Cedars-Sinai

Medical Staff Pulse Newsletter

COVID-19: Updates for Staff and Physicians

Cedars-Sinai continues to monitor the outbreak of COVID-19 (coronavirus) to protect the health and safety of our staff, physicians, patients, visitors, volunteers and community. We are prepared to respond and have put all appropriate healthcare protocols and isolation precautions in place. Here you will find timely, helpful information and resources on COVID-19. 

» Read more

LA Marathon Street Closures on March 8

The Los Angeles Marathon will be held Sunday, March 8, and could affect commutes to Cedars-Sinai. Physicians headed to the medical center that morning are advised to arrive before 5 a.m., when most of the road closures near Cedars-Sinai will begin. Most roads close to the medical center should reopen by early afternoon.

» Read more

Agency Awards Five-Star Rating to Cedars-Sinai

Cedars-Sinai Medical Center has earned a five-star hospital rating from the Centers for Medicare and Medicaid Services for the third year in a row—the highest distinction offered by the federal agency. Of the 3,600 U.S. hospitals rated, only about 11% earned five stars, and only about 3% of all hospitals rated earned five stars for the past three years.

» Read more

Honor a Deserving Nurse for Caring Award

Online nominations for the 2018 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are open through Monday, March 9. Only members of the medical staff may submit a nomination for this award, which recognizes nurses who exemplify professionalism, clinical excellence and caring. 

» Read more

Purim and Reading of the Megillah March 9-10

Cedars-Sinai will host services to celebrate Purim on Monday, March 9, and Tuesday, March 10. The services will include the reading of the Megillah and will be broadcast live for those unable to join in person in the chapel.

» Read more

Protect Your Patients by Checking Two Forms of ID

Proper patient identification remains a top priority at Cedars-Sinai, as well as a National Patient Safety Goal designated by The Joint Commission. To ensure patient safety and reduce adverse events and near misses, employees are encouraged to "Check Two Before You Do."

» Read more

Isolation Masks—Guidance for Use

Hospitals across the country are experiencing a spike in the use of isolation masks amid heightened public concern over coronavirus. We are seeing a similar dramatic increase in mask use at Cedars-Sinai. To ensure that we maintain adequate supplies of masks for our patients, visitors and staff, please follow guidance in this Q&A.

» Read more

More Doctors in the Valley for Staff

Vivity HMO, an insurance option created by Anthem, Cedars-Sinai and six top-rated health systems in Southern California, is now being offered to residents in the San Fernando Valley seeking specialty care.

» Read more

Changes at Molecular Pathology Laboratory

The Molecular Pathology Laboratory will discontinue the EGFR and KRAS single gene testing on solid tumors beginning Wednesday, April 1. The single gene tests are no longer utilized as these genes are included in the Comprehensive Cancer Panel by Next Generation Sequencing. Also, the laboratory has begun in‐house testing three assays that were previously sent out—Myeloid NGS Panel, Microsatellite Instability and Calreticulin.

» Read more

Cora Labs to Use New Assay Starting March 24

The Core Laboratories within the Department of Pathology and Laboratory Medicine will be going live with an N-terminal pro B-type natriuretic peptide assay beginning Tuesday, March 24.

» Read more

CS-Link Tip: Add-on Labs for Existing Specimen

Have you ever needed to add on a lab to a specimen from a previous order, but wish the process were simpler? For ambulatory Cedars-Sinai Lab orders, you can now request an add-on lab from within the order itself. This simplified process was added to CS-Link™ in the February 2020 bundle update.

» Read more

COVID-19: Updates for Staff and Physicians

coronavirus480px.jpg

Cedars-Sinai continues to monitor the outbreak of COVID-19 (coronavirus) to protect the health and safety of our staff, physicians, patients, visitors, volunteers and community. We are prepared to respond and have put all appropriate healthcare protocols and isolation precautions in place.

Here you will find timely, helpful information and resources on COVID-19.

Please keep in mind this is an evolving situation. Check back frequently for updated information.

LA Marathon Street Closures on March 8

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The Los Angeles Marathon Sunday, March 8, could affect commutes to Cedars-Sinai.

The Los Angeles Marathon will be held Sunday, March 8, and could affect commutes to Cedars-Sinai.

Numerous street closures will begin at 4 a.m., including some freeway ramps. For much of the day, the only ways to cross the marathon route will be on the 405, 101 or 110 freeways.

Physicians headed to the medical center that morning are advised to arrive before 5 a.m., when most of the road closures near Cedars-Sinai will begin. Most roads close to the medical center should reopen by early afternoon.

