Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Feb. 28, 2014 | Archived Issues

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 - February 2014


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to email us your milestones and comments.

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Normal Operations for Flu Precautions Resume

From Christopher S. Ng, MD, Neil Romanoff, MD, and Rekha Murthy, MD

Due to the exemplary efforts put forth in the past several weeks, we have seen a significant decline in the number of people with flu-like illness at the medical center, and we have not had any flu-related deaths in the past two weeks. On Feb. 23, we returned to our previous flu control policy level as implemented last fall.

» Read more

March 11 Talk to Cover Healthcare Reform's Effects

Do you know how insurers will judge the value of care that you provide and how this will affect your practice? Scott Weingarten, senior vice president and chief clinical transformation officer, will discuss these questions at the first in a series of lectures on population health sponsored by the medical staff. The event will take place Tuesday, March 11, from 5-7 p.m. in Harvey Morse Auditorium. Two CME credits will be awarded.
 

» Read more

Falling to Zero

Cedars-Sinai Achieves Zero Patient Falls With Renewed Efforts

Taking a major step forward in fall prevention, Cedars-Sinai achieved zero patient falls for the week ending Jan. 24, and only three falls the following week.

» Read more

Take the MD/RN Satisfaction Survey by March 7

Collaborative Seeks Input on CS-Link, Patient Safety

This year's MD/RN Collaborative Satisfaction Survey is going on now through March 7. Visit cedars-sinai.edu/MDRNsurvey to share your opinions. Responses are completely confidential.

» Read more

CS-Link to Include PEG Placement Orders

Need a percutaneous endoscopic gastrostomy (PEG)? Orders for PEG placement will be available in CS-Link™ starting March 13. This is merely a replacement for the original paper order form.

» Read more

ICD-10 Awareness Sessions Scheduled

Physicians can learn about the new ICD-10 coding system at information sessions in March. The hourlong CME sessions will take place March 18-20.

» Read more

CS-Link Tip: Filtering Notes

You might want to see just your own notes in CS-Link™ – not only the ones you wrote, but any you touched. If that's what you usually want to see, you can make your own filter based on notes to which you contributed, and make it a default filter.

» Read more

Research Day Abstracts Available as Book

Research abstracts for posters presented Jan. 17 at Research Day V have been compiled into an 86-page book. It is available as a PDF; click the "Read more" or visit the Cedars-Sinai Medical Library archives.
 

» Read more

FDA Eyes Saxagliptin Risk; Victrelis Label Changed

Pharmacy Focus

The U.S. Food and Drug Administration has requested clinical trial data from the manufacturer of saxagliptin to investigate a possible association between use of the Type 2 diabetes drug and heart failure. Also, the FDA said the label of the hepatitis C drug Victrelis has been updated to include information about serious reported cases of pancytopenia, and to add a virologic futility rule.

» Read more

Normal Operations for Flu Precautions Resume

From: Christopher S. Ng, MD, Chief of Staff
Neil Romanoff, MD, Vice President, Medical Affairs, Associate Chief Medical Officer
Rekha Murthy, MD, Director, Hospital Epidemiology

Due to the exemplary efforts put forth in the past several weeks, we have seen a significant decline in the number of people with flu-like illness at the medical center, and we have not had any flu-related deaths in the past two weeks. It appears that the peak of the flu season has passed, and this is consistent with a comparable decline in flu activity in our community.

We want to extend our sincere appreciation and congratulations to everyone for your efforts during this challenging flu season. Thank you for helping to keep our patients, staff and colleagues safe!

Based on this internal information and our review of community flu trends, on Feb. 23, we returned to our previous flu control policy level as implemented last fall, consistent with the regulations established by the Los Angeles County Department of Public Health.

As a reminder, everyone is still required to wear their green or orange "badge buddy," and anyone who is not vaccinated against the flu will have to continue to wear an isolation mask while working in patient care areas or having direct patient contact.

Although the downward trend in the number of influenza cases is encouraging, let's keep in mind that the flu season is not over, and we need to remain vigilant in our efforts to eliminate the spread of infection. We're asking that patients with respiratory illness continue to wear an isolation mask while outside their room, and visitors who are exhibiting symptoms of a cold or flu-like illness will be asked to either postpone their visit or wear an isolation mask. We are removing the restriction of two visitors at a time and returning to our policy of four visitors allowed at a time in a patient room. Please remind visitors to comply with our hand hygiene and isolation precautions.

