President’s Message

Message from the President-August 2018

Posted on Aug 1, 2018 in President's Message | 0 comments

On Saturday, September 15, Jo Shapiro, M.D. from Brigham and Women’s Hospital will train a group of our physicians in Peer Support. The Wellness Branch of the Physician Wellbeing Committee will launch the Peer Support program later this fall. This program will provide one-on-one peer support to medical staff members following emotionally stressful events, including adverse clinical events, litigation, or any life stressor, in a confidential manner from a medical staff member trained in peer support. More details will follow. If you are interested in becoming trained in Peer Support, please contact the Medical Staff Office at (510) 869-6565. We will be offering an additional training session following the initial September 15 date for those who are interested.

Required Sutter Safe Care training is continuing through the end of September. Thank you to those who have already completed the training. If you have not yet completed the training, please join Dr. Filip Roos, our CME, for a dinner session (with wine) or a lunch session (without wine) scheduled in lieu of grand rounds. Please see the training dates below. Also, you can join in on any of the hospital staff training sessions. Be sure to sign in to receive credit.

Please remember to sign your verbal orders within 48 hours. Surveyors are currently focusing on timely signing of verbal orders. Another Sutter facility was recently cited for this. Remember, you can sign your colleagues’ verbal orders too! We can all help each other out.

Soon, construction will begin in the cafeteria which will disrupt food services. Please watch for a notice regarding the change in location of food services and the physician’s dining area.

Also, Fir 1 and 2 will close permanently September 1. Please look closely at your meeting schedules for changes in meeting locations. Many medical staff meetings will move to either the Bay View Conference room on the 11th floor or room 1776.

And finally, congratulations to the Department of Pathology for a successful College of American Pathologists survey and to Rehabilitation for a successful CARF survey!

I hope you are able to take a little time off and enjoy the summer! Be well.

Message from the President – July 2018

Posted on Jul 2, 2018 in President's Message | 0 comments

Hi All,

First, I would like to welcome Gerald Kozai, our new Alta Bates Summit CEO. He comes to us from St. Francis Medical Center in Southern California where he was CEO for 16 years. He has experience managing a multi campus hospital with a high medi-cal population and was able to grow the hospital during his tenure. Welcome Gerald! We look forward to working with you.

Over the past year, it seems the frequency of disasters is increasing. From the Las Vegas shootings, to the North Bay Fires, to the multiple school shootings across the country, sadly, there are disasters abound. Plus, the Bay Area has another unique potential natural disaster, an earthquake. The unexpected computer failures of last month was a keen reminder of our vulnerability. According to our Emergency Preparedness Committee Chair, ER physician Ronn Berrol, MD, our hospital needs will vary depending on what type of disaster occurs. If there is an outbreak, we will primarily need ICU, Internal Medicine, Family Practice, ID and ER physicians. If there is an earthquake, we will rely on our Orthopedic Surgeons to fix broken bones with the help of our Anesthesiologists, our Surgical colleagues to take care of other injuries, and ICU and Medicine docs to stabilize our patients. A shooting will initially involve General Surgeons and Anesthesiologists. Our ER colleagues will help triage and stabilize our patients no matter what we encounter, and our Hospitalists will help manage their hospital course. Also, depending on the type of disaster, some forms of communication may work better than others, i.e. text messaging may work better than cell phones vs land lines vs email. Of note, our hospital has an Emergency Operations Plan and 72 hours worth of supplies. Each department has a disaster plan and copies are maintained within each department/unit.

So, many have asked, what do I do as a physician when faced with a disaster? We do include in your re-credentialing packet instructions about how to respond in a disaster. However, we all know there is a lot in that packet and a reminder is helpful. If you are in the hospital, an overhead announcement will be made. If you are at home, you may receive an email or text message depending on whether these systems are working. If you are aware of a disaster and have not heard from the hospital, please come in if you are able. Once you are in the hospital, report to what will be called the “Incident Command Center”. As of now, this will be located in the Fir 1 & 2 conference rooms. Please bring and present your badge. There will be a sign in sheet; please sign in. Your assignment will be made according to your Department Chairperson. Dissemination of information and instructions from the hospital command center regarding the emergency will be communicated through your Department Chairperson. Also, if you have a physician colleague who lives in the East Bay and cannot make it to their hospital, please ask if they would like to provide services at ABSMC. They would need to bring their badge and/or any other information identifying them as a physician. We have a way to temporarily credential physicians in an emergency situation. Also, if you are interested in participating in our Emergency Preparedness Committee, please contact the Medical Staff Office. The more, the merrier!

