Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Feb. 15, 2013 | Archived Issues

Sleeping with Dinosaurs

Medical staff members and their families enjoyed dinner and a sleepover adventure at the Natural History Museum on Feb. 8 as part of a special "Overnight at the Museum" event sponsored by Cedars-Sinai.

» Read more

Here Is Your Chance to Honor a Deserving Nurse!

Online nominations for the 2013 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are being accepted now through Monday, March 11.

» Read more

Update for Physicians: Monthly Improvements to CS-Link

Earlier this month, several improvements were added to CS-Link™. Click "read more" to learn about the key improvements providers will benefit from and experience with these additions.

» Read more

Orthopedic Surgeon Recognized for Dedication to Advancing Hip, Knee Surgery in Israel

Andrew I. Spitzer, MD, has traveled to Israel more than a dozen times over the past decade to perform his own brand of community service: Teaching surgeons the latest techniques for replacing hips and knees while treating many patients without charge.



» Read more

William Binder, MD: Heart of Bold

A self-proclaimed adrenaline junkie, neonatologist William S. Binder, MD, gets part of his fix leading the airborne Neonatal Transport Program. Off the clock, the medical director of the Neonatal Transport Program at Cedars-Sinai’s Maxine Dunitz Children’s Health Center skydives to sate his passion for taking flight.

» Read more

Study of Brain Cooling and Clot-Busting Drug Therapy for Stroke Receives FDA OK to Expand

An international multicenter clinical trial led by a Cedars-Sinai neurologist on the combination of brain cooling and "clot-busting" drug therapy after stroke has received Food and Drug Administration approval to expand from 50 patients to 400.

» Read more

July Is Coming, and So Are Fireworks, Sand 'N' Snore

It's not too early to start thinking about summer, and July has a couple of treats in store for medical staff members and their families.



» Read more

Circle of Friends Honorees for January

The Circle of Friends program honored 73 people in January. 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.

» Read more

Wear Red Event Puts Spotlight on Heart Disease

Numbers don't lie – a broken heart is the No. 1 killer of women. While progress is being made to reach and educate women about their risk, more research focused on women is needed in order to reverse heart disease's toll on women, said Puja K. Mehta, MD, director of the Non-Invasive Vascular Function Research Laboratory at the Cedars-Sinai Heart Institute's Barbra Streisand Women's Heart Center.

» Read more

Sleeping with Dinosaurs

Click the image above to see more photos from the sleepover at the museum.

Medical staff members and their families enjoyed dinner and a sleepover adventure at the Natural History Museum on Feb. 8 as part of a special "Overnight at the Museum" event sponsored by Cedars-Sinai.

About 50 physicians bunked down with their spouses and children last Friday night in one of two exhibit halls, following dinner and a tour of the Dinosaur Hall that included a special appearance by a two-legged "dinosaur" who roamed the halls as shrieking children followed in its path. On Saturday morning, everyone enjoyed a buffet breakfast before heading home.

The sold-out event, which drew more than 200 people, was organized by Marjorie Santore Besson and Cheryl Verne.

The next scheduled medical staff event is the ever-popular Hollywood Bowl Fireworks event on Wednesday, July 3. For more information and to reserve your tickets, please contact Verne at (310) 423-2681.

Here Is Your Chance to Honor a Deserving Nurse!

Online nominations for the 2013 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are being accepted now through Monday, March 11.

This annual award is given on behalf of the medical staff to a Cedars-Sinai nurse who exemplifies professionalism, clinical excellence and caring.

Click here to submit a nomination on the Intranet. Please fill out the form completely, as all fields are required except for the telephone information. Only medical staff members may submit a nomination.

The Excellence in Caring Award Medical Staff Selection Committee will conduct interviews of the top candidates and the recipient will be honored during Nurses Week in May.

If you submitted a nomination last year and would like your nominee to be considered for this year's award, please e-mail Chris Ng, MD, co-chair of the MD/RN Collaborative, at chris.ng@cshs.org or call him at (310) 423-4700.

Update for Physicians: Monthly Improvements to CS-Link

Earlier this month, several improvements were added to CS-Link™. This document highlights the key improvements providers will benefit from and experience with these additions.

