Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF December 15, 2017 | Archived Issues

Meetings and Events

Everyday Ethical Issues for Older Adults (Ethics Noon Conference)
Dec. 20

These events and more can be found in the medical staff calendar on the Cedars-Sinai website.


Grand Rounds


Upcoming CME Conferences


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.

President's Perspective

Presidents-Perspective-logo-callout

By Thomas M. Priselac, President and CEO

Accessibility to our services for patients and consumers is one of the three imperatives for Cedars-Sinai that I outlined in June’s President’s Perspective: retain our absolute commitment to quality; make our services more geographically and virtually accessible to patients and consumers; fulfill our obligation to make healthcare affordable through operational and clinical efficiency work. No matter how outstanding, efficient and appropriate Cedars-Sinai’s patient care is, if it is not accessible, we are not fulfilling our mission to the public.

» Read more

New Name in Orthopedics

Cedars-Sinai announced the formation of the Cedars-Sinai Kerlan-Jobe Institute this week, which includes multiple care locations throughout Los Angeles and Orange counties. Cedars-Sinai, Kerlan-Jobe and Santa Monica Orthopaedic & Sports Medicine Group are founding partners of the institute.

» Read more

HR Launches Multiyear Strategy to Support Staff

Human Resources has embarked on a transformational, multiyear strategy to cultivate Cedars-Sinai's skillful workforce and to meet the changing demands of the healthcare environment through greater efficiency, better service and enhanced talent management.

» Read more

POLST Project Prompts Important Conversations

"As an institution, Cedars-Sinai wants to ensure that the care we're providing aligns with our patients' goals, values and preferences, particularly in relation to end-of-life care. Physicians want to know that they're respecting their patients' wishes," said Edward Seferian, MD, chief patient safety officer and medical director, Medical Affairs.

» Read more

Pharmacists Help Reduce Medication Errors in ER

Pharmacist Jesse Wisniewski co

When pharmacy professionals — rather than doctors or nurses — take medication histories of patients in emergency departments, mistakes in drug orders can be reduced by more than 80 percent, according to a study led by Cedars-Sinai.

» Read more

Strangers Become Blood Relatives After Transplant

be the match co

Grace Brown and Darin Eisenhut were complete strangers on different coasts who were brought together by two things — blood cancer and Be The Match®, part of the National Donor Program, a nonprofit organization that connects patients with donors, educates healthcare professionals and conducts research. They recently met face-to-face for the first time at the Celebration of Life luncheon.

» Read more

Bell Project Inspires Cedars-Sinai Cancer Patients

Isabella Spar - New Beginng Bell co

When Art Tostado finished five weeks of radiation therapy at Cedars-Sinai, the 71-year-old became among the first cancer patients to sound a new brass bell to mark the end of the treatment. The brief but poignant ceremony also includes a short poem reading, and will be repeated as other cancer patients wrap up treatment.

» Read more

FDA Issues Alert About Risks of Febuxostat

The U.S. Food and Drug Administration is alerting the public that preliminary results from a safety clinical trial show an increased risk of heart-related death with febuxostat, (Uloric) compared to another gout medicine called allopurinol.

» Read more

CS-Link Tip: Pulling Imaging Results

When using CS-Link™, you may want to pull an imaging result into your note. Instead of using copy and paste, you can type dot, "img," and then the anatomical area. For example, typing ".lastimgchest" will pull results for any CT, ultrasound or X-ray of the chest.

» Read more

President's Perspective

By Thomas M. Priselac
President and CEO

Accessibility to our services for patients and consumers is one of the three imperatives for Cedars-Sinai that I outlined in June's President's Perspective:

  • Retain our absolute commitment to quality;
  • Make our services more geographically and virtually accessible to patients and consumers;
  • Fulfill our obligation to make healthcare affordable through operational and clinical efficiency work.

No matter how outstanding, efficient and appropriate Cedars-Sinai's patient care is, if it is not accessible, we are not fulfilling our mission to the public.

For decades in America, most healthcare providers operated under the principle that patients would come to them on the provider's terms. The provider would be in a single location (a hospital or a physician's office), would determine when and how they would be available to see patients, and it was the patient's responsibility to make any adjustments needed to fit the provider's setup.

