Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF September 8, 2017 | Archived Issues

Flu Shots for Staff Coming to Cedars-Sinai

Flu Shot co

Staff is asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Wednesday, Nov. 1. Medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccination.

» Read more

New Team Expedites Care of Pulmonary Embolism

The Cedars-Sinai Pulmonary Embolism Response Team is a new multidisciplinary team that provides rapid triage and access to state-of-the-art care for intermediate and high-risk pulmonary embolism, the third leading cause of death after coronary artery disease and stroke.

» Read more

Keytruda Has Risks for Multiple Myeloma Patients

The U.S. Food and Drug Administration has identified risks associated with the use of Keytruda (pembrolizumab) in combination with dexamethasone and an immunomodulatory agent (lenalidomide or pomalidomide) for the treatment of patients with multiple myeloma.

» Read more

Alan G. Silverman, MD: 1933-2017

Alan G. Silverman, MD, an active member of the medical staff as an attending in the Department of Medicine, died Aug. 27. He was 84. After completing his internship and residency at Cedars of Lebanon in 1966, he joined its medical staff in 1968. He remained on staff, including through the merger of Cedars of Lebanon and Mount Sinai hospitals, for nearly three decades.

» Read more

New Walk-in Clinic Eases Employees' Access to Care

Employee Clinic staff co

A new onsite, walk-in medical clinic for employees is making it easier — and faster — for Cedars-Sinai staff members to access urgent care services before their shifts start or after their shifts are over. The clinic is in the West Medical Office Tower at 8635 W. Third St., Suite 295W, and is open from 7-9 a.m. Monday through Friday. There, clinic staff members treat Cedars-Sinai employees experiencing common, non-emergency illnesses and injuries.

» Read more

New Cedars-Sinai Urgent Care Opens in Playa Vista

Cedars-Sinai is further expanding its reach on the west side of Los Angeles with more than 32,000 square feet of new medical office space offering urgent care, primary care, obstetrics and gynecological care services and more. Urgent care services are open now.

» Read more

Changes in Senior Leadership Structure

Cedars-Sinai is pleased to announce several changes in its senior leadership structure. These appointments will help the organization efficiently address the expanding geography and scope of Cedars-Sinai’s programs and services, and the important work of integrating clinical care across these sites.

» Read more

CS-Link Tip: Updates Coming

cs-link logo

Due to a series of new updates, CS-Link™ will be down Wednesday, Sept. 13, from 1-4 a.m. to allow for installation of an optimization bundle.

» Read more

Harm Report Has a New Look

The Harm Report has received a makeover to simplify communications about preventable harm and to decrease the likelihood of recurring events. The new features to the Harm Report will include: a recap of the previous week's preventable harm instead of four weeks of harm incident, a more prominent Safety Star section for readers to click on and to submit nominations easily and more clinical details regarding the selected incidents.

» Read more

Patient Safety Survey Runs Through Sept. 17

Executive leadership at Cedars-Sinai is conducting a survey of staff members through Sept. 17 to identify and prioritize opportunities for improving patient safety. Front-line staff members — including those in Admissions, Case Management, Clinical Operations, Clinical Care Services, faculty physicians and house staff — are strongly encouraged to participate in the nationally recognized Culture of Safety Survey.

» Read more

Flu Shots for Staff Coming to Cedars-Sinai

Naomi Jean-Baptiste, RN, receives a flu shot from Maria Delilah Frivaldo, RN.

Staff is asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Wednesday, Nov. 1.

Flu Shot Schedule

The schedule for vaccination clinics is as follows:

  • Monday, Sept. 11
    8 a.m.-10 p.m., ECC-C
  • Tuesday, Sept. 12
    8 a.m.-10 p.m., ECC-C
  • Wednesday, Sept. 13
    8 a.m.-10 p.m., Harvey Morse Conference Room 6
  • Thursday, Sept. 14
    8 a.m.-10 p.m., Advanced Health Sciences Pavilion, PEC 8
  • Friday, Sept. 15
    8 a.m.-10 p.m., Advanced Health Sciences Pavilion, PEC 8
  • Monday, Sept. 18
    8 a.m.-10 p.m., Harvey Morse Conference Room 1 & 2
  • Tuesday, Sept. 19
    8 a.m.-10 p.m., ECC-C

Medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccination. Exceptions may be given for those with approved medical exemptions per guidelines from the Centers for Disease Control and Prevention. Those who decline the vaccine without an approved medical exemption or religious accommodation will not be able to work and are subject to termination of employment.

