Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF July 29, 2016 | Archived Issues

Pharmacy and Therapeutics Committee Approvals

Pharmacy Focus

Highlights of the June meeting of the Pharmacy and Therapeutics Committee are summarized in the PDF link below.

P and T Approvals - June 2016 (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 - July 2016 (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 submit your milestones and comments.

Cedars-Sinai Helps Open Acute Care Hospital

The California Rehabilitation Institute has opened in Century City as the largest acute inpatient rehabilitation hospital on the West Coast. The 138-bed facility is a joint venture of Cedars-Sinai, UCLA Health and Select Medical, a leading provider of long-term acute care and rehabilitation services in hospitals and outpatient locations.

» Read more

New System Will Provide Near Real-Time Feedback for Outpatient Care

Cedars-Sinai will launch a new way for patients to provide near real-time feedback on their outpatient care experiences in early August. NRC Connect Experience will replace the existing Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey.

» Read more

Better Documentation Sought for Allergy to Meds

Cedars-Sinai is initiating a multidisciplinary approach to improve the accuracy of medication allergy documentation to help prevent adverse medication events. The Medication Safety Task Force requests that clinical staff "hover to discover" allergy documentation in the CS-Link™ banner.

» Read more

Seferian Promoted to Chief Patient Safety Officer

Seferian

Edward G. Seferian, MD, medical director of Medical Affairs, has been promoted to chief patient safety officer. Seferian joined Medical Affairs at Cedars-Sinai in 2009 as medical director.



» Read more

Grein Named Director of Hospital Epidemiology

Grein

Jonathan Grein, MD, has been promoted to medical director, Department of Hospital Epidemiology, and infection control officer. He joined Cedars-Sinai as associate director of Hospital Epidemiology in 2009 after completing an infectious diseases fellowship at the David Geffen School of Medicine at UCLA.

» Read more

Survey Says Employees Largely Satisfied With Jobs

Cedars-Sinai employees were largely satisfied with their jobs in 2016, continuing a pattern of high workplace fulfillment, according to this year's Employee Engagement Survey. Eighty-nine percent of 9,800 employees who answered the survey said they were engaged or content compared to the 2015 figure of 88 percent.

» Read more

Nominations Sought for Pioneer in Medicine Award

Members of the medical staff are encouraged to nominate a candidate for the 2016 Pioneer in Medicine award. This award is given to a member of the medical staff who has made clinical and research contributions recognized at Cedars-Sinai and in the national or international medical communities.

» Read more

Cedars-Sinai Stages Extensive Ebola Drill

After being selected as a federally designated regional treatment center for Ebola and other highly infectious diseases, Cedars-Sinai staged its most extensive preparedness drill to date. The drill required careful choreography and will help the response team’s hone its skills to properly handle patients who need specialized care.

» Read more

FDA: Monitoring System Coming off Market

Alere Inc. is voluntarily withdrawing its INRatio and INRatio2 PT/INR Monitoring System from the market due to potentially inaccurate results. Alere is working with the U.S. Food and Drug Administration to determine the appropriate timing for the removal of the product.

» Read more

Medical Staff and Families Enjoy Hollywood Bowl

About 500 medical staff members and their families joined the crowd at the Hollywood Bowl on July 3 for a night of patriotic music, fireworks and a performance by the legendary band Chicago.

» Read more

Sand 'N' Snore Set for Sept. 9

Sand 'N' Snore is just around the corner. The dinner, sleepover and breakfast starts Friday, Sept. 9, 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.

» Read more

Beware of Attempts to Obtain Confidential Data

Enterprise Information Services is reminding staff to be vigilant about safeguarding sensitive patient and company data as the scope and sophistication of attempts to obtain confidential information is advancing. Cedars-Sinai has seen a rise in "social engineering," or efforts to obtain unauthorized access to private information through human interaction.

» Read more

CS-Link Tip: E-Prescribing of Discharge Medications Starts July 30

cs-link logo

Starting July 30, Inpatient providers will be able to send most discharged medication orders electronically within CS-Link in a process referred to as e-prescribing.

» Read more

Cedars-Sinai Helps Open Acute Care Hospital

The California Rehabilitation Institute has opened in Century City as the largest acute inpatient rehabilitation hospital on the West Coast.

The 138-bed facility is a joint venture of Cedars-Sinai, UCLA Health and Select Medical, a leading provider of long-term acute care and rehabilitation services in hospitals and outpatient locations.