Today, both patients and healthcare providers benefit from ever-expanding ways to make care more accessible. At Cedars-Sinai, this has been a key component of our strategy and takes many different forms, including geographically distributed primary and specialty care locations, digital access to our services and expansion of urgent care.

Geographic expansion

A decade ago, Cedars-Sinai consisted of our flagship medical center and several nearby buildings for outpatient visits and procedures (the 310 Building, Mark Goodson Building, Medical Network offices and licensed space in the Medical Office Towers). Then, as now, people were willing to drive (and fly) great distances for our renowned tertiary and quaternary services. But for all other medical needs, most people prefer to get that care closer to where they live or work.

To help meet the growing community demand for Cedars-Sinai care closer to home or work, several years ago we began expanding our locations, and we're doing this in a variety of ways:

Medical Network offices: Starting a few years back with the opening of a primary/urgent care facility in Culver City, Cedars-Sinai Medical Network has since opened facilities in Playa Vista and Tarzana, providing both primary and urgent care, as well as a variety of specialty services. The largest one, in the new Runway Playa Vista retail/residential center, just opened and quickly has become a healthcare destination for local residents.

Affiliate offices: Many prominent medical practices throughout Southern California continue to join the Cedars-Sinai Medical Network, which further expands our geographic footprint and makes Cedars-Sinai care more accessible. These groups include primary care practices in the San Fernando Valley; oncology practices in Santa Monica, West Los Angeles, Tarzana and Beverly Hills; and two of the nation's most prominent sports medicine/orthopedics groups, now known as the Cedars-Sinai Kerlan-Jobe Institute, with offices throughout Los Angeles and Orange counties.

Joint ventures: Among our more visible joint ventures is the 138-bed California Rehabilitation Institute in Century City, a joint venture between Cedars-Sinai, UCLA Health and Select Medical. Other joint ventures include several freestanding outpatient surgery centers and freestanding imaging centers.

Cedars-Sinai Marina Del Rey Hospital: With the growing outpatient presence of Medical Network offices throughout the Silicon Beach area (Culver City, Playa Vista, Marina del Rey, Westchester), the availability of a nearby community hospital that is part of the same system provides an important piece of healthcare for the local community.

Our proposed affiliation with Torrance Memorial has the potential to facilitate many different collaborations between the two institutions, extending the geographic reach of both. Based on the success of our collaboration with Torrance Memorial's telestroke program, we anticipate many other opportunities to expand access to clinical trials and other specialized care.

Digital access

The launch of My CS-Link™ enabled our patients to access their health information online, ask their physicians questions any time and get test results. But that was just the beginning. Today, we are piloting a number of new ways to enable our patients to digitally access our care and expertise from wherever they are. The entry points for consumers to all of these services are the Cedars-Sinai website and flagship mobile app, both of which are undergoing major enhancements/overhauls to provide a simpler, easy-to-use interface and tools for consumers.

Expanded urgent care

Urgent care centers — providing immediate access to non-emergency, but time-sensitive care — have become increasingly popular with consumers around the country. The demand for Cedars-Sinai urgent care has been significant, with all three of the Medical Network's urgent care centers (Beverly Hills, Culver City and Playa Vista) keeping very busy. For some consumers, a visit to a Cedars-Sinai urgent care center is their first experience with us and becomes the start of a long-term relationship.

There are literally hundreds of other ways we facilitate access to healthcare for the public, including many of our community benefit programs — providing health education as well as screenings and immunizations to underserved residents in their communities.

In the months and years to come, we will continue to enhance access, in many different ways, to meet the growing regional demand. It is clear that the community wants the outstanding care that Cedars-Sinai provides, and it is our job to help them access it.

Closely related to access is our third imperative, affordability. If people (and other payers) cannot afford our care, then they won't be able to access it, no matter how close it is. In my next Perspective, I'll share some thoughts on how we can fulfill our obligation to make healthcare affordable through operational and clinical efficiency work.