Expansion of the CS Medicine RBC Transfusion Advisory Pilot

A new advisory pilot began in December in 4SW and 4SE and is being expanded housewide except for ED, OR, and Procedure Areas.

The advisory displays if a packed red blood cell (pRBC) transfusion is ordered on a patient whose most recent hemoglobin is greater than seven (or greater than eight, for patients with cardiovascular disease documented on the Problem List), or if no hemoglobin results are available within past three days.

The most recent hemoglobin and hematocrit results, and a link to blood transfusion guidelines will be displayed in the advisory.

Refer to Job Aid CCST 0022 for more detail around this advisory.

This improvement:

  • Enables providers to adhere to best practice guidelines
  • Enhances patient safety by encouraging judicious use of blood transfusions

Expansion of Duplicate Lab Order Advisory

CS Medicine and the Lab Department have identified commonly ordered labs that generally should not be ordered more than once a day. About 200 labs were identified initially. An additional 140 labs have been identified for use of this advisory to alert providers if one of these labs has already been recently resulted when ordering.

The advisory has already been in place for labs such as CBC, CMP, BMP, lipid panels, HbA1C and hepatitis C viral loads. The advisory fires if you try to order one of those tests within eight hours of a prior one being completed.

This improvement will:

  • Enhance patient safety
  • Improve patient satisfaction (fewer sticks)
  • Reduce lab costs

Duplicate Neuro Imaging Advisory

CS Medicine and Radiology would like to reduce unnecessary imaging orders by expanding the use of the duplicate procedure advisory to include CT Brain and MRI Brain orders.

An advisory will fire on any patient located in the 4NW Stroke Unit when a physician attempts to place any CT Brain or MRI Brain order that has already occurred within the past 24 hours.

This improvement will:

  • Reduce costs
  • Provide an opportunity to intervene proactively before a duplicate order is placed and potentially reduce callbacks from Radiology and Nursing

New Consult to Patient Relations Order

A consult to patient relations order will be added in production in February.

When this order is placed, patient relations will be notified via an in-basket message that can be seen by users in the patient relations pool.

This improvement:

  • Enhances communication between providers and patient relations.

Improvements specific to Emergency Department

  • Releasing 30 additional Notewriter HPI Smartforms to make additional HPI templates available
  • Modifications to the Existing Patient Summary Report:
    • Following the CS-Link upgrade in October, the ED Orders section started to display Override Cabinet Pulls for medications removed from the Pyxis.
    • Since ED is not set up for Pyxis overrides, the display of these orders were represented as duplicates; this issue has been resolved.

Other general changes to CS-Link

  • Platelet Advisory Pilot: CS-Medicine is creating an advisory to notify users that they may be ordering an inappropriate platelet transfusion. This advisory is in accordance with the platelet transfusion guidelines outlined by the CS-Medicine Transfusion Committee and will be piloted on 4SW, 4SE and 4NW (neuro).
  • Expansion of Inter-facility Transfer Workflow: For ISP patients on any Med Surg floor (with the exception of 7SW), nurses will now document the Inter-Facility Transfers to accepting facility using the Inter-Facility Transfer template, located within the Discharge Navigator.
  • Malignant Hyperthermia Banner: Anesthesia recognized a need for an order for "Malignant Hyperthermia" which would generate a patient summary banner similar to the "Difficult Airway" order.
  • Changes to Pneumococcal Vaccine Screen: Changing the custom list options for Pneumovax Indications to "Chronic heart/lung disease, renal disease, metabolic disease (i.e. D.M.), or prior splenectomy" and Removing thyroid problems as an example for metabolic diseases as it is not a CDC or TJC indication.
  • Ultrasound Guided IV Insertion Order Inactivated: Order was specific to the procedure center.

Orthopedic Surgeon Recognized for Dedication to Advancing Hip, Knee Surgery in Israel

Andrew I. Spitzer, MD, has traveled to Israel more than a dozen times over the past decade to perform his own brand of community service: teaching surgeons the latest techniques for replacing hips and knees while treating many patients without charge.

That work has earned Spitzer, director of the Joint Replacement Program at the Cedars-Sinai Orthopaedic Center, a rare distinction. He is one of only a handful of American surgeons to be named an honorary member of the Israel Orthopaedic Association.

