Common Ground e-News begins
March 23, 2014

   
TOP READStop
MESSAGE FROM THE CIC
IN THIS ISSUE
messageCommon Ground e-News:  What is it and why should I care?
  • E-newsletter launching.
  • Designed as a single communication tool for news. 
  • Click headlines to jump to stories important to you.

 

By David Holloway, MD, on behalf of the Compact Implementation Committee

 

Here's the dilemma: we send so many emails, newsletters, updates and letters to the medical staff, it is impossible for physicians to know what's important.  It's like a shipwrecked sailor dying of thirst while surrounded by an ocean of water.

 

There needs to be a way of converting the acres of saltwater into the right amount of something drinkable.

 

The Compact Implementation Committee (CIC) decided to tackle the communication issue as a first priority.  This will bring to life the third element of the Common Ground Compact under both the Medical Staff Contribution and the Hospital Contribution:

  • Develop and use recognized systems of communication to stay informed. Take responsibility for staying informed (Medical Staff), and
  • Provide the Medical Staff timely, relevant information and engage in meaningful, two-way communication using systems developed by the Medical Staff (Hospital).

The e-News you are reading is the result of work by the CIC, Physician Engagement Committee and a group of physician advisors. The idea pulls together all of the communication you previously received randomly throughout the week.

 

The essentials:

  • Sunday afternoon every other week the CG e-News will appear in your email. Unless something arises urgently, you will get no other emails from the hospital. This will become the single source.
  • An "editorial board" of physicians will receive and sort all communication from the hospital. The highest priority items will be Top Reads. Click the link and read the full communication. Anything other than the Top Reads will be sorted into various categories. You can choose what interests you.
  • The editorial board requests your feedback. The e-News will evolve and improve based on your feedback. Consider what you are reading today as a starting point.

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HONORS, AWARDS, and KUDOS
boardNancy Reyes-Molyneux and Rob Kelly

Two physicians were appointed to the Salem Health Board: Nancy Reyes-Molyneux and Rob Kelly. The third physician member on the board is always the MEC president, as an ex-officio member. That role goes to Dr. Mike Hanslits; and our thanks go to out-going MEC president Dr. Steven Mattison.

 

Deep appreciation to out-going board member Dr. David Elmgren for his many years of service. 

 

Nancy's details:

  • Private practice with Radiation Therapy Consultants, PC, since 1999.
  • Diplomat of the American Board of Radiology.
  • Medical degree from Loyola University Chicago Stritch School of Medicine, with residencies in radiation oncology at the University of Rochester Medical Center in New York and in radiation medicine at Loma Linda University Medical Center in California.  
  • Instructor then assistant professor, and assistant director of the residency program at the Loma Linda Department of Radiation Medicine.
  • Serves on Salem Health Quality Operations Committee and Oncology Peer Review Committee.
  • Section Chief for Radiation Oncology and the Clinical Site Director for Radiation Oncology with the Salem Cancer Institute.
  • Participated in Salem Health Physician Leadership Institute.
  • Co-chair of the Genitourinary Tumor Site Committee and weekly Cancer Conference.

Rob's details:

  • Emergency physician and partner in active practice with Salem Emergency Physician Service, PC, (SEPS) since 1997.
  • Medical degree from OHSU and completed a residency in emergency medicine at Orlando Regional Medical Center in Florida.
  • Board certified in emergency medicine by the American Board of Emergency Medicine.
  • President and CEO of SEPS since 2007. 
    Serves on steering committee of the Physician Leadership Institute, helping design the curriculum and participating in ongoing course evaluation and improvement activities.
  • Serves on Emergency Executive Committee.
  • Received two Salem Health Service Excellence Awards.

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intensivistsCredit to Intensivists

When we received the coveted Healthgrades honor putting Salem Hospital in the top 5 percent of the nation's hospitals, much of the heavy lifting to earn that honor came from our intensivists. Their outstanding work in critical care and pulmonary medicine contributed greatly to this accomplishment. A special breakfast was held in their honor recently. Their work helped Salem Hospital become ...

  • One of Healthgrades America's 100 Best Hospitals for Critical Care in 2014
  • A Five-Star recipient for treatment of pneumonia for two years in a row (2013-2014)
  • A recipient of the Healthgrades Critical Care Excellence Award™ in 2014
  • Ranked among the top 5 percent in the nation for critical care in 2014
  • A Five-Star recipient for treatment of sepsis for five years in a row (2010-2014)
  • A Five-Star recipient for treatment of pulmonary embolism in 2014, and
  • A Five-Star Recipient for treatment of respiratory failure in 2014

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YOUR QUESTIONS ANSWERED
YQAWe want to hear from you!
You might be familiar with Rumor Has It, our regular postings on the Salem Health intranet of questions submitted by staff and answered by the appropriate member of leadership. 
We'd love to hear your questions and provide answers in this regular column. 
Feedback on this newsletter is also welcome! Help us improve this communication model to be effective and efficient.
Email us at commonground@salemhealth.org.
 
COMING EVENTS
CanCancer Symposium for Primary Care April 11

 

April 11 from 12:30 to 6 p.m. Lunch at 12:30 p.m. Social hour 6 p.m. with wine tasting/cheese pairing.
 
Topics - personalized medicine, new challenges in breast screening, palliative care, updates in urologic oncology, lung cancer screening update, survivorship, patient navigation and intro to new cancer center.
 
Knight Cancer Institute Director Dr. Brian Druker will discuss the future of personalized medicine; how drivers of cancer are revolutionizing treatment and early detection.
 
Register online for this free event; salemhealth.org/invite or call 503-561-5419.
 

Thanks for your patience ... during the closure of the physician parking between Building D and Building E from 5:00 pm on Thursday, 4/10/14, through midnight 4/11/14. Nearby parking in the garage and other designated physician parking will be available.

 

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QUALITY & SAFETY
BPAsNew BPAs for cardiac, smoking patients
  • Two new BPAs begin March 24
  • Cardiac and smoking
  • Look in Discharge Navigator
Two important Best Practice Advisories were added to Epic, starting Monday, March 24. Look for the new BPAs in the Med Rec Section of Discharge Navigator in Epic.  
  • Cardiac patients BPA:  Present by default. This will be located in New Orders For Discharge section. When accepted, this BPA opens the Cardiovascular Discharge order set which allows the discharging provider to ensure all necessary outpatient medications have been ordered prior to discharge. Note: the Cardiovascular Discharge order set should only be used after discharge medication reconciliation. A tip sheet has been posted on the Medical Staff Website.
  • Smoking Cessation BPA: A Smoking Cessation BPA may also appear if the patient requests smoking cessation counseling on admission.

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FoleyNew Foley Catheter Order Sets
  • New SCIP order sets began March 11. These replace existing orders for Foley catheters.
  • A Best Practice Alert (BPA) will prompt you on options.
  • Dr. Raj Nair presented the new order sets to Physician Leadership Council. Consensus was to move forward.
  • Dr. Nair and Dr. Logan Priollaud are happy to attend your section meeting to demo the new workflow.
More Details
Foley catheters are required by SCIP to either be removed by midnight post-operative day 2, or have a documented, CMS-approved reason for retaining. This documentation must happen on either post-op day 1 or 2, not day of surgery. CMS requires us to comply with SCIP measures 100 percent of the time. Up to $2M may be at risk if we do not bring our overall Appropriate Care Score up to 96 percent from current 85 percent. 
In our work, we've found 15 failure opportunities. The team has thus created two order panels--one surgical, one non-surgical, modeling after a Epic system in the Midwest that succeeded in this measure. Both panels standardize insertion, care, and removal/retain orders. This reduces the list of free-standing and duplicate orders, reducing error potential. 
Both order sets will include best practice advisories that will prompt you to document a reason for retaining or enter a removal order. Questions go to Dr. Raj Nair.

