From the President, September 2016

Posted on Sep 6, 2016 in President's Message | 0 comments

Dr Tigno MS PresidentDear Medical Staff Colleagues:

The summer is coming to a close. I hope you were able to take some time away for family, fun and vacation.

  • Combined Alta Bates and Summit Medical Staff Welcome Luncheon for New Physicians will be held at the 11th floor Bay Room at noon September 7.
  • Reminder to please donate or participate in the American Heart Association walk October 2. 
  • I would also encourage donation and participation in the Making Strides Against Breast Cancer Walk, an annual event held by American Cancer Society, October 22 in San Francisco. Summit Radiation Oncology Department has been actively involved annually for 17 years. To make a donation or join the walk click on the following link:      http://main.acsevents.org/site/TR?team_id=2064224&pg=team&fr_id=77369&s_locale=en_US&et=41DuW_g2BiN9L_KPAwX-Yg&s_tafId=1885024.
  • The ambulance transport service (AMR) launched last month. Unfortunately, the initial roll-out under scoped the amount of resources needed to meet the demand. Areas needing improvement have been identified. I appreciate Administration’s commitment to improve this process, as well as AMR’s commitment and desire for a successful long term relationship. Please inform Dr. Steve O’Brien of challenges you may be experiencing with patient transfers.
  • For Psychiatry Inpatient Consults, call the Psychiatry Intake number 510-204-4405.  The expectation is a consult will be done within 24 hours.
  • John Ramirez is the new Administrative Director of Support Services and Facilities overseeing engineering, environmental services, food services, patient transportation, communications, parking and security.  Please contact him for concerns in any of these services.  He is eager to hear any feedback: 510-869-8383 or RamirJ7@sutterhealth.org. (Please see article from John below, “Identifying and Managing Aggressive Behavior.”)
  • Culture of Safety Survey is rolling out this month. I encourage you to fill out the survey, which takes about 10 minutes to complete. The survey is distributed from the Sutter System to all affiliates. This year there will be new questions focusing on professional burnout, sleep and nutrition. As you may know, there is an increased spotlight on physician wellness and burnout because of the impact not only on the health care team but also on patient quality and safety.
  • The new Physician Lounge and Dining Area: The blue print configuration has been drawn up. If you are interested in seeing the schematic, please ask for a copy at the Medical Staff Office.
  • Lung Nodule Program is a multi-disciplinary program involving Thoracic surgery, Pulmonary, Radiology and Oncology. The goal is early detection and management of lung nodules for better outcomes in lung cancer. Patient cases are referred by providers or detected on low-dose radiation chest CT screens. An outreach program is being rolled out to community primary care providers to streamline the process for ordering low-dose radiation chest CT scans. For more information, please contact Sam Monsale, N.P., lung nodule nurse navigator, monsals@sutterhealth.org or 510-204-2664. (See article below)
  • This is a gentle reminder to please not park in the ED parking lot unless you are on call and need to access the ED (i.e. cardiologist, neurologist, surgical hospitalist or any other on-call physician). The parking lot becomes very congested because of ambulance traffic and in addition this month, the lot needs to undergo necessary work. There are parking lots in the Merritt and South Pavilion/Hawthorne.

Until next month, be well,
Donna

By Donna Tigno, M.D.
Medical Staff President

 

Lung Nodule Program Tracks Results

Posted on Sep 6, 2016 in Health Information Management | 0 comments

Medicare now covers lung cancer screening for high-risk patients: ages 55-77, 30 yr pack history, active smoker or former smoker within past 15 years and without signs/symptoms of lung cancer.

Patients can be screened at the Summit Campus South Pavilion Imaging Center using a low-dose CT scan.  Once patients have been screened, results will be tracked by the Lung Nodule Program following CMS established guidelines.

The Lung Nodule Program meets every other Friday at 7 a.m. in the Oak Conference Room. For additional questions, please call the Radiology Department, 510-869-8800, or the Lung Nodule Nurse Navigator, 510-204-2664.

By Tom Volponi

 

 

Identifying and Managing Aggressive Behavior

Posted on Sep 6, 2016 in Uncategorized | 0 comments

Skills for managing aggressive behavior are essential to all staff providing human services. When confronted with potential violence, a person lacking training and skills in managing aggressive behavior tends to revert to ineffective instinctive responses, which are based on fear and self-preservation.

In order for us to develop the tools necessary to effectively manage aggressive behavior, it is important to understand the stages or levels of crisis development. The purpose of identifying the four levels of crisis development is to attempt to meet the distinct levels with the appropriate response to de-escalate and defuse.

