>> table of contents MEDICAL STAFF OFFICERS . . . . . . . 2 JOINT COMMISSION SURVEY PREPAREDNESS . . . . . . . . . . . . . . . 3 ZEN AND THE ART OF JC PREP . . . . 4 INDUCED HYPOTHERMIA . . . . . . . . . 5 WORKING TOWARD HIGH RELIABILITY . . . . . . . . . . . . . . . . . 6 CONSTRUCTION UPDATE . . . . . . . . . 7 NEW SERVICES, NEW PROVIDERS . . .8 EXPANDED PSYCHIATRIC CONSULT TEAM . . . . . . . . . . . . . . . 9 BALLOON SINUPLASTY . . . . . . . . . 10 CON UPDATE . . . . . . . . . . . . . . . . 11 RESOURCES FOR MEDICAL STAFF . .12 FAMILY CARE LINE . . . . . . . . . . . . 13 STROKE CARE EXCELLENCE . . . . . . 14 PREVENTING CAPACITY CRUNCH . .15 NEW SEPSIS PROTOCOL . . . . . . . . 19 SPINE SURGERY AT CARY HOSPITAL 20 STARK LAW UPDATE . . . . . . . . . . . 21 PHYSICIAN INVOLVEMENT IN SERVICE LINE STRATEGIES . . . . . . 22 OF NOTE . . . . . . . . . . . . . . . . . . . 25 NEW PHYSICIANS . . . . . . . . . . . . . 28 Stethoscope News NEWS & INFORMATION FOR PHYSICIANS PRACTICING AT WAKEMED SPRING 2009 RALEIGH CAMPUS TO OPEN Dedicated TIA Center T his month, the Raleigh Campus will formally establish a center designed to quickly and effectively treat patients who have suffered a transient ischemic attack (TIA). The American Stroke Association (ASA) defines a TIA as a “warning stroke” or “mini-stroke” that produces stroke-like symptoms but no lasting damage. In the United States, nearly 300,000 patients a year present to emergency departments with symptoms of a TIA, and unfortunately, many of those patients go on to suffer a stroke days or weeks later. In fact, 15 percent of ischemic strokes are preceded by TIA. The ASA indicates that recognizing and treating TIAs can reduce a patient’s risk of a major stroke and significantly improve patient outcomes. Four beds in Observation Unit 3 will be dedicated to serving TIA patients, and a dedicated team will ensure patients receive the necessary diagnostic testing and treatment in an expedited manner, which may include vascular studies, brain imaging and other relevant testing procedures. The team will also focus on patient and family education and identifying risk factors that could lead to a future stroke. Observation Unit 3 will serve only TIA patients whose primary diagnosis is TIA and whose symptoms are resolved within one hour of admission. Patients who have symptoms lasting longer than one hour or who have significant comorbidities will be admitted and treated on an inpatient basis. We are due for a five-day Joint Commission survey, starting anytime after January 1, 2009. This unannounced survey can occur anytime throughout the year. Please help us prepare by following the guidelines inside on page 3. continued on page 16
Transcript
> > t a b l e o f c o n t e n t s
M E D I C A L S TA F F O F F I C E R S . . . . . . . 2
J O I N T C O M M I S S I O N S U R V E Y
P R E PA R E D N E S S . . . . . . . . . . . . . . . 3
Z E N A N D T H E A R T O F J C P R E P . . . . 4
I N D U C E D H Y P O T H E R M I A . . . . . . . . . 5
W O R K I N G T O W A R D H I G H
R E L I A B I L I T Y . . . . . . . . . . . . . . . . . 6
C O N S T R U C T I O N U P D AT E . . . . . . . . . 7
N E W S E R V I C E S , N E W P R O V I D E R S . . . 8
E X PA N D E D P S Y C H I AT R I C
C O N S U LT T E A M . . . . . . . . . . . . . . . 9
B A L LO O N S I N U P L A S T Y . . . . . . . . . 1 0
C O N U P D AT E . . . . . . . . . . . . . . . . 1 1
R E S O U R C E S F O R M E D I C A L S TA F F . . 1 2
FA M I LY C A R E L I N E . . . . . . . . . . . . 1 3
S T R O K E C A R E E X C E L L E N C E . . . . . . 1 4
P R E V E N T I N G C A PA C I T Y C R U N C H . . 1 5
N E W S E P S I S P R O T O C O L . . . . . . . . 1 9
S P I N E S U R G E R Y AT C A R Y H O S P I TA L 2 0
S TA R K L A W U P D AT E . . . . . . . . . . . 2 1
P H Y S I C I A N I N V O LV E M E N T I N
S E R V I C E L I N E S T R AT E G I E S . . . . . . 2 2
O F N O T E . . . . . . . . . . . . . . . . . . . 2 5
N E W P H Y S I C I A N S . . . . . . . . . . . . . 2 8
Stethoscope NewsN E W S &
I N F O R M AT I O N
F O R P H Y S I C I A N S
P R A C T I C I N G
AT W A K E M E D
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RALEIGH CAMPUS TO OPEN
Dedicated TIA Center
This month, the Raleigh Campus will formally establish acenter designed to quickly and effectively treat patients whohave suffered a transient ischemic attack (TIA). TheAmerican Stroke Association (ASA) defines a TIA as a“warning stroke” or “mini-stroke” that produces stroke-like
symptoms but no lasting damage.