Flu vaccinations are free of charge and will be available to medical staff and volunteers. Vaccines have been ordered and a schedule of flu clinics will be emailed to staff, and will be available in future issues of Pulse and on the Intranet homepage.

All vendors and contracted personnel must provide proof of vaccination and wear badge buddies while they are in any Cedars-Sinai licensed area. If they wish to get their flu vaccination here, they will have to show their ID badge and pay a $25 fee; however, the fee will be waived if the vaccine is received during the flu clinics Sept. 5-Oct. 31.

"Thank you to all staff for continuing to provide for the health and safety of our patients and their families," said Jonathan Grein, MD, medical director, Department of Hospital Epidemiology, and infection control officer. "Getting vaccinated is the most important step towards protecting ourselves, our families and our more vulnerable patients, such as those without a strong immune system, from the complications of influenza."

Staff with a confirmed egg allergy that has been documented with Employee Health Services (EHS) may schedule a vaccination appointment with EHS in My CS-Link™.

Green badge buddies will be issued at the time of vaccination and those with an approved medical exemption or religious accommodation will receive a gray badge buddy. All badge buddies must be visibly worn by Nov. 1. These HIPAA-compliant badge buddies are the easiest method to ensure compliance with Cedars-Sinai policy and the County of Los Angeles Public Health Order.

For those with an approved religious accommodation or medical exemption, masks are not required to be worn in non-patient care areas such as administrative offices, cafeterias, break rooms, and parking lots. Per the County of Los Angeles Public Health Order, masks must be worn in all patient care areas, even for those with an approved vaccine exemption.

To request a medical exemption, a staff member must have a medical provider complete the Medical Exemption from Influenza Vaccination form, available from EHS. The request for exemption will be reviewed by a physician panel, who will determine if it meets criteria for an exemption based on CDC guidelines. Please return the completed form to EHS on the second floor of the Spielberg Building by Monday, Oct. 2.

Those requesting a religious accommodation should contact their HR Business Partner or call 310-423-5459 to receive the Request for Religious Accommodation form. Completed forms are given to your HR Business Partner. Your request will be evaluated and an approval or denial letter will be issued to you.

For questions, please call Employee Health Services at 310-423-3322 or Hospital Epidemiology at 310-423-5574.

Family members of staff are invited to get free vaccines at the family flu and blood pressure screening on Sunday, Oct. 22 from 10:00 a.m.-12:30 p.m. on the second floor of the Steven Spielberg Building.

For more information, please call 310-423-9581.

New Team Expedites Care of Pulmonary Embolism

The Cedars-Sinai Pulmonary Embolism Response Team (PERT) is a new multidisciplinary team that provides rapid triage and access to state-of-the-art care for intermediate and high-risk pulmonary embolism (PE), the third-leading cause of death after coronary artery disease and stroke.

The PERT team, which launched in May, includes specialists from pulmonary, critical care, cardiology, interventional cardiology and cardiothoracic surgery.

"Most people who are diagnosed with PE aren't diagnosed until death," said Victor Tapson, MD, pulmonary critical care and president of The National PERT Consortium. "PE can progress rapidly, and the death rate is high without treatment. Therapeutic options are evolving quickly, and our team aims to simplify identification and treatment of these cases."

Providers can call a dedicated phone line (3CLOT) for 24-hour access to the team, which activates all comprehensive care options for PE, including expert risk stratification, triage and therapeutic planning based on the clinical presentation and test results.

The pulmonary critical care fellow or attending will field the call, gather information and offer advice. In certain scenarios — such as high-risk (massive) PE (patients with hemodynamic instability) or a clot in transit — cardiology and cardiac surgery will be contacted.

The team will also help guide the decision to use systemic thrombolytics. If catheter-directed therapy is a consideration, interventional cardiology or interventional radiology will be contacted.

Intermediate risk PE can be quite heterogeneous, and the team will offer expert recommendations. All decisions — including anticoagulation alone, IVC filter placement and endovascular treatment — must be made quickly, and communication lines between team members and with the primary service must be open.

"PE is a disease that spans many different specialties — cardiology, interventional cardiology, pulmonary critical care, cardiothoracic surgery, interventional radiology and hematology in certain scenarios — so usually the provider has to make many calls. With 3CLOT, the provider makes one phone call," said Oren Friedman, MD, pulmonary critical care and cardiac surgery critical care. "There is now an abundance of different capabilities or treatment modalities that must be tailored specifically to a patient. The complexities of PE are understood, but patient-specific treatment is key."