  • Anxiety Level. Simply, anxiety is a noticeable change in a person’s behavior manifested by a higher level of energy expenditure. You may notice that there is something “different” about the person or that the person seems to be pacing without reason. This level is where most potentially volatile situations are defused. Staff members may effectively de-escalate by employing the Supportive Response at this level. The Supportive Response simply is to engage in active listening and be empathetic. Being dismissive or judgmental of the person’s source of anxiety contributes to an escalation into the next level.
  • Defensive Level. If staff did not recognize or was unable to intervene successfully at the Anxiety Level, an individual may enter this next level of crisis development, the Defensive Level. At this level, the individual will give verbal and nonverbal clues indicating a loss of rationality and self-control. The defensive person may challenge you and your authority. As the defensive person’s self-control deteriorates, you may find yourself a victim of verbal abuse and button pushing. Your race, weight, sex, and other sensitive areas are most often targeted by the defensive person to test your limits and professionalism.
    At this critical level of the crisis, a Directive approach by staff to establish behavioral limits may be effective. The key to successful intervention at this level is to set clear and simple limits in a non-negative manner. Deliver your directive in a way for the defensive person to understand that consequences are based on their decisions. Issuing “ultimatums” are usually ineffective. Consider the following two ways of delivering the same directive:
  • Clear and non-negative: “You may remain in the waiting room if you stay calm and not disturb other individuals who are also here to seek help. With your cooperation and understanding, I will be able to assist everyone.”
  • Ultimatum: “You need to be quiet or I will call security to have you removed.”

Dealing effectively with a defensive person to set behavioral limits requires a calm, professional approach and your loss of self-control could escalate the crisis to a dangerous level.

  • Acting-Out Level. If staff was unsuccessful in setting reasonable behavioral limits to de-escalate a crisis while in the Defensive level, the individual may lose total control. The Acting-Out person may resort to physical aggression and attempt to cause physical harm to staff, bystanders, or himself. At this level, physical intervention may be necessary as a last resort. It is imperative to follow policy and procedures during this level of crisis management.
  • Tension Reduction Level. Regardless of the prior level(s) of crisis development reached, the Tension Reduction Level is the final stage. Unfortunately, this level is most often forgotten or ignored even though it may be the most important stage of a successful resolution. At this stage, the individual starts to come down from the peak energy expenditure plateau. This stage is often recognized by either a reduction in physical energy (if restrained) or a change in behavior. The key point to remember is that the individual is beginning to regain control and rationality. You may facilitate this process by establishing therapeutic verbal communication. This is realized by encouraging deep breathing and being informative on the sequence of events to follow. A compassionate approach is most effective at this final level of managing a crisis.

This article is not intended to oversimplify the approach or techniques to managing aggressive or violent behavior. It is merely an introduction to bring awareness to how a crisis develops and the most basic guidelines for establishing an appropriate response to intervene and de-escalate.  The guidelines suggested here are recommended by the Crisis Prevention Institute (CPI).

The ABSMC Security Department facilitates an onsite eight-hour CPI Nonviolent Crisis Intervention training program which emphasizes recognition and early intervention for prevention of managing disruptive behavior. If you are interested in participating in the training program, please contact your department manager.

Finally, despite our best efforts at prevention, volatile situations do occur. Staff should familiarize themselves with the Fast Facts Emergency Response Instructions located in every department and work station.  The booklet allows you to customize department specific responses to emergencies including abusive/assaultive behaviors.

In addition to the Code response procedures listed in the Fast Facts, you may contact the Security Operations Center (SOC) directly at any hour to report non-emergency related security concerns.

  • Alta Bates/Herrick: 747-7847; Summit: Ext 7847
  • Berkeley Police non-emergency: 510-981-5911
  • Oakland Police non-emergency: 510-777-3333
  •  Emergency Line: Alta Bates/Herrick: Ext 611; Summit: Ext 5555

By John Ramirez
Administrative Director Support Services & Facilities

           

 

 

 

Register for Critical Incident Management Training

Posted on Sep 6, 2016 in Events | 0 comments

Assisting Individuals in Crisis & Group Crisis Intervention: Three-Day Certification Course for ABSMC Nurses, Physicians and Ancillary Staff

Sept. 28, 29 & 30, 2016
8:30 a.m. -5:00 p.m.
Alta Bates Auditorium #3, Alta Bates Campus
2450 Ashby Ave., Berkeley

Eligible ABSMC staff include those who are: 1. Respected among their peers; 2. Willing to travel to any campus; 3. Willing, interested and able to provide support services to employees who have experienced a “critical incident” (death/serious injury of staff on/off site, workplace violence when they or peers experienced threats and/or felt threatened, unexpected death of child patient, high profile workplace incident); and 4. Willing to assist in “off-hours.”

Attending all three days is required to complete the certification. Following this training, certified participants may be called to provide intervention to employees outside of their own department at another campus. This is a peer model of intervention in which the peer co-facilitates with a trained mental health professional following a structured protocol.