In the United States, nearly 300,000 patients a year present toemergency departments with symptoms of a TIA, and unfortunately,many of those patients go on to suffer a stroke days or weeks later. Infact, 15 percent of ischemic strokes are preceded by TIA. The ASAindicates that recognizing and treating TIAs can reduce a patient’s riskof a major stroke and significantly improve patient outcomes.
Four beds in Observation Unit 3 will be dedicated to serving TIApatients, and a dedicated team will ensure patients receive thenecessary diagnostic testing and treatment in an expedited manner,which may include vascular studies, brain imaging and other relevanttesting procedures. The team will also focus on patient and familyeducation and identifying risk factors that could lead to a future stroke.
Observation Unit 3 will serve only TIA patients whose primarydiagnosis is TIA and whose symptoms are resolved within one hour ofadmission. Patients who have symptoms lasting longer than one houror who have significant comorbidities will be admitted and treated onan inpatient basis.
We are due for a five-day JointCommission survey, starting anytime
after January 1, 2009. This unannouncedsurvey can occur anytime throughout theyear. Please help us prepare by following
the guidelines inside on page 3.
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WakeMed Raleigh Campus
John E. Perry, MDWakeMed Faculty Physicians –
Internal MedicinePRESIDENT
Sharon Foster, MDRaleigh Pediatric AssociatesCHAIR, MEDICAL EXECUTIVE
COMMITTEE
Jim Palombaro, MDWake Emergency Physicians, PA
PRESIDENT - ELECT
Wm. Charles Helton, MDCarolina Cardiovascular
Surgical AssociatesMEMBER -AT-LARGE
Eugene Maynard, MDBenson Area Medical Center
MEMBER -AT-LARGE
Michael Ferguson, MDWakeMed Faculty Physicians – ENT
MEMBER -AT-LARGE
Karen Bash, MDWakeMed Faculty Physicians –
OB/GynCHAIR, MSQI
Duncan Phillips, MDUniversity Pediatric Surgeons
VICE CHAIR, MSQI
WakeMed Cary Hospital
J. Richard Daw, MDWake Heart & Vascular Associates
PRESIDENT
Robert S. Alphin, MDCritical Health Systems of
North CarolinaPRESIDENT-ELECT
Lemuel G. Yerby, MDTriangle Surgical Associates
IMMEDIATE PAST PRESIDENT
Michael L. Anthony, MD Cary Obstetrics & Gynecology
MEMBER-AT-LARGE
Donald P. Hanna, MD Cary Plastic and
Reconstructive Surgery Center MEMBER-AT-LARGE
2 0 0 9Medical Staff
Officers ElectedWelcome to our Medical Staff Officers.
Thank you for your continuedcommitment to WakeMed.
Our Joint Commission ( JC) survey iscoming up! We are due for anunannounced, five-day survey anytimethis year. The JC has very specificstandards of care when they review
physicians’ work. Therefore, our physicians play asignificant role in our JC survey performance,particularly as it relates to documentation andmedical record management. Please consider thefollowing when you write orders, includingtelephone orders, use of order sets and handwrittenorders:
• Telephone orders must be authenticated within48 hours. This includes not only a signature butalso dating and timing the orders. They alsoexpect that verbal orders will not be used exceptin emergency situations when you are presentand caring for patients.
• Standing order sets can be initiated without thephysician present, but these also must be signed,dated and timed when you see the patient.
• All handwritten orders must be signed, datedand timed.
Other key areas the JC will review include:
• An H&P must be done no more than 30 daysprior to an inpatient admission or an outpatientprocedure; or it must be done within 24 hoursafter an inpatient admission.
• If the H&P was done within 30 days prior to aninpatient admission or an outpatient procedure,an update documenting any changes in thepatient’s condition needs to be completed within24 hours after inpatient admission or prior tosurgery. For example, if the surgery is done eighthours after the patient is admitted, the H&Pupdate must be done prior to the surgery.
• Mark the surgical site when appropriate.
• Actively participate in the time-out process priorto surgical and other invasive procedures, such ascardiac catheterizations and radiologyprocedures.
• Write indications for all PRN medications.
• Use only acceptable abbreviations when writingorders (see column on order sheets).
• Wash your hands as you move from patient topatient. Hand hygiene is one of the best ways tokeep our patients safe, which is everyone’s goalwhen providing patient care.
Please read information about our upcomingsurvey as it is shared. Updates will be available inthe physicians’ lounges, on the EPR as you log inand posted on the inpatient units. Thank you foryour assistance as we prepare for our upcomingsurvey!
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TO A WAKEMED FACILITY NEAR YOU
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Zen and the Art of Joint Commission Preparation(with apologies to Robert Pirsig and anyone with experiential knowledge of Zen)
WEST LAWSON, MD
I am often asked, “How can we get the doctors to comply with this rule; sign the site/dothe time out; complete this form with dated and timed signatures; help prevent this kind oferror…” The list goes on and on. These queries fly fast and furious in anticipation of theweek-long, tri-annual accreditation survey by The Joint Commission (our old friendJCAHO’s new moniker), which is due sometime this year at a date unknown, since theseare now stealthy, unannounced events. The anxiety behind these requests is genuine and notunwarranted. Accreditation determines our deemed status with CMS, and JC surveyors aregarnering a progressively persnickety reputation. The euphemistic RFIs (requirements forimprovement), presented at the conclusion of the survey to the hospital as an absolute“must-do” list, come with short deadlines by which time all deficiencies must be corrected.
