President’s Message

Posted on Feb 1, 2021 in President's Message | 0 comments

I hadn’t seen a doctor in years.

Some of it, probably most of it, was my fault of course. I had procrastinated and tried to reassure myself with thoughts that I was exercising pretty regularly, eating pretty well. Heck, probably too well. I thought, “I’m a doctor, I’ll know when there is something wrong.”

Then there was the pandemic and transition to virtual visits. The switching of primary care doctors due to changes in health insurance and contracted providers. My wife kept on pestering me, “When are you going to make a doctor’s appointment?” I relented, got onto MyHealthOnline (MHO), and made an appointment with my assigned PCP.

I was anxious the night before my appointment. What would be uncovered after several years of shameless neglect? I went into the clinic, breezed through the obligatory COVID screening, and was routed into the exam room. The medical assistant greeted me and promptly said, “We need to get your weight and height”. A sense of dread came over me as my pants had gotten quite a bit tighter around the waistline in the past year, and I reluctantly faced the music.

I was the heaviest I had ever been. Call it the COVID 20. My height had shrunk by half an inch. My blood pressure was high. The rest of the exam proceeded uneventfully, but then came the expected recommendations from my doctor regarding lifestyle modification. Easier said than done. Throughout the day, scattered blood test results filtered back through alerts on MHO. My vitamin D was low. My cholesterol was higher than I wanted it to be. My hemoglobin A1C was borderline. My uric acid was high.

Clearly, things had to change. Internally, I signed a commitment to change contract, and set about the next few days to right the ship. I refrained from eating too much food at night (difficult with ER shift schedule). I moderated my carb consumption. I went out for several runs in the next few days, but every time I got on the scale, I was mortified by the task before me.

I had a clinical day off midweek, and though it was raining and gloomy, I overcame inertia and got out on my bike. You have to take the opportunities when they come. I was thoroughly soaked and quite cold, but invigorated by being outdoors. Then the clouds parted, if only just briefly.

Call it coincidence, divine providence, or the physical diffraction of light. It was beautiful.

2021 hopes to be better than 2020, but only if we make it so. Self care is vital.  Make time to take care of yourself, and if you haven’t seen your doctor recently, make an appointment!

Verbal order signage

On the business side of things, our verbal order signage compliance has lagged considerably after gains in 2019.

Please remember to sign your Verbal/Telephone Orders. Our Medical Staff Rules and Regulations state that Verbal and Telephone Orders must be signed within 48 hours.

Right now, we are well below the 90% mark and at risk for citation by regulatory agencies (i.e. JCAHO). Please do your part and sign your orders ASAP.

Please see attached for order signage within Haiku!

Additional tips:

1. Hardwire signing your Verbal/Telephone Orders. Make signing deficiencies the first and last thing you do daily.

2. Sign ALL Verbal/Telephone orders including Discontinued and Canceled orders.

3. Work with your group to sign orders for each other. Inform your team when going off service and ask that your orders be signed.  Patty Fitzgibbons will work with you and your group to make it easy to sign each other’s verbal orders.

4. Inform Health Information Management when going on vacation so deficiencies can be placed on hold while you are out.

In order to place a hold on any potential medical record deficiencies, you have 3 options:

1. Call the local HIM/Medical Records Department, Chart Completion Team at Summit:  510-869-6545, option 2 (Summit Campus only).

2. Call or email the S3 physician line (Summit and/or Alta Bates Campus) 855-398-1641, Option 1, or email S3Chart CompletionTeam@Sutterhealth.org.

3. Call or email the HIM Manager (Summit and/or Alta Bates Campus) Summit:  510-869-8741, or Email Stinnal@sutterhealth.org.

Cosigning Verbal Orders – Setting Email Reminders

Verbal Order Email Reminder

Providers are able to receive email reminders when there are verbal orders in their In Baskets.  This requires a modification to the In Basket Settings.

1.  Click on In Basket from the main menu in EPIC.

2.  Click on Settings

3.  Click on Reminder Email

4.  Click the box to the left of “Subscribe with email address and,

     in the field to the right, type your email address

5.  Enter the Message Type “Verbal Order Cosign”

6.  Enter the Outstanding Days to the right of the Message Type

If there is a workflow issue we can assist with, please contact Patty Fitzgibbons, Physician Liaison, at 510-869-8339 (office) or 510-325-9618 (cell) or by email fitzp@sutterhealth.org.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

Two ends of the Covid Cove

Posted on Feb 1, 2021 in Wellness Committee | 0 comments

Two ends of the Covid Cove

Ms. A was an 85-year-old woman who always clutched her rosary and had a traditional Central American shawl on her bed.  My Spanish is not great, but I understood her prayer when I entered the room.  She had come in the night before with cough, fever and shortness of breath.  She had tested positive about 7 days before – so had all the people in her multigenerational home.  Her o2 sat was 95% on 5l nasal canula, so over the phone, I felt comfortable reassuring both her and family that she would likely do well.  All the time Ms. A said she just wanted to go home.

