Message from the President-February 2018

Posted on Feb 6, 2018 in President's Message | 0 comments

Aloha! Our family spent this past week in Hawaii for some much needed rest and relaxation. While sitting on the beach, I reflected upon how hard each of us works to take the best possible care of our patients and how much time we all have dedicated, not only to our training to become a physician, but now, to our patients and our careers. Many of us live multifaceted lives not only as busy physicians, but also as small business owners, friends, spouses, mothers and fathers, and/or care takers for elderly parents. There are days when patients are actively trying to die. Someone is septic, on pressors with an acute abdomen needing to go to the OR. You induce with a whiff of etomidate and their blood pressure still plummets to a dangerously low level. A pregnant woman delivers her baby via caesarian section and begins to hemorrhage. You have given 50 plus units of blood products and are still counting, trying to save her life. In the meantime, you feel like you have shaved a couple of months off the end of your life. We all face these types of challenges in our own specialty’s special way. In the meantime, our lives outside of medicine march on with our own unique challenges. You or a family member may be ill. You may be challenged with a lawsuit despite your best effort to care for a patient. Someone may be going through a divorce. Financial woes. You may have a teenager in the house.

It can be quite challenging at times to balance both your career and outside life, and still feel like you are doing a top notch job at each one. Life is not always easy. Many of us face similar life challenges and we can draw from the collective strength of our physician community. As you may have heard, our medical staff is actively trying to strengthen our physician community. We hired Dr. Jo Shapiro from Brigham and Women’s Hospital to train a subset of physicians for Peer Support. Once our program is up and running, you will be able to contact this group if you would like to debrief about a tough case, or chat about challenges in your career or your life in general. It is completely confidential and up to you to reach out. This program will be available to all physicians. For now, we are looking for volunteers to train in peer support. Please nominate someone in your department who you feel would be a great confidant or nominate yourself. We will hold two training sessions lasting approximately four hours on Saturday, September 15 and Monday, September 17, location TBA. Please email (shanklt@sutterhealth.org) if interested or if you have a nominee.

Life keeps changing like the ocean waves mold the sand on the beach. Let’s help each other through these changes and challenges.

Jill Kacher Cobb, M.D.
Medical Staff President, Summit Medical Staff

Wellness Committee Update

Posted on Feb 6, 2018 in Wellness Committee | 0 comments

This message is being on behalf of Drs. Leif Hass, Lenny Husen, and Jill Kacher Cobb, Wellness Committee Members

Dear Colleagues:

The Medical Staff and the Well-Being Committee are bringing a peer support program to ABSC to help our colleagues at risk for burnout.  We all have moments when we feel fried, but for some of us this leads to persistent emotional exhaustion that is true burnout.  Most of the reasons behind burnout are beyond our control.  The Medical Staff is working with Administration to address the institutional causes, but at times, many of us might need a little help coping.

We are bringing in a proven peer support program that was developed at Brigham and Women’s Hospital and now used at more than 30 centers around the country.  We are looking for volunteers to do a 4.5 hour training be become a one-one peer counselor.  They will learn the skills needed to talk to colleagues who are struggling of any number of issues.

The program recommends we ask doctors from different disciplines to recommend people who feel they could talk to, to be trained to become one of these counselors.  We are asking leaders around the medical center to bring this up with their colleagues and give us the name of people chosen by their peers who would like to work with us.

The training will take place on September 15 and 17 (choose your date) with providers from the Davis and Sacramento. We are hoping to have around 20 people trained from ABSMC.

Let us know if you have any questions.  Looking forward to hearing who is interested in join us in this endeavor! We are trying to get a rough head count in the next month.  We have attached a JAMA article on the program.

Thanks,

Leif, Lenny and Jill

Care Everywhere

Posted on Feb 6, 2018 in EHR Updates | 0 comments

Documentation of Sepsis, Severe Sepsis and Septic Shock

Posted on Feb 6, 2018 in Announcements | 0 comments

There continue to be missed and mis-diagnoses as well as CDI and coding queries about sepsis –much of this reflects unfamiliarity with the definitions and clinical indicators for sepsis, severe sepsis and septic shock.  For these reasons, it seems like a good time to review this information.  The following examples and comments are based on the current ICD-10 and CMS coding guidelines (which reflect Sepsis-1 and Sepsis-2 definitions).  The Sepsis-3 definitions were initially published in early 2016, but haven’t been adopted by ICD-10 and CMS yet.

Your patient could have SEPSIS if she is ill from a suspected or confirmed infection and has 2 or more SIRS criteria.  If there’s no infection, there’s no sepsis.  And if there’s infection but no SIRS criteria, there’s no sepsis.

The SIRS criteria are:

Temp > 38 C/100.4 F

            < 36 C/ 96.8 F

  HR > 90/min

  RR > 20/min

  WBC > 12k or < 4k or 10% bands

+ if the SIRS criteria can be explained by something else, don’t use them to determine if the patient has sepsis.

++ if the patient has SIRS but no infection, this is non-infectious SIRS (document the cause)

+++ Lactic acidosis is NOT a SIRS criteria

EXAMPLE of IDEAL DOCUMENTATION: “sepsis from UTI (SIRS criteria WBC 15k and temp 101”).

