Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Sept. 25, 2015 | 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 - September 2015 (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.

Contest Aims to Improve Patient Experience

More than 20 teams of physicians and registered nurses are testing their competitive and entrepreneurial skills as they work to create the best solution aimed at improving the patient experience at Cedars-Sinai. The competition, known as the MD/RN Patient Experience Innovation Challenge, will conclude next June. The winning team could see its solution implemented systemwide. The deadline for submitting a video description of an idea is Oct. 16.

» Read more

Prepared for a Successful ICD-10 Transition Oct. 1

The Cedars-Sinai ICD-10 project team has been preparing for the new medical coding system for close to three years. Its work —  training, testing, system upgrades, workflows, reporting —  has positioned Cedars-Sinai to have a very successful transition on Oct. 1 with minimal operational disruption.

» Read more

Annual Meeting of Medical Staff Is Oct. 19

The annual meeting of the medical staff is scheduled for Monday, Oct. 19, from 11:30 a.m.-1:30 p.m. in Harvey Morse Auditorium.

» Read more

Cedars-Sinai Joins Surgical Quality Program

From Bruce Gewertz, MD, Surgeon-in-Chief and Chair, Department of Surgery, and Harry Sax, MD, Executive Vice Chair, Department of Surgery

At Cedars-Sinai, we always strive to provide the highest-quality care and look for ways to improve the safety and outcomes of our patients. To help identify these areas for improvement, we recently joined the American College of Surgeons National Surgical Quality Improvement Program.

» Read more

Clinical Documentation Course Continues Oct. 6

Participants Can Earn Two Continuing Medical Education Credits

Members of the medical staff can take a "Clinical Documentation Integrity Power Course for Physicians" that meets the first Tuesday of each month through Dec. 1. The Oct. 6 session will take place from from 3:30-6:30 p.m. in Harvey Morse 4-5, and the Nov. 3 session will take place in PEC 8. Participants need to attend just one session. Two continuing medical education credits will be available.

» Read more

CS-Link Tip: Seeing PACS Images

Now you can see images from the picture archive and communications system on your phone or iPad using Haiku or Canto in CS-Link™.

» Read more

Patient Safety Survey Runs From Sept. 28-Oct. 11

While Cedars-Sinai maintains high safety standards, there is always room for improvement. To identify and prioritize opportunities to improve patient safety, executive leadership at Cedars-Sinai will survey staff members from Sept. 28-Oct. 11 utilizing a nationally recognized Culture of Safety Survey. Front-line staff members, including faculty, are encouraged to participate.

» Read more

Hitting the Beach for Sand 'N' Snore

About 200 medical staff members and their families enjoyed this year's Sand 'N' Snore event, which took place Sept. 11-12 at the Jonathan Beach Club in Santa Monica.
 

» Read more

Course Introduces Lean Management System

The Cedars-Sinai Performance Improvement Learning and Living Program will introduce the Lean management system to interested faculty members and employees this fall, starting with a White Belt training course. Sessions are scheduled for Oct. 16 and Nov. 13.

» Read more

Algorithm Bests MDs at Documenting 'Red Flags'

A computer algorithm did a better job than doctors at documenting "red flag" symptoms among patients with gastrointestinal disorders, a Cedars-Sinai study has found, underscoring the potential of the technology to improve patient care.

» Read more

Contest Aims to Improve Patient Experience

More than 20 teams of physicians and registered nurses are testing their competitive and entrepreneurial skills as they work to create the best solution aimed at improving the patient experience at Cedars-Sinai.

The competition, known as the MD/RN Patient Experience Innovation Challenge, will conclude next June. "The winning team could see its solution implemented systemwide," said Jeffrey Woods, MSN, RN, CMSRN, nurse manager of 4 South.

There is still plenty of time to form a team, sign up and start developing innovative ideas to improve the patient experience. The deadline for submitting a video description of an idea is Oct. 16.

Woods, part of the think tank behind the challenge, said the competition will resemble ABC's reality TV show Shark Tank in that teams will pitch their ideas to a panel of executive judges. The TV show has aspiring entrepreneurs pitch business ideas to a panel of "shark" investors.

The members of the panel are:

  • Linda Burnes Bolton, DrPH, RN, FAAN, vice president and chief nursing officer
  • Darren Dworkin, chief information officer
  • Mark Gavens, chief operating officer
  • Michael Langberg, MD, chief medical officer
  • Peggy Miles, MD, vice chief of staff
  • Scott Weingarten, MD, chief clinical transformation officer

Teams are currently generating as many ideas as they can and are working to bring those ideas to life through prototypes (models, storyboards, videos, simulations). In November, each team will pitch its prototypes to the panel, and the 10 best concepts will move on to phase I testing.