"It's the highlight of my professional career," Spitzer said. "It's nice to be recognized for what has come to be a passion of mine."

Spitzer got involved with the association in 2003, when he decided to put his surgical skills to use in hope of helping the Jewish state.

He took on surgical cases that would serve as teaching opportunities for residents and staff at hospitals in Jerusalem, Tel Aviv, Haifa and Beersheba, among other places. He began attending the association's annual meetings and delivered lectures to fellow orthopedists about his specialty, joint replacements for hips and knees.

"I wanted to contribute in some way to Israeli culture, to celebrate their yearning for knowledge," said Spitzer, who also is a member of the Cedars-Sinai/USC Dramatic Arts Dance Medicine Center. "I thought this was a great opportunity to make a contribution in a positive way."

Association leaders said Spitzer was a natural choice for induction into the organization. Spitzer received the award at the association's December meeting in Tel Aviv, where he delivered four lectures about innovations in hip and knee replacement surgery.

"Andrew is not only an excellent teacher and speaker but a real, true friend to Israel and Israeli orthopedics," said Steven Velkes, MD, the association's treasurer and chair of the Department of Orthopedic and Trauma Surgery at the Rabin Medical Center (Beilinson Campus) outside Tel Aviv.

At Cedars-Sinai, Spitzer serves as both surgeon and researcher, focusing on implant designs, blood management in total joint replacement, prevention of blood clots, and the nonoperative management of osteoarthritis of the hip and knee. He is board certified by the American Board of Orthopaedic Surgery and is a fellow of the American Academy of Orthopedic Surgeons.

Spitzer has written numerous articles for peer-reviewed publications, contributed chapters to textbooks on hip and knee replacement, and lectured extensively and presented scientific papers around the world. He also serves as a consultant reviewer to many of the major orthopedic journals, including the Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research.

He is a member of the American Association of Hip and Knee Surgeons, the Western Orthopaedic Association, the California Orthopaedic Association and the American Academy of Orthopaedic Surgeons.

William Binder, MD: Heart of Bold

A self-proclaimed adrenaline junkie, neonatologist William S. Binder, MD, gets part of his fix leading the airborne Neonatal Transport Program: When fragile preemies born in Southern California hospitals require critical care, Binder and his specialized team jump into a helicopter and bring the newborns swiftly and safely to Cedars-Sinai’s Neonatal Intensive Care Unit. Off the clock, the medical director of the Neonatal Transport Program at Cedars-Sinai’s Maxine Dunitz Children’s Health Center skydives to sate his passion for taking flight.

Taking the plunge: “Skydiving became my outlet in medical school because you have no distractions. You can’t think about anything else – you’re totally in the moment, and it becomes a sort of physical meditation.”

Free falling: Binder participates in competitive formation skydiving – the art of building configurations in free fall (without your parachute open) with groups of people. The falls typically last for about 60 seconds and start at an altitude of 12,500 feet. “But you don’t feel like you’re falling; you feel like you’re flying. Doesn’t every little kid dream of flying?”

Diving in: “I see a strong correlation between my work and skydiving – especially with the intensity of each. Both require so much team practice, whether it’s a formation or the resuscitation of a very premature infant. But when the real moment comes, you have to relax and trust your team. In both, you’re working together, you’re working against the clock, and you have to communicate nonverbally under pressure. You also need to know how to properly debrief.”

High stakes: In 2006, the king of Thailand invited Binder to participate in the largest formation ever – 400 people – which became a Guinness World Record. Binder’s 2009 team won a gold medal at the U.S. National Skydiving Championships. He is now part of a group of 500 people set on breaking the world record for largest formation. Their first step will be setting a new U.S. national record, with 333 skydivers in formation, scheduled to take place in Arizona in November.

Big picture: “There is still so much more to learn and understand about how to care for extremely premature babies. It’s like a big, vast, unknown frontier, and that’s where the sense of adventure comes in.”

Awww-some: An unflinching daredevil, Binder admits that, although jumping head first out of an airplane doesn’t make him weak in the knees, the sight of a brand-new baby probably always will. “When I’m in a delivery room and a baby is born, it truly is like witnessing a little miracle. I get to see the amazing changes a baby goes through to adapt from life in the womb to life in the world, and it’s incredible.”