LabChanging Lab Test Window for Orthopedic Surgery
  • Orthopedic elective surgeries testing a 90-day window for pre-surgical labs.
  • May be extended to other surgeries if successful.  

More Details 

The 10-day window for blood bank testing has inadvertently placed unnecessary time stress on our blood bank system. Patients don't want to make multiple trips, resulting in 30 percent of elective orthopedic surgeries lab testing being done day-of, which risks delays and creates boluses of work. However, there's no clinical reason to limit this blood bank testing to 10 days prior to surgery unless the patient is pregnant or has received a transfusion in the 30 days prior to surgery. Lab is partnering with Anesthesia and Orthopedics to determine which patients require blood bank testing, and extending the pre-surgical lab test window to 90 days prior to surgery. Lab and Imaging director Mary Ransome can answer any questions.

 

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MedsRestricted Medication Ordering Proposal
  • Current inconsistency in accurately applying medication restrictions from P&T committee.
  • A verification question will be embedded in Epic orders for restricted medication, requiring name of authorized provider.

More Details 

Medications with restrictions (regarding who can order them or for what indication) should be readily available to be ordered when use is appropriate to any provider working with an allowed provider. Currently, pharmacists are struggling to accurately and quickly identify which restricted medications should be available and when. Embedding a question within orders in Epic would give consistent application of these P&T restrictions and prevent an order in error, by requiring entry of an authorized provider name (answer options would be restricted to those providers). MEC approved this to increase our accuracy and consistency of application of these restrictions. Pharmacist Matthew Tanner can answer questions. 

 

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RenalRenal Dose Potassium Replacement Order for Adult Health
  • Renal Dose Potassium Replacement Order for Adult Health (Building B) use was approved by MEC.
  • Will utilize same protocol as currently active in Critical Care.
  • Use of protocol order will be at provider's discretion.

More Details 

Patients with low potassium and impaired renal function currently do not have potassium replacement by protocol. These patients currently require a provider call and entering a specific, one-time order. If this proposal is accepted, and providers in Adult Health choose, they could enter a protocol order that would allow potassium replacement to the same standard as in Critical Care, resulting in prompt addressing of hypokalemia. RNs will be educated on this protocol.

 

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PolUpdated Policies
Two updated policies were shared at the Feb. 20 Physician Leadership Council meeting. They include:
  • Chain of Command policy updated to clarify and expand focus to all members of healthcare team.
  • Swallow Screen policy updated to allow for NP and PA orders. A patient that fails an RN-administered swallow screen will get NPO and a speech eval order, and you will be notified. 

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treatTreating Yourself or Family Rules Revision
Proposed revision to the Medical Staff Rules & Regulations, Article II, Treatment of Patients.
  • Include specific language about it being inappropriate for a physician to write a prescription for controlled substances for themselves, members of their household, or any first-degree relative of a household member.
  • Clarify that there are times it may be appropriate for physician to provide care to themselves, members of their household, or first-degree relatives of household members, though generally it should not be done.  

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FINANCE & TECHNOLOGY
icdICD-10 Education
  • All active medical staff will be required to complete ICD-10 education by Aug. 31, 2014.
  • Education will be via online module; general plus specialty or specialties.
  • Modules will include exam and CME credit and may take 2.5-5 hours.
  • Modules will be available via Healthstream on May 1, 2014.
  • Education was recommended by Physician Coalition and approved by MEC.
More Details
The Physician Coalition recommends and MEC approved mandatory education and demonstration of competency for ICD-10 for all active medical staff who may enter documentation in the chart supporting ICD-10 billing, including locums, employed outpatient physicians, and West Valley active medical staff.
A general module plus one or more specialty module will be available by May 1, and must be completed by Aug. 31, 2014, via Healthstream. Precyse is the vendor delivering content, which will offer CME credit. This course will take 2.5-5 hours and each module has a competency exam which must be passed for CME credit.
  
ICD-10 is a mandatory move on Oct. 1, 2014. Failure to document with ICD-10 specificity will result in inaccuracies which will risk delayed or denied payment or lower reimbursement.
Dr. Claire Norton can answer your questions.

