circle of Friends program in August, including 95 physicians.

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 more information about the program and for a list of past honorees.

  • Kenneth Adashek, MD

  • Kristy Y. Kim, MD
  • Arie Alkaley, MD
  • Ryan H. Kotton, MD
  • Michelle Amarillas, RN
  • Gary E. Leach, MD
  • Joel A. Aronowitz, MD
  • Christopher Lemones
  • Mark J. Ault, MD
  • Ronald S. Leuchter, MD
  • Sushma Bhaudauria, MD
  • Andrew J. Li, MD
  • Marvalene Bickerstaff
  • Simon K. Lo, MD
  • Philip G. Brooks, MD
  • Joseph Loewy, MD
  • Erik A. Brown
  • Anthony J. Loffredo, MD
  • Ilana Cass, MD
  • Howard Mandel, MD
  • Kirk Y. Chang, MD
  • Amber Marbury
  • Wendy W. Cheng, MD
  • Robert McKenna, Jr., MD
  • Alice P. Chung, MD
  • Gail Millan, MN, RN, BC
  • J. Louis Cohen, MD
  • Bruce L. Miller, MD
  • Jeffrey Conklin, MD
  • Charles N. Moon, MD
  • Judy L. Conley
  • Larry H. Nagaoka
  • Stephen R. Corday, MD
  • Arpine Nahabedian, RN
  • Catherine M. Dang, MD
  • Ronald B. Natale, MD
  • Moise Danielpour, MD
  • Christopher S. Ng, MD
  • Robert W. Decker, MD
  • Nicholas Nissen, MD
  • Rick B. Delamarter, MD
  • Anne L. Peters, MD
  • Noam Z. Drazin, MD
  • Edward H. Phillips, MD
  • Marla C. Dubinsky, MD
  • Howard E. Pitchon, MD
  • Omar A. Durra, MD
  • Farrokh F. Poordad, MD
  • David A. Feldmar, MD
  • Jennifer M. Rack, MA CCC-SLP
  • Robert A. Figlin, MD
  • Rajeev K. Rao, MD
  • Phillip R. Fleshner, MD
  • Robert Richter , MD
  • Gregory Fontana, MD
  • Charlotte Roberts, CDE
  • Gerhard J. Fuchs, MD
  • Jay S. Rudin, MD
  • Clark Fuller, MD
  • Paul A. Rudnick, MD
  • Daryl C. Gabas, RN
  • Bruce Samuels, MD
  • Steven S. Galen, MD
  • Tanya M. Sanders, RN
  • Elayne K. Garber, MD
  • Benjamin S. Santos, MD
  • Avrom Gart, MD
  • Jay Schapira, MD
  • Nilo D. Gellegani, RN
  • John L. Sherman, MD
  • Eli Ginsburg, MD
  • Chrisandra L. Shufelt, MD, MS
  • Armando E. Giuliano, MD
  • Ellen Shukhman, RN, BSN, CCTC
  • Neil J. Goldberg, MD
  • Andrew Ira Spitzer, MD
  • Jeffrey Goodman, MD
  • William P. Stanford, MD, PhD
  • Martin Gordon, MD
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Paul J. Grodan , MD
  • Jerrold H. Steiner, MD
  • Inna Gromova, RN
  • James L. Stern
  • Lawrence S. Gross, MD
  • Charles D. Swerdlow, MD
  • Behrooz Hakimian, MD
  • Nicholas R. Szumski, MD
  • Michele A. Hamilton, MD
  • Edward P. Tangchitnob, MD
  • W. David Hardy, MD
  • Analisa Traba, RN
  • Donald R. Henderson, MD
  • Alfredo Trento, MD
  • Jethro L. Hu, MD
  • Laurice V. Trice
  • Andrew Ippoliti, MD
  • David M. Ulick, MD
  • Gregg Itzko, RN
  • Mark K. Urman, MD
  • Ifeoma S. Izuchukwu, MD
  • Michael B. Van Scoy-Mosher, MD
  • Stanley C. Jordan, MD
  • Eric Vasiliauskas, MD
  • Neel R. Joshi, MD
  • Nina H. Vinick
  • David Kattan, MD
  • Jonathan M. Weiner, MD
  • David Kawashiri, MD
  • Janet Y. White , MD
  • Kristy Y. Kim, MD
  • Edward M. Wolin, MD
  • Ryan H. Kotton, MD
  • Graham M. Woolf, MD
  • Gary E. Leach, MD
  • Lewis Wyatt, MD
  • Christopher Lemones
  • Clement C. Yang, MD
  • Ronald S. Leuchter, MD
  • John S. Yu, MD

 

  • Mae Zakhour, MD

Highlights from the Oct. 3 Meeting

MEC Update

The countdown to CS-Link™ and modifications to Medical Staff Rules and Regulations were among the topics at this month's Medical Executive Committee meeting.

CS-Link Update

  • Dec. 9 – Physicians begin to register for training
  • Jan. 16 – Training begins
  • March 2 – IP3 Go Live

Medical Staff Rules and Regulations

Several sections were modified to support the transition from a paper to an electronic medical record.

  • Article I - General Provisions and Definitions
  • Article II, Section 2.1.4.3 and 2.1.10.- Organization of the Medical Staff
  • Article IV - Medical Records
  • Article IX - Temporary Membership & Privileges
  • Article XI - Appointment, Reappointment and Reapplication
  • Article XVI - Specific Clinical Considerations

Rules and Regs on Documentation (PDF)

In addition, the Chief of Staff Award and Pioneer in Medicine Award were removed from the Rules and Regulations and turned into Policies and Procedures.