So what are a medical staff member and CMO to do? How to even consider, much lessdeal with, so many (too many!) rules, many of which seem arcane or arbitrary? Are anxietyand even defiant anger responses appropriate to our callings as healing professionals? In thewords of Zen master Bodhidharma, “Are you kidding me? But, let’s meditate on it.” Takenas a whole, the essence of JC’s requirements (and CMS’s regulations) is the promotion ofpractices intended to assure that our patients (and communities) are taken care of in safesettings, with appropriate functional and physical infrastructures, and that the care providedactually meets its intended marks. While we can and will quibble with the details, thisresonates with our inner healers. So, the better response presents itself more naturally: Wecan prepare ourselves for this external evaluation by focusing internally on the essence ofour own desires to heal. Thus, we might manifest in our actions, our decisions, ourbehaviors those qualities which we know, experientially and intuitively, are consistent withexcellence. We do that by considering each situation critically, communicating carefully,questioning respectfully (and respectfully receiving and answering questions), andendeavoring to make excellence our modi operandi (and vivendi). As we consider, andmeditate upon, our own “centers of excellence,” perhaps the burdens of their expectationswill begin to lessen.
So, we don’t prepare for JC survey per se, but we seek instead to be the excellent healingprofessionals of our callings. Then the need to date and time all entries; to sign, date andtime all orders within 48 hours; and to complete every form - and to do these thingsprofessionally with the understanding that this is all necessary stuff- then all this need notcause angst or anger. And maybe we can celebrate together an RFI-free survey.
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Several years ago, WakeMed and WakeCounty EMS began working togetherto administer induced hypothermiatreatment to sudden cardiac arrest(SCA) patients. Induced hypothermia is
a controlled cooling of the body that has beenshown to improve neurologic outcomes in SCApatients.
During the past two years, more than 120WakeMed cardiac arrest patients were treated withinduced hypothermia. How has the treatmentimpacted outcomes for WakeMed patients? We areproud to report a three-fold increase in the numberof patients who had their neurological systemintact after suffering sudden cardiac arrest.
Research shows that some patients who regain apulse after cardiac arrest may suffer injuries fromblood flow resuming too quickly to the brain, oftenresulting in brain death or severe brain injury.Multiple studies have demonstrated improvedneurological outcomes for patients who are cooled
for the first 24 hours after they have return ofpulse.
“Induced hypothermia has clearly been shown toimprove the outcomes of patients who havesuffered sudden cardiac arrests,” said Marc Silver,MD, Raleigh Cardiology Associates. “For peoplewho are resuscitated from sudden cardiac arrest,the major issues are neurologic and brain function.We know most of the time we can deal with theheart issues, but we didn’t have anything proactiveto address neurological outcomes until now.Induced hypothermia is one of the few things wecan do to try and improve neurologic outcomes.”
WakeMed’s induced hypothermia patients haveranged in age from 18 months to 96 years old.
WakeMed credits a community-wide, collaborativeeffort and the work of physician champions PaulHinchey, MD, and Brent Myers, MD, for thesuccessful implementation of the inducedhypothermia procedure and protocol.
INDUCED HYPOTHERMIA Proves Successful
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Working Toward a High Reliability Organization (HRO)MEERA KELLEY, MD
The delivery of health care is very complex. Itrequires input from many different people withdifferent training to coordinate efforts, even thoughthey may not be at the same place at the same time.Some complex industries have implementedsystems such that they have an exceedingly lowerror rate, in spite of their complexity. Threeexamples of such “high reliability organizations”(HROs) are aviation, nuclear power, and aircraftcarriers.
But health care is arguably more complex thanthese industries. Our patients get sick, and somewill die in spite of the best, or even perfect care.All of this is true. Yet we still identify preventableerrors in care every single day, such as a wrong-siteoperation, a patient getting too much warfarin andexperiencing an intra-cerebral hemorrhage, or apatient who gets a medication intended forsomeone else.
While these events aren't frequent, they occur inhospitals with some regularity-certainly more oftenthan seen in the HROs. And less severe incidentsoccur quite frequently.
In spite of our differences, can we learn somethingfrom HROs? I believe we can, but it will require achange in the way we think about things, the waywe go about our days and the way we interact withothers.
Key characteristics of high reliability organizations:
1) Preoccupation with failure. Rather than assumethings will go fine, staff are vigilant aboutlooking for what might go wrong.
2) Commitment to resiliency. Once errors or lessthan safe conditions are identified, teams worktogether to implement systems that make itmuch less likely for the risky event to occur, andmake it much more likely to identify the issueearly and mitigate the effects if it does occur.
3) Open communication about errors and nearmisses or “good catches”. If we do not openlyand frequently discuss problems, they will not betop of mind, making it unlikely we will bepreoccupied with failure.
4) Sense of a just or fair culture. Staff andphysicians must freely acknowledge thateveryone makes mistakes, even the best of us.We must trust that we will not suffer any kind ofpunitive action for reporting a concern that wewere part of. We must trust that we will beencouraged and will work together to make thesystem safer. This does not mean that there is noaccountability. Accountability must also be therein the much less common cases of repeatederrors not seen among similar colleagues, orintentional risky behaviors.
As we continue our journey to provide the best andsafest care possible, we will be sharing theseconcepts with staff and physicians. We invite anysuggestions to expedite our progress towardbecoming an HRO.
V I C E P R E S I D E N T , Q U A L I T Y & P A T I E N T S A F E T Y
Construction UpdateS
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Raleigh Campus
Loop Road Closed – A portion of the road that loopsthrough the Raleigh Campus remains closed toaccommodate construction of the Raleigh CampusPatient Tower and P1 Parking Deck. The road willremain closed until mid-April.