Copy"Copy & Paste" Rules Revision
Proposed revision to Medical Staff Rules and regulations, Article VII, Part B. clarifies that it is acceptable to copy and paste from a source document, but:
  • A provider may not copy another provider's document verbatim and use as  if it were their own work; if done, it must be stated as such and credit given to the author. This does not replace a provider's own documentation.
  • A provider may not copy forward their own document unless updated/edited to reflect the unique patient encounter.
  • If a copied and pasted or cloned document is unchanged/unedited and cannot be used for billing, the document will be considered "incomplete" and a deficiency created.  

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AnswAnswering Service
  • Review completed on quality and cost of Salem Health answering service.
  • Status quo not acceptable. 
  • Considering discontinuing or restructuring--your feedback is wanted. 
More Details
Salem Health provides an answering service to clinics and hospitals throughout the community at a flat rate. A review of quality and pricing was done, and a change is recommended. Currently, 138 customers with 452 pagers in total pay $70 per month for answering, or $25 for paging only.  Status quo is not appropriate to continue for three reasons:
  • Quality concerns as evidenced by PSAs.
  • Per Stark laws, service cannot be provided free; Salem Health is subsidizing at $84,000 per year currently. 
  • Salem Health cannot meet industry standard service without increasing costs.

Two options are being considered--either discontinuing the service, with customers provided with information on local service providers, and Salem Health continuing to note which provider is with which vendor, so calls and pages could go through Salem Health operators to vendors, or increasing positions, structures, and technology to bring existing services up to standard, but would result in increased prices.  

 

Your feedback is desired! Dr. Ken Graven presented this information to PLC.  

 

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ENGAGEMENT
OHSUMore forums coming on affiliation
  • Partnership talks announced with OHSU.
  • Watch for more details here.

As you've read or heard, on March 17, Salem Health announced OHSU as the final affiliation candidate. Details of the possible partnership will be discussed over the next year, with forums scheduled soon for medical staff. 

 

The over-all goal in affiliation is to find a partner that best complements Salem Health's mission and culture. Salem Health and OHSU already have a formal collaboration in place through the Salem Cancer institute and OHSU's Knight Cancer Institute. Working together has revealed the two hospitals share a similar commitment to quality and putting patients first.

 

As soon as they're arranged, we'll provide forums and other opportunities for you to learn more. If you have questions or concerns you want addressed, email the Common Ground contact.   

 

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affiliationYour feedback from affiliation forums

 

Salem Health is responding proactively to challenges we all face in health care - in short, how can we deliver high quality care at a lower cost?  This analysis includes examining affiliations with other organizations -- a practice happening nationwide.

 

CEO Norm Gruber hosted many opportunities for open dialogue, including forums at Salem Hospital, West Valley Hospital, physician breakfasts, and two physician listening sessions.  With last week's announcement about OHSU, these forums will continue.

 

Here's a summary from physician listening sessions held prior to the OHSU announcement. 

 

Process

  • Physicians are concerned they haven't been given enough information. Some said medical staff doesn't have enough information to comment effectively.
  • Some believe physician input is crucial, since physicians ultimately drive quality. Others believe the decision will be made based on economics and that physician input will not factor into it. Everyone has heard rumors; there is a level of distrust and concern by some that a deal may already be made.
  • All agreed they want straightforward information: Be transparent and honest with us, one physician commented, because ultimately it's our lives and livelihoods.

 Impact on autonomy and ability to practice

  • Physicians are concerned that they are perceived as expendable; that the affiliate system would have all the power and could bring in its own physicians. Many believe an employed physician model could lower quality and damage Salem's collegial medical community. Employed physicians wouldn't have the same commitment to the community as independent physicians, many felt.
  • Some groups have less negotiating power than others: Pathology, infusion, anesthesiology and cardiac surgeons were all positions mentioned that might be at risk for replacement. "Will we still have jobs?" and "Will we be able to practice the way we want to?" were common questions.
  • All agreed the affiliation model should include an option for physicians who do not want to be employed.

