sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY February 2015 | Archived Issues

Mark Your Calendar


Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

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Grand Rounds

Click here to view a schedule of all upcoming grand rounds.


Education Schedule

Click the PDF links below to see the Department of Surgery's education schedule.

Education Calendar - February 2015 (PDF)

Education Calendar - March 2015 (PDF)


Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

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Johnson, Team Publish Series on Image-Guided Surgery

J. Patrick Johnson, MD, and his team of experts on modern spinal technologies have published a series of six manuscripts on image-guided spinal surgery.

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Sinus Center's Achievements Include March 28 Symposium

The recent accomplishments of the Cedars-Sinai Sinus Center of Excellence include measuring surgical outcomes, outreach to physicians and patients, organizing a March 28 surgery symposium and participation in valuable studies.

» Read more

Cedars-Sinai Launches Inpatient Hospice Program

To help ensure that Cedars-Sinai patients who are experiencing acute symptoms at the end of life receive the best care possible, Cedars-Sinai has launched an inpatient hospice program, effective Feb. 10. The program is designed to provide comfort-oriented care in the hospital, after a patient enrolls in hospice, if they are having acute symptoms that cannot be managed adequately in a setting other than the hospital.

» Read more

How to Use Medication Orders in CS-Link

Nursing Communications Should Not Be Used for Medication Orders

Proper use of nursing communications in CS-Link™ continues to be a challenge. Although nursing communications are technically orders, they do not activate any downstream services, such as pharmacy, radiology, respiratory therapy or nutrition. It is imperative that nursing communications never be used for medication orders.

» Read more

New POLST Alert Appears in CS-Link

A new best-practice alert has been added to CS-Link™ regarding completion of Physician Orders for Life Sustaining Treatment forms for patients with Do Not Attempt Resuscitation orders.

» Read more

Recognition for Cossman, Gordon, Reich

Physician News

David Cossman, MD, delivered the keynote address at a gathering of Louisiana surgeons, Leo Gordon, MD, spoke before the Congress of the American College of Surgeons, and Heidi J. Reich, MD, has won a fellowship from the Thoracic Surgery Foundation for Research and Education.

» Read more

Circle of Friends Honorees for January

The Circle of Friends program honored 110 people in January. 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

Johnson, Team Publish Series on Image-Guided Surgery

J. Patrick Johnson, MD

J. Patrick Johnson, MD, and his team of experts on modern spinal technologies have published a series of six manuscripts on image-guided spinal surgery.

The authors include Terrence Kim, MD, Doniel Drazin, MD, and Faris Shweikeh, MD, among other Cedars-Sinai spine surgeons.

The articles were published in the Journal of Neurosurgery.

Image-guided technologies have made a major impact on this area of surgical advancement and have demonstrated safety, precision and reduced complications, particularly in complex spinal procedures. The papers have helped educate the public and other spine surgeons about how the technology is evolving.

Surgeons across the country use this transformative technology, which many expect to lay the foundation for computer-guided robotic surgery.

The articles:

Johnson is a neurosurgeon at the Cedars-Sinai Spine Center and director of the Neurosurgery Spine Fellowship program.

Sinus Center's Achievements Include March 28 Symposium

Martin L. Hopp, MD, PhD

The recent accomplishments of the Cedars-Sinai Sinus Center of Excellence include measuring surgical outcomes, outreach to physicians and patients, organizing a March 28 surgery symposium and participation in valuable studies.

The center's medical director is Martin L. Hopp, MD, PhD.

SNOT-22

The Sinus Center continually strives to deliver high-quality, patient-centered care by using quality measurement tools such as the Sino-Nasal Outcome Test (SNOT-22) and the Eustachian Tube Dysfunction Questionnaire. Patients are asked to complete a set of questions related to their illness before surgery and in three-, six- and 12-month intervals after surgery. According to the latest results, more than 88 percent of patients show improvement one year after surgery at the Sinus Center.