Down the hall was Mr. D; he was an 81-year-old former Vietnamese “boat person” refugee.  He had experienced cognitive decline and weakness for a couple of years and went into a snf 6 months before the “lockdown.”  He had come in 3 days prior to my coming on service.  While he didn’t talk even with an interpreter, he ate well and had looked comfortable for days on 45% O2.

Each day the hard-working nursing staff on the unit, donned their sweaty blue plastic robes, face shields and N-95s and worked to feed, bathe and provide medicines.   And of course, we all relied upon the RTs who essentially managed the all-important oxygen for us.

Ms A’s o2 needs crept up each day as did her anxiety and the plaintive tenor of her prayers and enquiries about going home.  I got a priest to visit, not for last rites but just for some support.  I backtracked on prognosis with the family. 

4 days into her stay she needed 95% O2 and with that her pO2 was only 70.  I told her family it seemed the virus would likely claim her life shortly.  I said we could see how she did on 60% – that’s the max she could get at home with hospice.  If she did ok with that, she could get home which was clearly her wish.  I called them after 2 hours on 60% to tell them she was up eating and despite a low sat and slight increased resp rate, she looked ok.  “Can you guarantee that she would not make it if she stayed in the hospital? “

“I am sorry, but this is such a new disease, I can’t say that for certain.” I replied.   Feeling bad about it, the opted to have her stay in the hospital.

Down the hall Mr. D had stopped eating.  First it was dinner and now it had been a day and a half without food; also, his sats dropped as did his bp.  A nurse exited his room; despite the mask and steamed up glasses, I could read her body language.  “That poor man is dying.’ She said.  I told her I agreed and called the family with the news and to offer them a chance to visit and to talk about home hospice. 

“He has not seen any of us in 10 months. We would love to visit and talk about bringing him home on hospice.”  The next morning 4 of his 9 kids showed up with a quart of jook, an Asian rice porridge, for him and pastries for the staff.

They left the room smiling an hour later. “He ate all the jook and he smiled!  Yes, let’s work on home with hospice.”  That night he bp was better and we were able to move him to 8 liters oximizer and the staff agreed he looked much better.

The next day Ms. A was less responsive with sats in the 80’s, but still had this great sense of warmth and dignity about her.  Family was able to visit and when I walked in the room, Spanish catholic hymns were playing on a phone, her two children each had hand and, on an iPod, there was a chorus of tears.  20 family members were all crying on a Zoom call.  Together this made the most beautiful soundtrack to an end of life I have ever heard. I tried hard not to join the chorus as we talked about turning off the oxygen to help limit her suffering.

With the help of Sara, the RT and Kamal, the nurse, we added a bolus of morphine to her drip and removed the oxygen.  She looked so much more beautiful and peaceful without it.  Briefly, she closed her eyes then opened them, her breathing calmer.  And with the hymns and the chorus of her crying family, she lived another 20 minutes in the loving presence of her big family.

Meanwhile, down the hall, Mr. D’s family arrived in great spirits armed with more food for patient and staff.  He was to go home later that day with hospice.  When they saw him up in the chair without the oxygen, they said, “It is a miracle Dr Hass!  He is going home on hospice but having beat Covid!  We can’t thank you enough!” 

“Don’t thank me!  He was cured by love and jook!  What a lesson for us all.  Sometimes there is no better medicine than food from home and love!”  All bursting with joy, we shared some “elbow love” and took some pictures before he was wheeled home.

Back at the nurse’s station, there were tears. Sometimes life is so full of emotion that it is hard to give it a name – joy? grief?  Our bodies almost pulsing, our minds searching for words, it is as if an ancient process is marking a time and place in our souls.  “This is what it is to be a human being living with love and creating meaning” the experience seems to be telling us.

All I can say is “Well everybody, thank you all for your efforts. And isn’t this amazing work!”