Avoid the term “urosepsis”

ANOTHER EXAMPLE: “non-infectious SIRS due to severe pancreatitis, no sepsis”

*************************************************************************************

SEVERE SEPSIS is currently defined as SEPSIS with acute organ dysfunction that is DUE TO or SECONDARY TO SEPSIS.

A few examples of organ dysfunction:

acute respiratory failure, hypoxic and/or hypercarbic

acute renal failure, AKI, ATN

acute encephalopathy

Lactic acidosis > 2 but less than 4  (AVOID the terms “elevated lactic acid or “elevated lactate”) 

Hypotension

Hepatic failure, shock liver

DIC, thrombocytopenia

AMI, acute coronary synd

Shock

MODS multiple organ dysfunction syndrome

+ if the organ dysfunction is due to sepsis, document this association

++ if the lactic acidosis is due to sepsis, document this association

IDEAL DOCUMENTATION: “Severe sepsis from empyema, with DIC due to sepsis”

ANOTHER EXAMPLE: “Severe sepsis—leg cellulitis with SIRS and lactic acidosis due to sepsis”

ANOTHER EXAMPLE: “Severe sepsis—aspiration pneumonia with acute encephalopathy due to sepsis”

************************************************************************************

If after iv fluid, the patient with SEVERE SEPSIS still has SBP < 90 mmHg or 40 mmHg below baseline and

MAP < 65 OR has persistent lactic acidosis > 4, then document SEPTIC SHOCK.

+ if present, specify other etiologies of shock as well

Beth Gong, MD for the CDI Team /gongb@sutterhealth.org— contact me if questions

Why Sutter Community Connect

Posted on Feb 6, 2018 in Committee Briefings | 0 comments

MAR Hold

Posted on Feb 6, 2018 in EHR Updates | 0 comments

MAR Hold – information sheet

 Big picture:

  • MAR hold functionality is live in all hospitals across the Sutter Enterprise
  • When a patient is transferred into a perioperative or procedural area, all active medication orders are automatically placed on a HOLD status
  • This workflow has been recommended by the Joint Commission and adopted as a Sutter standard for patient safety.
  • When the patient is transferred back to the floor, the medication hold will remain until the surgeon/proceduralist performs Order Reconciliation via PeriOp, Procedural or Transfer Navigator

 Why is this important?

  • By promoting medication reconciliation between levels of care, MAR hold increases patient safety by clarifying which medications should be available for a procedure vs which medications are meant for the hospital ward
  • If Order reconciliation is not performed, the ward nurses cannot administer medications in a timely fashion- as meds active prior to the procedure remain on Hold status.

Details:

  • Note that MAR hold will only come into play when the patient is transferred from the floor (e.g. a med surg unit) to a perioperative or procedural area, then back to the floor.  This does NOT affect same-day surgery cases.
  • The surgeon or proceduralist is responsible for medication reconciliation.
  • Nurses who receive patients who have not had their medications reconciled will first contact the surgeon or proceduralist to request that med rec be performed
    • Note: If you receive a call from a nurse requesting that you perform med rec, but you know you have already done so, you should ask if the nurse has released your reconciled orders (MAR hold will not be released until (s)he does so)
  • If a proceduralist encounters difficulties with the Order Reconciliation process or is unable to perform the reconciliation of certain medication orders, they should communicate directly with the hospitalist, attending, or other appropriate provider to request assistance with the process to ensure that all medications are reconciled in a timely fashion.

Support:

  • Your local Physician Liaison, Patty Fitzgibbons is available for education and support.

Electronic Access to POLST Launches February 6, 2018

Posted on Feb 6, 2018 in Health Information Management | 0 comments

On Feb. 6, 2018, we will launch system-wide a comprehensive software solution to capture, store, and access Physician Orders for Life-Sustaining Treatment (POLST) forms. POLST forms are vital to ensure that we meet patients’ end-of-life wishes. This technology will help Sutter Health providers navigate conversations with patients and families, accurately document patient preferences and easily access POLST forms.

POLST forms allow people with serious, life-limiting illnesses to document their care preferences. However, the lack of electronic access to POLST has made it difficult for providers to find and access patients’ documents, especially during emergencies. In paper form, patients’ end-of-life wishes are accurately documented only about 30 percent of the time and about 25 percent of paper forms have an avoidable error that renders them unusable.

This new robust platform from Vynca, Inc. ensures that documentation truly reflects patient preferences, supporting best practices for advance care planning. The platform makes completed documents easily accessible by multiple providers via the electronic health record, which eliminates redundant data entry, improves accuracy and saves time. For more information, click here for the FAQ, Flier, and Know Do Share.

ePOLST Registry

Posted on Feb 6, 2018 in Health Information Management | 0 comments

Physician Orders for Life-Sustaining Treatment

Posted on Feb 6, 2018 in EHR Updates | 0 comments

New Providers

Posted on Feb 6, 2018 in Uncategorized | 0 comments

Dawud O. Lankford, MD
Urology
East Bay Medical Oncology Hematology Associates DBA Epic Care
355 Lennon Ln., Ste. 205
Walnut Creek, CA  94598
(925) 935-0627

Erin I. Lewis, MD Obstetrics and Gynecology
Reproductive Science Center
89 Davis Rd., Ste 280
Orinda, CA  94563-3033
(925) 867-1800

From the Medical Staff Office