Changes to Pioneer and Medicine and Chief Staff Awards Language (PDF)

Two-thirds of Hepatitis C Patients Can See Cure in the Half the Time, New Study Finds

Research Corner

Treatment with a telaprevir-based combination regimen for hepatitis C - until now a chronic, destructive and difficult to manage disease - effectively can be shortened to six months in about two-thirds of patients, finds a new study recently published in the New England Journal of Medicine.

Fred Poordad, MD, chief of Hepatology and Liver Transplantation at Cedars-Sinai, was senior author on the study.

Telaprevir, a drug approved for use against hepatitis C in May, inhibits replication of virus. This anti-viral drug and a similar medication called boceprevir have nearly doubled the number of patients with sustained response. Among patients treated with telaprevir, pegylated interferon and ribavirin in the new study, 72 percent were cured of their hepatitis C.

This study shows that two-thirds of patients can be cured in half the time: Patients who are clear of the virus within the first four to 12 weeks of therapy effectively can cut their treatment time from 48 weeks to six months. Besides the considerable benefits to patients of shorter treatment, these findings also show that response-guided therapy is a successful strategy.

"This means that rather than a one-size-fits-all approach, we can individualize treatment for patients based on their specific response to the drugs," Poordad said. "Once you're cured by these anti-viral drugs, you’re cured of hepatitis C completely. That's a little known fact among the public – and even among physicians who don't regularly treat liver disease."

Cedars-Sinai is one of the major research sites investigating new treatments for hepatitis C; the medical center is involved in developing most of these new compounds. Earlier this year, Poordad was the lead author of a study published in the New England Journal of Medicine on the anti-viral drug boceprevir, also an oral protease inhibitor. In that study, 1,097 patients with hepatitis C who had never been treated for the virus received standard treatment - pegylated interferon and ribavirin - for four weeks. Then, a third of the patients continued only on those drugs, while two other groups also received different durations of boceprevir. The boceprevir patients responded well, with 63 percent and 66 percent achieving sustained virus suppression - compared to 38 percent among patients taking only pegylated interferon and ribavirin.

According to the Centers for Disease Control, an estimated 3.2 million people in the United States have chronic hepatitis C virus infections. The disease is spread through virally infected blood, often by sharing of syringes or other equipment to inject drugs; prior to 1990, some infections can be attributed to blood transfusions. Some rare infections can be traced to medical procedures. Chronic hepatitis C is the leading cause of liver cancer and cirrhosis and is the chief reason for the need for liver transplants in the U.S. The disease is linked to as many as 10,000 deaths each year.

In the new telaprevir study, funded by Vertex Pharmaceuticals in Cambridge, Mass., a total of 540 patients were enrolled. They took a 12-week course of 750 milligrams of telaprevir three times a day in addition to therapy with pegylated interferon and ribavirin. Patients eligible for shortened treatment - meaning the virus was not detectable in the first month of treatment - were randomized to receive either 24 weeks or 48 weeks of treatment. The high cure rates among both groups showed that there was no benefit to additional treatment for early responders.

For patients, the shorter course of treatment means decreased costs, fewer side effects and less disruption to their daily lives, as this therapy requires intensive monitoring and laboratory visits

A Rosy Life after Toddler's 2nd Kidney Transplant

Cedars-Sinai

Mother who Donated Organ to Daughter will Ride on Rose Parade Float

Cedars-Sinai performed hundreds of organ transplants last year. But one family's remarkable journey stood out when it came time to select who would represent Cedars-Sinai's Comprehensive Transplant Center on the 2012 Donate Life Rose Parade float.

Cedars-SinaiGaena "Gina" Song Cho, who donated a kidney to her young daughter, will be one of 28 donor family members, living donors and transplant recipients who will ride on the float during the internationally televised Tournament of Roses parade on Jan. 2 in Pasadena. The parade is held each year before the Rose Bowl college football game.

When Cho gave birth to her daughter, Cherity, in 2007, doctors suggested hospice care for the infant whose kidneys weren't working.

The family refused to give up on the little girl and came to Pediatric Nephrology at Cedars-Sinai’s Maxine Dunitz Children’s Health Center for a second opinion.

"After she was born, we were being told to prepare for memorial services," Cho said. "She's now 3 ½ and just starting pre-school."

It was a rough road for the little girl with bouncing pigtails. Cherity was on dialysis when she was just two days old. She received a donor kidney in September 2009. At the time, Cho was pregnant with her son. That transplant failed and the toddler had to undergo hemodialysis five times a week. She had also made antibodies following her first transplant, which precluded her from getting a second transplant. With the use of the cutting-edge research done at Cedars Sinai, she underwent a long "desensitization" process to be ready for another transplant attempt.

Finally, on Nov. 2, 2010, when Cherity was 2 ½ years old, Cho was able to donate her own kidney to her daughter.

"Cherity is the youngest patient in our highly sensitized program," said Dechu Puliyanda, MD, pediatric nephrologist and one of Cherity's doctors. "She would not have had a transplant at most other centers."

Cedars-Sinai is one of the leaders in performing kidney transplants on patients who would otherwise not receive an organ because they have too many antibodies or a perfectly matched donor is unavailable.

While there's no doubt Cherity would easily charm Rose Parade audiences, she is too young to ride on the float. Instead, her mother will carry Cherity's photo with her as the parade rolls down Colorado Boulevard.

"Cherity is the poster child not just for pediatrics, but for the highly sensitized transplant patient and the living donor teams," said Elaine S. Kamil, MD, clinical director of Pediatric Nephrology at Cedars-Sinai's Maxine Dunitz Children’s Health Center and one of Cherity’s doctors.

Cedars-Sinai

Gaena Song Cho and her daughter, Cherity, surrounded by their doctors - (l-r) Dechu Puliyanda, MD, J. Louis Cohen, MD, Elaine S. Kamil, MD.