Thank you again for all of your help during these past few months and for your continuing assistance in this important patient safety initiative.

March 11 Talk to Cover Healthcare Reform's Effects

Do you know how insurers will judge the value of care that you provide and how this will affect your practice?

These questions will be discussed at the first in a series of lectures on population health sponsored by the medical staff. "Succeeding in the New World of Healthcare Reform" will take place Tuesday, March 11, from 5-7 p.m. in Harvey Morse Auditorium. Two CME credits will be awarded.

The speaker will be Scott Weingarten, senior vice president and chief clinical transformation officer (pictured at right). Time has been allotted for open forum discussion, so bring your questions.

Dinner is included.

RSVP by March 7 to Jocelyn Rivera, 310-423-5148 or jocelyn.rivera@cshs.org.

Falling to Zero

Cedars-Sinai Achieves Zero Patient Falls With Renewed Efforts

Taking a major step forward in fall prevention, Cedars-Sinai achieved zero patient falls for the week ending Jan. 24, and only three falls the following week.

Inservice trainings on units with high fall rates and renewed fall prevention education for everyone from physicians to certified nurse assistants and nursing communication technicians made the achievement possible, said Richard Riggs, MD, chair and medical director of Physical Medicine and Rehabilitation, who co-sponsors the Quality Council Falls Collaborative with Linda Burnes Bolton, DrPH, RN, FAAN, vice president and chief nursing officer.

While all staffers are being urged to call for help if they see a high-risk patient attempting to move without assistance, physicians have a special responsibility to support fall precautions because "patients listen to doctors more than any other caregiver," said Peachy Hain, MSN, RN, director of Medical, Surgical and Rehabilitation Services and nursing lead for the Falls Prevention Committee.

"Having everyone understand why every caregiver has a role in preventing falls and creating a culture of keeping patients safe — that's what has made the difference," Riggs said. "We've put the right foundation in place and will continue to work with the units, monitor performance data and share best practices to build on our success."

Unassisted falls cause serious injury to 90,000 patients in hospitals across the nation each year. Cedars-Sinai had been averaging 30 unassisted falls per month when the collaborative launched its 2013 campaign to reduce unassisted falls by 50 percent. This year, the collaborative aims to meet that target for three consecutive months.

While the medical center already has a robust fall prevention bundle, the inservice trainings focused largely on the dangers of leaving high-risk patients alone in the bathroom, which accounts for the majority of unassisted falls. More than 300 Cedars-Sinai staff members attended the trainings, which included instructions that nurses go up the chain of command if patients refuse to comply with precautions.

"We continue to have challenges with patients who refuse to comply," Riggs said. "But the reality is, once we have created a culture around the precautions, the patients and families go along with them more often."

Take the MD/RN Satisfaction Survey by March 7

Collaborative Seeks Input on CS-Link, Patient Safety

This year's MD/RN Collaborative Satisfaction Survey is going on now through March 7. Visit cedars-sinai.edu/MDRNsurvey to share your opinions.

Responses are completely confidential.

"Improving physicians' work satisfaction at Cedars-Sinai is a top priority of the MD/RN Collaborative," said Chris Ng, MD, chief of staff, who has co-chaired the collaborative with Peachy Hain, RN, for the past decade.

"This will be the first of our surveys in the CS-Link™ era, so we are particularly interested in getting your feedback on how it has affected collaboration and safety," Ng said. "The survey results are used to create tests-of-change on your units, so it's important that we receive your honest input."

Please complete at least one survey for the unit where you have the most contact. For additional units, physicians are encouraged to complete additional surveys.

If you have any questions, please contact either Ng at chris.ng@cshs.org or Hain at 310-423-6747 or peachy.hain@cshs.org.

CS-Link to Include PEG Placement Orders

Need a percutaneous endoscopic gastrostomy (PEG)? Orders for PEG placement will be available in CS-Link™ starting March 13. This is merely a replacement for the original paper order form.

Please note that to schedule a PEG by GI or Interventional Radiology, or in the ICU, the electronic order needs to be placed in CS-Link by either the attending physician or the gastroenterologist.

The PEG order will include the same evaluation and appropriateness questions. PEG placement in patients with certain conditions (e.g., those with end-stage dementia) is included in the metric as part of the Quality Council's fiscal year 2014 goal to eliminate harm at the end of life. Patients with any of the conditions listed in the order that are a relative or absolute contraindication to PEG placement will undergo secondary review by a gastroenterologist before the procedure is scheduled.