Study of Brain Cooling and Clot-Busting Drug Therapy for Stroke Receives FDA OK to Expand

An international multicenter clinical trial led by a Cedars-Sinai neurologist on the combination of brain cooling and "clot-busting" drug therapy after stroke has received Food and Drug Administration approval to expand from 50 patients to 400.

"This approval is highly significant because, after reviewing our initial safety data, the Food and Drug Administration approved us to include more patients in our study," said Patrick D. Lyden, MD, chair of the Department of Neurology at Cedars-Sinai Medical Center and the study's overall principal investigator. Thomas Hemmen, MD, PhD, director of the University of California, San Diego Health System Stroke Center, and James C. Grotta, MD, chair of the Department of Neurology at the University of Texas Health Science Center at Houston (UTHealth), are co-principal investigators.

This study, which includes the use of intravenous tissue plasminogen activator (IV tPA), the only FDA-approved treatment for acute stroke, is the latest in a series of clinical trials on brain cooling – controlled hypothermia – to reduce neurological damage after stroke.

Researchers employ a state-of-the-art system to provide rapid heat exchange and very fast cooling, achieved by inserting a special catheter into the inferior vena cava – the body's largest vein. No fluid enters the patient; an internal circulation within the catheter absorbs the body's heat and transfers it out to slow metabolism, keep tissue swelling in check and give the brain time to rest.

Study participants are covered with a warming blanket to trick the body into feeling warm, and temperature sensors in the skin and a mild sedative help suppress shivering. Body temperature is cooled to 33 degrees Celsius (about 91 degrees Fahrenheit) for 24 hours before the patient is gradually warmed.

Brain cooling has been shown to decrease brain swelling and reduce loss of neurological function after acute stroke. It also has proved highly effective in saving lives and preventing neurological damage after heart attack and after oxygen deprivation in newborns.

TPA, which must be given to a patient as quickly as possible after stroke onset, sometimes can dissolve a clot and prevent or reduce serious brain injury. Lyden, the Carmen and Louis Warschaw Chair in Neurology at Cedars-Sinai, helped lead the pivotal clinical trial of the drug that led to its approval by the FDA in 1996.

The brain cooling clinical trials (ICTuS, Intravascular Cooling for Acute Stroke) are funded by grants supported under the Specialized Program for Acute Translational Research (SPOTRIAS) from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health (Grant numbers NIH/NINDS P50NS044227 and P50NS044148). A UCSD grant includes funding for 18 study sites; a UTHealth grant funds eight sites. Most locations are in the United States but some are in Europe.

July Is Coming, and So Are Fireworks, Sand 'N' Snore

It's not too early to start thinking about summer, and July has a couple of treats in store for medical staff members and their families:

Hollywood Bowl Fireworks – July 3

Celebrate Independence Day with fireworks and music by the Hollywood Bowl Orchestra and special guest Josh Groban. The event on Wednesday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $125 per adult and $60 per child younger than 12. To reserve tickets, call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681.

>> See coverage of last year's event.

Sand 'N' Snore – July 19

The dinner, sleepover and breakfast starts Friday, July 19, at the Jonathan Beach Club in Santa Monica. Those who don't want to sleep on the sand are welcome to enjoy dinner and the evening with colleagues and their families. There's a limit of one tent per physician. Tickets for the whole event are $65 per adult and $40 for each child under age 12. Tickets for Friday's dinner only are $50 per adult and $20 for each child younger than 12. Call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681 to reserve your spot.

>> See coverage of last year's event.

Circle of Friends Honorees for January

The Circle of Friends program honored 73 people in January.

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.