In the meantime, visitors continue to have access toLoop Road for parking. They can reach the P5Parking Deck by entering at the Emergency Entranceand following the road past the Andrews ConferenceCenter, Medical Office Building and PatientRegistration.
Please pardon the inconvenience as we continue togrow our campus. Visit www.wakemed.org foradditional information and a downloadable map.
Patient Tower Topping Out – On December 15,physicians, administrators, Foundation members andemployees gathered outside the Heart Center entrancefor a traditional Topping Out ceremony tocommemorate the placement of the final beam on thebuilding. In keeping with tradition, a fir tree tosymbolize growth, was placed on the beam before itwas lifted by crane to the top of the structure.Individuals also had the opportunity to sign the beamthroughout the day and at the ceremony.
Scheduled to open in early 2010, the new patient toweris a 168,000-square-foot, four-story addition that willhouse Wake County’s first dedicated children’s hospital,82 more medical/surgical and rehabilitation beds, 20intensive care unit beds and support services. A new,1,200-space parking deck will connect directly to thenew tower via an elevated and covered walkway. Formore details about the Raleigh Campus Patient Tower,visit www.wakemed.org.
Cary Hospital
2 East – All 1 East patients and equipment wererecently relocated to 2 East in order to streamlineoperations for physicians and staff. 2 East is now a
full-service, 28-bed Medicine Unit, managed by Justin Kott, RN.
1 East – A proposed plan calls for the relocation of thesix-bed Neuro Care program from 5B Raleigh Campusto 1 East at Cary Hospital. Neuro Care is a specialty,acute license program managed in the rehab continuumto care for patients with severe neurologicalimpairments who are not ready for rehab hospital careor too medically and functionally complicated for anursing facility. The Neuro Care’s relocation willexpand the program’s bed capacity from six to 10 andwill help WakeMed respond to the increased demandfor this specialty level of care. Available space on 5Bwill be used for acute Neuro patients. Carolina Rehaband Surgical Associates will continue to serve asattending physicians for the Neuro Care program atCary Hospital.
Women’s Pavilion & Birthplace – Ten new labor anddelivery rooms recently opened in the newly expandedWomen’s Pavilion & Birthplace. The spacious newrooms include many comforts, such as spa-inspiredshowers, flat-screen TVs and futon sofas for supportpersons. The rest of the Women’s Pavilion & Birthplacewill be renovated in phases, beginning with the oldestsection.
Dr. Michael Weinstein, Raleigh Pathology Laboratory
Associates, makes his mark on WakeMed history as he
signs a Raleigh Campus Patient Tower construction beam.
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New Pulmonary Consult Service
In December, WakeMed Faculty Physicians (WFP)established a new Pulmonary Consult Service for RaleighCampus inpatients suffering from a broad range of general
pulmonary conditions such as pneumonia, COPD, lungmasses, pulmonary hypertension, asthma, or chest X-rays.
WFP intensivist Dr. Linda Paradowski has transitioned to afull-time pulmonary consult physician. Dr. Paradowski and theWFP Pulmonary Consult Service work closely with Dr. Hart,who has single-handedly managed almost all pulmonaryconsults at the Raleigh Campus for a number of years.
“This new service allows us to consult patients suffering frompulmonary problems more quickly than ever before, which canimprove patient outcomes and reduce complications and lengthof stay,” explains Dr. Paradowski. “We are pleased to workwith Dr. Hart to offer a higher level of service and to improvethe continuity of care we deliver to our patients together.”
Maternal Fetal Medicine Service Grows
In late 2007, WFP-Maternal Fetal Medicine was introducedon the Raleigh Campus to meet the needs of high-riskmaternity patients. The practice, led by Dr. Steven Wells,
began with one sonographer, one RN and two patient accountrepresentatives. Two additional sonographers and a geneticcounselor are now on staff.
Services available at the practice include preconceptioncounseling, comprehensive obstetrical ultrasound (Level II isavailable), gynecological ultrasound, neural tube defect andchromosomal abnormality screenings, amniocentesis, and more.Between 350 and 400 ultrasounds and 100 non-stressantepartum tests are performed at the practice each month.Dr. Wells also conducts daily rounds on high-risk pregnancypatients. Currently, Dr. Wells is located at the RaleighCampus, but he will have a Cary office location in the nearfuture.
“Our practice represents a higher level of service that ourpatients truly appreciate,” explains Dr. Wells. “Because wework with our high-risk patients throughout their pregnancies,we feel confident that we are improving patient outcomes andproviding a service that is needed in our community.”
ENT Practice Expands
In the past six months, WakeMed hasadded two new physicians to itsgrowing ENT practice. Bothphysicians will serve patients in theWakeMed Faculty Physicians andWake Specialty Physicians practices.
Esa A. Bloedon, MD completed hismedical schooland Otolaryn-gology trainingat ThomasJeffersonUniversity inPhiladelphia. Hisclinical interestsinclude pediatric
and adult ENT disorders, sinusdiseases and thyroid surgery. Dr.Bloedon is happy to return to thisarea, having spent his undergraduateyears at UNC-Chapel Hill. He ismarried with two boys and a girl.
Carol Shores, MD, PhD, FACS comesto WakeMedfrom theUniversity ofNorth Carolina,where she hasspent the pasteight years as ahighly valuedfaculty member
in the Division of Head and NeckSurgery. She brings a great deal ofexperience and a wealth of knowledgein the treatment of head and neckcancer, and WakeMed is extremelyfortunate to have recruited someoneof her status to our hospital to fill avital need in this community. She ismarried and has two grown sons.
