Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Sept. 26, 2014 | Archived Issues

P and T Approvals, Details About Tramadol Change

Pharmacy Focus

See highlights of the Aug. 5 meeting of the Pharmacy and Therapeutics Committee. Also, more details are available about tramadol's new status as a controlled substance.

» Read more


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 - September (PDF)


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.

» Read more

New Flu Policy Goes Into Effect Nov. 1

Vaccination Clinics Start Sept. 26

To help protect the health and safety of patients, visitors and staff members, Cedars-Sinai is implementing a new flu vaccination policy that will be in effect for the duration of the flu season, from Nov. 1 through March 31, 2015. The new policy applies across the health system and is the same for everyone, including medical staff.

» Read more

Annual Meeting of Medical Staff Is Oct. 20

The annual meeting of the medical staff is scheduled for Monday, Oct. 20, from 11:30 a.m.-1:30 p.m. in Harvey Morse Auditorium.

» Read more

TJC Is Coming; Here's Help With Survey Prep

Cedars-Sinai's triennial survey by the Joint Commission will occur before Dec. 31. In preparation for the survey, we will be providing tidbits for you to review so that you may be better equipped to respond to questions from the surveyors.

» Read more

CS-Link Tip: Keep Patient Information in Its Place

Remember that the appropriate way to communicate about your patients is through CS-Link™. You can view and respond to InBasket messages with your smartphone using the Haiku app, your iPad using the Canto app, or using any of the work stations in the medical center.

» Read more

How to Respond to the Possibility of Enterovirus

The federal Centers for Disease Control and Prevention has released a Morbidity and Mortality Weekly Report on a severe respiratory illness associated with Enterovirus D68 (EV-D68). Healthcare providers should consider EV-D68 as a possible cause of acute, unexplained, severe respiratory illness, particularly in young children and those with pre-existing asthma.

» Read more

'Kinky Boots' Tickets Available to Medical Staff

Medical staff members are invited to the production of the award-winning musical "Kinky Boots" on Tuesday, Nov. 11, at the Pantages Theater in Hollywood. The cost is $110 per person and includes a pre-show dinner.

» Read more

Spine Surgeons Get Updated Postop Order Sets

Spine surgeons at Cedars-Sinai will have access to more user-friendly and standardized postoperative order sets beginning Oct. 1. The updated order sets will be accessible in CS-Link™ and are primarily for physicians performing lumbar or cervical fusion postoperative procedures.

» Read more

Researchers Test Bioartificial Liver

Cedars-Sinai physicians and scientists are testing a human-cell-based, bioartificial liver support system for patients with acute liver failure, often a fatal diagnosis.

» Read more

Cadaver Meniscus Is Used to Rebuild Finger Joints

Artist Joost van Oss was chopping wood a few years ago when he injured the middle knuckle on his right hand. The intense pain and swelling that followed nearly ended his career as a painter and sculptor. Then van Oss, 58, turned to Cedars-Sinai plastic surgeon David A. Kulber, MD, and underwent a novel surgery. Kulber used knee meniscus from a cadaver to reconstruct van Oss' finger joint.

» Read more

Marking the High Holidays at Cedars-Sinai

Senior Rabbi Jason Weiner, manager of Spiritual Care, will conduct services for the High Holidays at Cedars-Sinai. The services – Kol Nidre on Oct. 3 and Yom Kippur on Oct. 4 – also will feature cantor Jordan Gorfinkel.

» Read more

New Flu Policy Goes Into Effect Nov. 1

Michael J. Alexander, MD, gets a flu shot from Susan Phillips, MSN, RN.

Vaccination Clinics Start Sept. 26

To help protect the health and safety of patients, visitors and staff members, Cedars-Sinai is implementing a new flu vaccination policy that will be in effect for the duration of the flu season, from Nov. 1 through March 31, 2015. The new policy applies across the health system and is the same for everyone, including medical staff.

Vaccinations Available

Free flu vaccinations are available onsite to all medical staff members for their convenience at Employee Health Services. Cedars-Sinai also is scheduling flu shot clinics; the first will take place Friday, Sept. 26, from 9:30 a.m.-2 p.m. outside on the north concourse area of the South Tower, Plaza Level (near the outside entrance to the Plaza Café). Additional flu shot clinics will be announced shortly.

Per the new policy, all medical staff and allied health professionals must be vaccinated by Nov. 1. Physicians who are vaccinated will be issued green badge buddies upon either receiving the flu shot at Cedars-Sinai or by submitting an online attestation of vaccination. Those who decline will be issued orange badge buddies. Badge buddies must be worn visibly at all times beginning Nov. 1.

