Cedars-Sinai Medical Center

medical staff pulse newsletter

Text size: A A A
A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF June 15, 2018 | Archived Issues

Letter From Chief of Staff: New Opioid Protocol

Due to a critical nationwide shortage of injectable opioids, Cedars-Sinai will implement the following protocol immediately: Pharmacists will automatically substitute PRN orders for IV Dilaudid and IV morphine with PO oxycodone, if a patient tolerates oral medications.

» Read more

Organizational Changes and Staff Reductions

By Thomas M. Priselac, President and CEO

Thanks to the quality of care provided throughout the organization, our patient volumes remain high. At the same time, the costs to operate a world-class health system—one that offers education, research and community benefit programs—are rising faster than the rate of payments we receive for our services.

» Read more

Letter From Chief of Staff: End of Life Option Act

As you may have heard, California’s End of Life Option Act (EOLOA) was recently deemed invalid by a California court. Although we anticipate further court proceedings challenging this action, at this time Cedars-Sinai is halting its participation in the EOLOA, including any Cedars-Sinai-based EOLOA consultations, orders and prescriptions.

» Read more

Physician Review Sites May Mislead, Study Finds

Physician satisfaction scores on online third-party review sites tend to be skewed and can easily mislead patients, according to a new study by Cedars-Sinai investigators. This distortion may have significant consequences as consumers rely increasingly on these scores when choosing a physician. Research shows that patients largely trust these ratings as the sole source of information when choosing a physician.

» Read more

Teams Ready to Treat Highly Infectious Diseases

As Africa grapples with another Ebola outbreak, the Emergency Department and the Special Pathogens Response Team are ramping up efforts to identify, diagnose and treat patients with highly infectious diseases. 

» Read more

Ahn and Neeman Win 2018 Rubenstein Award

Improving healthcare for patients with liver disease and cancer were the goals of the two studies that won this year's Rubenstein Award for Excellence in Resident Research. Joseph Ahn, MD, and Elad Neeman, MD, received their awards and $3,000 prizes on May 30 in Harvey Morse Auditorium. The annual event featured oral presentations by the four finalists.

» Read more

Researcher Joins Women’s Basketball Hall of Fame

Lisa Thomas, a Cedars-Sinai laboratory investigator of inflammatory bowel disorders and immunobiology, was recently inducted into the Women’s Basketball Hall of Fame. As a collegiate player, the researcher set a school record by scoring 42 points and grabbing 36 rebounds in a single game.

» Read more

My CS-Link Now Integrated With Apple Health

Patients with My CS-Link™ accounts now can access key parts of their health records on their iPhones using the Apple Health app. By syncing accounts from participating healthcare organizations, the Health app feature gives patients the ability to view data from multiple providers at once, presented in seven categories: allergies, clinical vitals, conditions, immunizations, lab results, medications and procedures.

» Read more

CDC Warns About Synthetic Cannabinoids

The Centers for Disease Control and Prevention has issued a warning about synthetic cannabinoid products, which have been linked to severe unexplained bleeding in more than 200 people in nine states.

» Read more

Summer Is Coming, and So Are Fireworks

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the Hollywood Bowl Orchestra and special musical guest, The Go-Go’s. The event on Tuesday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $140 per adult and $70 per child, 3-11 years of age.

» Read more

Annual Sand N’ Snore Set for Sept. 7

Sand N' Snore is just around the corner. The dinner, sleepover and breakfast are slated to begin Friday, Sept. 7, at the Jonathan Beach Club in Santa Monica. To reserve a place, contact Cheryl Verne at 310-423-2681 or cheryl.verne@cshs.org.

» Read more

Gordon To Give Talk on Parathyroid Glands June 18

The Cedars-Sinai Alumni Association, Emeritus Society,and medical staff welcome Leo Gordon, MD, who will discuss the discovery of the parathyroid glands in a talk entitled “We’ll Always Have Paras! Frolics and Diversions of Four Small Glands." The event will take place Monday, June 18, at 6:30 p.m. in Harvey Morse Auditorium.

» Read more

CS-Link Tip: Shielding Your Cell Number

You can enjoy the convenience of calling a patient on your cellphone, but still keep your personal number private. With the help of Epic Haiku and Doximity Dialer, you can talk to a patient on your cellphone and the number they will see will be your office number.

» Read more

Letter From Chief of Staff: New Opioid Protocol

Due to a critical nationwide shortage of injectable opioids, Cedars-Sinai will implement the following protocol immediately: Pharmacists will automatically substitute PRN orders for IV Dilaudid and IV morphine with PO oxycodone, if a patient tolerates oral medications.

In addition, we need your cooperation to adhere to the following best practices:

  • Order oral opioids (and benzodiazepines) as soon as patients can tolerate them (please see PDF conversion table for reference)
  • Consider multimodal analgesia (e.g., oral acetaminophen, celecoxib, meloxicam, ketorolac), and/or topical products such as lidocaine patch and capsaicin
  • As always, the pain management service is available for consultation and support

We are actively trying to obtain additional IV opioids from manufacturers and distributors, and working through our legislative channels.

If you have any questions or concerns, please contact: 

Rita Shane, PharmD, at Rita.Shane@cshs.org or at 310-423-5611, or Hai Tran, PharmD, at Hai.Tran@cshs.org or at 310-423-5630.

Clement C. Yang, MD
Chief of Staff

Opioid Conversion Table (PDF)  

Organizational Changes and Staff Reductions

By Thomas M. Priselac, President and CEO

Thomas M. Priselac

Cedars-Sinai has a long and proud tradition of striving to meet our community’s need for outstanding healthcare that is accessible, affordable and high-quality. We remain committed to these principles as we face growing pressures in the healthcare environment around us.

Thanks to the quality of care provided throughout the organization, our patient volumes remain high. At the same time, the costs to operate a world-class health system—one that offers education, research and community benefit programs—are rising faster than the rate of payments we receive for our services.

As I mentioned in the recent President’s Perspective, we need to respond strategically to these pressures to remain financially viable while upholding our mission. This means reducing our operating costs in ways that allow us to continue providing the excellent care for which we are known while simultaneously investing in our growth.

Recognizing these challenges, and continuously working to confront them successfully, has become part of our ongoing journey. To maintain our commitment to exceptional patient care and to prepare for the future, we are re-examining the way we operate across the institution to become more efficient clinically and operationally.

With this in mind, some team members’ job responsibilities are changing. And regrettably, the positions of approximately 175 individuals are being eliminated in areas across the organization; as we have done previously, every effort is being made to find alternative placements for affected staff. In making these decisions, we took a comprehensive look at workflows and work processes to determine how we can be more efficient while continuing to provide the highest-quality patient care.

We know these changes can be difficult and disruptive, most of all for the people involved. We are taking steps to reduce the impact and will continue to treat affected staff in a manner that aligns with our values. We are committed, as always, to finding the best solutions for our employees and to providing the resources needed to make smooth transitions, whether the next opportunities lie within Cedars-Sinai or elsewhere. We value our employees and strive to treat them with dignity and respect. I want to thank all those affected by these changes for your service and dedication to Cedars-Sinai.

The economic landscape in healthcare continues to evolve, and Cedars-Sinai is not immune to changing market forces. These challenges require us to make difficult decisions that will enable Cedars-Sinai to continue serving the community and the nation. Thank you for your continued efforts and commitment, which will help ensure a vibrant future for the organization and, most important, for those we serve.

Letter From Chief of Staff: End of Life Option Act

Dear Medical Staff,

As you may have heard, California’s End of Life Option Act (EOLOA) was recently deemed invalid by a California court.

Although we anticipate further court proceedings challenging this action, at this time Cedars-Sinai is halting its participation in the EOLOA, including any Cedars-Sinai-based EOLOA consultations, orders and prescriptions.

We will update you as we receive clarification about the validity of this law. In the meantime, please contact the Center for Healthcare Ethics at 310-423-9636 if you have any questions about Cedars-Sinai patients who have already initiated this process or terminally ill patients who are asking about eligibility for aid-in-dying drugs.

Clement C. Yang, MD
Chief of Staff

Physician Review Sites May Mislead, Study Finds

Physician satisfaction scores on online third-party review sites tend to be skewed and can easily mislead patients, according to a new study by Cedars-Sinai investigators.

This distortion may have significant consequences as consumers rely increasingly on these scores when choosing a physician. Research shows that patients largely trust these ratings as the sole source of information when choosing a physician.

"Patients put so much trust into ratings, and the stakes are much higher than simply choosing a restaurant," said lead author Timothy J. Daskivich, MD, MSHPM, assistant professor and director of Health Services Research in the Department of Surgery. "It's important to interpret this data correctly because selecting the right physician can have a serious impact on health and wellbeing."

Daskivich and his co-authors pulled reviews from October 2014 to March 2017 on Healthgrades, a consumer ratings website that ranks medical providers from 1-5 stars. The investigators linked this data to providers listed in the U.S. Centers for Medicare & Medicaid Services' Physician Compare tool. They narrowed the field to 212,933 providers, who had at least four reviews evaluating overall patient satisfaction. They grouped the providers by medical, surgical and allied health specialties, and performed a statistical analysis to examine the distribution of the providers' average satisfaction scores.

The study, published in the Journal of Medical Internet Research, found that overall satisfaction ratings consistently skewed positively, fell within narrow ranges and had different distributions across specialties. As a result, scores that appear high might actually be comparatively average or low, effectively misleading patients. For example, if 90 percent of physicians in a particular specialty are rated higher than four stars, patients could be misled into thinking the physician they select is at the top of their field.

Providers' satisfaction ratings also differed significantly by specialty group. Median scores for allied health providers (physical therapists, optometrists) were much higher than those of physicians in medical and surgical specialties.

Some of the differences in rankings between specialties might be related to the nature of the work. That may explain why psychiatrists, who field emotional trauma, get lower ratings than chiropractors, who provide physical relief and lots of one-on-one interaction, Daskivich said. But he and his co-authors think review sites should flag such statistical quirks and caveats.

The study comes at a time when consumers increasingly are turning to third-party websites to post reviews of physicians and comments about a wide variety of healthcare services and experiences. Although there has been a proliferation of these third-party sites (including Healthgrades, Zocdoc and Yelp), they often present information based on a small number of reviews and incomplete or unverified information. As a result, many health systems (such as Stanford, Cleveland Clinic and University of Utah) have begun posting more complete ratings and comments from their own outpatient satisfaction surveys.

These hospital-driven tools measure satisfaction with providers for attributes such as communication, friendliness and time spent with patients. The tools do not measure healthcare quality. Healthcare providers are giving consumers access to this information to offer greater transparency and visibility into feedback from real patients.

The authors of the ratings study suggest that third-party online review sites can do better by posting median star ratings for each medical provider and noting where they rank among peers in their specialty. The investigators also note in the study that they created an online tool, Compare My Doc, which uses a provider's specialty and online rating to show how that provider compares to their colleagues.

"Scores from third-party sites aren't going away," said senior author Brennan Spiegel, MD, professor of Medicine and director of Health Services Research. "These sites have a responsibility to tell consumers that these reviews can be skewed and to provide more guidance around interpreting them."

Teams Ready to Treat Highly Infectious Diseases

As Africa grapples with another Ebola outbreak, the Emergency Department and the Special Pathogens Response Team are ramping up efforts to identify, diagnose and treat patients with highly infectious diseases.

"The current outbreak in the Democratic Republic of Congo is a great reminder for all healthcare workers that they should always ask about a patient’s travel history," said Jonathan Grein, MD, medical director, Department of Hospital Epidemiology, and infection control officer. "As an academic medical center in a big city, we need to track global outbreaks of Ebola or newly emerging viruses like Middle East Respiratory Syndrome (MERS). These seemingly exotic diseases are only a plane ride away."

Triage staff plays a vital role in helping Cedars-Sinai safely treat highly infectious diseases by gathering initial symptoms from patients who walk into the Emergency Department. When a patient is suffering from symptoms of an infection, triage staff will ask for a travel history. If any high-risk destinations are flagged, such as the Arabian Peninsula where MERS cases remains active, clinicians will immediately isolate that patient and wear masks during treatment.