Visit www.icisf.org for complete course description and certification details.

Registration required by September 9. Enrollment limited to 50 participants.
Contact Mia Boggs, 510-204-6730, BoggsM@sutterhealth.org

Course Trainer: Patricia L. Tritt, R.N., M.A., is the director of EMS and trauma for HealthONE in Denver. She has been involved in Emergency Medical Services and trauma systems for over twenty years. She is responsible for the administration of a complex EMS medical direction system for both metropolitan and rural areas and a diverse EMS education program for all levels of prehospital providers.

Her experience and interests include program development and management. In 1985, she organized the Mayflower Crisis Response Team and continues as team coordinator. She has coordinated the Colorado Crisis Response Network since inception in 1988. She is an ICISF faculty member for the Group Crisis Intervention, Advanced Group Crisis Intervention, Assisting Individuals in Crisis, Strategic Response to Crisis and Grief Following Trauma courses.

Pat has trained CISM teams across the United States and has presented programs in Canada and Australia. She is a Certified Trauma Responder and a contributing author on stress and EMS issues for numerous emergency services texts.

By Tom Bonas
Behavioral Healthcare Services

 

Sutter EHR Upgrade Highlights

Posted on Sep 6, 2016 in EHR Updates | 0 comments

Sutter EHR will be upgraded effective Oct. 8, 2016. Below are some highlights.  Your EHR Physician Liaison will demonstrate the changes at department meetings and in the doctors’ cafeteria.  For private appointments, please call Patty Fitzgibbons, 510-325-9618.

Inpatient M.D.:

  • Changes to the color, font and header appearance
  • Ability to personalize the background colors
  • New Triage buttons with quick access to triage information
  • New Chart Review layout and color-coding of encounter types
  • Radar dashboard – new layout
  • Open Manage Orders tab and notice that order sets have been separated and individual orders are now at the top of the options
  • Customizable In Basket toolbar

Anesthesiology:

  • Notice the new time stamp option for “Ready for Procedure” under the Review and Sign Section
  • Layout changes in the Intra-Procedure section. Quick events have been moved to the left column and checklist is readily accessible on the top left corner of the screen
  • Selecting “Start Data Collection” in the Intraop workspace and see the new prompt to validate the correct patient
  • Under the LDA section, see how you can now specific who placed the LDA
  • Multiple procedures done on the same patient will now be separated out into discrete procedure notes.
  • “Close Encounter” is now renamed “Sign Record”

By Patty Fitzgibbons

Welcome, New Physicians

Posted on Sep 6, 2016 in New Physicians | 0 comments

Please welcome the physicians who joined the staff in August:

Yazen Beddawi, MD
Pulmonary Services
411 30th St. Fl. 3
Oakland, CA.  94609
(510) 465-6800

Gene Chang, MD
Nephrology
13851 E. 14th St. Ste. 206
San Leandro, CA 94578
(510) 881-1490

Patrick Gonzales, MD
Diagnostic Radiology
2125 Oak Grove Rd. Ste. 200
Walnut Creek, CA 94598-2520
(925) 296-7150

Gregory Horner, MD
Orthopedic Surgery
4626 Willow Rd. Ste. 200
Pleasanton, CA 94588
(925) 463-0470

Michael Huynh, MD
Medical Hospitalist
350 Hawthorne Ave.  Rm. 2346
Oakland, CA. 94609
(510) 869-6883

Pandora Lee, MD
Internal Medicine
3300 Webster St. Ste 1000
Oakland, CA. 94609-3117
(510) 271-4400

Laurent Menut, MD
Anesthesiology
3000 Colby St. Ste. 205
Berkeley, CA.  94705
(510) 666-0854

Swathi Nadindla, MD
Emergency Medicine
2450 Ashby Ave.
Berkeley, CA. 94705
(510) 204-1660

Sara Reinganum, MD
General Surgery
13847 E. 14th St. Ste. 109
San Leandro, CA 94578-2625
(510) 357-7141

Patrick Ryan, M.D.
Diagnostic Radiology
2125 Oak Grove Rd. Ste. 200
Walnut Creek, CA. 94598-2520
(925) 296-7150

Rajiv Shah, DO
Diagnostic Radiology
2125 Oak Grove Rd. Ste. 200
Walnut Creek, CA 94598
(925) 296-7150

Barry Wong, DO
Medical Hospitalist
350 Hawthorne Ave. Rm. 2346
Oakland, CA. 94609-3108
(510) 869-6883

Meghan Woods, MD
Medical Hospitalist
350 Hawthorne Ave. Rm. 2346
Oakland, CA. 94609-3108
(510) 869-6883

Jiashou Xu, MD
General Surgery
365 Hawthorne Ave. Ste. 101
Oakland, CA. 94609
(510) 465-5523

From Medical Staff Services

 

From the President, August 2016

Posted on Aug 1, 2016 in President's Message | 0 comments

Dear Medical Staff Colleagues,Dr Tigno MS President

Greetings,

I want to take a moment and acknowledge that current events have created a tough stressful month. There is news coverage of violence stemming from race relations and law enforcement, violence due to terrorist activities within our nation and abroad, and depending on your political affiliation, stress brought on by reality TV programming — the election campaign.

