President’s Message

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

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

Message from the President, January 2018

Posted on Jan 10, 2018 in President's Message | 0 comments

Dear Medical Staff Colleagues,

Happy New Year,

As you are aware, the census is high and in retrospect, the previously low census was the calm before the storm. There are many patients with high medical acuity and who are positive for Influenza. Thank you for all your hard work! Special thanks to the Emergency Department, Hospitalists, Surgeons and Intensivists.

Sutter Safety Care- This is the High Reliability project focusing on our processes to decrease patient harm. This a Sutter system initiative and we will be one of the early adopters. We can anticipate a roll out in the spring with Physician leadership training and then will be disseminated to the rest of the staff.

Drug shortages- For several reasons, we are facing challenging drug shortages. We need to make wise choices and consider alternative medications. It is vital to be aware of which drugs these are and to be abreast on the latest changes. There is an icon on the Sutter computer desktops which gives the weekly updates. (See screenshots below). I recommend being familiar with how to access the information and checking on a regular basis.

Currently physician representatives from ED, Hospitalists, Cardiologists, Critical Care, and Anesthesia are engaged with pharmacy and nursing administration on providing recommendations for alternative drugs.

Interpretation services- We are fortunate to care for a diverse patient community. This does make it more important to rely on interpretive services. From the Patient Safety Risk Committee, a theme is recognized in regards to patient falls and in practically every case, upon review, interpretive services were not used. This is not the main reason for the fall but likely contributed. It is recommended not to rely solely on family members. There are interpreters physically present at the hospital during the work week. There are telephone interpreters on every unit (ask the charge nurse for a phone if not present in the room). You are encouraged to ask for an interpreter off hour if you require one. Simply ask the house supervisor and they will work on obtaining one for you.

Dr Ursi Boynton has moved on to be the CME at Delta Medical Center. Congratulations Ursi! They are very fortunate and lucky to have you.  Thank you for all your physician support these past several years.

I am completing my term as your Medical Staff President. It has been a humbling experience and an honor serving you all. I want to thank my fellow officers Dr Junaid Khan, Immediate Past President, Dr Charu Puri, Secretary/Treasurer and Dr Jill Kacher Cobb, Vice -President and Physician Leaders on the Medical Executive Committee for their council and much needed advice. The ladies in the Medical Staff Office Heidi Van Waveren, Terri Smith, Karen Souvandara, and Joanne Jellin who not only provide support for our medical staff meetings but create magic behind the scenes by keeping  the medical staff operations running smoothly. I would like to thank the Administration Chuck Prosper, Rose Calhan, Denise Navellier, Dr Ursi Boynton for their partnership in working toward our shared goals- the continued success of Alta Bates Summit Medical Center and providing quality care to patients.

But most of all, thank you to the dedicated and hardworking medical staff physicians who are the heart of the medical community.

Message from the President, December 2017

Posted on Dec 5, 2017 in President's Message | 0 comments

Dear Medical Staff Colleagues,

The hospital is facing tough financial challenges. As you know, the hospital needed to make difficult decisions by laying off several management positions. This has created a restructuring in administrative support for certain departments and services. We will be learning more about what the new structure is going to look like. My understanding is that the goal is not to have a disruption in the front line delivery of care. My recommendation is to continue to ask questions of the Administration. Our medical staff leadership and I will continue to have a dialogue, provide feedback and partner with Administration on shared goals.

Shortages in medications- Pharmacy is keeping us updated on the latest medication shortages. Apparently IV KCL is on the short list. This is a frequently used medication. With help from the nephrologists, a protocol is being developed and will be rolled out very soon.

Telemetry usage- we were doing really well, but more recently there has been a drop off on appropriate cardiac monitoring usage. This is just a gentle reminder to use the guidelines for usage and to take patients off monitoring once it is no longer needed.

Much appreciation and thanks to Dr. Ursi Boynton for her years of service as the Administrative Medical Director.  Delta Medical Center will be fortunate to have her as their new Chief Medical Executive.

The Summit Medical Staff has generously donated $1,000.00 for the Holiday Giving – Grocery Gift Cards for Families in Need.

Best wishes during this Holiday Season.

Stay safe and be well,

Donna

Donna D. Tigno, M.D.

President of Summit Medical Staff

Co-Director of Critical Care at Summit Medical Center.