Physicians who decline the vaccine without an approved medical exemption will not be able to work in high-risk patient-care areas and will have to wear an isolation mask in patient-care areas that are not considered high risk. The only exceptions are the Davis Research Building and the research floors of the Advanced Health Sciences Pavilion, as well as general public areas such as lobbies, entrances, eating areas such as the cafeteria, and pedestrian walkways.

For those requesting medical exemptions, the request process is the same as last year. Medical exemption request forms are available from Employee Health Services in the Steven Spielberg Building.

For more information about the new flu policy, please contact the medical staff office at 310-423-5154 or Hospital Epidemiology at 310-423-5574.

Annual Meeting of Medical Staff Is Oct. 20

The annual meeting of the medical staff is scheduled for Monday, Oct. 20, from 11:30 a.m.-1:30 p.m. in Harvey Morse Auditorium.

Agenda items include the chief of staff report, the CEO report and executive update, the Chief of Staff Award and the Pioneer in Medicine Award.

Annual Meeting of the Medical Staff - Oct. 20, 2014 (PDF)

TJC Is Coming; Here's Help With Survey Prep

Cedars-Sinai's triennial survey by the Joint Commission (TJC) will occur before Dec. 31. In preparation for the survey, we will be providing tidbits for you to review so that you may be better equipped to respond to questions from the surveyors.

For example, TJC surveyors may ask you to describe new clinical programs or initiatives that Cedars-Sinai has implemented to enhance the quality, safety and/or efficiency of patient care. The following is a summary of some of these programs. Thank you for your attention to this and future tidbits.

New programs

  • Total Artificial Heart (TAH): The Total Artificial Heart®, an implanted pumping device that replaces the human heart, is a treatment option in the Heart Transplant Program as a bridge to transplantation. The device is prescribed for patients who are candidates for heart transplantation, are in imminent danger of death and for whom a donor heart is not available. In the future, the TAH will be utilized as an alternative for heart transplantation for patients who qualify. Cedars-Sinai Heart Institute surgeons implanted the TAH for the first time in 2012. To date, 43 Cedars-Sinai patients have received the Total Artificial Heart.
  • Medical Observation Unit: Located on the third floor of the South Tower, the new Medical Observation Unit is a specialized unit designed to observe patients who are expected to be discharged within 24-48 hours. Medical conditions typically include chest pain, dehydration and/or electrolyte disturbances, syncope/near syncope, asthma and pneumonia, among others.
  • Supportive Care Services: Supportive Care Medicine is treatment given to prevent, control or relieve complications and side effects and to improve the patient's comfort and overall quality of life. It is available to any patient who is facing serious illness at any age, even those who are pursuing curative treatment. It is not to be confused with hospice, which focuses exclusively on patients with a life expectancy of less than six months. The Supportive Care Medicine team is led by Brad Rosen, MD.
  • Physician Advocates: This is a new role for Cedars-Sinai, which is one of the first to pioneer the strategy. Physician advocates serve as eyes and ears for attending physicians during daily progression of care rounds. As part of a multidisciplinary team, they offer extra clinical support to help facilitate appropriate patient care and overcome obstacles to patients progressing toward appropriate discharge. The program is being implemented on units 5 North, 5 South and 7 North. Bill Stanford, MD, is medical director of the program.
  • Post Discharge Resources (Transitions in Care): Cedars-Sinai offers a number of services to improve patients' ability to manage care in the outpatient setting and to help patients transition successfully from the hospital to their next level of care. These services include the Enhanced Care Program, nurse practitioner coverage provided at certain skilled nursing facilities; Enhanced Home Health, an intensive bundle of services provided by participating home health services; and Healing at Home, acute-level care provided to older adults in the comfort of their own homes.
  • 5 South Closure: Peer institutions are using long-term acute-care facilities (LTACs) to improve the care for ventilator-dependent patients. Learning from them, we decided the most appropriate care for these long-term vent-dependent patients was not at our institution but at LTACs with more expertise in caring for these patients.
  • Future Acute Inpatient Rehabilitation Hospital: This is a joint venture with UCLA Health System and Select Medical. The site is the former Century City Hospital. The hospital will be an expansion of our inpatient rehabilitation services from 28 beds (always at capacity) to 138 beds. It will be a comprehensive, dedicated rehabilitation facility to meet the growing demand for highly specialized care of individuals with spinal cord injuries, brain injuries, stroke and other neurological, musculoskeletal and orthopedic conditions. It is expected to open by 2016.

CS-Link Tip: Keep Patient Information in Its Place

Remember that the appropriate way to communicate about your patients is through CS-Link™.

You can view and respond to InBasket messages with your smartphone using the Haiku app, your iPad using the Canto app, or using any of the work stations in the medical center. For more information about Haiku and Canto, see the Technical Resources page at CS-Link Central.

Your office staff or nurse can alert you to an urgent InBasket message via a text, but the patient information should remain in CS-Link.

You can schedule physician-efficiency training at your office by emailing Alex Bram at alex.bram@cshs.org or Lisa Masson, MD, at lisa.masson@cshs.org.

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

How to Respond to the Possibility of Enterovirus

The federal Centers for Disease Control and Prevention (CDC) has released a Morbidity and Mortality Weekly Report on a severe respiratory illness associated with Enterovirus D68 (EV-D68).

Healthcare providers should consider EV-D68 as a possible cause of acute, unexplained, severe respiratory illness, particularly in young children and those with pre-existing asthma.

All patients with symptoms of viral respiratory illness should be placed in both contact and droplet isolation until etiology of the infection is determined.

Pediatric Infectious Disease consultation should be considered in seriously ill children to aid with appropriate specimen collection and testing, and to work with the appropriate public health authorities.

Laboratory testing of respiratory specimens for enteroviruses can be considered when the cause of respiratory infection in severely ill patients is unclear.

The Cedars-Sinai Microbiology Laboratory does not offer a specific test for EV-D68. State health departments or the CDC will be approached for enterovirus typing.

Viral cultures from throat and stool should be considered in patients suspected of having severe enteroviral disease. Enteroviruses are best isolated from these sites.

A multiplex respiratory PCR panel is offered in the Cedars-Sinai Microbiology Lab. It should be ordered only for:

  • Critically ill patients in the Intensive Care Unit (ICU)
  • Children who are immunocompromised or in the ICU
  • Post-transplant or immediately pretransplant patients

The panel detects enteroviruses but does not specifically subtype EV-D68.

Collect a high nasal swab (inserted high in the nasal passage, not nares) or nasopharyngeal swab placed in universal transport media (UTM) for transport to the Microbiology Lab (tube station 271).

If you have questions:

  • About patient evaluation, contact Pediatric Infectious Disease at ext. 3-4471
  • About isolation precautions, contact Hospital Epidemiology at ext. 3-5574
  • About microbiologic testing, contact the Microbiology Lab at ext. 3-4778

This CDC page has more information about EV-D68.

'Kinky Boots' Tickets Available to Medical Staff

Medical staff members are invited to the production of the award-winning musical "Kinky Boots" on Tuesday, Nov. 11, at the Pantages Theater in Hollywood.

The cost is $110 per person and includes a pre-show dinner at the W Hotel across the street from the theater. Valet parking is available at the hotel.

Inspired by a true story, "Kinky Boots" features a Tony Award-winning score by Cyndi Lauper, direction and Tony-winning choreography by Jerry Mitchell and a book by four-time Tony winner Harvey Fierstein.

There is a limit of two tickets per physician. Call Cheryl Verne in the office of Marjorie Santore-Besson at 310-423-2681 to reserve tickets.

Spine Surgeons Get Updated Postop Order Sets

Spine surgeons at Cedars-Sinai will have access to more user-friendly and standardized postoperative order sets beginning Oct. 1.

The updated order sets will be accessible in CS-Link™ and are primarily for physicians performing lumbar or cervical fusion postoperative procedures.

In January 2012, a committee was formed to streamline spine postoperative order sets. The committee established guidelines for the new order sets in July 2013, followed by approval from several performance improvement committees and the leadership of the Cedars-Sinai Spine Center.

Since a pilot project began, the length of stay of patients whose physicians used the new postoperative order sets dropped from 1.35 days to 1.08 days.

One of the main goals of the new order sets is to reduce variations in practice and to reduce length of stay after spine surgery, namely postoperative procedures for lumbar or cervical fusion, said orthopedic spine surgeon Leonel Hunt, MD, who helped lead the team that developed the order sets.

"Although these order sets aren't entirely new, they are designed in a way that works better in CS-Link and makes it easier for spine surgeons to simply check a box for our most routine orders," Hunt said. "We aim to create uniformity among our spine surgeons, which these new postoperative order sets accomplish."

The new order sets also are easier for the nursing staff to follow, Hunt said.

A multidisciplinary team of nurses, administrators and physicians, headed by Hunt and spine surgeon Alexandre Rasouli, MD, developed the spine postoperative order sets.

Researchers Test Bioartificial Liver

Cedars-Sinai physicians and scientists are testing a human-cell-based, bioartificial liver support system for patients with acute liver failure, often a fatal diagnosis.

"The quest for a device that can fill in for the function of the liver, at least temporarily, has been underway for decades. A bioartificial liver, also known as a BAL, could potentially sustain patients with acute liver failure until their own livers self-repair," said Steven D. Colquhoun, MD, surgical director of Liver Transplantation at the Cedars-Sinai Comprehensive Transplant Center.