The new hospital offers a broad range of treatment and therapy services to meet a growing demand for highly specialized care among patients with spinal cord and brain injuries, neurological disorders, strokes, amputations and other acute conditions. It is expected to draw patients from Southern California and around the nation.

"We are excited that two of the nation's best healthcare institutions and Select Medical's highly regarded rehabilitation expertise have come together to develop a world-class rehabilitation hospital," said Thomas M. Priselac, president and CEO. "This collaboration will allow us to better meet the needs of our own community, the region and the West."

The comprehensive facility greatly expands the area's acute rehabilitation services. Until now, the inpatient rehabilitation units at Cedars-Sinai and UCLA frequently have been filled to capacity, and prospective patients often have been referred to other institutions.

Select Medical will operate the new hospital. The partnership behind it was announced in December 2013. Since then, extensive renovations have been undertaken at the site, formerly known as Century City Hospital.

Cedars-Sinai patients began arriving on Monday and Tuesday.

With the opening of the new hospital, Cedars-Sinai will close its 28-bed inpatient rehabilitation unit, located on the seventh floor of South Tower. Patients will be given the choice of being transported to the new rehabilitation hospital, discharged home or moved to other facilities based on their needs. Outpatient rehabilitation services will not be affected.

Richard Riggs, MD, chair of the Department of Physical Medicine and Rehabilitation, and medical director of the rehabilitation unit since 1997, said the interdisciplinary team model as well as the quality and research outcomes cultivated in the unit aided in formulating national standards of care for inpatient rehabilitation patients and their families.

Pamela Roberts, PhD, director of the Department of Physical Medicine and Rehabilitation, and her team have been instrumental in facilitating both the exemplary outcomes and interdisciplinary team processes that helped lay the foundation for the new rehabilitation hospital.

"We are proud of the work we did at our rehabilitation unit for the past 40 years," said Linda Burnes Bolton, DrPH, RN, FAAN, health system chief nurse executive, vice president and chief nursing officer. "We look forward to this new opportunity to provide a wider range of services and enhanced, specialized care to our rehabilitation patients."

New System Will Provide Near Real-Time Feedback for Outpatient Care

Cedars-Sinai will launch a new way for patients to provide near real-time feedback on their outpatient care experiences in early August.

NRC Connect Experience will replace the existing Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey.

The shorter, easier-to-administer and provider-focused Connect Experience survey will ensure that Cedars-Sinai is able to keep a pulse on the performance of medical clinics by capturing feedback from medical practice patients in a timely and cost-effective way. With NRC Connect Experience, patients will be able to rate nearly 600 Cedars-Sinai hospital and medical network providers.

"This software is a game changer because we will now have almost real-time availability of information to identify and respond to service opportunities," said Neil E. Romanoff, MD, who supervised the project. "The information provided by this new approach will allow Cedars-Sinai to improve both clinical outcomes and service excellence."

NRC Connect Experience makes it easier for patients to provide survey feedback the day after their office visit. After their appointment, they will receive a survey by email or over the phone based on their authorization to contact them.

The email survey is available in English and Spanish, and survey by phone is available in English, Spanish and Russian. In the future, the survey will also be available in Farsi and Korean. The survey consists of nine questions — six provider-specific questions, two global questions and one open-ended question.

Questions catalog how well providers answer questions, respect patients, explain care plans, know the patient’s record and spend time with the patient during the appointment. Patients are also able to provide an overall provider rating, share whether they would be likely to recommend the clinic and provide feedback on how to improve their care experiences.

"How patients assess provider communication is important," said Alein Chun, PhD, MSPH, IQCP, director of Resource and Outcomes Management. "This is about managing the patient experience, and this is an incredible amount of data to help us learn what patients are saying about our providers."

Once the survey is complete, the results will be readily available to providers and leadership. Reports will be available on a weekly, monthly and quarterly basis. Providers will receive monthly scorecards related to each survey question, and vice presidents, directors and clinic managers will be able to track the survey performance of each clinic and its providers to set goals and compare results.

Better Documentation Sought for Allergy to Meds

Cedars-Sinai is initiating a multidisciplinary approach to improve the accuracy of medication allergy documentation to help prevent adverse medication events.