WakeMed Introduces New Services, New Providers
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WakeMed is pleased to welcome Jeffrey Childers, MD, tothe WakeMed Faculty Physicians – Psychiatry practice.As the newest member of the Raleigh CampusPsychiatric Consult Team, Dr. Childers brings a new areaof focus to the team with his years of training and
expertise in child and adolescent psychiatry. The addition of Dr. Childersalso gives us greater capacity to meet the mental health needs of WakeMedpatients. The Psychiatric Consult Team includes (pictured above, l to r),Elaine Youngman, CNS, Dr. David Gittelman, Dr. Jeffrey Childers, and Dr. Manish Fozdar. As a result of the practice expansion, physicians canexpect greater availability and faster response as it relates to psychiatricconsults.
“With the growth of WakeMed’s pediatric patient population over the years,this new level of expertise is an extremely valuable addition to the team,”explains Dr. Gittelman. “The addition of another psychiatrist also allows usto offer a higher level of coverage and availability to our patients and theirphysicians. We can now provide mental health and substance abusecounseling seven days a week for both adult and pediatric patients.”
In addition to providing inpatient consult services, this team now has thecapacity to serve as backup for the Emergency Department BehavioralHealth Team who provide mental health and/or substance abuse assessmentand intervention/disposition to our emergency patients. The team can alsoperform daily rounds on patients who are awaiting bed assignment atDorothea Dix Hospital. Our psychiatrists will also have the ability todischarge patients as needed.
The Psychiatric Consult Team along with an agreement with HareshTharwani, MD, and Elena Matthews, MD, also offers psychiatric consultservices seven days a week at WakeMed Cary Hospital.
WAKEMED FACULTY PHYSICIANS - PSYCHIATRY
WakeMed Expands Psychiatric Consult Team
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New, Minimally Invasive Surgical Technique for Chronic Sinusitis
Patients who suffer from chronic sinusitis can benefit from a new, minimally invasive surgicaltechnique instead of medical therapy or conventional sinus surgery. Balloon sinuplasty isperformed by placing a small, flexible balloon catheter into the blocked sinus passageway.The balloon is then inflated to gently restructure and open the sinus passageway, restoringnormal sinus drainage and function.
Until recently, sinusitis patients were limited to two treatment options: medical therapy such as antibioticsand nasal steroids, or conventional functional endoscopic sinus surgery (FESS), which requires theremoval of bone and tissue to open blocked sinus passageways.
Wake Specialty Physicians – ENT, Head & Neck Surgery is one of the first practices in the area to offerthis technology. All the physicians in the practice perform the procedure, and they expect case volumes togrow as patients learn about it. “As physicians, we know that minimally invasive surgery is always a greatoption for patients when it comes to recovery time, comfort and reducing surgical complications,” explainsMichael Ferguson, MD, practice director. “While balloon sinuplasty is not a substitute for all standardsinus surgery, it gives us another wonderful addition to our growing armamentarium of ways to deal withsinus problems.”
In addition to the providers at Wake Specialty Physicians – ENT, Head & Neck Surgery, physicians atseveral practices throughout the area offer balloon sinuplasty at WakeMed facilities. They includeCarolina ENT (Raleigh), North Carolina Eye, Ear, Nose & Throat and Mann Ear, Nose & ThroatClinic (Cary), and Anita Jackson, MD, MPH (Clayton).
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WakeMed is pleased to announcethat we were awarded Certificateof Need (CON) approval to add41 licensed acute care beds toNorth Healthplex for women’s-
focused inpatient services. The new beds will beadded to the 20 acute care beds already approved forrelocation from the Raleigh Campus, making NorthHealthplex Wake County’s fifth full-service hospitaland the county’s first and only women’s hospital.Competitive applications were submitted byWakeMed, Rex Healthcare and Novant.
The new 61-bed women’s hospital will offercomprehensive preventive, diagnostic, andtherapeutic care, including a full range of obstetricand gynecological services. These new services willbe supported by the facility’s existing emergency,
surgery, imaging and laboratory services. Theproposed addition will be 72,300 square feet.Construction is expected to begin in February 2010.
Additionally, WakeMed’s CON application to addtwo operating rooms (ORs) at North Healthplexand two ORs at Cary Hospital has been denied.Many thanks to all the medical staff members for all your support throughout the CON process.
CON Update
WakeMed is pleased towelcome Kimberly Livingston,MD, who has officially joinedWakeMed Faculty Physicians(WFP). Dr. Livingston seespatients in the WFP VascularPractice in suite 1130 (firstfloor) of the Raleigh CampusHeart Center.
Dr. Livingston established the area’s firstendovascular neurosurgical service at WakeMed withRaleigh Neurosurgical Clinic in 1993, following herneurological surgery residency at Ohio StateUniversity in Columbus, Ohio, and fellowship inendovascular neurosurgery at the State University ofNew York at Buffalo, NY. She is board certified inneurological surgery and a member of severalprofessional organizations, including the American
Association of Neurological Surgeons, the Congressof Neurological Surgeons, the Charles Kerber Societyand the Society of NeuroInterventional Surgery.
With more than 15 years of experience inendovascular neurological surgery, Dr. Livingston’sclinical interests focus on evaluation, counseling andmanagement of vascular lesions of the nervoussystem, including:• Diagnostic neuroangiography• Minimally invasive (catheter-based) adjunctive and
definitive treatment of:• Subarachnoid hemorrhage• Intracranial aneurysm• Intracranial AVM• Vascular tumor of the brain• Occlusive neurovascular disease• Acute stroke intervention
WAKEMED FACULTY PHYSICIANS
First Endovascular Neurosurgeon Joins the Staff
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WakeMed offers several services and resources to medical staff members as benefits ofmembership. Resources and instructions on how to access them are available online.Click on “For Our Physicians” at www.wakemed.org to access them or callWakeMed Physician Relations at 350-5824 for assistance.
• Remote access to WakeMed patient data systems • Including ED, inpatient and outpatient• For initial set-up instructions, visit www.wakemed.org and click
on “For Our Physicians” to access the Remote Access for Physicians link or call 350-5824 for assistance.
• Pathology Laboratories Physician Services• Online Forms
• English and Spanish versions• Anesthesia • Informed consent• Authorization for release of medical information• Imaging Services requisition• Remote Access application• Library registration
• Medical Staff Services• Staff is available to assist with processing applications and
medical staff reappointments for physicians, advanced practice nurses and physician assistants. Call 350-8595 for assistance.
• Inclusion in Doctor Choice – Physician referral program• A free referral service for community members who are looking
for a primary care physician or specialist.• Call 350-8900 to register
• Continuing Education• Grand Rounds – Regular monthly specialty education
conferences• Continuing education through Wake Area Health Education
Center (AHEC), www.wakeahec.org.• Full Access to the Wake AHEC Digital Library
• Online databases, such as MEDLINE, CINAHL, Cochrane• Online journals• 1,500+ full-text journals• 75+ full-text searchable books• Patient education materials in English and Spanish• Literature searches – Visit www.wakeahec.org/library
• UptoDate Medical Reference• An electronic information source that includes 7,400 topics in 13
subspecialties and more.
To Access the AHECDigital Library (ADL)
and UptoDate
• ADL From within aWakeMed facility – Youautomatically have access.Visit the WakeMedWeb(intranet) and click “For theEmployee” > “AHEC DigitalLibrary.”
• ADL From your home oroffice – Submit a WakeMedMedical Library RegistrationForm. Download it by goingto www.wakemed.org, clickon “For Our Physicians”,then click on “PhysicianForms.”
• UptoDate access withinWakeMed – Access the ADLthrough the WakeMedWeb(intranet). Go to the top leftside of the page and click“Databases.” Then, click on“UptoDate.”
Resources Available to WakeMed Medical Staff
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This December,WakeMed introducedthe Family Care Line, anew service for inpatientsthat allows family members
or loved ones to call and report asignificant decline in their loved one’smedical condition when immediate assistance isneeded. The service has been implemented on theRaleigh Campus and at Cary Hospital.
An extension of the Rapid Response Team (RRT)program, this new service immediately connectsconcerned loved ones with a clinical administrator(CA), 24 hours a day, 7 days a week. While the firststep for family members will always be to talk withthe patient’s nurse, this service offers peace of mindfor families in the event their nurse isn’timmediately available and they feel significantconcern for their loved one. It is designed to givepatients’ loved ones yet another method forcommunicating with the WakeMed team.
The CA has a dedicated phone line with a specialring tone just for Family Care Line calls to ensurethey are answered immediately. When the CAreceives a call, they will talk with the family memberto understand the concerns. The CA will respondaccordingly, whether it requires immediately visitingthe patient, calling the nurse, care team and/or
physician, or taking whatever action the situationrequires.
Physicians are encouraged to explain this newservice to patients and their families and to helpeducate them on when to call.
How It WorksIf a family member notices a decline in their lovedone’s condition, they should:
Step 1: Immediately notify nurse or caregiver staff
Step 2: Explain the concern and what has changedin their loved one’s condition
Step 3: If the family member feels the patient needsadditional help, call the Family Care Line.
I N T R O D U C I N G T H E
RALEIGH CAMPUSEXT. 04444 OR 350-4444
CARY HOSPITAL EXT. 06600 OR 350-6600
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This October, WakeMed proudly earned itsrecertification as a Primary Stroke Centerby the Joint Commission for fourWakeMed sites including the RaleighCampus, Cary Hospital, North
Healthplex and Apex Healthplex. Additionally, theRaleigh Campus, which cares for approximately 100stroke patients every month, has been recognizedwith a silver award from the American Heart andStroke Association for excellence in stroke care.
As the only certified primary stroke center in WakeCounty, WakeMed has proven its ability to providequality care to stroke patients by following nationalstandards and guidelines designed to significantlyimprove outcomes for stroke patients.
This expertise has benefitted over 1,700 patientssince the Raleigh Campus and North Healthplexwere originally certified as primary stroke centers inAugust 2006. The Raleigh Campus and NorthHealthplex were recertified during an on-site reviewthis past August. Cary Hospital and ApexHealthplex earned their designation as certifiedprimary stroke centers this year.
Certification and Award Criteria Introduced in 2003, the Joint Commission’s Primary Stroke Center Certification is based on the recommendations for primary stroke centerspublished by the Brain Attack Coalition and theAmerican Stroke Association’s guidelines for stroke care.
Criteria for achievement of the Silver PerformanceAchievement Award from the American Heart and Stroke Association included maintaining an 85 percent or greater compliance with therequirements in the American Heart and StrokeAssociation Get With The GuidelinesSM program for 12 consecutive months. Get With The Guidelines-Stroke is a quality improvement program that helpsensure quality care for patients with stroke.WakeMed will be eligible for the Gold Award aftermaintaining these high standards for two years.
The requirements include acute stroke treatment andsecondary prevention measures. This 12-monthevaluation period is the second in an ongoing self-evaluation by the hospital to continually reach the 85 percent compliance level needed to sustain thisaward.
For achieving the silver award status, the AmericanHeart Association recognized WakeMed and 517other hospitals around the country in U.S. News &World Report’s July 2008 Best Hospitals issue.
“Change is never easy, but when it came to makingchanges to improve the care we provide to strokepatients, our caregiver team really stepped up,” saysKeith R. Hull, Jr., MD, Raleigh NeurologyAssociates, PA. “Our hospitalists and intensivists doan excellent job of following recommendedguidelines, and our ED doctors play a key role in theacute treatment part of stroke care. Thanks to a greatteam, we have an excellent compliance rate.”
WAKEMED RECOGNIZED FOR
Excellence in Stroke Care
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We all know WakeMed Raleigh Campus and Cary Hospital arebusy places. During the winter, we are busier than ever andexperience numerous days in “Gridlock” status, which meansthere are either very few or no beds available. We recognize thisimpacts our patients, physicians and caregivers at all levels.
Even with WakeMed’s effective and sophisticated patient placement system, wemust all work together to ensure our patients get through the system in the mostefficient way possible. That’s why we need your help to prevent gridlock. Here area few things you can do.
• Identify all potential discharge candidates the day prior to discharge andcommunicate effectively with the patient, family and nursing staff.
• Have discharge/transfer orders written the day prior to discharge or transfer.
• Round on your potential discharges first thing in the morning, even beforevisiting the ICUs. If all surgeons visit just one patient a day in the morning toget the discharge process started before going into surgery, we could significantlyincrease our capacity.
• Consider ordering consultation services on an outpatient basis for non-urgentservices such as follow-up diagnostic testing.
• Take note of the capacity reports that are posted each day in the physicianlounges at Cary Hospital, in the physician parking deck on the RaleighCampus, on the EPR Dashboard and in surgical areas. When you see “Orange:Gridlock”, please work harder than ever to discharge appropriate patients.
Thank you for your support. Working together, we can enhance our ability to meetthe health care needs of the community.
C A P A C I T Y C R U N C H
Preventing Gridlock and How Physicians Can Help
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On October 23, 2008, WakeMed andWilson Medical Center (WilMed)announced a comprehensive cardiacservices affiliation. This mutuallybeneficial relationship will closely align
WakeMed Heart and Vascular Services withWilMed’s Cardiopulmonary Services, enhancing thecardiac services available to Wilson County residents.
This affiliation was driven in part by a formalcontract forged between Wake Heart & VascularAssociates, a 23-member physician group based inRaleigh and one of the primary practices servingpatients in the WakeMed Heart Center, and WilsonCardiology Associates, the sole cardiology practice inWilson. Together, the groups will recruit morephysicians to serve the area’s needs.
“We know patients and their families are concernedabout access to care, cost, and most importantly,quality of care,” explained Dr. Bill Atkinson,president and CEO. “When it comes to the care ofone’s heart, this affiliation addresses many of theseconcerns by strengthening the depth of cardiacservices available in Wilson. Both organizations bringa lot to the table to make this affiliation a win forpatients in Wilson County.”
By leveraging the support and clinical capabilities ofthe WakeMed Heart Center, WilMed can addprograms for patients to receive cardiac care closer tohome. Plus, WilMed patients needing specializedtreatment from a tertiary referral center will have adirect link to the Heart Center. The organizationscontinue to work together to identify opportunitiesfor expanded services for Wilson-area residents.
WAKEMED AND WILSON MEDICAL CENTER
Announce Cardiac Services Affiliation
While the TIA Center will begin by treating TIApatients who present to the Raleigh CampusEmergency Department, future plans for the serviceinclude physician referral. This would allowcommunity-based physicians who have a patient withTIA symptoms to refer their patients immediately toWakeMed’s TIA Center for a full stroke work-up,24 hours a day, seven days a week. Oftentimes,patients with TIA symptoms are scheduled fordiagnostic testing several days or even weeksfollowing their symptoms. Since research indicates the risk of suffering from a full stroke following aTIA is greatest within the first 48 hours, immediateand comprehensive care is critical to improve patient outcomes.
Dr. Keith Hull, a neurologist and medical director ofthe WakeMed Stroke Program, provided the initialvision for the center. This innovative idea has growninto an outstanding collaborative effort by WakeMedNeurosciences, Emergency Services, Radiology,Cardiovascular Imaging, hospitalists and LaboratoryServices. The TIA center concept is critical in helpingproviders determine the etiology of the event soappropriate preventive treatment and risk factormodification can be implemented promptly.
The TIA Center also supports our Joint CommissionPrimary Stroke Center designation and our growingNeurosciences capabilities.
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The da Vinci Surgical System®, a surgicalrobot that offers 3-D visualization alongwith greatly enhanced dexterity, precisionand control in the operating room, arrivedat the Raleigh Campus in October 2004
and at Cary Hospital in September 2007. Since then,the da Vinci has helped surgeons on both campusesperform minimally invasive surgical procedures usingadvanced robotic technology. Benefits for patientsinclude less pain, blood loss and scarring as well as ashorter recovery, decreased hospital stay and fewercomplications.