During December, January and February, those 10 teams will use the Plan, Do, Study, Act model to conduct tests, while modifying and refining their prototypes. Then in March, they will again pitch their results to the panel. The panel will select six teams for phase II testing and the finals. Each panelist will select a team to sponsor during phase II.

Finally, in June, the six teams will present one final time and the panel will select one successful pilot.

"We're also thinking of a unique prize for the successful team, such as an all-expense-paid trip to a conference or sending the winning team to Silicon Valley to pitch their ideas to a healthcare venture capitalist," Woods said.

Each team has five to seven members, including at least one physician and one nurse.

"There are two strategies behind the MD/RN Patient Experience Innovation Challenge," said Chris Ng, MD, chief of staff. "First, we want to improve the patient experience at Cedars-Sinai. And we want to create a culture of empowered innovation at Cedars-Sinai. We want our staff to understand that we welcome their ideas. We want them to think outside the box."

Ng said the MD/RN Innovation Challenge is a perfect fit for those two strategies.

Omkar Kulkarni, MPH, manager of Performance Improvement and one of the innovation coaches, agreed.

"This challenge has created a lot of energy, and the ideas coming in are just amazing. Even though there will be one grand prize winner, all of the teams will have learned so much about how to take an idea, test it and present it to a panel," he said. "The teams are really motivated by the fact that we are not telling them their idea isn't going to work, but offering them encouragement."

For more information, email groupmdrnchallenge@cshs.org.

Prepared for a Successful ICD-10 Transition Oct. 1

The Cedars-Sinai ICD-10 project team has been preparing for the new medical coding system for close to three years. Its work — training, testing, system upgrades, workflows, reporting — has positioned Cedars-Sinai to have a very successful transition on Oct. 1 with minimal operational disruption.

Many in the industry are uncertain of the effect that the transition will have on their organization. The Cedars-Sinai team is confident of its preparation efforts, but with less than 10 days to prepare, the team continues to urge anyone who feels they require assistance to email askicd10@cshs.org.

Go-live issues are not anticipated, but the project team plans to staff a command center in the days after the transition to ensure that any issues that may arise can be addressed quickly. Contact the command center at 310-423-6428, option 6, or askicd10@cshs.org.

The project team has taken the following steps to prepare for the transition:

  • Provide organizationwide education and awareness
  • Appoint an interdisciplinary steering committee and executive oversight
  • Develop an ICD-10 strategy, including comprehensive project management
  • Determine opportunities and gaps, and remediate
  • Partner with vendors to prepare the workforce and systems
  • Establish payer implementation and testing plan
  • Provide detailed training for employees, providers and medical staff members
  • Manage change

For detailed information surrounding CS-Link™ changes — including FAQs, job aids and an e-learning module — please visit CS-Link Central.

For general resources and project updates, visit the ICD-10 Watch page on the Intranet.

Previously in Medical Staff Pulse:

More Details About Oct. 1 Transition to ICD-10 (Aug. 28, 2015)

ICD-10 Readiness: Oct. 1 Change Is Coming Soon (July 31, 2015)

Annual Meeting of Medical Staff Is Oct. 19

The annual meeting of the medical staff is scheduled for Monday, Oct. 19, 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.

Cedars-Sinai Joins Surgical Quality Program

From Bruce Gewertz, MD, Surgeon-in-Chief and Chair, Department of Surgery, and Harry Sax, MD, Executive Vice Chair, Department of Surgery

At Cedars-Sinai, we always strive to provide the highest-quality care and look for ways to improve the safety and outcomes of our patients. To help identify these areas for improvement, we recently joined the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

ACS NSQIP is based on collecting clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. By using clinical data gathered from our patients' medical charts, rather than administrative data, we will be able to catch more complications, helping Cedars-Sinai to improve patient outcomes and cut healthcare costs. Our results can then be compared to those of other hospitals similar to ours in size and type across the country to help us determine where we need to make quality improvements.

On average, ACS NSQIP participating hospitals have been able to prevent 250 to 500 complications and save 12 to 36 lives each year, saving millions of dollars annually. Tracking 30-day outcomes helps identify complications such as surgical site infections, urinary tract infections and pneumonia.

Rodrigo F. Alban, MD, has been selected to serve as our hospital's surgeon champion to oversee the implementation of ACS NSQIP, educate others on the program and work closely with the surgical clinical reviewer (SCR) to accurately capture our hospital's data.

With the assistance of our Health Information Department, led by Thea Campbell, MBA, RHIA, and Laura Hardy, RN, we have identified our hospital's SCR, who will undergo special training through the American College of Surgeons. The SCR role is dedicated to collecting and entering data and works closely with the surgeon champion, surgeons and internal hospital committees to ensure accurate data collection and best results. Because the SCR is responsible for tracking 30-day patient outcomes, the HID team will be contacting surgeons' offices and hospital committees. Your collaboration is appreciated.