Physician Outreach Program

The Sinus Center hosts seven or eight continuing medical education conferences every year with lectures by world-renowned guest speakers, often physicians. Participants in these events include Sinus Center physicians, divisional physicians, allied healthcare professionals and operating room staff members. The Physician Outreach Program is designed to create a more consistent experience to help Sinus Center physicians and their staff members build and maintain collaborative interactions and open communication.

Patient Outreach Program

The Sinus Center hosted free monthly patient education forums last year. At each event, a Sinus Center physician discussed the latest diagnostic, treatment and management services for adult and pediatric patients, including balloon sinuplasty and other minimally invasive sinus procedures.

Sinus Symposium March 28

On Saturday, March 28, the Sinus Center will host the symposium "Sinus and Eustachian Tube Surgery: How I Do It." This continuing medical education program, which occurs every two years, is designed to inform participants about new developments in sinus surgery and other rapidly changing aspects of otolaryngological care. A group of national experts will present new findings that will be useful in physician practices.

Sleep Apnea Project

The Sinus Center is involved in a project helping patients who have had sleep apnea for years. Physicians implant a device known as the aura6000 system, which stimulates the hypoglossal nerve and muscles of the tongue, opening the upper airway during sleep. Using a remote control, patients can turn the device on and off and can recharge it wirelessly.

Elliot Study

The Sinus Center also is involved in the Elliot study, which is designed to determine if balloon dilatation of the eustachian tube, which connects the middle ear to the back of the throat, is as effective as medical therapy in the treatment of eustachian tube disorder (failure of the tube to open properly). This randomized clinical study will measure the safety and efficacy of the eustachian tube balloon catheter.

OASIS

The Global Sinus Surgery Registry is a multicenter, nonrandomized, prospective study designed to capture two-year data on the effectiveness and safety of endoscopic sinus surgery for chronic or recurrent acute sinusitis. Known as OASIS, this will be one of the largest prospective collections of clinical outcomes for sinus surgery. Enrollment is expected to be a combined 2,000 subjects, age 18 or older, at up to 75 investigational sites worldwide, including the Sinus Center. Participants will be followed for two years after their procedure, with an in-office follow-up visit within four weeks of surgery. The purposes of the registry include assessing the long-term safety and effectiveness outcomes of sinus surgery, determining if any collected preoperative patient characteristics are associated with postoperative outcomes, and serving as a repository of data for economic analyses.

Cedars-Sinai Launches Inpatient Hospice Program

To help ensure that Cedars-Sinai patients who are experiencing acute symptoms at the end of life receive the best care possible, Cedars-Sinai has launched an inpatient hospice program, effective Feb. 10. The program is designed to provide comfort-oriented care in the hospital, after a patient enrolls in hospice, if they are having acute symptoms that cannot be managed adequately in a setting other than the hospital.

Cedars-Sinai has contracted with Seasons Hospice, a leading national hospice organization, to collaborate in the delivery of care for these vulnerable patients. Patients who are enrolled in inpatient hospice will be cohorted to beds on 4 Southeast whenever possible, with the option of being cared for in any bed throughout the hospital (including in an intensive care unit) using a "scatterbed" approach if no beds are available on 4SE.

The patient's care plan will be established and managed closely on a daily basis by an interdisciplinary team consisting of the patient's hospice attending MD of record, Cedars-Sinai clinical providers and other physicians who have been involved in the patient's care, as well as an experienced hospice team from Seasons.

"Our goal is to take a person-centered, family-oriented approach to caring for patients with advanced illness who are acutely symptomatic so that we can provide them with world-class care while honoring their wishes and expertly managing their symptoms," said Bradley T. Rosen, MD, medical director of the Office of Care Transitions and Complex Medical Management. "Patients who qualify for inpatient hospice will receive aggressive pain and symptom management, while their loved ones benefit from emotional, spiritual and psychological support by members of the hospice team.