Recently, there have been privacy breeches in EPIC at other Sutter facilities involving both staff and physicians inappropriately accessing patient’s medical records for personal interest. The employees have been terminated. Please take time to review the privacy policy summary below regarding appropriate accessing of patient records, including accessing family member’s records (you must have a release from HIM on file in EPIC if you are not a treating physician) and your own records (preferred route to access is via my health online).

I hope you all are enjoying your summer! Take care.

Message from the President – June 2018

Posted on Jun 5, 2018 in President's Message | 0 comments

Medical Staff Leaders recently completed Sutter Safe Care Leadership training. A special thank you is extended to everyone who donated eight hours out of their busy schedule to participate. We learned during the training that Sutter Safe Care is about creating a safe environment for not only our patients, but also for everyone in hospital. Zero harm is our goal.

Sutter Safe Care is about having a preoccupation with failure and safety, and linking this to our decisions to help create a safe environment for all. It’s about addressing potential safety issues before they become problems and cause harm. It’s about speaking up about issues we encounter on a daily basis, and thanking individuals for bringing up their concerns. It’s about actively finding problems and fixing the proximate causes. Also, it’s about changing our culture by creating an environment of trust and cooperation.

A more technical aspect of Sutter Safe Care is changing some of the details of our reporting system to better categorize events that could lead to harm or have caused harm e.g. Intensive Analysis (IAs) and Root Cause Analysis (RCAs). This will help us as an organization better understand patterns of safety events and create solutions within our system to avoid these events from occurring in the future.

Furthermore, there is an emphasis on “Just Culture”, or in other words, having a fair and accountable culture, which is understanding that most events are unintentional. When a safety event occurs, rather than blaming the individual, we take a deep dive into our system and determine how we can prevent future incidents through improving our systems. Also, as physicians and care givers, we hold ourselves accountable to our patients and each other.

The dates, times, and location for the two hour Sutter Safe Care sessions will be emailed soon.

Remember, if you see a problem or potential problem, please report it to your unit manager or to your Medical Staff leader, either your Department Chair or Medical Director. Below is an outline of the Medical Staff leadership reporting structure.

Required two hour training sessions for physicians and staff will occur June through September. Many options will be available at varying times of the day. Specifically, there will be a few grand rounds dedicated to Sutter Safe Care training. Administration will sponsor dinner sessions at both the Summit and Alta Bates Campuses for physicians and allied health professionals. Also, you can join the hospital staff during any of their training sessions. It’s the same training. Please be sure to sign up and sign in to receive participation credit. CME credits are also available. Thank you in advance for participating in the quest toward zero harm!

A special thank you goes out to each and every physician and allied health professional caring for our patients during the unexpected downtime which began the night of May 14th. Around 10:30 p.m., activation of the fire suppression system in the Sacramento data center forced an immediate shut down of all of Sutter’s data systems. All Sutter computer services and systems were down. Our physicians, nurses and staff worked side by side quickly pulling together all available resources during this unfortunate event. While walking through every floor and visiting almost every department, I noticed a strong sense of camaraderie and team work. Adversity brought out the best in everyone despite the challenges we faced. Radiologic studies were read at the bedside. Lab results were both hand delivered and faxed. Physicians heard through the grapevine potential consultations and without being called, came to the patient’s bedside.

Two radiologists deserve recognition: Dr. Phillip Wong and Dr. Chris Lee. The night hawk service was unable to function without computer services, therefore, no teleradiology. Both radiologists came in to care for our patients the night of the outage despite not being on call so studies could be read in real time. Thank you Drs. Lee and Wong.

Sutter is doing a deep dive into the circumstances surrounding the unexpected downtime. They will report their findings to each affiliate and we will report the findings via the medical staff newsletter. Also, we are doing our own debriefing as there is a lot we can learn as this situation simulated a true disaster. Please escalate downtime concerns, or ideas to streamline downtime procedures to your unit manager, Medical Director, or Medical Staff Chair. We can learn from your experience.