We will continue to provide updates as the program progresses. In the meantime, for more information on ACS NSQIP, visit site.acsnsqip.org or contact Rodrigo F. Alban at rodrigo.alban@cshs.org with questions specific to Cedars-Sinai's quality-improvement efforts.

Clinical Documentation Course Continues Oct. 6

Members of the medical staff can take a "Clinical Documentation Integrity Power Course for Physicians" that meets the first Tuesday of each month  through Dec. 1. Sessions take place from 3:30-6:30 p.m. in various locations; the Oct. 6 meeting will be in Harvey Morse 4-5, and the Nov. 3 session will take place in PEC 8. Participants need to attend just one session.

Under the Affordable Care Act, physicians will have to justify treatments and demonstrate satisfactory quality outcomes. Clinical documentation therefore will need to be accurate and timely and to reflect the scope of services provided.

Objectives of the course:

  • Explain the role of the Clinical Documentation Integrity Department at Cedars-Sinai
  • Discuss how hospitals and physicians are rated
  • Explore the DRG system and how documentation affects profiles
  • Understand the interplay among SOI, ROM, LOS and reimbursement
  • Compare ICD-9 and ICD-10 documentation requirements
  • Compare Cedars-Sinai’s score to those of similar hospitals
  • Learn definitions for common diagnoses
  • Recognize documentation that is vague and nonspecific
  • Identify documentation strategies to reflect the true severity of illness of the patient

Two continuing medical education credits will be available.

For more information, call Clinical Documentation Integrity at 310-423-3052. For a list of dates and locations, click the PDF link below.

CDI Power Course for Physicians (PDF)

CS-Link Tip: Seeing PACS Images

Now you can see images from the picture archive and communications system (PACS) on your phone or iPad using Haiku or Canto in CS-Link™.

It's easy — once you are in the app, select the patient and open the chart. Go to the results tab, find an imaging report and open this report. Scroll down to the bottom of the report. There will be a link for the PACS image. Touch the link and the viewer will launch.

If you haven't downloaded those apps yet, here are the settings you need:

  • HTPPS: on
  • Server: cslinkmobile.csmc.edu
  • Path: mobile

To arrange a CS-Link training session, please contact Shaun Miller, MD, at 310-423-8759 or shaun.miller@cshs.org.

Patient Safety Survey Runs From Sept. 28-Oct. 11

Patient safety is a key in providing the highest-quality care, and while Cedars-Sinai maintains high safety standards, there is always room for improvement.

To identify and prioritize opportunities to improve patient safety, executive leadership at Cedars-Sinai will survey staff members from Sept. 28-Oct. 11 utilizing a nationally recognized Culture of Safety Survey. Front-line staff members — including faculty members and those in Admissions, Case Management, Clinical Operations and Clinical Care Services — are encouraged to participate in the survey.

The survey will take place online, and responses are completely confidential.

"The message here is that we are doing extremely well. We are safe, and we want to be safer. Your feedback is needed to get us there," said Neil Romanoff, MD, MPH, chief patient safety officer. "This survey is used nationally and is known for assisting organizations in identifying and prioritizing opportunities to improve patient safety practices and in making decisions to improve patient safety."

Marle Shelton-Hoff, RN, manager in Patient Safety, said the Culture of Safety Survey is administered in a similar fashion to the annual Employee Engagement Survey. However, the Employment Engagement Survey no longer will incorporate a patient safety component. The rationale for using the Culture of Safety Survey is to continue to capture important front-line data that identifies opportunities for improvements in patient safety and to ensure that all staff members know their role in addressing those issues.

The survey will home in on questions such as:

  • Does front-line staff feel comfortable reporting safety concerns?
  • Are there any concerns of retaliation if staff members report safety issues?
  • Do front-line staff members feel they receive enough support from the leadership to make safety changes within their department?

In addition, Shelton-Hoff said, gathering patient safety data is necessary for value-based payments and other contractual obligations.

"We really want your feedback," she said. "This survey is short, about 10 minutes, and it really does give you an opportunity to have a voice in patient safety. You are letting our leadership know what it's like on the front line so that they can identify best practices and also direct attention to areas of opportunity."

Selected staff members will receive an email with the subject line "Cedars-Sinai Culture of Safety Survey." The email will contain a link that will allow the recipient to complete the survey online.

The executive leadership will analyze the survey results and drive dissemination of appropriate interventions, where needed, starting in mid-November.

The Culture of Safety Survey is expected to take place every other year in the fall.