New Name in Orthopedics

Cedars-Sinai announced the formation of the Cedars-Sinai Kerlan-Jobe Institute this week, which includes multiple care locations throughout Los Angeles and Orange counties.

The new name reflects Cedars-Sinai's, Kerlan-Jobe's and Santa Monica Orthopaedic & Sports Medicine Group (SMOG)'s positions as founding partners of the institute. The naming also highlights the expanding footprint of Cedars-Sinai's Department of Orthopaedics, which was created in 2016.

"This transition has been years in the making and best represents our joint commitment to be a world leader in the diagnosis, treatment and prevention of sports-related injuries and illnesses, and other orthopedic conditions," said Mark Vrahas, MD, founding chair of the Department of Orthopaedics.

Kerlan-Jobe Orthopaedic Clinic and Santa Monica Orthopaedic & Sports Medicine Group first joined forces with Cedars-Sinai in 2013. SMOG, located at 2020 Santa Monica Blvd. Suite 400, also will be known as the Cedars-Sinai Kerlan-Jobe Institute.

"For us, this is more than a name change. It is an opportunity to synergize and integrate our world-class institute with other preeminent physician leaders, researchers and staff members throughout our orthopedic network and the Cedars-Sinai Health System," said Bert R. Mandelbaum, MD, DHL (hon), co-chair of Medical Affairs for Cedars-Sinai Kerlan-Jobe Institute.

The Cedars-Sinai Kerlan-Jobe Institute is internationally recognized for research and education in sports medicine. Institute physicians have pioneered advanced surgical methods and procedures to enhance treatment, rehabilitation and recovery.

"We're excited about the opportunity to take this powerful partnership to new heights," said Neal S. ElAttrache, MD, a member of the Kerlan-Jobe Orthopaedic Clinic Board of Directors and co-chair of Medical Affairs for Cedars-Sinai Kerlan-Jobe Institute. "This step further solidifies the collaborative work of these long-standing names in orthopedic medicine to provide exceptional care to the Los Angeles community and beyond."

As the sports division of the Cedars-Sinai Department of Orthopaedics, Cedars-Sinai Kerlan-Jobe Institute physicians also are the team healthcare providers for the Los Angeles Dodgers, Los Angeles Rams, Los Angeles Angels, Anaheim Ducks, Los Angeles Galaxy, U.S. Men's and Women's Soccer and the Special Olympics.

HR Launches Multiyear Strategy to Support Staff

Human Resources has embarked on a transformational, multiyear strategy to cultivate Cedars-Sinai's skillful workforce and to meet the changing demands of the healthcare environment through greater efficiency, better service and enhanced talent management.

The strategy, to be implemented over the next few years, is rooted in four pillars:

  • Enhancing operational efficiency and service
  • Energizing the work climate
  • Facilitating change
  • Recruiting, developing and retaining top talent (talent management)

This approach will help maintain Cedars-Sinai as a leading healthcare employer through a new service delivery model, advanced technologies and other efforts to attract, serve and develop top-performing staff.

"A superlative health system needs to engage top talent to achieve its mission of providing world-class healthcare," said Andy Ortiz, senior vice president of Human Resources and Organization Development. "That requires a world-class Human Resources function, and that's what we've set out to deliver. The foundation for this work is building a platform for operational efficiency and enhanced service."

In the next year, employees will see several changes in Human Resources, including more active recruitment efforts, streamlined performance management tools, development of an employee culture change plan and enhanced communications with staff.

Human Resources will soon roll out HR Connect — a new cloud-based technology that will streamline access to Human Resources services. This new technology, coupled with implementation of an HR Shared Services Center, will make it easy for employees to get answers to Human Resources questions, and for leaders to get complete and accurate HR data to support better decisions.

"The healthcare industry has its challenges, but this strong foundation will enable Cedars-Sinai to meet them with a talented workforce that is inspired by those challenges, engaged in their work and deft in their ability to adapt to the ever-changing healthcare environment," said Ortiz, who marked his one-year anniversary with the organization in July.

Watch The Bridge in the months ahead for follow-up stories about Human Resources' strategic pillars.