Leif Hass, MD
Summit Wellness Chair

EPIC Corner

Posted on Feb 1, 2021 in Health Information Management | 0 comments

Sutter Community Connect

Posted on Feb 1, 2021 in Uncategorized | 0 comments

Research and Pharmacy Teams Collaborate on Historic “Win” for ABSMC

Posted on Feb 1, 2021 in Announcements | 0 comments

https://newsplus.sutterhealth.org/blog/2021/01/27/research-and-pharmacy-teams-collaborate-on-historic-win-for-absmc/?doing_wp_cron=1611861806.2731199264526367187500

EBAC Helps Prolong and Improve the Lives of Those Afflicted with HIV

Posted on Feb 1, 2021 in Announcements | 0 comments

While the world begins immunizing the public against COVID-19, our EBAC team led by Christopher Hall, M.D., is leading a research initiative in the East Bay that may provide even more HIV prevention options. Thank you to our EBAC staff members for their amazing work.

https://vitals.sutterhealth.org/no-vaccine-for-this-virus-but-advances-have-saved-lives/

Feeding Our Community and Reducing Food Waste at Alta Bates Summit

Posted on Feb 1, 2021 in Uncategorized | 0 comments

ABSMC has launched a program to drastically cut food waste, while helping feed local communities in need. In the first four months of operation, ABSMC has already donated 7,600 pounds of edible food, which equates to 6,349 meals, to multiple local, non-profit community programs. Kudos to our FNS team on this great achievement.

https://newsplus.sutterhealth.org/east-bay/2021/01/25/feeding-our-community-and-reducing-food-waste-at-alta-bates-summit/?doing_wp_cron=1611687547.5397999286651611328125

CDC Update to Gonococcal Infection Treatment

Posted on Feb 1, 2021 in Announcements | 0 comments

CDC Update to Gonococcal Infection Treatment

Neisseria gonorrhoeae is an important cause of sexually transmitted diseases and can lead to complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. While effective treatment can prevent complications and transmission, N. gonorrhoeae can rapidly develop resistance to antibiotics.

In December 2020, the CDC has updated its guidelines on gonococcal treatment. The CDC now recommends a single 500 mg intramuscular (IM) dose of ceftriaxone for treatment of uncomplicated gonococcal infection of the urogenital, anorectal, and/or pharyngeal region. For patients weighing 150 kg or more, 1 gram of ceftriaxone IM is recommended. In cases where chlamydial infection remains in the differential, doxycycline 100 mg orally twice daily for 7 days is recommended. Prior guidelines from 2010 recommended a single 250 mg IM dose of ceftriaxone and a single 1 gram dose of oral azithromycin.

This change in recommendation comes from increasing N. gonorrhoeae resistance to azithromycin. In the United States, N. gonorrhoeae resistance to azithromycin increased from 0.6% in 2013 to 4.6% in 2018. This, along with additional evidence concerning for reduced efficacy of azithromycin to treat chlamydial infections, especially rectal infections, has led to the decrease in strength of recommendation for azithromycin. In pregnant patients, oral azithromycin 1 gram as a single dose is still recommended to treat chlamydia. Meanwhile, N. gonorrhoeae remains susceptible to ceftriaxone. However, pharmacokinetic and pharmacodynamic studies demonstrate the need for higher ceftriaxone doses to avoid treatment failure, especially for pharyngeal gonorrhea treatment. Monitoring for emergence of ceftriaxone resistance will be essential for ensuring continued efficacy of the recommended regimens.

References:

St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a6external icon

New Physicians Memo

Posted on Feb 1, 2021 in New Physicians | 0 comments

President’s Message

Posted on Jan 4, 2021 in President's Message | 0 comments

Who would have thought that getting a shot would be such an emotionally charged event? As the Pfizer and Moderna vaccine began to be deployed nationwide, social media and news sites erupted with images of the first recipients receiving their inoculations.

ABSMC rolled out its first wave of vaccinations for health care workers two weeks ago, and it has been extremely successful (aside from the initial hiccups with myEHS). All active medical staff members are eligible to receive the vaccine in this first round, and affiliate and courtesy staff will be offered the vaccine later.

I never thought that I would have wanted to have my picture taken for a shot, but others clearly felt the same. Elation, relief, anxiety – all of those emotions bundled into one brief moment.

I applaud all of you for stepping up to get vaccinated. This is the first step of real recovery from the pandemic. You are protecting yourself, your patients, and your families in this process. As I looked at the initial data from the Pfizer vaccine, I was struck by one particular graph.
Red is placebo, and blue is the vaccine, and that’s only after the first dose.

We have to be mindful however, that our eagerness to be vaccinated does not translate wholly to other health care workers and patients. Vaccine hesitancy is a real issue, particularly among communities of color, who have justifiable reasons to distrust medicine in the U.S. We must play our part to convince those around us that the vaccine is first safe, and that it is also efficacious.  Tell your stories, in person, online, and whatever avenues you have to promote mass vaccination.  This is how we get back to normal.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus