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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF November 18, 2016 | 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 - November 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.

Submit your milestones and comments.

Get Smart About Antibiotics Week Ends Nov. 20

In an effort to reduce adverse antibiotic events and promote effective use, the Centers for Disease Control and Prevention (CDC) is sponsoring Get Smart About Antibiotics Week, which runs through Sunday, Nov. 20. Every year, more than 2 million illnesses and 23,000 deaths are related to antibiotic resistance, according to the CDC.

» Read more

Conference Participants Tackle End-of-Life Issues

More than 100 healthcare providers gathered Nov. 7 for an all-day conference to discuss the impact and implications of end-of-life care on clinicians and patients. The conference, Bridging the Gulf: Challenges of End-of-Life Care in California, was hosted by Cedars-Sinai, the National Academies of Sciences, Engineering and Medicine, and the Leonard D. Schaeffer Center for Health Policy and Economics at USC.

» Read more

New Guidelines for PCU Level of Care Begin Nov. 21

Cedars-Sinai is implementing new patient placement guidelines for Progressive Care Unit level of care beginning Monday, Nov. 21. The changes are expected to promote a more efficient process of assigning the appropriate level of patient care.

» Read more

Medical Staff Can Take Shot at Clippers Tickets

Medical staff will soon have an opportunity to win tickets to an NBA game thanks to Cedars-Sinai’s new partnership with the Los Angeles Clippers. Clippers tickets will be made available to Cedars-Sinai staff through a random drawing. Staff members may enter only once and can win only once this season.

» Read more

Circle of Friends Honorees for October

The Circle of Friends program honored 75 people in October. 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.

» Read more

Medical Units Relocate and Reopen to Improve Care

In an effort to improve patient care and to provide extra space and beds during high-volume periods, several medical units at Cedars-Sinai have relocated and reopened.

» Read more

Latest Techniques Emphasized in Ebola Drill

Ebola

The Special Pathogen Response Team practiced the latest techniques for treating potential patients who contract Ebola. The quarterly drills help Cedars-Sinai continue to serve as a federally designated regional treatment center for Ebola and other highly infectious diseases.

» Read more

Karlan Receives Cancer Society Award

Capping a string of recent accolades for her discoveries related to ovarian cancer, Beth Karlan, MD, was honored earlier this month with an American Cancer Society Giants of Science award in Beverly Hills.

» Read more

Klein Gives 1st Sachs Lecture in Transplant Surgery

Andrew Klein, MD, was the inaugural speaker for The David Sachs Lecture in Transplant Surgery at Massachusetts General Hospital in Boston on Oct. 13 and 14. Klein, director of the Cedars-Sinai Comprehensive Transplant Center, presented two lectures: "The Barbers of Civility" and "LA Confidential: Transplantation in Tinseltown."

» Read more

Pharmacy and Therapeutics Committee Approvals

See highlights of the October meeting of the Pharmacy and Therapeutics Committee.

» Read more

CS-Link Tip: Changing Screen Color

cs-link logo

As part of recent upgrades, screens for CS-Link™ have a new mint green color. If you don't like the color, it's easy to change. Go to the button on the top left of the screen. Scroll down to "personalize" and select "choose a theme."

» Read more

A Special Invitation for Night Shift Staff on Friday

Night shift staff and volunteers are invited to attend an early morning event on Friday to mark the community phase of the Campaign for Cedars-Sinai, the institution’s most ambitious fundraising effort to date with a goal of raising $600 million by 2018. So far, $494 million has been raised. The event will be held from 4-5 a.m. in Harvey Morse Auditorium.

» Read more

Get Smart About Antibiotics Week Ends Nov. 20

In an effort to reduce adverse antibiotic events and promote effective use, the Centers for Disease Control and Prevention (CDC) is sponsoring Get Smart About Antibiotics Week, which runs through Sunday, Nov. 20.

Every year, more than 2 million illnesses and 23,000 deaths are related to antibiotic resistance, according to the CDC.

In support of the national campaign, the Cedars-Sinai Antimicrobial Stewardship team has implemented year-round initiatives to encourage the precise use of antibiotics, which involves prescribing the right antibiotic with the right dose, at the right time and for the right duration.

In December 2015, the team implemented clinical decision support in CS-Link™ on several pilot units to initiate a three-day antibiotic timeout. During that period, prescribers were asked to reassess the need for certain antibiotics and evaluate if further treatment was required. New guidelines were also recently introduced that promote evidence-based guidance for duration of antibiotic treatment.

The Antimicrobial Stewardship team found that as a result of its interventions, more than 80 percent of antibiotic recommendations — to discontinue, narrow or target therapy — were accepted. These and other efforts resulted in a reduction in antibiotic days of therapy. Two antibiotics — vancomycin and levofloxacin — drove the reduction. The team is working to expand the clinical decision support tools.

Other efforts have included the expanded use of rapid diagnostic testing on positive blood cultures. This approach uses sophisticated molecular tests to rapidly identify organisms with antibiotic resistance markers in patients with bacteria in their blood.

Thanks to these tests, staff from Microbiology and Pharmacy Services are able to help clinicians select the best antibiotic treatment quickly or change treatment when needed. Compared to traditional testing methods, this approach has shortened time from blood culture collection to appropriate therapy by more than 24 hours.

The Antimicrobial Stewardship team's latest work for fiscal year 2017 also includes efforts to improve criteria for urine and C. difficile testing to reduce false positive tests that may lead to unnecessary antibiotic use. Rates of C. difficile, or Clostridium difficile, a bacterium that causes inflammation of the colon, are the lowest since 2014. This reduction is a direct result of both infection prevention and antimicrobial stewardship efforts.

"Our work to reduce the overuse of antibiotics and antibiotic resistance have been successful, but we must remain vigilant in this effort," said Rita Shane, PharmD, chief pharmacy officer. "De-escalation of antibiotics using rapid diagnostic testing and proper use of urine studies are focus areas that will help us continue to provide for the safety of patients and ensure they receive the proper treatment."

To learn more information on how to help promote the safe use of antibiotics, visit the CDC's website.

Conference Participants Tackle End-of-Life Issues

More than 100 healthcare providers — including physicians, ethicists, social workers, nurses and patient advocates — gathered Nov. 7 for an all-day conference to discuss the impact and implications of end-of-life care on clinicians and patients.

The conference, Bridging the Gulf: Challenges of End-of-Life Care in California, was hosted by Cedars-Sinai, the National Academies of Sciences, Engineering and Medicine, and the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.

Leonard D. Schaeffer, the Judge Robert Maclay Widney Chair and Professor at USC, began the day by addressing the challenges and complexities of treating patients at the end of life.

"The public is way ahead of policymakers," said Schaeffer. "For many patients, the clear desire is for final days to be spent under palliative care at home. We need to identify the changes that need to be made and the stakeholders who can make it happen."

Schaeffer and others pointed out the disconnect between what people want and what healthcare provides.

"What is the goal of healthcare at the end of life?" asked Arthur Stone, director of the USC Dornsife Center for Self-Report Science. His research identified what is most important to patients: to die at home (70 percent), to be comfortable without pain (66 percent) and to ease the burden of healthcare costs on their families (67 percent).

Elizabeth Bailey, author of The Patient's Checklist, brought a patient's point of view to the room. The former music video producer became an advocate for patients after years of caring for her ailing father.

"Modern medical care can make it hard to trust human intuition and common sense," Bailey told the gathering.

Bailey said a prescription for steroids sent her father, once an independent man, into a catastrophic medical decline. What followed were "10 years in the wilderness" of managing his care through myriad specialists. He found relief at a Veterans Administration facility. "They asked him, ‘Mr. Bailey, what is most important to you?' " His answer was simple — The New York Times, two bowls of ice cream and one martini a day.

During breakout sessions, participants got an opportunity to grapple with pressing issues in end-of-life care. The small group discussions focused, for example, on challenges faced by care teams, advance care planning and the needs of diverse patient populations.

Claudia Crist, chief deputy director of policy and programs at the California Department of Public Health, discussed the Let's Get Healthy California campaign, which includes end-of-life initiatives.

Good communication is the first step, Crist said. Only 27 percent of Californians have written down their end-of-life wishes, she noted. Only 7 percent said their doctors had raised the subject with them.

"Start the conversation," Crist told the conference. "Help your colleagues."

New Guidelines for PCU Level of Care Begin Nov. 21

Cedars-Sinai is implementing new patient placement guidelines for Progressive Care Unit (PCU) level of care beginning Monday, Nov. 21.