The course runs from Dodger Stadium to Santa Monica, passing just north and west of Cedars-Sinai.

Streets and freeway ramps near the course will close from as early as 4 a.m. until the afternoon. The best access to the medical center for those coming from north of the marathon route will be from the 10 Freeway, exiting at Robertson or La Cienega boulevards.

The marathon's website includes an interactive map of street closures associated with the race.

For the latest traffic alerts and updates, tune into local news radio stations or check websites such as:

Agency Awards Five-Star Rating to Cedars-Sinai

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Cedars-Sinai Medical Center has earned a five-star rating from the Centers for Medicare and Medicaid Services.

For the third year in a row, Cedars-Sinai Medical Center has earned a five-star hospital rating from the Centers for Medicare and Medicaid Services—the highest distinction offered by the federal agency.

The ratings are based on 49 quality measurements that fall into categories such as patient experience, mortality and readmissions for treatment of common conditions. Of the 3,600 U.S. hospitals rated, about 11% earned five stars, and only about 3% of all hospitals rated earned five stars for the past three years.

Found on Medicare's Hospital Compare website, the ratings range from one to five stars and are meant to provide consumers with an easily understandable way to compare hospital performance.

This year's top honor for Cedars-Sinai was driven by a low rate of complications after hip or knee replacement surgery, high marks for patient experience and continued strong performance in mortality measures that track the rate of patient survival 30 days after hospitalization for common conditions such as pneumonia.

"These achievements reflect not only our commitment to drive improvements in clinical quality but to also sustain those gains once a goal has been achieved," said Rekha Murthy, MD, vice president of Medical Affairs and associate chief medical officer.

She pointed to a recent quality-improvement project in antibiotic stewardship that focused on getting the right antibiotics and dosage to the right patient at the right time for the right duration. The project helped reduce rates of infections from C. difficile, or Clostridium difficile, a bacterium that causes inflammation of the colon that can be life-threatening. Though the formal project has concluded, medical center teams continue to monitor related data and train new clinicians around appropriate antibiotic use.

Although not reflected in the current rating, Murthy said that Cedars-Sinai has been laying the groundwork for future quality improvement in complex areas such as sepsis. Treating sepsis can be challenging because many of the signs and symptoms of sepsis—such as fever and difficulty breathing—are the same as in other conditions, making sepsis hard to diagnose in its early stages.

Early identification is important so that clinicians can intervene rapidly by ordering lab tests, antibiotics and administering fluids to provide the best opportunity for a successful outcome.

"We've enlisted expertise from our data intelligence team to develop alerts for early signs that a patient might be at risk of developing sepsis by monitoring vital signs and other information from the electronic medical record," Murthy said. "This can trigger rapid testing and appropriate treatment with antibiotics and fluids."

Providence Cedars-Sinai Tarzana Medical Center also received a five-star rating. Cedars-Sinai became a joint owner of the hospital last year along with Providence St. Joseph Health.

 

 

Honor a Deserving Nurse for Caring Award

Online nominations for the Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are open through Monday, March 9.

Only members of the medical staff may submit a nomination for this award, which recognizes nurses who exemplify professionalism, clinical excellence and caring. Originally known as the Excellence in Caring Award, this annual recognition was renamed in 2005 in honor of the late Maggie Stempson-Carter, RN, who won the award in 2004.

Past award recipients include:

  • Peachy Hain, RN
  • Jean Eskenazi, RN
  • Bernice Coleman, PhD
  • Betty Nersesian, RN
  • Paula Anastasia, RN
  • Tess Constantino, RN
  • Naomi Tashman, RN
  • Monette De Leon, RN
  • Raji Gandhi, RN
  • Rema Pendon, RN
  • Grace Romulo, RN
  • Joan Kirschner, RN
  • Jason Kirsnis, RN
  • Donna Dooley-Aiello, RN
  • Haesook Kim, RN

Nominations can be submitted via the intranet or the internet.

The award recipient will be selected by the Excellence in Caring Award Medical Staff Selection Committee and will be announced at the 2020 Nurses Week Housewide MDRN Collaborative Luncheon on May 7.

If you submitted a nomination last year and would like your nominee to be considered for this year's award, email chris.ng@cshs.org.

Purim and Reading of the Megillah March 9-10

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Cedars-Sinai will host services to celebrate Purim on Monday, March 9, and Tuesday, March 10.

The services will include the reading of the Megillah and will be broadcast live for those unable to join in person in the chapel. The holiday commemorates the saving of the Jewish people from Haman, a Persian ruler who was planning to annihilate the Jews.