"In addition, Medicare requires 13 months of bereavement support for the family and loved ones of patients who die on hospice," Rosen said. "This kind of support can make the difference between loved ones being able to work through the necessary grieving process versus suffering from debilitating, complex grief."

Inpatient hospice provides an additional layer of support for hospice patients and families who are experiencing acute symptoms associated with advanced illness, said Rishi Gupta, MD, medical director of the inpatient hospice program.

"The inpatient hospice team will work closely with the patient's physicians and nursing staff to ensure that care is personalized to achieve comfort in a manner that reflects each patient's values and goals," Gupta said.

If a patient's acute pain or symptoms are brought under control and the patient is clinically stable, the team will work with the patient and family to seamlessly transition the patient to another care setting out of the hospital, still with hospice care. The Seasons clinical nurse liaison and social worker will work closely with the Cedars-Sinai team to coordinate discharge planning, and the Seasons staff will continue to care for the patient and family after discharge.

To request an inpatient hospice evaluation, a physician or nurse practitioner can place an order in CS-Link™. If a physician would like assistance to assess whether a patient will qualify for inpatient hospice or to manage complex symptoms, the Supportive Care Medicine team is available to assist 24/7 via CS-Link order or at 310-423-9520.

For more information about the inpatient hospice program, please contact Gupta at rishi.gupta@cshs.org, cell/text 310-926-4930, or Rosen at rosenb@cshs.org, cell/text 310-948-7930.

How to Use Medication Orders in CS-Link

Nursing Communications Should Not Be Used for Medication Orders

Proper use of nursing communications in CS-Link™ continues to be a challenge. Although nursing communications are technically orders, they do not activate any downstream services, such as pharmacy, radiology, respiratory therapy or nutrition. The nurse must then call the physician to obtain a proper order, which delays patient care.

In the case of medication orders, this creates a potentially significant patient safety risk. Therefore, it is imperative that nursing communications never be used for medication orders.

Here are some tips to ensure that a proper, actionable medication order is entered:

  • Help order: Type "help" in Order Entry to bring up such options as "Help (unable to find medication)" for nonformulary medications, investigational medication, patient's pump orders, request pharmacy to dose or request pharmacy to renally adjust a medication.
  • Hold order: In Order Entry, type "hold" and multiple options are available. "Hold medication with parameters" is a particularly useful option. Another is "Hold IVF during blood transfusion."
  • Modify or discontinue an existing order: The Manage Orders tab will bring up all active orders, including medications. Click "Modify" or "Discontinue" next to the order.
  • As a last resort, there is an option for a Pharmacy Communication Order, which can be found by typing "pharmacy" in Order Entry. Select "Nursing and/or Pharmacy Communication," then the button for "Pharmacy Communication."

To see illustrations of these tips, click here. Because the linked PDF is behind the Cedars-Sinai firewall, it is available only on Cedars-Sinai computers.

New POLST Alert Appears in CS-Link

A new best-practice alert has been added to CS-Link™ regarding completion of Physician Orders for Life Sustaining Treatment (POLST) forms for patients with Do Not Attempt Resuscitation (DNAR) orders.

When a physician places a DNAR order, a Best Practice Advisory will display indicating that a POLST should be completed for the patient. Once the form is completed, the physician can acknowledge the action, suppressing the alert. However, if the DNAR patient does not have a completed POLST in the system upon discharge, the Best Practice Advisory will display, indicating that POLST should be completed for the patient prior to discharge.

This improvement will streamline recording and communication regarding a physician's DNAR order in the out-of-hospital setting, ensuring that patients' end-of-life wishes outlined in the POLST are honored. The change took effect Feb. 10.

The POLST form is a physician's order that outlines a plan of care reflecting the patient's preferences concerning care at the end of life and the physician's clinical judgment based on a thorough medical evaluation of the patient's condition. The POLST provides default orders in the event a patient becomes seriously ill, and it contains information about the use of CPR, preferred scope of medical interventions and use of artificially administered nutrition.