More information about the Culture of Safety Survey is available on the Intranet.

Hitting the Beach for Sand 'N' Snore

About 200 medical staff members and their families enjoyed this year's Sand 'N' Snore event, which took place Sept. 11-12 at the Jonathan Beach Club in Santa Monica.

Participants had dinner on the beach, and many stayed the night in their tents on the sand.

Course Introduces Lean Management System

The Cedars-Sinai Performance Improvement Learning and Living Program will introduce the Lean management system to interested faculty members and employees this fall, starting with a White Belt training course.

The Lean White Belt course is a four-hour program that provides an introduction to Lean management principles. The course comes highly recommended for faculty, employees and leaders working on "high-value" performance improvement projects.

Participants will learn tools and techniques to help improve the efficiency and quality of patient care, sustain patient satisfaction and lower the cost of care.

"The course is open to clinicians, nonclinicians or anyone interested in redefining the way they deliver and improve patient care," said Chase Coffey, MD, MS, medical director of Clinical Transformation at Cedars-Sinai. "In our training, physicians naturally learn the Lean management methodology, especially as it relates to problem-solving patients’ medical problems.

"Physicians, though, have never applied that type of thinking to the system within which they work. With this course, we are providing all employees with the tools and techniques they can apply to certain aspects of their jobs, and helping physicians use their existing skills to improve how they care for patients."

Lean is a series of principles and methods developed by the Japanese manufacturing industry — most notably Toyota — that focuses on improving workflow, eliminating wasteful spending and improving customer satisfaction. In recent years, healthcare and other industries have utilized Lean thinking or methodology, said Coffey, a member of the White Belt course planning team.

"The course teaches a rational, analytic approach that fosters team building and critical thinking," said Karl Wittnebel, MD, who has participated in the course. "These tools help Cedars-Sinai leverage its greatest asset — its employees — to make critical improvements in efficiency and quality."

While similar courses in the community can cost up to $600, the White Belt course is free to physicians and employees. Two sessions are available:

  • Friday, Oct. 16, 8 a.m.-noon in the Human Resources/Organization Development Center, 50 N. La Cienega Blvd., Suite 210
  • Friday, Nov. 13, 8 a.m.-noon, also in the HR/OD Center

Those who complete the course will receive a certificate, and Cedars-Sinai will offer up to four continuing medical education credits.

After completing the White Belt, a second step in Lean management system training is a Yellow Belt course, which Cedars-Sinai also offers, Coffey said. This course is a more intensive two-day program that expands on Lean principles and skills so that students can complete a quality improvement project.

More information, including registration instructions, is available on the Intranet.

Algorithm Bests MDs at Documenting 'Red Flags'

A computer algorithm did a better job than doctors at documenting "red flag" symptoms among patients with gastrointestinal disorders, a Cedars-Sinai study has found, underscoring the potential of the technology to improve patient care.

The algorithm, developed by investigators at Cedars-Sinai's Center for Outcomes Research and Education, identified more "alarm features" than did doctors who treated patients in GI clinics. The computer program also provided useful details about the onset, frequency and amount of symptoms such as blood in the stool or unintended weight loss.

Investigators said their findings, published online by the International Journal of Medical Informatics, demonstrate how computers can complement — rather than replace — physicians in the exam room. The researchers explained that a red flag "checklist" of symptoms could serve as a useful tool to inform doctor-patient consultations.

"In essence, this system could help doctors provide better care for their patients by identifying illnesses at earlier stages and providing treatment sooner," said Christopher V. Almario, MD, MSHPM, the study's lead author and a research scientist in the outcomes research center.

The study said that GI doctors may be underreporting red flag symptoms partly because physicians with other clinical and administrative tasks don't have enough time to fully inquire about symptoms with each patient. The study did not say whether improved identification of symptoms leads to better patient outcomes.

This is the second study from the Cedars-Sinai research center into the use of computers as a tool for clinical care. A companion study last year showed that the same algorithm was more effective than doctors at creating complete and organized patient medical histories.

Both studies drew on the same group of patients with a variety of active GI symptoms, including abdominal pain, heartburn, reflux, nausea, vomiting, constipation and diarrhea. For the studies, patients initially visited doctors and later answered questions about their conditions on a website called My GI Health.

The investigators said the pair of studies highlights the enormous potential of computers to give doctors a valuable hand with patients.

"This is where digital health is at its best, by offering a simple yet compelling way to take better care of patients," said Brennan Spiegel, MD, MSHS, director of Cedars-Sinai Health Services Research and director of the Center for Outcomes Research and Education. "Patients want to know that their doctor will ask all the right questions and detect anything serious. But sometimes even doctors need digital aides to support their knowledge and intuition."