Sept. 6, 2015
TOP READS
gordonSalem Health providers discuss affiliation potential
How do physicians feel about the affiliation with OHSU? What new possibilities do they see resulting from the new relationship with OHSU? Watch this video to learn their answers to these and other questions.

The next issue of Common Ground will include a recap of the questions and answers from the recent forums. If you were unable to attend and have questions you would like to see addressed, please submit questions to commonground@salemhealth.org

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BylawsProposed revision to Medical Staff Bylaws
The current policy for privileging licensed independent practitioners in a disaster does not meet Joint Commission Emergency Management standards. Changes are being proposed to the Medical Staff Bylaws and Credentials Procedure Manual to bring the policy into compliance. Read the details of the proposed changes. 

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vteICD-10 update includes survival guide
Thank you for your hard work and dedication in completing the Precyse training modules for ICD-10 preparedness.
 
There will be a command center in place for the Oct. 1 go-live in Building A, 7th Floor, Conference Room A-1 and A-2 with daily report outs at 11 a.m. and 4 p.m. More details in the coming weeks.

Please review the following documentation tips from Dr. Claire O'Brien: 

ICD-10 survival guide for medicine and medicine-related specialties
Key documentation elements in ICD-10:
 
First thing to remember: document to the required specificity. Your documentation is required to support the SOI (severity of illness), length of stay (LOS), risk of mortality (ROM) and to support the codes that need to be assigned. Codes will be 'built' and if a piece is missing, there will be no code available. Coders cannot code from lab values, past chart notes, imaging studies, path reports, etc. They code from your documentation.
  1. AcuityAcuity: Document acute, chronic, or acute on chronic whenever possible.
     
  2. UnderlyingUnderlying or associated conditions: Example for DM (specific type of course), document associated or related conditions such as nephropathy, neuropathy, arteriosclerosis, osteomyelitis, etc.
     
  3. TypeType: Document the type of disease when appropriate. For example, hypertrophic/dilated/alcoholic cardiomyopathy.
     
  4. LateralityLaterality: Document left, right, bilateral or affected quadrant, lobe, etc.
     
  5. SiteSite: Give specific location of an injury, fracture, tumor, etc. Site may also include specific anatomy. Example, location of stroke and/or hemorrhage (intracerebral, subarachnoid, subdural, etc.) and specific area affected (cortical, basilar, vertebral, etc.). Another example, vessel affected in acute MI, etc.
     
  6. ManifestationManifestation: TB may manifest as disease of lung, pericardium, meningitis, skeleton, genitourinary, etc. These should be documented.
     
  7. TabaccoTobacco, alcohol and drug status:  For example, nicotine dependence takes a more prominent role with further subcategories for specific type of tobacco product used and if in withdrawal, or if abuse is associated with a condition (CAD or COPD associated with 40 pack/year smoking).
Additional tips:
  1. Stroke: Need to document patient's dominant side and whether affected.
     
  2. Episode of care: Designate the episode of care as initial or subsequent for injuries. It is the new seventh digit in the diagnosis code and it is not specific for outpatient only. More to come on this one.
     
  3. Patient condition: Document if mild, moderate, severe, critical, guarded, etc. For example, asthma and malnutrition are documented as mild, moderate or severe. Remove 'A & O x 3, in NAD' from your template. It can negate much of your documentation on sick patients when it appears they do not look ill to their attending.
     
  4. Compression fractures: Any time that you document 'compression fracture', we need to know if it is traumatic or pathological. If pathological, is it initial, is it healing but still being treated (i.e. with pain meds), or healed and not being treated? We also need documentation of the etiology of pathological fractures. There are now combination codes for pathological fractures due to osteoporosis.
     
  5. Urosepsis will no longer have a code-remove from your vocabulary.
     
  6. Preserved ejection fraction does not have a code in ICD-10 either. We still have to document diastolic heart failure.
     
  7. Pain: Document the location, laterality, acuity, if suspected to be psychological, and what caused the pain.
     
  8. Afib and flutter each have their own code and are not interchangeable. If both exist intermittently, must say so, otherwise, document the one most appropriate condition.
     
  9. HIV/AIDS: These are not synonymous. A patient may have HIV infection but not AIDS, but if a patient has ever had an AIDS defining illness, that patient has AIDS from then on. It must be documented as AIDS on every admission.
     
  10. Glasgow Coma Scale: Documentation must include three key elements: eye response, verbal response and motor response. Coders can get much of this information from nurses' notes, physical exam, etc., but only the physician can document the injury or condition underlying the mental status changes.
Happy documenting,  
Claire E. O'Brien, MD (formerly Norton) 

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StarStar Awards program resumes
As promised, the Salem Health Star Awards program resumed service Sept. 1, 2015!
 
Look for the Star Awards link in the lower right corner of the Salem Health intranet home screen.  The nomination link was re-activated on Sept. 1. All of the wonderful stories of the great actions and people who bring their talents to this organization can be shared once more.
 