POLST Project Prompts Important Conversations

A three-year improvement project resulted in increased completion rates of POLST forms.

"As an institution, Cedars-Sinai wants to ensure that the care we're providing aligns with our patients' goals, values and preferences, particularly in relation to end-of-life care. Physicians want to know that they're respecting their patients' wishes," said Edward Seferian, MD, chief patient safety officer and medical director, Medical Affairs.

To help achieve these objectives, the Cedars-Sinai Quality Council launched an initiative in 2014 aimed at improving end-of-life care.

"We knew we needed to do a better job of eliciting from patients what they wanted in relation to end-of-life care, and we knew we needed to be more effective in making those preferences available in the medical record for use by all providers," said Michael Langberg, MD, chief medical officer and the initiative's executive sponsor. "One way to do this is with the POLST form, so we launched an effort specifically focused on this form as a means of prompting these dialogues and documenting patients' wishes."

POLST is an acronym for Physician Orders for Life-Sustaining Treatment, a form designed to increase patients' control over end-of-life care and across care settings. Recognized in California since 2009, the POLST form is administered by the Coalition for Compassionate Care of California and enables patients to have frank discussions with their healthcare providers and specify their preferences in relation to CPR, artificially administered nutrition and the scope of medical interventions desired.

Printed on hot-pink paper, the form reflects the provider's clinical judgment and is signed by the patient (or a legally recognized decisionmaker in case of incapacity) and provider — which can be a physician, nurse practitioner or physician assistant. POLST forms transform patients' preferences into physician orders that are to be followed across healthcare settings.

"One of the POLST form's goals is to protect patients and preserve their preferences outside of a hospital environment," said Jaime Goldberg, clinical social worker with Supportive Care Medicine. "Increasing completion rates of POLST forms has been a focus for several years, but over the last three years we've refined and intensified that focus."

For example, two populations were targeted: patients being discharged who have a Do Not Attempt Resuscitation (DNAR) order in their hospital medical record; and patients with dementia being discharged to a skilled nursing facility.

"These aren't the only patients we've been working with. We're also focusing on patients with advanced conditions, such as cancer and other complex, life-limiting illnesses," said Seferian, associate professor of Pediatrics.

Seferian is a team leader of the improving end-of-life care initiative along with: Beth Karlan, MD, director of the Women's Cancer Program in the Samuel Oschin Comprehensive Cancer Institute and professor of Obstetrics and Gynecology; and Bradley Rosen, MD, vice president of Physician Alignment and Care Transitions and assistant professor of Medicine.

Several strategies were employed to boost completion rates of POLST forms.

"One of the most effective strategies was integrating POLST into the workflow, particularly into progression of care rounds where patients appropriate for a POLST conversation could be identified," explained Seferian. "This was a multidisciplinary effort, including social work, case management, supportive care medicine, internal medicine, nursing, surgery, transplant, the enhanced care program, bioethics, the emergency department and physician advocates."

Seferian pointed to other impactful strategies.

"Since 2014, we've been providing physician-specific POLST form completion rates annually. We also showed how they compared with their peers' POLST completion rates," said Seferian. "In many cases, physicians wanted to know which patients would have been appropriate for POLST conversations."

A CS-Link™ best-practice alert similarly helped move the POLST-form-completion needle. When a physician places a DNAR order, a Best Practice Advisory displays indicating that a POLST form should be completed for that patient.

"The first phase of the POLST effort was increasing completion rates, which has been accomplished," Seferian said. "The completion rate for patients with a DNAR order went from about 41 percent to more than 73 percent. For patients with dementia, which is a much more complex population, the completion rate was at around 45 percent and is now nearing 60 percent."

Goldberg credits rising completion rates to the combined impact of multiple strategies.

"Some strategies were very concrete, such as making sure POLST forms were available on the units. Others were more philosophical, focusing on the importance and benefits of having these conversations," Goldberg explained.

"The POLST initiative is now in sustainment mode. The next step is making sure that the care we're delivering aligns with patients' preferences," Seferian said.

For additional information, POLST forms and a FAQ sheet in multiple languages, visit the Cedars-Sinai POLST web page.