The Medication Safety Task Force requests that clinical staff "hover to discover" allergy documentation in the CS-Link™ banner. Allergies to food, medications and dyes are recorded in the allergy activity section of CS-Link and appear in the highlighted yellow header.

CS-Link has checks and alerts to identify potential issues when placing orders and to prevent adverse medication reactions, such as a pop-up that promotes user review and updates of allergies before orders can be signed.

Documentation of allergies should always include reactions and types, such as allergies, contraindications, sensitivities and side effects. However, the Medication Task Force recognizes that specific documentation is needed to accurately assess patient allergies. Use of the "comments" field helps characterize allergies in more detail.

"Verifying patient allergy information in CS-Link requires significant effort, and providers must be diligent in making sure that information is accurate," said Steve Simons, MD, medical director of Medical Affairs and chair of Medication Safety. "These records follow our patients the entire time they are in our care, so we must continue to take the responsibility for accurate documentation of allergies and medication side effects seriously."

Side effects, including nausea and vomiting, may preclude prescribing a given medication, as may sedation and true allergic reactions such as swelling and inability to breathe. Providers need to evaluate medication side effects and allergies to determine whether certain medications are worth the risk.

"Physicians are always looking at risk versus benefit," said Donna Duong Luong, medication safety coordinator at Cedars-Sinai. "It is also important for all care team members to converse with not only the patient, but also each other to ensure everyone on the care team has the same game plan."

For more information about the Medication Safety Task Force and what can be done to prevent medication errors, email luongd@cshs.org.

Seferian Promoted to Chief Patient Safety Officer

Edward G. Seferian, MD

Edward G. Seferian, MD, medical director of Medical Affairs, has been promoted to chief patient safety officer. The promotion became effective July 1.

Seferian joined Medical Affairs at Cedars-Sinai in 2009 and, as medical director, established himself as a highly collaborative leader. He has forged strong relationships with faculty, medical staff, nursing and other caregivers.

In addition to playing an important role in recent Quality Council initiatives, including a multiyear effort to improve end-of-life care, Seferian co-led a successful effort to eliminate mislabeled lab specimens.

Seferian is a faculty intensivist in the pediatric and congenital cardiac ICU, and participates in clinical and teaching activities in the Pediatrics Department. He lectures on pediatric critical care for Cedars-Sinai trainees and for regional, national and international audiences.

A certified instructor for the Society of Critical Care Medicine's Fundamentals of Pediatric Critical Care course, Seferian has directed the class in underserved medical regions, including Armenia. He has published in peer-reviewed journals on health outcomes research in critical illness and on quality and safety. His academic credentials include the rank of associate professor of Pediatrics at Cedars-Sinai and professor of Pediatrics at UCLA.

Grein Named Director of Hospital Epidemiology

Jonathan Grein, MD

Jonathan Grein, MD, has been promoted to medical director, Department of Hospital Epidemiology, and infection control officer. The promotion became effective July 1.

Grein joined Cedars-Sinai as associate director of Hospital Epidemiology in 2009 after completing an infectious diseases fellowship at the David Geffen School of Medicine at UCLA. He obtained his medical degree from UCLA and completed his internal medicine residency at Cedars-Sinai.

As associate director of Hospital Epidemiology over the past seven years, Grein has played a critical role in leading organizational efforts to eliminate hospital-acquired infections through multidisciplinary teams. These efforts have led to substantial gains in patient safety and improved clinical outcomes in device-associated infections such as central line-associated blood stream infections and catheter-associated urinary tract infections.

Grein also has been a leader in Cedars-Sinai's Ebola preparedness and response, and has collaborated with colleagues in nursing, environmental health and safety and other areas to achieve the federal government's recent designation of Cedars-Sinai as one of 10 regional Ebola and special pathogens treatment centers.

In addition to his clinical and programmatic achievements in Hospital Epidemiology, Grein participates in clinical, teaching and research activities as a member of the faculty in the Infectious Diseases Division, and he has mentored several residents and fellows on research projects. His academic accomplishments include several publications in peer-reviewed journals, and he is an assistant clinical professor at the David Geffen School of Medicine at UCLA.

Survey Says Employees Largely Satisfied With Jobs

Cedars-Sinai employees were largely satisfied with their jobs in 2016, continuing a pattern of high workplace fulfillment, according to this year's Employee Engagement Survey.

Eighty-nine percent of 9,800 employees who answered the survey said they were engaged or content, compared to the 2015 figure of 88 percent. Such highly engaged employees are seen as essential in advancing the organization's mission of providing high-value, patient-centered care.