  • Kristine Acorda (Baker), RN, BSN
  • Farin Amersi, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Johana E. Avalos
  • Irene K. Barnett, MD
  • Philip G. Brooks, MD
  • Eileen G. Brown, OCN, RN
  • Ilana Cass, MD
  • Elizabeth Cervantes
  • Jason S. Cohen, MD
  • Steven D. Colquhoun, MD
  • Stephen T. Copen, MD
  • Stephen R. Corday, MD
  • Daisy DaSilva, RN
  • Fardad Esmailian, MD
  • Margaret R. Farrell, RN, BSN
  • David E. Fermelia, MD
  • Morton H. Field, MD
  • Charles A. Forscher, MD
  • Arnold S. Friedman, MD
  • Gerhard J. Fuchs, MD
  • Clark B. Fuller, MD
  • Kristi M. Funk, MD
  • Armando E. Giuliano, MD
  • Richard N. Gold, MD
  • Travis L. Goul, LVN
  • Jeffrey R. Gramer, MD
  • Almar Guevarra, RN
  • Vincent Ha, DDS
  • Behrooz Hakimian, MD
  • Cynthia D. Hall, MD
  • Randy S. Harris, MD
  • Donald R. Henderson, MD, MPH
  • Theodric B. Hendrix, MD
  • Beth Y. Karlan, MD
  • Hyung L. Kim, MD
  • Terrence T. Kim, MD
  • Wesley A. King, III, MD
  • Jon A. Kobashigawa, MD
  • Megan S. Laib
  • Rachel M. Leon
  • Norman Lepor, MD
  • Roger L. Lerner, MD
  • John C. Liu, MD
  • Susan Lowenbraun, RN, BSN, OCN
  • Robert J. McKenna, Jr., MD
  • Roz Morgan, RN, MPA, CDE
  • Jaime Moriguchi, MD
  • Raphael D. Nach, MD
  • Reza Nazemi, MD
  • Ryan F. Osborne, MD
  • Resa Oshiro, MD
  • Surasak Phuphanich, MD
  • Edwin M. Posadas, MD
  • Paula Ruiz, PA-C
  • Cherry R. Sanchez, RN
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Michael M. Shehata, MD
  • John L. Sherman, MD
  • Randolph Sherman, MD
  • Allan W. Silberman, MD, PhD
  • Leslie Stricke, MD
  • Kamran Toluie, MD
  • Alfredo Trento, MD
  • Angela Velleca, RN, BSN, CCTC
  • Robert A. Vescio, MD
  • Mark W. Vogel, MD
  • Christine S. Walsh, MD
  • Xunzhang Wang, MD
  • Jonathan M. Weiner, MD
  • Edward M. Wolin, MD
  • Keyvan Yousefi, MD

Wear Red Event Puts Spotlight on Heart Disease

Numbers don't lie – a broken heart is the No. 1 killer of women.

While progress is being made to reach and educate women about their risk, more research focused on women is needed in order to reverse heart disease's toll on women, said Puja K. Mehta, MD, director of the Non-Invasive Vascular Function Research Laboratory at the Cedars-Sinai Heart Institute's Barbra Streisand Women's Heart Center.

Mehta was one of several to speak during Cedars-Sinai's annual Wear Red Day for Women event in Harvey Morse Auditorium on Feb. 1. One of many across the nation, the event focused on increasing awareness about heart disease in women among its employees. Dozens of women and men wearing red attended Friday's event and took part in a group photo (above).

Terran Lamp, who was born with heart disease, also spoke at the event. She read a poem her grandmother wrote for her that centered on Lamp's broken heart.

"While all the other kids were learning how to read books, I was learning how to read an EKG," she said about living with heart disease as a child. "I had monthly pacemaker checks. … I couldn't be in the kitchen when the microwave was on."

Lamp said her mission is to inspire others.

"I want to do my part to encourage others to ensure they are heart healthy,” she said. "Half of all Americans have at least one pre-existing condition for heart disease.”

During her presentation, Mehta, also co-director of the Cardio-Oncology Program in the Barbra Streisand Women's Heart Center, detailed the pre-existing conditions of heart disease, especially as they relate to women. And she highlighted the atypical early warning signs of heart disease in women, such as shortness of breath, pain that feels like heartburn, nausea, unusual and profound fatigue, and unusual anxiety.

She said there are several ways to prevent heart disease, such as by eating healthy and exercising.

Mehta also discussed the consequences that certain cancer treatments – chemotherapy and radiation – have on the heart.

Maria Estella, a medical lab assistant who attended the event for the first time on Friday, said she was impressed by the presentations of Lamp and Mehta. She said they hit home because she recently underwent tests related to heart disease.

"After hearing what Dr. Mehta had to say about women and how we don't necessarily pay attention to symptoms, I know there are questions I need to ask," she said. "I know what to pay attention to now."