"If a patient comes in and says, 'I just came from Saudi Arabia, and I’ve got a fever and a headache,' that’s easy," said Sam Torbati, MD, co-chair of the Emergency Department. "The hard part is when a patient says they have a fever and a headache, and you have no way to know where they’ve been and no reason to assume until you ask."

Torbati and his colleagues are evaluating new tools to help triage staff stay up-to-date on emerging pathogens. They are also exploring new features in the electronic health record system that would flag a travel history request for certain patients.

If it appeared that a patient was suffering from a deadly highly infectious disease, the Special Pathogens Response Team would spring into action. This group of volunteer clinicians, lab scientists and waste transporters is prepared to accept a patient from anywhere in the nation—or even an American abroad—with only eight hours notice. Preparedness includes prepping critical care unit rooms, evaluating possible experimental therapy and retraining staff in safety protocols for protective gear.

"We’re much better prepared than we were three or four years ago during the last Ebola outbreak because of all work that’s gone into building this program," Grein said.

To join the Special Pathogens Response Team, contact Jennifer Garland at Jennifer.Garland@cshs.org.

Ahn and Neeman Win 2018 Rubenstein Award

Rubenstein Award winners Joseph Ahn, MD, (left) and Elad Neeman, MD.

Improving healthcare for patients with liver disease and cancer were the goals of the two studies that won this year's Rubenstein Award for Excellence in Resident Research. Joseph Ahn, MD, and Elad Neeman, MD, received their awards and $3,000 prizes on May 30 in Harvey Morse Auditorium. The annual event featured oral presentations by the four finalists.

Ahn's study found that obesity places patients with extensive liver scarring, known as decompensated cirrhosis, at higher risk for developing severe liver dysfunction, which rapidly can lead to multi-organ failure. About 30 percent of patients hospitalized with decompensated cirrhosis develop this severe dysfunction, known as acute-on-chronic liver failure (ACLF).

The findings were based on analyzing data from a nationwide database of 387,884 individuals with decompensated cirrhosis who were waiting for liver transplants. ACLF was found to be significantly more prevalent among the severely obese patients—those with a body mass index of 40 or higher. Another condition, known as ACLF-related renal failure, was more prevalent among obese patients at all levels of severity.

"We concluded that class III obesity is a newly identified risk factor for ACLF development in patients with decompensated cirrhosis, which highlights the importance of weight management to reduce the risk of ACLF," Ahn said. "Patients with class III obesity also should be closely monitored for renal failure."

The multicenter study was published online in April in the Journal of Hepatology. Ahn was a co-author. The principal investigator and first author was his mentor, Vinay Sundaram, MD, director of Hepatology Outcomes Research and assistant medical director of Liver Transplantation.

Neeman's research examined how well physicians' and nurses' scorings of the daily living activities of patients with various malignant solid tumors predicted disease progression and treatment outcomes. The scores were based on the Eastern Cooperative Oncology Group Performance Status standardized criteria, which quantify cancer's impact on a patient’s functioning, such as walking and working, and help inform treatment and prognosis.

Thirty-two oncologists and 41 chemotherapy nurses at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute independently scored the performance status of 311 cancer patients receiving outpatient chemotherapy.

Neeman and his team found that the nurses' scores of the patients' abilities were stronger predictors of important outcomes, such as hospitalizations, mortality and severe side effects from chemotherapy, than were the doctors' scores. They also found that significant differences in a physician's and a nurse's scores for the same patient were predictive of a poor prognosis. The findings could help improve patient care, Neeman said.

"Having nurses evaluate patients' performance status may offer a simple, inexpensive, and easy-to-implement intervention to improve quality of care and better direct medical decision-making in the care of cancer patients," he said.

Neeman was the study's first author. His mentor was Arvind Shinde, MD.