Questions about the POLST form can be directed to Supportive Care Medicine (Inpatient: 310-423-9520; Outpatient: 310-423-7500) or the Center for Healthcare Ethics, 310-423-9636.

Pharmacists Help Reduce Medication Errors in ER

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Pharmacist Jesse Wisniewski, PharmD, on the job at Cedars-Sinai

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Joshua Pevnick, MD

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Rita Shane, PharmD

When pharmacy professionals — rather than doctors or nurses — take medication histories of patients in emergency departments, mistakes in drug orders can be reduced by more than 80 percent, according to a study led by Cedars-Sinai.

Acting on the findings, Cedars-Sinai now assigns pharmacy staff members to take medication histories for high-risk patients admitted to the hospital through the Emergency Department.

Injuries resulting from medication use are among the most common types of inpatient injuries at U.S. hospitals, affecting hundreds of thousands of patients every year. Errors in medication histories contribute significantly to such problems, according to Rita Shane, PharmD, chief pharmacy officer. These errors can lead physicians to order the wrong drug, dose or frequency.

Electronic health records for patients, while helpful, are no panacea. "Across healthcare settings, errors that are introduced into the record by individuals with varying levels of knowledge can become 'hardwired' and used for prescribing medications that can cause harm," said Shane, a co-investigator for the study, published in the journal BMJ Quality & Safety.

Joshua Pevnick, MD, associate director of the Cedars-Sinai Division of Informatics and the study's first author, said establishing accurate medication histories poses a "huge challenge," especially in hospital emergency departments.

"The standard practice in the U.S. is for doctors and nurses to take these histories, along with simultaneously delivering and coordinating care for the patients," said Pevnick, an assistant professor of Medicine. "That's why it's so helpful to assign this task to pharmacy experts, whose sole role is to take these histories."

In the study, the investigators focused on 306 medically complex patients at Cedars-Sinai who were taking 10 or more prescription drugs and had a history of heart failure or other serious conditions. The study found that when pharmacists or pharmacy technicians, instead of medical staff, took these patients' histories in the Cedars-Sinai Emergency Department, errors in both the histories and medication orders fell by more than 80 percent. As a result, significantly fewer errors in drug orders were made during hospitalization.

Cedars-Sinai now assigns pharmacy staff to take medication histories for certain high-risk patients who are admitted to the hospital after first seeking treatment in the Emergency Department, Shane said. These patients include those who are elderly and rely on multiple drugs. Having pharmacy staff perform this function enables doctors and nurses to focus on patient-care needs, she explained.

To ensure accuracy when taking histories, pharmacy professionals may need to reconcile electronic health records with prescription databases and any written lists from the patient, the patient’s pharmacy and the primary care physician, along with information provided verbally by the patient or the patient's family or caregiver.

Patients in the Emergency Department pose special challenges. They may be unable to offer information because they are unconscious or otherwise compromised by a health crisis. A medication list found in a person's wallet may be for a family member, or a drug on the list may have been discontinued by the patient months ago.

"There can be a lot of CSI-type investigation," said pharmacist Jesse Wisniewski, PharmD, referring to the television series featuring crime-scene investigations. In complex cases, Wisniewski said he may spend 40 minutes or more taking a medication history for an Emergency Department patient.

Studying and solving medication history errors is a continuing, cooperative effort at Cedars-Sinai that involves the departments of Pharmacy Services, Medicine and Biomedical Sciences. The initiative continues to expand, with plans in the works to provide pharmacy staff reviews of medications for a wider range of patients in the Emergency Department and inpatient areas, Shane said.

The BMJ Quality & Safety study also involved investigators from Western University of Health Sciences in Pomona, California; University of Toronto and University Health Network in Toronto; the VA Greater Los Angeles Healthcare System; and UCLA.

Research reported in this publication was supported by the National Institute on Aging and the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers K23AG049181 and UCLA CTSI KL2TR000122.


Disclosure: Pevnick receives funding from the American Society of Health-System Pharmacists Research and Education Foundation to design a toolkit for pharmacists to use in postdischarge medication management.