 Impact on quality of care

  • A loss of local control could lower quality, and decisions made elsewhere might be sound financially, but bad for patients.  

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normYour partnership is crucial

 

We had originally intended to make this announcement later this Spring, or possibly even into Summer, to give us time to work through the many issues we know need to be addressed. Given that other groups have had affiliation talks falter, we wanted to be safe.

 

Over the last two months we have provided a number of opportunities for members of the medical staff, employees and volunteers to learn our rationale for seeking an affiliation partner, to ask questions and to share their thoughts. Those have been fruitful conversations.

 

In keeping with the Common Ground Compact, we are committed to providing meaningful opportunities for our medical staff to provide input, be engaged and to ensure that those perspectives are understood and considered as we move through this process. We have worked through the basic questions and concerns. We are now at the point that in order to provide meaningful input we need to announce the potential partner.

 

It is early in the process and too soon to tell if our ongoing conversations with OHSU will lead to a formal affiliation, however, I am encouraged by our progress to date. Partnering with our local physicians is crucial. We need your support and help throughout this process as we explore our partnership with OHSU, so I appreciate your input. We've shared your thoughts with Board of Trustees at their board retreat March 7 and 8 and will schedule additional forums soon so that we can gather further feedback specific to OHSU.


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acaMedical Students--Growing great physicians
  • 10 percent increase in medical student program last year and another 10 percent more expected this year.
  • Will be limiting placements to OHSU and Pacific-Northwest Western Univ. of Health Science.
  • Requests for other placements or students may be directed to Office of Medical Education.

More Details 

Good news: Salem Hospital's Medical Student Program has had a 10 percent increase for Medical Student enrollment in the last six months. We expect an additional 10 percent increase in the 2013-2014 Academic year.  

 

To meet student requests with available preceptors, Salem Health has been limiting student placements from only two medical schools, College of Osteopathic Medicine of the Pacific-Northwest Western University of Health Sciences and Oregon Health & Science University. 

 

At this time Salem Health will be placing students from these medical schools with our available preceptors.

 

To accommodate recent requests by members of our medical staff for placement of students who are not affiliated with Western University or OHSU, the Medical Education Steering Committee will consider other student placements on a case by case basis depending on the availability of preceptors.

 

Medical students need to register through the Office of Medical Education to be accepted into Salem Health's Medical Student Program. If you are contacted by a student who desires a clinical rotation with you at Salem Health, please refer them to this office at 503-561-3905. Contact Yelena Seroshtan, Medical Student Program Coordinator, if you have any questions regarding student enrollment.

 

The Medical Education Steering Committee is responsible for meeting federal regulations:

David Holloway, MD, CMO, Chair; Kendall Graven, MD; Preethi Prakash, MD; John Hannig, MD; Martin Johnson, MD; Raj Nair, MD; Michelle Rasmussen, MD; Jay Wung, MD. 

 

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IN THE NEWS...News
danDancing in the snow!
The physicians and staff of Salem Health Heart & Vascular Center created a dance video to celebrate the American Heart Association's 'National Wear Red Day,' designed to raise awareness of heart health. Your toes will be tapping as you recognize friends who willingly wore red and danced for this important cause. Check this out!

Reducing ED usage through Coordinated Care
Cheryl Nester Wolfe, Salem Health COO, and Dr. William "Bud" Pierce served as panelists for the Salem City Club luncheon on Friday, Feb. 14.

Read the story at the Statesman.
 
Legislature approves $200 million state bond request from OHSU

Before it adjourned, the Oregon Legislature approved OHSU's $200 million request for bond financing for expansion of cancer research. More on this story. 

 

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Common Ground Newsletter Editorial Board 
Email us anytime with feedback, suggestions, or something for the next issue!
Dr. David Holloway, CMO, Dr. Michael Hanslits, Medical Staff President
 Dr. Ian Loewen-Thomas, Chair, Compact Implementation Committee

Salem Health

503-561-5200