The two other award finalists were: Amir Hadi Maghzi, MD, presenting "Impact of Multiple Sclerosis-Associated TNF-α Receptor Polymorphism on Clinical Characteristics and Serological Biomarkers of IBD Patients"; and Devin Patel, MD, presenting "Early Urinary Catheter Removal Following Pelvic Colorectal Surgery: A Prospective Randomized, Non-Inferiority Trial."

Named for Paul Rubenstein, MD, Cedars-Sinai's first director of medical education, the annual award recognizes outstanding research by residents. It is sponsored by the Burns and Allen Research Institute and the Clinical and Translational Science Institute at Cedars-Sinai.

The IRB numbers for human subjects in research referenced in this article are 41679 and 51972.

Researcher Joins Women’s Basketball Hall of Fame

Lisa Thomas, a laboratory investigator of inflammatory bowel disorders and immunobiology, was inducted into the Women’s Basketball Hall of Fame on June 9.

Lisa Thomas thought her basketball days were over.

For 19 years, the Cedars-Sinai laboratory investigator of inflammatory bowel disorders and immunobiology concentrated on studying the human microbiome—the ecosystem of microorganisms, bacteria, fungi and viruses that naturally lives within the human gut. Her glory days as a forward and center for collegiate and professional teams were behind her.

And then she got a phone call that returned her to the hardwood courts of her youth. On June 9, Thomas was one of 96 players from the now-defunct Women’s Professional Basketball League to be inducted as "Trailblazers" into the Women’s Basketball Hall of Fame.

"It's a dream come true," Thomas said. "It’s an incredible feeling to be recognized as Trailblazers and to know that we haven’t been forgotten."

In 1975, after Thomas played the forward and center positions for her high school basketball team, she earned a full scholarship to the University of Illinois at Chicago, where she excelled in basketball and tennis. Her collegiate basketball career resulted in several scoring and rebounding records.

"Most of my records have been broken by the women players who came after me," said Thomas, who stands at 6'3". "The most points I scored were 42 points in a game and 36 rebounds in a game, which were both records."

After graduating college with a bachelor’s degree in biology, Thomas was the seventh pick in the draft for the Women’s Professional Basketball League and played for two years with the Chicago Hustle.

When the league folded, Thomas taught tennis for a while and eventually decided to go back to school to brush up on her science knowledge and prepare for a career change.

"I always was into science," Thomas said. "After my basketball career, I still had a love for science and decided this is what I wanted to do."

Basketball’s loss was science’s gain, said Stephan Targan, MD, who runs the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute at Cedars-Sinai, where Thomas works.

"Science is a team sport just like basketball, and we are fortunate to have Lisa on our side now," Targan said. "It takes a team to advance our understanding of diseases and create new treatments for patients."

Thomas took a break from the lab to attend the induction in Knoxville, Tennessee, and catch up with her teammates—some of whom she hadn’t seen in more than 30 years.

Thomas is happy that today’s U.S. women’s professional basketball league, the Women’s National Basketball Association (WNBA), is succeeding and that there is a fan base for the sport that didn’t exist when she was playing.

"We weren’t paid a lot," she said. "We just played because we loved the game."

She tries to convey that message to every girl she meets.

"I always encourage young girls to start playing sports. It gives you confidence," she said. "It gives girls a very positive body image, and you learn how to make decisions and trust yourself. Sports is always a great life lesson. You can translate what you learn in sports to life."

My CS-Link Now Integrated With Apple Health

Patients with My CS-Link™ accounts now can access key parts of their health records on their iPhones using the Apple Health app.

By syncing accounts from participating healthcare organizations, the Health app offers patients a single touchpoint through which they can access data from multiple providers, presented in a timeline view and in seven categories: allergies, clinical vitals, conditions, immunizations, lab results, medications and procedures.

"Putting the patient at the center of their care by enabling them to direct and control their own health records has been our focus for some time," said Darren Dworkin, senior vice president and chief information officer. "Using the Health app, patients will be able to access historical and current data from a variety of providers in one place, reducing administrative friction and making it easier to make informed care decisions."

The integration also makes it easier for patients to keep track of their health records while moving cities or changing local care providers.