The two services, which will be led by Rabbi Jason Weiner, will take place in the chapel:

  • 6:45 p.m. Monday, March 9
    With Michael Felsenthal
  • 10 a.m. Tuesday, March 10
    With Jay Braun

For more information, contact the Spiritual Care Department at 310-423-5550.

Protect Your Patients by Checking Two Forms of ID

Proper patient identification remains a top priority at Cedars-Sinai, as well as a National Patient Safety Goal designated by The Joint Commission. To ensure patient safety and reduce adverse events and near misses, employees are encouraged to "Check Two Before You Do."

The new "Check Two Before You Do" campaign is launching in conjunction with Patient Safety Awareness Week, taking place March 9-13.

"Patient safety touches everything we do, each day," said Edward Seferian, MD, chief patient safety officer. "Proper patient identification is not only a national patient safety goal, but also one of the highest priorities we have at Cedars-Sinai."

The "Check Two Before You Do" campaign serves as a reminder to never use a room number as a form of patient identification. That's because patients are quickly, and constantly, moving between rooms and departments to triage their care quickly and efficiently. 

When communicating with your colleagues—including ordering consults or tests, performing procedures and requesting imaging and other tests or procedures between departments—ensure patient identification is verified using the following:  

  • For inpatients: Use a Medical Record Number (MRN) and full name.
  • For ambulatory care: Use a patient's full name and date of birth.

Again, a room number or patient location can never be used as a patient identifier. Please also note that through the use of on-campus digital monitors, patients and their visitors will be encouraged to ask their healthcare providers to verify their identity if not initially asked.

 

Isolation Masks—Guidance for Use

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Hospitals across the country are experiencing a dramatic spike in mask utilization.

Hospitals across the country are experiencing a spike in the use of isolation masks amid heightened public concern over coronavirus. We are seeing a similar dramatic increase in mask use at Cedars-Sinai. To ensure that we maintain adequate supplies of masks for our patients, visitors and staff, please follow guidance in this Q&A.

Who needs to wear a mask?

People who are coughing or sneezing should wear a mask to help contain respiratory secretions, particularly in waiting rooms or when close to others. Masks also should be worn by clinical staff providing direct care to patients based on the need for isolation precautions.

When are masks unnecessary?

Wearing a mask in public areas—such as hallways, cafeterias or outdoors—is not a recommended approach for preventing infection. There is no evidence that masks are protective in these settings, and doing so diverts resources from those who need this protection.

Frequent hand hygiene—specifically, washing with soap and water or using Purell—is the most important method for reducing the spread of respiratory illnesses. Healthcare providers with active respiratory symptoms should not come to work; wearing a mask is not a substitute for staying home while ill.

Is there harm in wearing a mask for extended periods? Aren’t I being safe by using a mask more often?

Masks should not be worn for prolonged periods. They become moist over time, making them less effective, and the outer surface may serve as a source of contamination. Again, wearing masks when not needed diverts this important resource from those who have symptoms and need to protect others in their proximity.

What is the right way to wear and remove a mask?

Masks are only effective if they fully cover your mouth and nose. Because the outer surface of a mask becomes contaminated over time, don’t touch the front of a mask or pull it down under your nose or chin. Doing so can increase your risk of infection. Remove masks by touching the ear loops, and always wash your hands after removal.

What do I tell patients or visitors if they ask for masks?

You can remind visitors or patients that masks are not helpful in public areas unless individuals have symptoms of a respiratory infection such as coughing or sneezing. Masks should be provided to patients in public areas and waiting rooms if they have symptoms of a respiratory infection. Masks also should be given to visitors of patients who are on droplet or airborne isolation. The use of masks by visitors or patients beyond this should be discouraged. 

Who can request additional mask supplies?

The charge nurse is the only team member authorized to request or order additional masks. The delivery of masks will require signature receipt. Supply Chain Management will deliver quantities of masks up to individual unit's historical usage levels; Executive Director approval will be needed for quantities above these levels.

- Rekha Murthy, MD, Vice President for Medical Affairs, Associate Chief Medical Officer

- Jonathan Grein, MD, Director, Hospital Epidemiology

- Bryan Croft, Senior Vice President, Operations

 

 

More Doctors in the Valley for Staff

Vivity HMO, an insurance product offered by Anthem Blue Cross and created with Cedars-Sinai and six top-rated health systems in Southern California, is now being offered to residents in the San Fernando Valley seeking specialty care. Until now, patients with the Vivity plan could only see Cedars-Sinai primary care providers in the region.

To offer this specialty care, 75 new private, attending physicians were contracted through Cedars-Sinai.