Sixty-nine percent of employees said that Cedars-Sinai exceeds expectations in three important cultural areas: informing employees of the organization's future plans and directions, valuing ideas and suggestions, and managers being open and responsive to staff input. Last year, about 68 percent responded this way.

"In the healthcare community, higher engagement scores are also tied to higher patient satisfaction scores," said Andy Ortiz, senior vice president, Human Resources and Organization Development. "We value employee feedback and will continue to nurture a culture that encourages collaboration and continuous open dialogue between management and staff. Our employees' input and ideas are critical to our success."

The annual survey is a key to attracting, retaining, developing and optimizing staff performance and to positioning Cedars-Sinai as a preferred healthcare employer. The survey was taken by employees across the health system.

The results are being shared within departments and will be used to develop action plans to address salient issues raised by the survey.

Nominations Sought for Pioneer in Medicine Award

Members of the medical staff are encouraged to nominate a candidate for the 2016 Pioneer in Medicine award. This award is given to a member of the medical staff who has made clinical and research contributions recognized at Cedars-Sinai and in the national or international medical communities.

The deadline for nominations is Monday, Aug. 22.

The criteria for candidates for the Pioneer in Medicine award are:

  • The candidate shall have made a major contribution to the medical center.
  • The candidate shall be or have been involved in research.
  • The candidate shall have been published in national or international peer-reviewed journals.
  • The candidate shall be a teacher and positive role model.
  • The candidate shall be an innovator or have changed the medical world around him or her.
  • The candidate shall have made clinical contributions recognized nationally.
  • The candidate shall have been a physician at the medical center during a major part of his or her career.

A committee of the medical staff will select the honoree, and the award will be presented at the annual meeting of the medical staff on Monday, Oct. 17.

To nominate a candidate for the Pioneer in Medicine award, please send a letter to Clement C. Yang, MD, vice chief of staff, with the nominee's qualifications, key contributions and major accomplishments. Include a copy of the nominee's curriculum vitae.

Send nominations and letters of support to clement.yang@cshs.org, or submit printed documents to:

Clement C. Yang, MD
Vice Chief of Staff
Cedars-Sinai Medical Center
8700 Beverly Blvd., Suite 2211
Los Angeles, CA 90048

Cedars-Sinai Stages Extensive Ebola Drill

Eileen Dulce, RN, (left) and Nathan Whitehouse, RN, participate in a recent preparedness drill for treating patients with highly infectious diseases like Ebola.

Inside zipped coveralls, a hood, mask and three layers of gloves, Isabel Pedraza, MD, inserted a needle into an arm. With the help of two nurses wearing protective suits and respirators, Pedraza then readied a catheter for an Ebola patient.

Later, the team strictly observed sterile procedures before handing off specimens to local health department representatives for a final diagnosis.

Fortunately, the careful choreography was only a drill, part of a recent preparedness event at Cedars-Sinai to help train healthcare teams how to manage highly infectious diseases.

The response team practices inserting a needle into a dummy arm during the drill.

Cedars-Sinai has conducted similar drills before, but none as extensive. The latest exercise marked the first one since Cedars-Sinai was selected as a federally designated regional treatment center for Ebola and other highly infectious diseases.

In June, the U.S. Department of Health and Human Services tapped Cedars-Sinai to become part of a national network of 10 regional centers. The designation means Cedars-Sinai will play a critical role in bolstering the nation’s front-line defense against Ebola and other highly communicable diseases.

"Being part of this Special Pathogen Response Team means belonging to an elite club with the skill set to provide care to the most challenging of patients," said Jonathan Grein, MD, medical director, Department of Hospital Epidemiology, and infection control officer. "It makes us unique in being able to care for people with very limited options as to where they can go."

The Cedars-Sinai drill began by converting a couple of rooms and a connected anteroom in the Saperstein Critical Care Tower into an isolated lab, patient room and observation area.

Eileen Dulce, RN, a critical care nurse, and her fellow volunteers helped each other put on the cumbersome protective suits. Each was outfitted with an ice-packed vest to help combat the heat inside the bulky suits.

With respirators turned on, the team made their way to the ambulance bay to collect the pretend patient, Nathan Whitehouse, RN. After wheeling him back to an isolation room, the nurses connected their pretend patient to monitors and inserted an IV into a fake arm lying next to him.