Remember, this recognition system can be used to show appreciation for individuals and teams. Volunteers, employees and members of the medical staff are all eligible.
 
The new system has a redesigned look, but will function similarly to the previous one. Nominations for the Stop-The-Line Award will also be submitted through the new link. This award is specifically for team members that displayed the courage to stop what is happening to make certain all we do is safe.
 
Please welcome in the new system and submit your nominations.
 
Thank you,
Medical Staff Engagement Committee
 
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ParkingParking lot closure begins Sept. 14 
Beginning Sept. 14, 2015, the physician parking lot behind Building B will be closed so that NW Natural can install a new natural gas line through the north and west lots of Building B.  Temporary parking will be available for physicians on the southwest corner of Winter Street. (This is the gravel lot on the  construction site for the new outpatient rehabilitation building. Access is off Winter Street. Click here for a map.)  After Sept. 28, a temporary traffic lane will be flagged open for physicians to return to the lot behind Building B. There will still be some construction during this time, so please use caution and watch for directional signage. Construction should wrap up by Oct. 2, 2015.  Thank you for your patience during this time.
 
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PRACTICAL MATTERS
ICDProposed revision to treatment order rules
A change has been proposed to the Salem Hospital Medical Staff Rules & Regulations relating to treatment orders. The change is being recommended because of the recently revised and approved physician assistant privilege request form. Read the text of the proposed changes.
 
clinicalIV promethazine returns with safety precautions
Effective Thursday, Aug. 27, IV promethazine is once again available for patients at Salem Hospital. To reduce the probability of harm from promethazine extravasation, the dose will be limited to 12.5 mg, each dose will be diluted in 100 mL of normal saline and it will be removed from order sets. This will ensure that promethazine continues to be safely available to the patients who need it the most.
 
There have been questions about the process that led to the temporary moratorium on IV promethazine. After an incident in NTCU which necessitated a plastic surgery consultation, and based on numerous case reports and recommendations for safer administration in the pharmaceutical literature, patient safety staff submitted a proposal to medical staff leadership to re-evaluate how (or if) we should continue to utilize IV promethazine. Due to meeting schedules, neither P&T nor MEC would be able to discuss the proposal for over a month. This led to the decision by Howard Cohen (P&T chair) to stop-the-line in the name of patient safety. This decision was made in collaboration with Rob Harder (medical executive committee member on call) and Mike Hanslits (president of the medical staff) on Saturday, June 27.
 
Once the moratorium was in place, the proposal was discussed at the July physician leadership meeting, at the August P&T committee meeting and then MEC during their second meeting in August. The reintroduction of IV promethazine, with alterations to enhance its safe delivery to patients, occurred shortly after the MEC meeting.
 
One of the most important lessons learned was about communication to the medical staff. In the future, stop-the-line issues will be communicated with medical and nursing staff with a more targeted word of mouth campaign, accompanying submission of an Urgent Common Ground and a RADAR message.

If you have any questions about this, please contact Matt Tanner in Pharmacy at 4-2048 or Matthew.Tanner@SalemHealth.org.  
      
WELCOME TO SALEM HOSPITALWELCOME 
brogochLaura A. Brogoch, MD - Psychiatry
Salem Health Psychiatry Unit
 
Medical Education: 
University of California, San Diego
School of Medicine

La Jolla, California
August 2008 to June 2012
Residency:  Oregon Health & Science University
School of Medicine
Portland, Oregon
July 2012 to June 2016
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burtonElan C. Burton, MD - Cardiothoracic Surgery
Willamette Health Partners Cardiothoracic Surgery Clinic
 
Medical Education:  Morehouse College
School of Medicine
Atlanta, Georgia
August 2001 to May 2005
Residency:
General Surgery
 
University of Pittsburgh
Medical Center
Pittsburgh, Pennsylvania
July 2005 to June 2010 
Fellowships:

Endovascular/

Tavi
University of Maryland
Medical Center

College Park, Maryland
July 2013 to June 2014 
Cardiothoracic
Surgery  
   
University of North Carolina
School of Medicine

Chapel Hill, North Carolina
July 2010 to Oct. 2010 
Cardiothoracic Surgery  University of Minnesota
School of Medicine
Minneapolis, Minnesota
February 2011 to June 2013
 
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HaysBret A. Hays, MD - Internal Medicine 
Salem Clinic, PC
  
Medical Education:  University of Nebraska
Medical Center

Omaha, Nebraska
August 2008 to May 2012
Residency:
 
 
University of Nebraska
Medical Center
Omaha, Nebraska
July 2012 to June 2015  
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HughesDeborah A. Hughes, MD - Cardiology 
Salem CardioVascular Associates, PC
   
Medical Education:  University of Vermont
College of Medicine

Burlington, Vermont
August 1997 to June 2001 
Internship:
Internal Medicine
 
Mayo Graduate
School of Medical Education
June 2001 to July 2002  
Residency:

Internal Medicine
Mayo Graduate
School of Medical Education
June 2002 to June 2004
Fellowship:

Cardiology 
 
Mayo Graduate
School of Medical Education
July 2004 to Aug. 2009
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LeeJessica R. Lee, DO - Anesthesiology
Oregon Anesthesiology Group PC
   
Medical Education:  Western University of Health Sciences
Pomona, California
August 2007 to May 2011  
Internship:
Transitional
   
Virgina Mason Hospital
Seattle, Washington
July 2011 to June 2012  
Residency:

Anesthesiology
Virgina Mason Hospital
Seattle, Washington
July 2012 to June 2015
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PlatteauAstrid S. Platteau, MD - Neonatal-Perinatal Medicine
OHSU - Pediatric Neonatology
   
Medical Education:  Universidad Central de Venezuela
Caracas, Venezuela
October 1999 to December 2005   
Fellowship:
Transitional
   
University of Miami
Jackson Memorial Hospital
Miami, Florida
December 2007 to  June 2009 
Residency:

Pediatrics
University of Miami
Jackson Memorial Hospital
Miami, Florida
June 2009 to June 2012
Fellowship:
Neonatal-Perinatal Medicine
 
Oregon Health & Science University
Portland, Oregon
July 2012 to June 2015
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rathNaciketa Rath, DO - Internal Medicine 
Salem Hospital Adult Medicine Hospitalist
  
Medical Education:  Nova Southeastern University
Fort Lauderdale, Florida
August 2007 to May 2011
Residency:
Internal Medicine 
State University of New York
at Stony Brook School
Stony Brook, New York
July 2011 to June 2014   

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StierJames R. Stier, MD - Internal Medicine 
Salem Clinic - Adult Medicine Hospitalist
  
Medical Education:  Oregon Health & Science University
Portland, Oregon
August 2007 to May 2011
Residency:
 
Tulane University
School of Medicine
New Orleans, Louisiana
July 2011 to June 2015    
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IN THE NEWSNEWS 
KeizerReach out and read program featured in Keizertimes
Julianne Brock, FNP-C, from Willamette Health Partners family medicine clinic in Keizer was recently featured promoting the Reach Out & Read program designed to improve early literacy. Read the Keizertimes article "Medical providers prescribe books for young children."   
  
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LeanSalem Health SCIP uses Lean principles to reduce infections
Salem Health's Quality Operations Committee (QOC) and the work of the Surgical Care Improvement Project (SCIP) was highlighted in the Summer/Fall Hospital Voice magazine. Read the article "A Study in Lean: Salem Health's 'SCIP' Effort Focuses on Reduced Infections."
  
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NICUNICU Parent Advisory Council highlighted in Hospital Voice 
Read the article titled "A Family Affair: Hospitals work to engage patients and their families at all levels of care."
  
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COMING EVENTScoming
forumsBreakfast with the CEO
A new breakfast format has begun. Salem Hospital medical staff now have the opportunity to attend three times a year.

The next meeting will be:
  • For providers whose last name begins with F through K
  • Wednesday, Sept. 16, from 7 to 8 a.m.
  • Salem Hospital, Building A, 7th Floor Conference Room
Download the invitation. Contact Mary Maberry with questions at 503-561-3778. 
   
checsUpcoming classes at the CHEC  
Select class headlines to download a flier to print and share with your patients. For more information and to register, visit the CHEC website or call 503-814-2432 (CHEC). 
  
This class is offered by the Salem Spine Center and is taught by an experienced physical therapist. An Achilles heel bone density screening is included for each participant.
Date: Thursday, Sept. 10
Time:  1 to 2 p.m.
Cost: $5
 
This walking program, designed by the Arthritis Foundation, is for people who are able to walk for about ten minutes at a slow pace, and who would like to build up to walking about a mile.
Date: Monday, Wednesday and Friday, Sept. 14 through Oct. 23
Time: 9 to 10 a.m.
Cost: $10
 
This class is perfect for those who have never tried Tai Chi or for those who are looking for a class that moves at a slower pace.
Date: Mondays and Wednesdays, Sept. 14 through Nov. 4
Time: 9 to 10 a.m.
Cost: $48
 
This gentle form of Tai Chi can be performed sitting or standing and is adaptable to most anyone's ability and comfort level.
Date: Mondays and Wednesdays, Sept. 14 through Nov. 4
Time: 3 to 4 p.m.
Cost: $48

Aphasia Support Group (no flier available)
Community members can come and learn about stroke and aphasia. This group provides a place to meet and discuss with people who are currently living with aphasia.
Date: Every Thursday
Time: 12 to 1:30 p.m.
Cost: Free
 
 
 
Common Ground Newsletter Editorial Board 
For past issues of this newsletter, visit
Email us anytime with feedback, suggestions, or something for the next issue!  Dr. Ian Loewen-Thomas, Chair, Compact Implementation Committee

Salem Health

503-561-5200