"We have assembled top-ranked, highly regarded physicians to join our Vivity expansion in the Valley," said Joe Gutierrez, executive director of Cedars-Sinai Health Associates, an independent physician association. "These newest physicians complement our existing primary care physicians, and together offer expanded access and care for specialty needs to patients in the comfort of their own community where they live and work."

Specialty areas now offered in the Valley include cardiology, ENT, OB-GYN, pulmonary, vascular, colorectal, general surgery, orthopaedics/sports medicine, rheumatology, dermatology, neurology and urology.

Services requiring hospitalization or surgery will now be offered at Providence Cedars-Sinai Tarzana Medical Center. Ancillary services such as urgent care and physical therapy will also be provided at various locations throughout the Valley.

"We have been building our primary care footprint in the Valley since 2014," said Julie Reback Spencer, vice president of Physician Recruitment and Network Development. "With a robust presence now fully established in this area, including a local Valley hospital partner, we can now offer cost-effective, specialty care that meets the growing needs of this community."

In addition to Cedars-Sinai, Vivity includes the hospitals and affiliated medical groups of Good Samaritan Hospital, Huntington Memorial Hospital, MemorialCare Health System, PIH Health, Torrance Memorial Medical Center and UCLA Health.

Changes at Molecular Pathology Laboratory

The Molecular Pathology Laboratory will discontinue the EGFR and KRAS single gene testing on solid tumors beginning Wednesday, April 1. The single gene tests are no longer utilized as these genes are included in the Comprehensive Cancer Panel by Next Generation Sequencing.

Also, the Molecular Pathology Laboratory has begun in‐house testing three assays that were previously sent out—Myeloid NGS Panel, Microsatellite Instability (MSI) and Calreticulin (CALR). There should be a reduction in turnaround time and increased pathologist interpretation.

For more information, see the PDFs below.

MP Updates—GFR, KRAS (PDF)  

MP Updates—In-House-Testing  

Cora Labs to Use New Assay Starting March 24

The Core Laboratories within the Department of Pathology and Laboratory Medicine will be going live with an N-terminal pro B-type natriuretic peptide (NT-proBNP) assay (Roche Diagnostics) beginning Tuesday, March 24.

We are adding this offering for heart failure, as we have already been running an intact BNP assay (Abbott Laboratories) for years. While NT-proBNP is derived from BNP, the concentrations in vivo do not correlate 1:1, hence different reference intervals are used for both.

The addition of NT-proBNP is relevant now as use of Entresto for heart failure becomes more common. Entresto (Sacubatril/Valsartan) inhibitis neprilysin, which initially shifts the BNP concentration to the right (e.g., increases BNP concentration), as the intact form is preserved for longer.

At first it was thought that this increase in BNP values for patients taking Entresto would obfuscate accurate interpretation and follow-up of patients. However, BNP remains a clinically valid biomarker with independent prognostic value similar with that of NT-proBNP, according to results of the PARADIGM-HF trial released in March 2019, as the concentration over time will ultimately be what matters (J Am Coll Cardiol2019 Mar, 73 (11) 1264-1272). That said, use of NT-proBNP, which shows an initial decrease with use of Entresto, may be preferred to avoid initial clinical confusion. Ultimately, both markers can be used post 8-10 weeks for accurate prognosis.

Reference ranges for flagging of results in CS-Link™ are shown below. However, additional interpretive comments that further stratify results by age will be posted with results.

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If you have questions, contact Kimia Sobhani at kimiasobhani@cshs.org, or Anders Berg, PhD, at anders.berg@cshs.org.

CS-Link Tip: Add-on Labs for Existing Specimen

Have you ever needed to add on a lab to a specimen from a previous order, but wish the process were simpler? For ambulatory Cedars-Sinai Lab orders, you can now request an add-on lab from within the order itself. This simplified process was added to CS-Link™ in the February 2020 bundle update.

To start the process, open up the initial encounter or a new Orders Only encounter. You can then search for and choose the lab you want to order. In the order composer window that opens when clicking on the order, choose Add-On as the Priority. Note that there may not be a quick button for Add-On, but you can still type it into the Priority field. Also make sure that the Resulting Agency is set to Cedars-Sinai Lab, since this process will not work with other laboratories.

One more step is needed to complete the process. You will need either the accession number, the specimen ID or the collection date/time of a previous order associated with the original blood draw you want to add on your new order. This will need to be added to the Order Comments section of the new order. You can find this information by choosing the existing lab from the Chart Review > Labs tab and scrolling down in the report. You can now associate the order and sign it.

For more information please see the CS-Link job-aid on this topic by clicking here.

If you have questions, feel free to contact us at groupeisphysicians@cshs.org.