The PERT expedites care and eliminates the need for numerous time-consuming communications, which can cause treatment delays. The team now offers coordination of multiple endovascular procedures, cardiac surgery and extracorporeal membrane oxygenation (ECMO).

The PERT team carefully assesses the patient's clinical status and study results, and provides rapid clinical evaluation and triage of high-risk PE patients.

In addition to inpatient treatment, the team monitors patients after they leave the hospital at the PE outpatient clinic. Follow-up management for pulmonary embolism is crucial, as there are many nuances and options for long-term anticoagulation. The rise of direct oral anticoagulants has introduced many more options for long-term care, including low-dose extended anticoagulation.

PERT members include:

  • Victor Tapson, MD, pulmonary critical care
  • Aaron Weinberg, MD, pulmonary critical care
  • Oren Friedman, MD, pulmonary critical care, cardiac surgery critical care
  • Suhail Dohad, MD, interventional cardiology
  • Danny Ramzy, MD, cardiothoracic surgery
  • Hooman Madyoon, MD, interventional cardiology
  • David Hildebrandt, BSN, Heart Institute team manager
  • Interventional radiology team

The Cedars-Sinai PERT is a founding member of The National PERT Consortium initiated by Massachusetts General Hospital. The consortium hosts annual meetings to discuss developments in PE care and provides a forum for members to share information on care and research.

Cedars-Sinai will contribute to a national database and will be able to publish from this database. The PERT Consortium newsletter has featured the Cedars-Sinai PERT's approach and its access to multiple modalities of advanced PE care — including the robust cardiac surgery and ECMO programs, which have opened the door to aggressive PE treatment not routinely available at many large centers.

A number of clinical trials and research projects are underway. For more information on the PERT, email victor.tapson@cshs.org.

Keytruda Has Risks for Multiple Myeloma Patients

The U.S. Food and Drug Administration has identified risks associated with the use of Keytruda (pembrolizumab) in combination with dexamethasone and an immunomodulatory agent (lenalidomide or pomalidomide) for the treatment of patients with multiple myeloma. Earlier this summer, clinical trials demonstrated an increased risk of death for patients receiving Keytruda (pembrolizumab) when it was combined with an immunomodulatory agent as compared to the control group.

The FDA website has more information.

Alan G. Silverman, MD: 1933-2017

Alan G. Silverman, MD, an active member of the medical staff as an attending in the Department of Medicine, died on August 27. He was 84.

After completing his internship and residency at Cedars of Lebanon in 1966, he joined its medical staff in 1968. He remained on staff, including through the merger of Cedars of Lebanon and Mount Sinai hospitals, for nearly three decades. In 1997, Silverman left to join the UCLA Medical Group, but in 2004, he returned to Cedars-Sinai and remained in private practice until his death.

Silverman is survived by his wife, Leeda, three children, Jeffrey Silverman, MD, Marc Silverman, DVM, and Lisa Cueto, and six grandchildren.

Silverman's contributions and invaluable service to the medical center and to the community will be greatly missed.

Donations in his memory may be made to the Cedars-Sinai Heart Institute or to the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, care of Community Relations & Development Department, 8700 Beverly Blvd., Suite 2416, Los Angeles, CA 90048.

New Walk-in Clinic Eases Employees' Access to Care

Physician Assistant Dinah Irani checks on a patient at the recently opened onsite, walk-in medical clinic for employees.

A new onsite, walk-in medical clinic for employees is making it easier — and faster — for Cedars-Sinai staff members to access urgent care services before their shifts start or after their shifts are over.

The clinic is in the West Medical Office Tower at 8635 W. Third St., Suite 295W, and is open from 7-9 a.m. Monday through Friday. There, clinic staff treat only Cedars-Sinai employees experiencing common, non-emergency illnesses and injuries.

Employees are served on a first-come, first-served basis, and should bring their badges and insurance information with them when visiting. No appointments are necessary, and there is no copayment for the visit, regardless of insurance coverage.

"What we want to do is provide dedicated, enhanced access for employees early in the morning," said Mary Clare Lingel, vice president of Strategic Integration. "We want to make it easy for them to get the care they need so they can continue caring for our patients and families."