The new guidelines streamline much of the current five pages of PCU placement procedures into five main criteria and also impact the list of medications requiring PCU status. The changes are expected to promote a more efficient process of assigning the appropriate level of patient care including ICU avoidance when possible.

Teams from the medical staff, nursing, pharmacy and patient placement, with support from clinical transformation, collaborated to create the new guidelines. The executive sponsors of the initiative are Scott Weingarten, MD, senior vice president and chief clinical transformation officer, and Linda Burnes Bolton, DrPH, RN, FAAN, health system chief nursing executive, vice president for Nursing and chief nursing officer.

"The guidelines will assist the team in providing appropriate care in the right setting," said Burnes Bolton. "When fully operationalized the guidelines will facilitate appropriate patient placement, decrease inappropriate use of PCU status for patients and improve access to PCU beds to avoid ICU admission."

The new five main criteria for PCU placement are:

  • Ongoing nursing interventions and assessments every two hours (not to exceed eight occurrences)
  • Moderate to high risk of cardiac dysrhythmia
  • Moderate to high risk of respiratory decompensation
  • Invasive hemodynamic devices (e.g., PA catheter)
  • Use of medications which require PCU level of care

Nurses assigned to PCU patients have advanced training to care for these higher-acuity patients.

Earlier this month, staff training began to support implementation of the new criteria. Clinical decision support in CS-Link™ is expected to begin March 2017.

For more information or questions, please contact Todd Griner, MSN, RN, NEA-BC, at todd.griner@cshs.org or 310-962-7859.

Medical Staff Can Take Shot at Clippers Tickets

Medical staff will soon have an opportunity to win tickets to an NBA game thanks to Cedars-Sinai's new partnership with the Los Angeles Clippers.

Clippers tickets will be made available to Cedars-Sinai staff through a random drawing. Staff members may enter only once and can win only once this season.

After submitting the proper information online, a staff member will automatically be entered to win tickets for the Clippers' game against the Indiana Pacers on Dec. 4 or against the Miami Heat on Jan. 8. Winners will be notified by Nov. 29 for the Pacers game, and by Dec. 9 for the Heat game.

After notification, winners can pick up their tickets from Recreation Connection, located in the South Tower, Street Level, Room 1604. T-shirts will be distributed with each ticket as well.

"We are pleased to offer our staff this great opportunity," said Andy Ortiz, senior vice president of Human Resources and Organization Development. "Good luck, and let's go Clippers!"

During the NBA season, Cedars-Sinai will sponsor a half dozen "Heart of LA" games that will celebrate health, wellness and the partnership's community outreach, which will include educational materials, videos, cooking demonstrations and exercise techniques.

To participate in the drawing for the Clippers tickets, fill out a brief online form. (There will be additional drawings in 2017.)

Circle of Friends Honorees for October

The Circle of Friends program honored 75 people in October.

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.

  • Daniel C. Allison, MD
  • Mary H. Alvarado
  • Paula J. Anastasia Davis, MN, RN, AOCN
  • Esther Baik, MD
  • C. Noel Bairey Merz, MD
  • Babak R. Bamshad, MD
  • Peyton Berookim, MD
  • Page A. Bertolotti, BSN, RN, OCN
  • Natalie Beyder, RN
  • Darina Brezhnev, PharmD
  • Eileen G. Brown, OCN, RN
  • Neil A. Buchbinder, MD
  • Kirk Y. Chang, MD
  • Martin Cooper, MD
  • Catherine M. Dang, MD
  • Robert W. Decker, MD
  • Stephen C. Deutsch, MD
  • Noam Z. Drazin, MD
  • Fardad Esmailian, MD
  • Sharmayne Farrior, RN
  • Rajinder Gandhi, RN
  • Ivor L. Geft, MD
  • Jeffrey S. Goodman, MD
  • Robert A. Gross, MD
  • Daniel A. S. Hoffman, DO
  • David M. Hoffman, MD
  • Lucia Jimenez Kinsey, LCSW
  • Jeffrey E. Johnson , MD
  • Neel R. Joshi, MD
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Robert F. Katz, MD
  • David Kawashiri, MD
  • Lennoux Laryea
  • Caroline Lee, MD
  • Andrew J. Li, MD
  • Simon K. Lo, MD
  • Hayden Lowenstein, MD
  • Rajendra Makkar, MD
  • Cindy Margolis, RN
  • Kelsey T. McCusker
  • Zab Mosenifar, MD
  • Youram Nassir, MD
  • Leslie Nieva
  • Tiffany Perry, MD
  • Edward H. Phillips, MD
  • Edwin M. Posadas, MD
  • Irving Posalski, MD
  • Jana Posalski, MD
  • Lupita Rabago
  • Shervin Rabizadeh, MD
  • Madison F. Richardson, MD
  • Bobbie J. Rimel, MD
  • Mario A. Rivera
  • Fred P. Rosenfelt, MD
  • Steven M. Rudd, MD
  • Royinna D. Ruzgal-Byrne
  • Alexander Salazar
  • Gregory P. Sarna, MD
  • Yoshinao Sasase, PT
  • Michael M. Shehata, MD
  • Olga Shichko, RN
  • Tara D. Smith
  • Thomas P. Sokol, MD
  • Andrew Ira Spitzer, MD
  • Steven W. Tabak, MD
  • Esperanza Tercero, LVN
  • Camille O. Thornton
  • Alfredo Trento, MD
  • Tatevik Tsaturyan, RN
  • Mark K. Urman, MD
  • Robert A. Vescio, MD
  • Robert N. Wolfe, MD
  • Lewis Y. Wyatt, MD
  • Patrick M. Yaffee, MD