Charlene Bugais, RN, a clinical nurse specialist, supervised from the observation area, while other nurses handed instruments to the healthcare workers inside the patient room. They could leave only when their shift was over, and they must carefully remove each layer of clothing while disinfecting their gloves.

The environment requires extreme care in order to avoid contracting the virus through direct contact with an infected person’s bodily fluids or contaminated objects. That means the team must continually clean everything used throughout the process.

Even the garbage bags have to make a coordinated exit. Wiped down with sterilizing cloths, nurses placed them in a trash bin dragged to the doorway, and repeated the process before handing over the waste to Environmental Services

In a nearby lab, technicians mimicked running standard diagnostics on blood samples. They handed off a specimen to Los Angeles County Department of Public Health colleagues, who placed the test tube sample inside an elaborate series of protective containers that looked like a set of Russian nesting dolls.

Cedars-Sinai is constantly updating its protocols by learning from other regional centers and with data received from the few hospitals that have already treated Ebola patients. This latest drill helped identify areas that needed to be tweaked, such as figuring out better ways to communicate when wearing the suits.

"I was extremely proud of the way our team practiced our safety protocols while still providing optimal care," Grein said. "They were poised, confident and professional."

The response team is still recruiting nurses, physicians and respiratory therapists. Anyone interested can contact Nursing Director Joanne Laguna, RN, at joanne.laguna@cshs.org or 310-423-2037 or Grein at jonathan.grein@cshs.org or 310-423-5574.

FDA: Monitoring System Coming off Market

Alere Inc. is voluntarily withdrawing its INRatio and INRatio2 PT/INR Monitoring System from the market due to potentially inaccurate results.

Alere is working with the U.S. Food and Drug Administration to determine the appropriate timing for the removal of the product and will provide guidance on transitioning patients to an alternate solution to allow them to continue anti-coagulation monitoring.

The FDA website has more information.

Medical Staff and Families Enjoy Hollywood Bowl

A photo from this year's Independence Day event at the Hollywood Bowl. More photos are below.

About 500 medical staff members and their families joined the crowd at the Hollywood Bowl on July 3 for a night of patriotic music, fireworks and a performance by the legendary band Chicago.

Sand 'N' Snore Set for Sept. 9

A photo from a recent Sand 'N' Snore

Sand 'N' Snore is just around the corner.

The dinner, sleepover and breakfast starts Friday, Sept. 9, 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 $45 for each child age 3-11. Tickets for Friday's dinner only are $50 per adult and $25 for each child 3-11.

To reserve a place, contact Cheryl Verne, in the office of Marjorie Santore Besson, at 310-423-2681 or cheryl.verne@cshs.org.

Beware of Attempts to Obtain Confidential Data

Enterprise Information Services is reminding staff to be vigilant about safeguarding sensitive patient and company data as the scope and sophistication of attempts to obtain confidential information is advancing.

Cedars-Sinai has seen a rise in "social engineering," or efforts to obtain unauthorized access to private information through human interaction. For instance, social engineering attacks could take the form of a phone call from a person posing as a help desk representative who asks for your username and password.

Information is the most powerful tool in blocking social engineering attacks. Here are some tips:

  • Be suspicious of emails, instant messages and phone calls from unsolicited people such as service providers. Verify the legitimacy of the source (caller, email sender, etc.) before providing any health system information.
  • When in doubt, take down the caller’s name and number and let them know you’ll get back to them. Talk to your manager about the situation and verify the caller’s identity.
  • Reject tech support questions from strangers no matter how legitimate they may appear. For instance, the EIS Service Desk will never ask for your password.
  • Never download an email attachment from unknown senders. If absolutely necessary, open the attachment in protected view which is enabled by default in most operating systems.

Please report security incidents to the EIS Service Desk at 310-423-6428.

For more information on social engineering:

CS-Link Tip: E-Prescribing of Discharge Medications Starts July 30

Starting July 30, inpatient providers will be able to send most discharged medication orders electronically within CS-Link in a process referred to as e-prescribing.

The new default for discharge prescriptions will be electronic transmission to a patient’s preferred pharmacy. For prescribing controlled substances, eligible providers must obtain a security token, which can be configured on a smartphone.

For more information about the security token, contact the help desk at 310-423-6428.

More information about general e-prescribing is here.

More information about e-prescribing of controlled substances is here.