Since opening in July, the clinic has been well received, treating a handful of patients a day, Lingel said. Access to the electronic medical record ensures visit information is shared with a patient’s primary care physician.

The clinic provides a close, convenient alternative for medical center staff members who do not need an emergency level of care. Depending on how much employees use the new clinic, the Medical Network will adapt to meet their needs.

The walk-in clinic does not replace employee flu vaccination clinics. Watch The Bridge for information on how to get your flu vaccines.

In addition to this clinic, there are several other convenient options for care for staff members:

  • In addition to Playa Vista, urgent care is also available in Beverly Hills and Culver City. Copayments are waived.
  • Employees under Anthem plans can access LiveHealth Online through Anthem’s website or mobile phone app to video conference with a physician, 24 hours a day, seven days a week. There is no copay.
  • If your illness or injury is job-related, or if you think you might be infectious to co-workers or patients, you can visit Employee Health Services in the Steven Spielberg Building. Copayments are waived.
  • You also can schedule an appointment with your primary care physician by phone or through My CS-Link™. Many physicians offer same-day appointments.

New Cedars-Sinai Urgent Care Opens in Playa Vista

Cedars-Sinai is further expanding its reach on the west side of Los Angeles with more than 32,000 square feet of new medical office space offering urgent care, primary care, obstetrics and gynecological care services and more.

The offices are located at the Runway Playa Vista Shopping Plaza, at 12746 W. Jefferson Blvd. The second-floor urgent care clinic opened on Aug. 21. Urgent care hours are noon to 9 p.m. on weekdays and 9 a.m. to 6 p.m. on weekends, and patients can drop in to see a provider same-day.

"The urgent care and new offices are part of our ongoing efforts to bring our doctors closer to where our patients and employees live and work," said John Jenrette, MD, executive vice president of the Cedars-Sinai Medical Network. "In the next few months, primary care physicians, obstetrics and gynecology doctors and pediatricians also will be moving in, making this a convenient location for patients in this area to access our expert care."

Services offered at the urgent care include:

  • Walk-in visits with shorter wait times
  • Expedited services for common conditions like cold and flu, ear infections, sprains and muscle aches
  • Providers who can treat children and adults
  • On-site lab collection services and X-ray services

Primary care offices are expected to open in October followed by the opening of obstetrics and gynecology and pediatrics offices in November. Those medical offices will be located on the third and fourth floors of Runway, which is also home to other major retailers such as Whole Foods, CVS and Starbucks.

Changes in Senior Leadership Structure

By Mark Gavens, John Jenrette, MD, Shlomo Melmed, MD, and Ed Prunchunas

One of the reasons for Cedars-Sinai’s success over the years is our ability to continually adapt our organizational structure to effectively address changes in the health care environment. As part of that endeavor, we are pleased to announce several changes in our senior leadership structure. These appointments will help us efficiently address the expanding geography and scope of Cedars-Sinai’s programs and services, and the important work of integrating clinical care across these sites.

Bryan Croft will be assuming a broader role in leading day-to-day operations of Cedars-Sinai Medical Center as Senior Vice President for Operations. In this new role, he will assume operational responsibility for all service line and clinical support services. Reporting to Bryan will be Vice President for Service Line Operations Joan August, as well as the successor to Bryan’s former position of Vice President for Service Line Operations and the successor to Vice President for Clinical Support Services Jeff Deeter. Bryan is beginning those two recruitments immediately. He will continue to report jointly to Mark Gavens and Shlomo Melmed, MD. Bryan joined Cedars-Sinai in 2010 as Vice President for Service Line Operations after serving in operating capacities at Methodist Hospital in Texas and Queen’s Medical Center in Hawaii. He has been instrumental in advancing our operations agenda and developing clinical programs and services, working closely with our chairs and medical staff leadership.

Reflecting the increasingly important responsibility of delivering high-quality nursing care to our patients and the development and support of the professional practice of nursing at Cedars-Sinai Medical Center, our ambulatory care clinics, the Medical Network and Marina Del Rey Hospital, the Chief Nursing Officer/Health System Chief Nursing Executive position is being advanced from a Vice President to a Senior Vice President. This will apply to the incumbent, Linda Burnes Bolton, RN, PhD, FAAN, as well as her successor. The position will continue to report to Mark Gavens. As you know, Linda announced her retirement from the position last year, and will become our Chief Health Equity Officer upon the recruitment of her successor.