Medical Units Relocate and Reopen to Improve Care

In an effort to improve patient care and to provide extra space and beds during high-volume periods, the following medical units at Cedars-Sinai have relocated and reopened:

  • 7 Southwest — The 28-bed medical unit opened Monday, Oct. 31.
  • 3 North Short Stay Medical Unit — The 28-bed unit opened Tuesday, Nov. 1.
  • The 3 North Short Stay provides specialized care for patients under observation and short-stay inpatients. The unit, located on the third floor of the North Tower, is designed to meet the care needs of patients while also:
    • Providing a specially trained staff experienced with caring for patients.
    • Ensuring that any tests necessary for discharge are completed as quickly as possible.
    • Anticipating patient and physician needs by initiating discharge planning and ensuring the patient's stay does not exceed 48 hours.
  • Both 7 Southwest and the 3 North Short Stay units will have patient telemonitoring and will be observed from the central monitoring center.
  • Emergency Department Inpatient Boarding — The 23-bed inpatient boarding unit is now open.

For more information about these units, email patricia.hain@cshs.org.

Latest Techniques Emphasized in Ebola Drill

Ebola

Charlene Bugais, MS, RN, a clinical nurse specialist, (left) supervises as Sam Do, RN, (right) draws blood from a simulation dummy in a recent preparedness drill for treating patients with highly infectious diseases like Ebola.

After drawing blood, inserting an IV and placing a catheter into a patient, Sam Do, RN, and Isabel Fanelli, RN, carefully removed their hoods and suits. They ran their hands under an ultraviolet light looking for specs of a fine powder that mimics the spread of germs.

They were clean — no small feat after spending an hour in a room cloaked in the flecks.

The two volunteers were practicing medical procedures on a mannequin in a mock intensive care unit at the Women's Guild Simulation Center for Advanced Clinical Skills. It was part of the Special Pathogen Response Team's quarterly training to help Cedars-Sinai serve as a federally designated regional treatment center for Ebola and other highly infectious diseases.

In the event of an outbreak, the doctors, nurses and respiratory therapists will play a critical role in bolstering the country's front-line defense against highly communicable diseases.

"Once trained, that knowledge is the ultimate personal protective equipment," said Flora Haus, MSN, RN, an education program coordinator with the Geri and Richard Brawerman Nursing Institute. She and Charlene Bugais, MS, RN, a clinical nurse specialist, managed the volunteers through the lesson.

"We're tremendously proud of our volunteer team, and we take feedback from them very seriously," said Jonathan Grein, MD, medical director of the Department of Hospital Epidemiology and infection control officer. "The protocols we develop are constantly evolving based on lessons learned at other regional centers, and our volunteers' input is really critical. We need our healthcare workers to feel safe."

In addition to brushing up on basic skills, the group reviewed the latest techniques for treating potential patients. Volunteers practiced using protective disposable sheets and wiping down surfaces when drawing blood in order to prevent splashing and spreading germs. They also worked on speaking slowly and clearly to each other, a critical task when wearing full hoods and noisy air-cleansing machines.