Strangers Become Blood Relatives After Transplant

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Grace Brown helped save cancer patient Darin Eisenhut's life by donating bone marrow. The two met face-to-face for the first time at the Celebration of Life luncheon earlier this year.

She named him after a character on one of her favorite TV shows. He ended up calling her "Amazing Grace" for saving his life.

She is Grace Brown, a 35-year-old CT technologist from Sanford, Florida, and he is Darin Eisenhut, a 52-year-old photographer and graphic designer from La Habra, California.

They were complete strangers on different coasts who were brought together by two things — blood cancer and Be The Match®, part of the National Donor Program, a nonprofit organization that connects patients with donors, educates healthcare professionals and conducts research.

Last month, Cedars-Sinai helped sponsor a Be The Match® Walk+Run event in Long Beach to increase awareness about the ongoing need to register new donors, particularly those in younger, diverse populations. Cedars-Sinai raised more than $1,400, which supports stem cell or bone marrow transplant patients.

In October, Grace and Darin met face-to-face for the first time at the 18th Celebration of Life luncheon, hosted by the Cedars-Sinai Blood and Marrow Transplant Program and the Samuel Oschin Comprehensive Cancer Institute.

"There wasn't a dry eye in the house when Darin and Grace hugged," said Patricia Van Strien, MSN, RN, clinical program coordinator of the Blood and Marrow Transplant Program. "We don't always get to see things come full circle. It's such a reward to see patients with their friends, family, children and grandchildren."

More than 170,000 Americans are expected to be diagnosed this year with a potentially fatal blood cancer that requires a bone marrow or stem cell transplant. While about a third of patients find a donor within their families, the majority receive transplants from altruistic strangers who donate stem cells or bone marrow.

Darin's long journey to the luncheon began in late 2015. He'd been feeling extremely run down for several weeks and thought he had the flu. Instead, weeks later, he would be diagnosed with acute myeloid leukemia.

"To get up and walk 50 feet to the bathroom would wear me out," said Darin, who has two sons and two grandsons. "It was terrible."

After undergoing several rounds of chemotherapy, Darin's best chance for long-term survival was to receive a bone marrow transplant. His younger sister was a good match, but Grace turned out to be better — a nearly perfect match.

Grace had registered in 2009 to become a donor. At the time, she gave a swab sample from her cheek and didn't hear a thing for eight years.

"My dad is a firefighter. I'm in the medical field," said Grace, who has rarely missed a chance to donate blood every 56 days since she was 17. "It's just what I was raised to do. If you can help people, you help people."

Then, she got a call saying she might be a match and was asked if she could donate blood for further tests. The results confirmed her suitability to be a bone marrow donor for Darin.

In early May 2016, Grace underwent a 90-minute procedure in a Tampa hospital to donate bone marrow. Shortly after the collection, the bone marrow cells were quickly picked up by courier and flown to Cedars-Sinai where Darin waited. Darin had undergone high doses of chemotherapy to remove the malignant marrow cells which helped to prepare him to receive Grace's new healthy bone marrow cells. The goal was to restore the healthy function of Darin's bone marrow and cure him of leukemia. The bone marrow cells were quickly administered through a catheter line placed in Darin's vein. It took five weeks for Darin to recover and restore bone marrow function of the newly engrafted donor cells. Darin was grateful for his care at Cedars-Sinai and, in particular, wanted to thank these members of the Blood and Marrow Transplant Program: Michael Lill, MD, director; Yuliya Linhares, MD, attending physician; and, Sarah Cooper, RN, nurse practitioner.

"The transplant basically re-booted my system," said Darin.

After a transplant, donors and recipients remain anonymous and must wait a year before learning about each other. The wait was difficult for both Darin and Grace, who were very eager to contact the other. Grace was so excited to put a face on her unknown recipient that she gave him a name, Frank — after a character on one of her favorite shows, How to Get Away with Murder.

After a year, they first introduced themselves to each other on Facebook. Then, in October, Darin got to meet his "Amazing Grace," as he had begun calling her, in person at the Celebration of Life luncheon.