The ELAD investigational bioartificial liver support system

Colquhoun is leading an investigation at Cedars-Sinai to assess the safety and effectiveness of the ELAD bioartificial liver system, which is designed by Vital Therapies Inc., the sponsor of the clinical trials. Most of the 49 sites currently involved in the investigation are in the U.S., but studies also are underway in Europe and Australia. The research at Cedars-Sinai involves patients with liver disease caused by acute alcoholic hepatitis, a group with few therapeutic options.

In the bioartificial liver under investigation, blood is drawn from the patient via a central venous line and then is filtered through a component system featuring four tubes, each about 1 foot long, which are embedded with liver cells. The external organ support system is designed to perform critical functions of a normal liver, including protein synthesis and the processing and cleaning of a patient's blood. The filtered and treated blood is returned to the patient through the central line.

"If successful, a bioartificial liver could not only allow time for a patient's own damaged organ to regenerate, but also promote that regeneration. In the case of chronic liver failure, it also potentially could support some patients through the long wait for a liver transplant," Colquhoun said.

Devices that do the work of human organs have been used successfully for years. Patients with kidney disease can use dialysis, and those with cardiac problems have ventricular assist devices or artificial hearts available to support or replace vital organ functions.

"Liver failure patients and their doctors have long been frustrated by the critical need to provide the kind of life-saving care kidney patients are afforded by dialysis. This important investigation we are undertaking at Cedars-Sinai is a critical step in addressing the medical emergency presented by liver failure," said Andrew S. Klein, MD, director of the Comprehensive Transplant Center and the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine.

A drawing shows how the bioartificial liver system works. Images courtesy of Vital Therapies Inc.

Cadaver Meniscus Is Used to Rebuild Finger Joints

Artist Joost van Oss was chopping wood a few years ago when he injured the middle knuckle on his right hand. The intense pain and swelling that followed forced him to give up his love of cooking and sailing, and nearly ended his career as a painter and sculptor.

Then van Oss, 58, turned to Cedars-Sinai plastic surgeon David A. Kulber, MD, and underwent a novel surgery. Kulber (pictured at right) used knee meniscus from a cadaver to reconstruct van Oss' finger joint, departing from the customary technique of inserting a hard silicone implant.

The meniscus — a resilient, spongy cushion that prevents joints from rubbing against one another — blended into van Oss' finger. The result was life-changing: Nine months after surgery, he is cooking, sailing, painting and sculpting again, all without pain.

"It's given me a new lease on life," van Oss said. "I have a hard time remembering what it used to be like."

Kulber, director of the Cedars-Sinai Center for Plastic and Reconstructive Surgery, pioneered joint reconstruction with cadaver meniscus in the hope of achieving better outcomes for patients like van Oss who suffer from damaged finger joints or arthritis, the most common cause of disability among U.S. adults, according to the Centers for Disease Control and Prevention.

Silicone implants, Kulber said, are imperfect because they can become infected or break over time, leaving patients with lasting pain or in need of follow-up surgeries. Because the meniscus is malleable, it fits neatly into the joint, merging into the finger as new blood flows through it.

"This is a very exciting approach to a problem that has defied reliable solutions," said Kulber, who also serves as director of the Plastic Surgery Center of Cedars-Sinai Medical Group. "It's a promising option because the meniscus becomes part of the finger."

Kulber's approach has won praise from other leaders in the field of orthopedic surgery.

"Dr. Kulber's technique utilizing cadaver knee meniscus to repair arthritis finger joints has great potential to avoid problems associated with prosthetic reconstructions that limit motion, loosen or break," said Michael Hausman, MD, chief of Hand and Elbow Surgery at Mount Sinai School of Medicine in New York and a member of the American Society for Surgery of the Hand. "Early results look extremely promising."

Van Oss is pleased that he has regained mobility in his finger. Before surgery, severe pain had prevented him from even picking up a pen or reading a newspaper. Now, he's thinking again about one of his grandest dreams — sailing around the world.

"You don't realize what you're missing when you have pain," he said. "Once it's gone, all of the possibilities that were once there show up again."

Marking the High Holidays at Cedars-Sinai

Senior Rabbi Jason Weiner, manager of Spiritual Care, will conduct services for the High Holidays at Cedars-Sinai. The services also will feature cantor Jordan Gorfinkel.

  • Kol Nidre — Friday, Oct. 3, from 7-8:30 p.m. in Harvey Morse Auditorium
  • Yom Kippur — Saturday, Oct. 4, from 10 a.m.-12:30 p.m. in Harvey Morse Auditorium

The services will be available for viewing on channel 50 of the inpatient TV system.

High Holidays 2014 (PDF)