Another focus was learning how to help quarantined patients who might not feel a human hand for weeks cope with loneliness. Simple steps can mitigate feelings of isolation. Healthcare workers who write their names on their suits and share photos and short bios with the patient can help, as can having patients display pictures of their own families and friends.

Fanelli and her epidemiology colleagues — including volunteer Sylvia Cumplido, MSN, RN, who also participated in the training — are helping develop a process for putting on and taking off the protective gear. But it was her first time wearing it for hours.

"It was helpful to see how I actually felt being in the suit and to learn from that experience," Fanelli said.

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.

Karlan Receives Cancer Society Award

Beth Y. Karlan, MD

Capping a string of recent accolades for her discoveries related to ovarian cancer, Beth Y. Karlan, MD, was honored Nov. 5 with an American Cancer Society Giants of Science award at a Beverly Hills gala.

Karlan, director of the Women’s Cancer Program in the Samuel Oschin Comprehensive Cancer Institute and the Division of Gynecologic Oncology, and three other top local scientists were selected by a national committee to receive cancer society grants to continue their work in cancer research.

The cancer society noted Karlan’s translational — or "bench to bedside" — research, which "has helped shape current standards of ovarian cancer care and research." That includes findings about the inherited risk, early detection and treatment of ovarian cancer.

Cedars-Sinai recently honored Karlan with this year’s Pioneer in Medicine award, which recognizes the clinical and research contributions of a Cedars-Sinai medical staff member. She is the Board of Governors Endowed Chair in Gynecologic Oncology and a professor of Obstetrics and Gynecology.

Karlan was inducted last month into the National Academy of Medicine, one of the highest honors in health and medicine. The academy is a branch of the National Academies of Sciences, Engineering and Medicine, the top U.S. source of expert advice on science, engineering and health.

"I consider being a physician-scientist a great privilege," Karlan said.

Klein Gives 1st Sachs Lecture in Transplant Surgery

Andrew Klein, MD

Andrew Klein, MD, was the inaugural speaker for The David Sachs Lecture in Transplant Surgery at Massachusetts General Hospital in Boston on Oct. 13 and 14.

Klein, director of the Cedars-Sinai Comprehensive Transplant Center, presented two lectures: "The Barbers of Civility" and "LA Confidential: Transplantation in Tinseltown."

Sachs is a world-renowned scientist who established the Transplantation Biology Research Center at Massachusetts General Hospital.

Pharmacy and Therapeutics Committee Approvals

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

P and T Committee Approvals - October 2016 (PDF)

CS-Link Tip: Changing Screen Color

As part of recent upgrades, screens for CS-Link™ have a new mint green color. If you don't like the color, it's easy to change.

Go to the button on the top left of the screen. Scroll down to "personalize" and select "choose a theme."

While under that personalize button, you can access the "SmartTool Accessibility Buttons." This button can change the highlight color of "SmartLinks" and "SmartLists," which can make screen reading easier.

More details on how to personalize your screen can be found here.

Learn to be more efficient by attending a Physician Efficiency Training session. The classes are held in Cafeteria Conference Room C. The schedule:

  • Thursday, Dec. 8, noon-1:30 p.m.
  • Tuesday, Dec. 13, 7:30 a.m.-9 a.m.

If you have questions, email groupeisphysicians@cshs.org.

A Special Invitation for Night Shift Staff on Friday

Night shift staff and volunteers are invited to attend an early morning event on Friday to mark the community phase of the Campaign for Cedars-Sinai, the institution's most ambitious fundraising effort to date with a goal of raising $600 million by 2018. So far, $494 million has been raised.

The event will be held from 4-5 a.m. in Harvey Morse Auditorium.

Staff will have the opportunity to learn more about the campaign and how they can become involved at this special one-hour event.

Each member of the Cedars-Sinai staff can have a direct impact on the campaign's success. Cedars-Sinai's collective commitment to providing world-class care to patients is critical to raising awareness about philanthropic support. Grateful patients comprise the majority of Cedars-Sinai's donors — about 75 percent. These investments help fund innovative research and technology that lead to groundbreaking advances in patient care.

Friday's event will feature breakfast, giveaways and presentations from senior medical and institutional leaders about significant innovations and research funded by the campaign.