"It was worth getting cancer to get that hug," said Darin. "It's like I came out way ahead in that deal. She cried and I cried a little bit. I tried not to cry as much as she did because I'm the man, but that didn't work out so well."

Added Grace: "The entire experience for me was the best-case scenario. He's super cool and has a wonderful family. I feel like I have a new family member. And technically, he is a blood relative now."

Bell Project Inspires Cedars-Sinai Cancer Patients

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Art Tostado and Isabella Spar are shown with a newly installed ceremonial bell at Cedars-Sinai that signals the end of treatment.

When Art Tostado finished five weeks of radiation therapy this year at Cedars-Sinai, the 71-year-old became among the first cancer patients to sound a new brass bell to mark the end of the treatment.

The brief but poignant ceremony, which also includes the reading of a short poem, will be repeated again and again as other cancer patients wrap up their treatment.

"It feels wonderful to be a part of this beginning," said Tostado, who was treated for prostate cancer. "Bells have been used for thousands of years to signify journeys. Every time I hear a bell, I'll think of this moment."

The new tradition began thanks to 13-year-old Isabella Spar and her ambitious bat mitzvah project, which raises money to buy and donate celebratory bells at radiation treatment centers across the country.

Earlier this year, Isabella and her family, who are from New Jersey, visited Cedars-Sinai to dedicate the new bell, which is in the waiting room of the Department of Radiation Oncology on the lower level of the North Tower.

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Patients ring the ceremonial bell and read the poem inscribed on a plaque.

Isabella developed the idea for Project Bell when her mother, Wendy Jeshion, underwent radiation treatment for a benign brain tumor. The hospital where she received treatment had a "new beginning" bell that would ring three times when a patient completed treatment.

"When a patient rings the bell, everyone at the treatment center joins in to celebrate," said the eighth-grader. "It gives so much hope — everyone talks about when they're going to ring the bell."

Isabella soon learned that few radiation centers used bells. She became determined to see that set more cancer patients would be able to experience the joyful sense of closure that the bell ceremony brings.

Isabella started making and selling jewelry to finance her goals. She has raised more than $5,000, which she has used to donate seven bells to medical centers across the country, including Cedars-Sinai. She has enough money for five more bells as well.

The bells are installed with a plaque inscribed with a poem to be read aloud during each ceremony. The plaque reads:

Ring this bell,
Three times well
Its toll to clearly say ...
My treatment's done
The course is run
And now I'm on my way.

The ceremonial ringing isn't just meaningful for patients and their families. It's important for staff, too.

"We become like a family here, and we love celebrating this important milestone with our patients," said Lynn Abess, associate director of the Department of Radiation Oncology. "It also inspires and motivates everyone in the waiting room. They know their turn will come too."

Isabella isn't stopping with a dozen bells. Her goal is to get a bell in every hospital that wants one before she heads off to college.

"After seeing how much the bell ringing ceremony meant to my mom and family, I decided that all radiation centers should have bells," said Isabella. "It's really nice to know that more and more people will get to use the bells."

FDA Issues Alert About Risks of Febuxostat

The U.S. Food and Drug Administration is alerting the public that preliminary results from a safety clinical trial show an increased risk of heart-related death with febuxostat, (Uloric) compared to another gout medicine called allopurinol. Healthcare professionals should consider this safety information when deciding whether to prescribe or continue patients on febuxostat.

The FDA website has more information.

CS-Link Tip: Pulling Imaging Results

When using CS-Link™, you may want to pull an imaging result into your note. Instead of using copy and paste, you can type dot, "img," and then the anatomical area.

For example, typing ".lastimgchest" will pull results for any CT, ultrasound or X-ray of the chest. Make sure you still review the results under the imaging tabs as this link pulls in the summary and you need to read the entire report.

Also, HealthStream offers physician efficiency training modules for continuing medical education credit. There are 22 modules that last 15 minutes each. They include topics such as "In Basket Quick Actions," "Smart Blocks in Progress Notes" and "SmartList Editor."

To take advantage, log into HealthStream and search the catalog using keywords: PET CME. Select the module you want to view, then click "Enroll."

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