ICD-10 Awareness Sessions Scheduled

Physicians can learn about the new ICD-10 coding system at information sessions in March:

  • Internal medicine: Tuesday, March 18, noon-1 p.m., Advanced Health Sciences Pavilion, PEC 4
  • Orthopedics: Tuesday, March 18, 5-6 p.m., Advanced Health Sciences Pavilion, PEC 8
  • General awareness: Wednesday, March 19, 5-6 p.m., Advanced Health Sciences Pavilion, PEC 6-7
  • General awareness: Thursday, March 20, 8-9 a.m., Advanced Health Sciences Pavilion, PEC 4

Attendance at only one session is recommended, as content will be replicated.

CME credit will be awarded.

The switch to ICD-10 is mandated by the federal Department of Health and Human Services, which says the new coding system must be in place effective Oct. 1. The change will result in an increase from about 17,000 codes in ICD-9 to just over 140,000 in ICD-10.

If you have questions, email Jennifer Esterbrooks at jennifer.esterbrooks@cshs.org.

ICD-10 Awareness Sessions - February-March 2014 (PDF)

Previously in Medical Staff Pulse:

New Intranet Section Gives Healthcare Coding Tips

Physicians and Office Staff - Not Just Coders - Need to Prepare for ICD-10

CS-Link Tip: Filtering Notes

You might want to see just your own notes in CS-Link™ – not only the ones you wrote, but any you touched.

If that's what you usually want to see, you can make your own filter based on notes to which you contributed, and make it a default filter. Click the training updates link below for instructions.

Click here for more CS-Link training updates for physicians.

Research Day Abstracts Available as Book

James Smyth, a project scientist, presented one of more than 130 posters at Research Day V.

Research abstracts for posters presented Jan. 17 at Research Day V have been compiled into an 86-page book. The book is available as a PDF via the link below or in the Cedars-Sinai Medical Library archives.

This year’s event, celebrating scientific accomplishments at Cedars-Sinai, featured more than 130 research posters, the most ever. The studies embraced a wide range of scientific disciplines, including behavioral science, cancer biology and therapeutics, cardiovascular and respiratory disease, endocrinology, gastroenterology, genetics, imaging, immunology, neuroscience, regenerative medicine and reproductive biology.

Research Day V Abstract Book (PDF)

FDA Eyes Saxagliptin Risk; Victrelis Label Changed

Pharmacy Focus

The U.S. Food and Drug Administration has requested clinical trial data from the manufacturer of saxagliptin to investigate a possible association between use of the Type 2 diabetes drug and heart failure. In addition, the FDA said the label of the hepatitis C drug Victrelis (boceprevir) has been updated to include information about serious reported cases of pancytopenia.

The FDA's request regarding saxagliptin resulted from a study published in the New England Journal of Medicine, which reported an increased rate of hospitalization for heart failure with use of saxagliptin (marketed as Onglyza and Kombiglyze XR) compared to an inactive treatment.

The study did not find increased rates of death or other major cardiovascular risks, including heart attack or stroke, in patients who received saxagliptin. The manufacturer is expected to submit the trial data to FDA by early March.

At this time, the FDA considers information from the study to be preliminary. Analysis of the saxagliptin clinical trial data is part of a broader evaluation of all Type 2 diabetes drug therapies and cardiovascular risk.

The FDA says patients should not stop taking saxagliptin.

To learn more, visit this FDA Web page.

Changes Made to Victrelis Label

The FDA said the label of the hepatitis C drug Victrelis has been updated to include information about serious cases of pancytopenia that have been reported in patients receiving Victrelis in combination with peginterferon alfa and ribavirin. Complete blood counts (with white blood cell differential counts) should be obtained at pretreatment and at treatment weeks two, four, eight and 12, the FDA said. Blood counts should be monitored closely at other times, as clinically appropriate.

The label also was updated to include the risk of agranulocytosis, thrombocytopenia, pneumonia and sepsis.

Separately, the FDA approved an update to the Victrelis label to include a new virologic futility rule: If a patient has HCV-RNA results greater than or equal to 1,000 IU/mL at treatment week eight, then discontinue the three-medicine regimen.

Discontinuation of therapy is recommended in all patients with any of the following:

  • HCV-RNA levels of at least 1,000 IU per mL at treatment week eight
  • HCV-RNA levels of at least 100 IU per mL at treatment week 12
  • Confirmed detectable HCV-RNA levels at treatment week 24

The complete revised label can be viewed here.