Message from the President-May 2018

Posted on May 2, 2018 in President's Message | 0 comments

Hello everyone! First, I would like to thank the Administration on behalf of the Summit Medical Staff for a lovely Doctor’s Day breakfast and lunch, along with the donation to New Day for Children, a non-profit organization supporting victims of sex trafficking. Also, thank you Chuck Prosper for your years of service as both COO and CEO at ABSMC. We wish you well in your future endeavors.

This month’s newsletter will focus on Summit campus highlights.

-This summer, we will launch our new Neuro Interventional Program. Initially, we will perform thrombectomies on patients who have had an acute thrombotic stroke. The program may expand later to include aneurysm coiling. Staff will go to Eden for training, as Eden has a well-established program.

-Dr. Rock Liu is leading our new Robotics Hernia Mentor/Case Observation program for robotic assisted hernia repair. Physicians will come from around the country to train and learn about our program. Details were published in the March newsletter.

-Construction for the new hybrid OR begins in April and will take approximately one year to finish. The hybrid OR will have all of the capabilities of a regular operating room plus built in advanced imaging technology.

-Our Preoperative Clinic, led by Dr. Catherine Stapleton, continues to ramp up its volume and is seeing a majority of patients who come through the operating room. A satellite clinic at Ashby is currently under consideration.

-MCMI is moving to a new location on Telegraph Avenue.

-The new in-house MRI will be operational at end of 2018.

-The construction for the new Doctor’s Lounge is scheduled to finish at the end of 2018. There will be a small exercise area, plenty of space to chart, a lounge and a dining area.

-Soon, construction will begin disassembling the West wing of the hospital. The disassembly will occur over five weekends, and construction will continue in this area of the hospital for 12-15 months.

-The Medical Staff has been engaging Sutter leadership about growth strategies for ABSMC. Suggestions or ideas? Please let myself, the Chair of your Department, or the Medical Staff Office know, as this is a collaborative effort.

-Sutter Safe Care Leadership training has begun. Dates and times for the two hour training for all physicians and staff will soon be released and will occur June through September. Administration will provide dinner for physician training on a few selected evening dates at both the Summit and Alta Bates campuses. Two hour training sessions will also be available during a few selected grand rounds on each campus. Physicians also may join in on the staff training sessions. The content is the same no matter which venue you choose. CME credits will be available.

Jill Kacher Cobb, MD
President, Summit Medical Staff

Message from the President-April 2018

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

Welcome back to another edition of the medical staff newsletter! As many of you know, we have been encountering shortages of both medications and supplies. Medications have included items such as amiodarone, many antibiotics, KCL, local anesthetics, and compounded medications including drips and epidural solutions. If possible, please use oral medication for your patients, saving the limited supply of IV medications for those patients who need it the most. Also, please call ahead to pharmacy if you anticipate needing a compounded medication, such as a drip. Regarding supplies, we have experienced shortages of IV bags, sterile irrigation solution, connectors, extension sets, adaptors, stopcocks, and many more items.

Currently, we have limited allocations of certain drugs and supplies from many companies. The landscape changes weekly, and sometimes daily. Every now and again, we avert a crisis with an unexpected allotment. Emergency teams are pulled together immediately to address this ever-changing atmosphere of shortages as needed. Thank you to everyone who has participated on these teams. As this is a fluid situation, please look for the rainbow colored icon, located on every ABSMC computer, titled “Supply Backorders” listing both the current medication and supply shortages. We asked about sharing medications and supplies with other Sutter hospitals. Unfortunately, they too are on limited allotments from manufacturers and often do not have extra supplies or medications to share. Sutter has a committee, above the affiliate level, coordinating efforts whenever possible.

What has lead up to these issues? Well, there are many factors. I’ll touch on a few. Pfizer’s Kansas facility experienced quality problems leading to an almost full shut down of its major production facility impacting availability of opoids and local anesthetics. The Baxter manufacturing facility in Puerto Rico, damaged during hurricane Maria, lead to shortages in small volume drug bags. The FDA did take action to import supplies from other manufacturers located in other countries, which eased some of the supply issues.