In emergencies, the orders contained on a POLST form are to be used to direct medical care until further orders can be decided upon and written. The POLST helps patients and their healthcare professionals to discuss and develop plans that reflect patients' preferences concerning end-of-life care, and it conveys those plans to other healthcare professionals, facilities and emergency personnel.

The POLST form is an effective instrument to prevent unwarranted treatments and helps ensure that medically indicated treatments desired by the patient are provided.

To see an illustration of the new advisory, click here. Because the linked PDF is behind the Cedars-Sinai firewall, it is available only on Cedars-Sinai computers.

Recognition for Cossman, Gordon, Reich

Physician News

Cossman Delivers Keynote Address to at Louisiana Surgeons Meeting

David Cossman, MD, of the Cedars-Sinai Division of Vascular Surgery delivered the keynote address to a combined meeting of the Louisiana Chapter of the American College of Surgeons and the Louisiana Surgical Society in New Orleans on Jan. 17.

Cossman discussed the impact of the Affordable Care Act on the private practice of surgery. He analyzed the influence of regulation, declining reimbursement in the face of surgical progress and the social changes that have remolded surgical practice and education. He presented alternative practice options as a vehicle for maintaining a professionally satisfying surgical practice.

The role of national societies — their failures and successes — was discussed in the context of their contributions to private surgical practice.

Cossman is director of Vascular Trauma and medical director of the Vascular Laboratory.

Gordon Presents to Medical Student Section of American College of Surgeons

Speaking at the Congress of the American College of Surgeons, Leo Gordon, MD, outlined the importance of incorporating elements of medical history into the surgical curriculum.

The presentation before more than 400 surgery-bound medical students took place last October in San Francisco. Gordon, an attending surgeon at Cedars-Sinai, shared the podium with Justin Barr, PhD, a medical student from the University of Virginia with a doctorate in medical history.

Barr presented three seminal discoveries in surgery, all made by medical students. Gordon followed up with three dates that surgical students should know — the date in 1822 that Army surgeon William Beaumont cared for Alexis St. Martin's abdominal gunshot wound, the date in 1846 of the first demonstration of the use of general anesthesia, and the date in 1909 that the Nobel Prize in Physiology or Medicine was first awarded to a surgeon, Emil Theodor Kocher, MD.

A discussion of the role of surgical history in educational curriculum followed. Gordon and Barr explained their Web-based repository of seminal papers in clinical surgery. The goal is to have these articles readily available for residents during their surgical education.

Reich Wins Fellowship From Thoracic Surgery Foundation

Heidi J. Reich, MD, a surgical resident at Cedars-Sinai, has won the 2015 Braunwald Fellowship from the Thoracic Surgery Foundation for Research and Education (TSFRE), in recognition of her basic science research conducted in the Cedars-Sinai Heart Institute with her mentor, Eduardo Marbán, MD, PhD.

The $30,000 grant supports Reich's project titled "Repeat Dosing of Allogenic Cardiosphere-Derived Cells After Myocardial Infarction in Immunocompetent Rats."

The fellowship is named for Nina Starr Braunwald, MD, the first woman to be certified by the American Board of Thoracic Surgery. In 1960, at age 32, she led the surgical team that was the first to implant a prosthetic heart valve, which she also designed and fabricated. The TSFRE Braunwald Fellowship supports the clinical or basic science research efforts of women cardiac surgical trainees.

Circle of Friends Honorees for January

The Circle of Friends program honored 110 people in January.

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.