For Cedars-Sinai patients, the feature is a valuable companion to My CS-Link: The Health app presents a high-level view of data across providers while My CS-Link focuses on the Cedars-Sinai care experience, providing features such as physician office texting and appointment scheduling.

Cedars-Sinai was one of 10 organizations to offer Health app support during initial beta testing that ended with the March update to the iPhone operating system. Hundreds of healthcare organizations have since supported the Health app, with the number continuing to grow.

To set up your Cedars-Sinai health records:

  • Go to the Health Data section of the Health app and select Health Records.
  • Dismiss the “Beta” screen if it appears.
  • Select Add Account and find Cedars-Sinai by scrolling through the list of providers or using the search bar.
  • Log in with your existing My CS-Link ID™ and password.

After you log in once, your health records will start to appear in the Health app, and you will be notified when new records are ready to view. Health record data is kept secure because it is encrypted and protected by your iPhone passcode.

The Health Records feature is available to patients with an iPhone running iOS 11.3 or later.

Learn how to check your iPhone’s iOS version.

CDC Warns About Synthetic Cannabinoids

The Centers for Disease Control and Prevention (CDC) has issued a warning about synthetic cannabinoid products, which have been linked to severe unexplained bleeding in more than 200 people in nine states.

Some of the synthetic cannabinoid products tested positive for brodifacoum, a highly lethal vitamin K antagonist anticoagulant used in commercial products for killing rodents and other pests.

Five patients have died, while others have exhibited symptoms of coagulopathy (bruising, nosebleeds, excessively heavy menstrual bleeding, hemoptysis, hematuria, flank pain, abdominal pain, etc.).

The CDC website has more information.

Summer Is Coming, and So Are Fireworks

The Hollywood Bowl

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the Hollywood Bowl Orchestra and special musical guest,  The Go-Go’s.

The event on Tuesday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $140 per adult and $70 per child, 3-11 years of age.

Parking passes also are available. Valet is $55, lower terrace is $23.

To reserve a place, contact Cheryl Verne at 310-423-2681 or cheryl.verne@cshs.org.

Annual Sand N’ Snore Set for Sept. 7

Campfires on the beach are part of the annual Sand 'N' Snore.

Sand N' Snore is just around the corner.

The dinner, sleepover and breakfast are slated to begin Friday, Sept. 7, at the Jonathan Beach Club in Santa Monica. (The club has restrooms and hot showers.) Those who don't want to sleep on the sand are welcome to enjoy dinner and the evening with colleagues and their families. Food and entertainment are provided, but physicians must bring their own tent and equipment.

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 at 310-423-2681 or cheryl.verne@cshs.org.

Gordon To Give Talk on Parathyroid Glands June 18

The Cedars-Sinai Alumni Association, Emeritus Society and medical staff welcome Leo Gordon, MD, who will discuss the discovery of the parathyroid glands in a talk entitled “We’ll Always Have Paras! Frolics and Diversions of Four Small Glands.”

The event will take place Monday, June 18, at 6:30 p.m. in Harvey Morse Auditorium.

Light refreshments will be available. Admission is $5 for medical staff members, employees and volunteers, and $10 for the general public.

RSVP to Ellen.Eichenberger@cshs.org.

CS-Link Tip: Shielding Your Cell Number

You can enjoy the convenience of calling a patient on your cellphone, but still keep your personal number private. With the help of Epic Haiku and Doximity Dialer, you can talk to a patient on your cellphone and the number they will see will be your office number.

Configuring Epic Haiku and Doximity Dialer

For iPhones:

  1. Install and login to Doximity Dialer
  2. Install and login to Epic Haiku
  3. Tap on the main Settings icon on your iPhone
  4. Scroll down and tap on Haiku settings
  5. Scroll down and select “Doximity Dialer” under “Place Calls Using”
  6. Open a patient's chart on Haiku
  7. Tap on the patient's phone number and Doximity Dialer will launch

For an Android device:

  1. Install and login to Doximity Dialer
  2. Install and login to Epic Haiku
  3. Open a patient's chart on Haiku
  4. Tap on the patient's phone number and select Doximity Dialer to place the call

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