As part of an effort to decrease misuse of opiod pain killers, the DEA called for a 25% reduction in the manufacturing of opoids last year, and an additional 20% reduction this year. This, along with the manufacturing issues at Pfizer’s Kansas facility, has led to opoid shortages. Many hospital systems across the country are experiencing opoid shortages, causing staff either to be judicious with usage and using alternative medications that are less potent, or, if available, giving alternative opoid medications in concentrations that RNs are unfamiliar. As a result, there have been reports from other hospitals of inadequate pain control, elective surgery cancellations, and overdoses due to lack of familiarity and mistakes in dosage administration. A letter was written on February 27, 2018 jointly by the American Hospital Association, the American Society of Clinical Oncology and the American Society of Health-System Pharmacists to the US Drug Enforcement Administration stating that the shortages “increase the risk of medical errors” and are “potentially life threatening”. The American Society of Anesthesiology is working with other national organizations to address these issues and stay ahead of drug shortage problems. They have been a leading advocate in Congress and are partnering with the FDA and their Office of Drug Shortages to monitor these issues and work toward solutions. So far, our hospital has not been significantly affected by opoid shortages.

On February 27, 2018, the California State Board of Pharmacy sent a Cease and Desist order to Pharmedium Services as an investigation demonstrated noncompliance with state regulations and federal good manufacturing practices. The California Pharmacy Board is currently working to identify alternative manufactures and alternative strategies in lieu of Phamedium sterile compounded and nonsterile drug products. This has placed an enormous burden not only on our pharmacy, but on all hospital pharmacies in California. At a recent ABSMC committee meeting pharmacy stated that we went from compounding 10% of compounded drugs to compounding 90% of compounded drugs in our pharmacy. What this means: first, the increase in compounding medication on site is a large burden for the pharmacy staff. Second, drugs compounded on site have a 12 hour shelf life, limiting the number of premade compounded medications available on demand. The company has 30 days to respond to this issue and hopefully we will see a resolution soon. In the meantime, please call ahead to pharmacy, if possible, if you need a compounded medication, such as a drip, STAT. Also, please give your pharmacy colleagues a kind word for their hard work.

Jill Kacher Cobb, MD

President of the Summit Medical Staff, ABSMC

Message from the President – March 2018

Posted on Mar 2, 2018 in President's Message | 0 comments

It has been said that two things are guaranteed in life: death and taxes. I’ll propose a third. Change. Many of us who have been out of residency for a while have watched the practice of medicine change over the years. Not too long ago, the majority of Internal Medicine and Family Practice physicians followed their patients throughout the patient’s hospitalization. Now, hospitalized patients are mainly cared for by Hospitalists, and our outpatient physicians pick up where our Hospitalists left off, helping keep our patients healthy in the community. In the past, many Surgeons, Obstetricians/Gynecologists, and other specialists hung their own shingle. Now, many physicians have joined multispecialty physician practices, larger groups, some with University affiliations, and some are employed. There are not many of us are left in solo practice. Many of these changes resulted from external pressure making it difficult to practice medicine and deliver care as we had in the past. We continue to adapt to the ever changing environment of medicine, sometimes in order to survive.

On the hospital side, to remain viable, there is pressure to deliver high quality care at a lower cost, resulting in many changes at ABSMC. The Huron Group continues to make recommendations including finding ways to increase efficiencies and reduce overhead to drive down cost. To help improve quality and reduce preventable errors, Sutter is implementing a program called Sutter Safe Care, a high reliability program. For the program to achieve success, the expectation is that all Active Medical Staff will participate in training. Four hour physician leader training (i.e. Department Chairs, Medical Directors, etc.) will occur in April and May, and two hour Active Medical Staff physician training will begin in June and end this Fall. We will receive CME credit for participation. Dates are TBA.

We also have seen changes in hospital leadership recently. We welcome our new CME, Dr. Filip Roos, who was Chief of Staff at his previous hospital and is a Cardiac Anesthesiologist. Chuck Prosper announced last week that he will be departing as CEO on May 6th. We thank him for his dedicated service to ABSMC for the past 6 years.

A national search will take place to recruit a new CEO to ABSMC.

In light of the inevitability of change, please join us for our second annual Physician Mindfulness One Day retreat at Green Gulch Sunday, April 15 from 9:30 a.m to 4:30 p.m. The event last year was both relaxing and invigorating, and also helped many of us to refocus our sense of self in our ever-changing busy lives. A bonus: the food was fantastic. Details are in the flyer below.

Take care,

Jill Kacher Cobb, MD

President, Summit Medical Staff, ABSMC