  • Shirley B. Abatay, RN
  • Melinda A. Adams, BSN, RN, RN-C
  • Michael J. Alexander, MD
  • Teresita G. Almario
  • Farin Amersi, MD
  • Justin Andersen, RN
  • Ellen Anifantis, LCSW
  • Arash Asher, MD
  • Caden Austin, RN
  • Loreta Ayvazyan, BSN, RN, CCRN
  • Tessie M. Baltazar
  • Lorelei W. Bangate, CHAA
  • Donnabel Bartolo-Wilson, CHAA
  • Kaylan A. Basacker, RCIS
  • Rochelle L. Berkowitz, RN
  • Mary Grace Brandon, RN, ACNP-BC
  • Philip G. Brooks, MD
  • Jolly Ann A. Cabili Tagab, RN
  • Ilana Cass, MD
  • Irma C. Chan
  • David H. Chang, MD
  • Kirk Y. Chang, MD
  • J. Louis Cohen, MD
  • Stephen R. Corday, MD
  • Lawrence S. Czer, MD
  • Robert M. Davidson, MD
  • Ryan DellaMaggiora, MD
  • Rusela M. Desilva, BSN, RN, CAPA
  • Roselyn G. Dorado, RN
  • Marylou Ehret, MSN, RN
  • Fardad Esmailian, MD
  • Claudia Espinoza, LVN
  • Richard Essner, MD
  • Stephanie Farrant, BSN, RN
  • Dael Geft, MD
  • David H. Geller, MD, PhD
  • Alexander Gershman, MD
  • Steven B. Graff-Radford, DDS
  • Abe Green, MD
  • Jennifer Hajj, RN
  • Behrooz Hakimian, MD
  • Michele A. Hamilton, MD
  • Emily A. Hendry
  • Roy S. Hernandez
  • Shaynan Hill, PharmD
  • Kevin M. Hsu, MD
  • Jethro L. Hu, MD
  • Leonel A. Hunt, MD
  • Patricia A. Jenkins, RN
  • Amy M. Jones, RN
  • Stanley C. Jordan, MD
  • Kiana Kahanamoku-Llanes
  • Saibal Kar, MD
  • Robert F. Katz, MD
  • David Kawashiri, MD
  • Ilan Kedan, MD, MPH
  • Michelle M. Kittleson, MD, PhD
  • Robert Klapper, MD
  • Jon A. Kobashigawa, MD
  • Evan B. Koursh, MD
  • Mariam Kyababchyan, RN
  • Naileen R. Lal, RN
  • John M. Larsen, BSN, RN
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Fataneh Majlessipour, MD
  • Sharareh Malekzadeh, RN
  • William J. Mandel, MD
  • Ariadna Martinez
  • Ruchi Mathur, MD
  • Paula McAllister, MD
  • Karla L. Melendez
  • Erin Meschter, MD
  • Jessica Minnich, BSN, RN, CHFN
  • Alain Mita, MD
  • Joel D. Mittleman, MD
  • Mark S. Noah, MD
  • Byung O. Noh, RN
  • Jignesh K. Patel, MD, PhD
  • Lauren J. Pellegrini, RN
  • Denise A. Piastrelli, BSN, RN
  • John F. Reinisch, MD
  • Barry E. Rosenbloom, MD
  • Fred P. Rosenfelt, MD
  • Jason A. Rothbart, MD
  • Jay S. Rudin, MD
  • Paul A. Rudnick, MD
  • Wendy Sabbah, BSN, RN, OCN
  • Howard M. Sandler, MD, MS
  • Eunice S. Santos, BSN, RN, PCCN
  • Ma Teresa L. Santos, BSN, RN, PCCN
  • Eunice A. Saul, RN
  • Jennifer Scanlan, BN, RN, OCN
  • Jay N. Schapira, MD
  • Laurence Seigler, MD
  • Liliana Sloninsky, MD
  • Nicole Smith, RN
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Jay J. Stein, MD
  • Sari Steinberg, LCSW
  • Emily Stimpson
  • Daniel J. Stone, MD, MPH, MBA
  • Conrad J. Tseng, MD
  • Ronald G. Victor, MD
  • Irina Vinogradova, BSN, RN, PHN
  • Frederick J. Walker, RN
  • Amy S. Weinberg, MD
  • Edward M. Wolin, MD
  • Phillip C. Zakowski, MD
  • Veronica Zoleta, RN