It becomes that much more important to focus on wellness and emotional health among ourselves and colleagues.  We will benefit and ultimately our patients will benefit. I want to share an article: In Challenging Times Practice More Compassion.   (Thank you for sharing, Dr. Mouratoff.)

We did meet for the first gathering of the Wellness Branch of the Well Being of Practitioners Committee and we came up with some great ideas. The overarching chair of the Well Being Committee is Dr. Donnis Hobson. Dr. Douglas Patton will remain the chair of the traditional Well Being of Practitioners Subcommittee.

We continue to have a high patient census and with high acuity of illness. Thank you to both the hospitalists and intensivists for your strong work and for managing the volume and complexity of these patients.

  • Intensivist program: Starting Aug. 1, the Intensivist program is simplifying the way to reach them for consults and ED admissions. The one number is 510-301-3871 . Flyers will be posted as a reminder.
  • Verbal orders: A friendly reminder — please sign verbal orders within 48 hours. I would strongly encourage that physicians sign the outstanding verbal orders for themselves and for members of their own group. I will go one step further and ask that you sign the verbal orders by all the physicians caring for your patient. Tip sheets were sent out on the various ways this can be done. Patty Fitzgibbons, our Sutter EHR physician liaison, can walk you through these steps. In the old days (pre-EHR), the pink sticky tabs were easily visible and we could reach our goal. Nowadays, it is not as easily visible. So please take extra steps to accomplish this. (See article below on signing verbal orders.)
  • The newly elected Chair of Ob-Gyn Department is Dr. Elisabeth Schleuning.
  • Tele beds: Reminder to please evaluate on a daily basis whether your patient who is on a tele bed still needs tele monitoring. We continue to have a shortage of tele beds and this impacts patient flow throughout the hospital. Here are the indications for tele monitoring.  (Double click to enlarge.)
  •  American Heart Association Heart Walk: This will be the 12th year ABSMC participates in the American Heart Association Heart Walk to be held Oct. 2, 2016, 8:30-11 a.m. at Bishop Ranch 8 in San Ramon. You may have seen the announcements. Please register to join the Heart Walk and/or donate to the cause.  If you donate at least $10 for each day, you can wear jeans as a sign of support August 26 and/or September 23rd.

Be well,
Donna

By, Donna Tigno, M.D.

 

 

 

Quick Tips for Signing Verbal Orders & EHR Updates

Posted on Aug 1, 2016 in EHR Updates | 0 comments

To meet Summit Campus Rules and Regulations, physicians need to co-sign verbal orders within 48 hours. We continue to fall short of the Joint Commission requirement.  It is imperative that we improve our compliance on an ongoing basis.

There are three efficient methods for signing verbal orders. Our recommendation is to co-sign your orders at the end of your shift/day. With two of these methods, you will be able to co-sign verbal orders for your colleagues or other physicians on the treatment team.
See quick tips here.  (Double click on screen shots to enlarge.)

For further assistance, please see EHR Physician Liaison Patty Fitzgibbons. She can be reached at 510-325-9618 or FitzgiP@Sutterhealth.org.

Please help us to meet this strict requirement.

Interval H&P

Previously, clinicians could only create an Interval H&P from an H&P note.

Now, interval H&Ps can be created from Consults & Progress notes, including those created in a previous outpatient encounter. This saves time.

Catheter-Associated Urinary Tract Infection (CAUTI) Orders

In-dwelling Urinary Catheter LDA and Assessment documentation has been changed to reduce CAUTI instances.

“Manage Urinary Catheter Discontinue Per algorithm criteria” order is pre-checked in order sets.  If the physician does not want the nurse to remove per algorithm criteria, uncheck the box.

Fever/Antibiotics Report is available to all MDs

It will be available in the Summary Tab. Use the reports search box to find it. It can be wrenched in.  Lactate will also be included in this report with the other labs.

By Patty Fitzgibbons, EHR Physician Liaison

Quick Tips: Signing Verbal Orders

Posted on Aug 1, 2016 in EHR Updates | 0 comments

Preferred method - LR CP PF_Page_1Preferred method - LR CP PF_Page_2

Admitting Guidelines for Telemetry

Posted on Aug 1, 2016 in Uncategorized | 0 comments

Admitting Guidelines for Telemetry_Page_1

 

 

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