With the ongoing major expansion of the Medical Network, the role and responsibilities of its Chief Operating Officer have grown significantly. As a result, Jill Martin is being promoted to Senior Vice President. She will continue to report to John Jenrette, MD. Over the past few years, the operations of the Medical Network have added 10 new physician practices, created three joint venture outpatient surgery centers and opened four new primary care sites and two new urgent care centers. Since joining Cedars-Sinai in 1997, Jill has been a key member of its leadership team, helping to guide its growth, steward its resources and integrate its operations with the rest of Cedars-Sinai.

As a result of Ed Prunchunas taking on additional responsibilities in the last few years, David Wrigley’s role is being expanded to include not only his current responsibilities, but to encompass all of the Medical Center’s financial operations. Reflecting this change, he is being promoted to Senior Vice President for Finance. Patricia Kittell, Vice President for Patient Financial Services, will report to David. David joined Cedars-Sinai as Vice President for Finance in 2014, after serving in leadership positions at Presence Health (the largest Catholic health system in Illinois) and at the accounting firm KPMG. At Cedars-Sinai, he has had significant involvement in the acquisition of Marina del Rey Hospital and the 6500 Wilshire building, and the proposed Torrance Memorial affiliation.

Please join us in thanking these leaders for their past and future contributions to Cedars-Sinai, and congratulating them on their new roles.

CS-Link Tip: Updates Coming

Due to a series of new updates, CS-Link™ will be down Wednesday, Sept. 13, from 1-4 a.m. to allow for installation of an optimization bundle.

CS-Link has more information about bundle related job aids and eLearning courses.

Also, as a result of the updates, the following common workflows will be unavailable in production beginning Monday, Sept. 11, at 9 p.m.:

  • Applying filters to Chart Review
  • Personalizing Dashboards
  • Creating, editing or sharing NoteWriter macros
  • Creating or editing Quick Actions
  • Creating or editing SmartPhrases
  • Hyperspace customization

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."

CSLink tip- Physician Efficiency Training

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

Harm Report Has a New Look

The Harm Report has a new look.

The Harm Report has received a makeover to simplify communications about preventable harm and to decrease the likelihood of recurring events.

"This redesign is a refresh around preventing harm with a new format that is easy to read at a glance and recognizes individuals who embody the principles of doing everything possible to ensure safe care," said Rekha Murthy, MD, vice president for Medical Affairs and associate chief medical officer. "We hope this new format will create awareness, spark curiosity and energize staff around the topics and provide tools and resources that promote our efforts toward achieving and sustaining a culture of safety."

The report was created six years ago by the Patient Safety Department to promote learning from staff experiences and to encourage employees to reflect on care processes in their work environments.

The newly improved Harm Report's featured enhancements include:

  • A recap of the previous week's preventable harm instead of four weeks of harm incidents
  • A more prominent Safety Star section for readers to click on and to submit nominations easily
  • The new "Takeaway Tip," which will replace the former "Lesson of the Week" and highlight opportunities and helpful reminders
  • More clinical details regarding the selected incidents
  • Links to more information regarding best practices, industry trends and policies and procedures when available

"I believe that the redesign will contribute to organizational learning to spread and sustain best practices that enhance patient safety," said Edward G. Seferian, MD, chief patient safety officer. "I hope that readers will find the report more engaging and interactive and something they look forward to receiving each week."

For more information, please email edward.seferian@cshs.org.

Patient Safety Survey Runs Through Sept. 17

Executive leadership at Cedars-Sinai is conducting a survey of staff members through Sept. 17 to identify and prioritize opportunities for improving patient safety.

Front-line staff members — including those in Admissions, Case Management, Clinical Operations, Clinical Care Services, faculty physicians and house staff — are strongly encouraged to participate in the nationally recognized Culture of Safety survey.

"Enhancing the culture of safety is fundamental to the mission of Cedars-Sinai to provide the highest quality and safest patient-centered care," said Edward Seferian, MD, chief patient safety officer. "Be a voice of patient safety by taking this survey: It allows us to hear directly from staff to identify best practices and continuously improve safety culture."

The survey will be available online and responses are confidential. The survey will feature questions such as:

  • Do front-line staff members 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?

Selected staff members will receive an email with the subject line "Cedars-Sinai Culture of Safety Survey."

Leadership will analyze survey results and drive dissemination of appropriate interventions, where needed, beginning 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.