Until now, the da Vinci has primarily been used byurologists at WakeMed to treat prostate cancer,ureteropelvic junction obstruction and kidneycancers. Now, however, more OB/GYNs and generalsurgeons are beginning to explore the use of the daVinci for procedures like removing uterine fibroids,correcting pelvic organ prolapse, performing
hysterectomies and repairing hernias. In fact, morethan 20 members of the WakeMed Medical Staff arecurrently using the da Vinci on the Raleigh Campusor at Cary Hospital for surgical procedures in thefollowing areas: Urology, OB/GYN, General Surgery,Cancer and Cardiac Care. Many procedures are alsobeing performed as a result of the collaborationbetween different specialty physicians, enabling abroader range of complex surgical procedures thatwould have previously required open surgery. Forexample, Sam Chawla, MD, urologist (WakeMedFaculty Physicians-Urology) and OB/GYNCatherine Dingman, MD, (Woman Care ofRaleigh), work together using the da Vinci system toperform sacrocolpopexy to treat pelvic organprolapse. As additional physician specialists becomeexperienced with the da Vinci, more patients willbenefit from this advanced robotic technology.
the da Vinci Surgical System with the assistance of a da Vinci sales representative.
WakeMed’s da Vinci Surgical System Gains Momentum
Three WakeMed Critical Care Units
Earn National AwardsCongratulations to the Surgical Intensive Care Unit, Cardiac Care Unit andCardiothoracic Surgical Unit staff and physicians. Their extraordinary commitment tohigh-quality, critical care standards earned them national Beacon Awards for CriticalCare Excellence.
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Hands of Health Award
Jerry Bernstein, MD,pediatrician and co-founderof Raleigh PediatricAssociates, was honored asone of two recipients of the2008 John Rex EndowmentHands of Health Award forhis vision in improving and
raising the standard of pediatric health care for allWake County children. Dr. Bernstein providedthe guidance and vision to build WakeMed’sChildren’s Emergency Department, whichopened in 1997, and he is now helping leadWakeMed’s efforts to create the first children’s“hospital within a hospital” in Wake County.
Welcoming WakeMed’s FirstGynecological Oncologist and Surgeon
This October, Dr. MonicaJones joined WakeMed’sMedical Staff as our firstand only gynecologiconcologist and surgeon.Practicing out of the CancerCenters of North Carolinain Raleigh, Dr. Jones joins
our Medical Staff from the Mayo Clinic Collegeof Medicine in Rochester, MN, where sheprovided care as a consultant and served as anassistant professor for the Department ofObstetrics and Gynecology at the Mayo ClinicCollege of Medicine. Dr. Jones is board certifiedin gynecologic oncology as well as generalobstetrics and gynecology.
J. Michael Weeks Awards
Juan L. Granados, MD, andStephen P. Montgomery,MD, received WakeMed’sannual J. Michael WeeksHumanitarian Award.
Granados is a long-timephysician with WakeMedFaculty Physicians –
OB/Gyn and served as the director of thepractice for 20 years. He specializes in treatinghigh-risk pregnancies and works tirelessly for theunderserved in our community, particularly theHispanic population.
Montgomery practiced at Raleigh OrthopaedicClinic from 1980 until 2007. His love for thecommunity and loyalty to the facilities he wasinvolved with were evident to all those whoworked with or received care from him. Hedevoted much of his time and talents to Urban
Ministries and to caring for the underprivilegedin Wake County. He was also very committed tohis patients and colleagues at WakeMed, wherehe served as president of the Medical Staff, chiefof Orthopaedics and on various committeesthroughout his tenure with the health system.Dr. Montgomery passed away in 2008. His wife(pictured left) accepted the award on his behalf.He is deeply missed by many.
The J. Michael Weeks Humanitarian Award wasestablished in 1989 by the WakeMed MedicalExecutive Committee to honor providers whodevote extraordinary time to teaching or to thecare of those less fortunate; one who hasparticipated significantly in an event whichvisibly demonstrates a commitment to those lessfortunate; or one who has demonstratedleadership and participation in a significantproject which directly contributes to the welfareof the citizenry.
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“Taking an interdisciplinary approach, I amcommitted to working with other physicians andsubspecialists to build a comprehensive service tomeet the needs of women who are facinggynecological malignancies,” explains Dr. Jones.“From general gynecologists and oncologists toradiology oncologists to regular radiologists, there isa full team of physicians and subspecialists who areall involved in caring for these women. My goal is towork together with the medical community in WakeCounty to serve the women who need our services.”
Dr. Jones completed her residency and received herdoctorate from the University of Cincinnati. Shealso completed fellowships at the National Cancer
Institute, and a fellowship in gynecologic oncologyin Rochester, MN.
Dr. Jones is accepting referrals and treats womenwith a variety of gynecological problems includingbut not limited to primary, metastatic or recurrentuterine, ovarian, fallopian tube, endometrial, cervix,vagina and vulva cancers. Available surgicalprocedures include abdominal and vaginalhysterectomy; staging and cytoreductive surgeryincluding pelvic and paraaortic lymph nodedissections, omentectomy, splenectomy, diaphragmresection, bowel resections and urinary diversion,among others.
On October 1, 2008, the WakeMedRaleigh Campus joined many hospitalsthroughout the country inimplementing a new bundle protocolaimed at improving outcomes for adult
emergency department patients with severe sepsisand septic shock. The new protocol is based onrecommendations made by the Surviving SepsisCampaign (SSC), an international collaborationbetween the European Society of Intensive CareMedicine, the International Sepsis Forum, and theSociety of Critical Care Medicine. The Campaignwas developed to improve the management,diagnosis, and treatment of sepsis throughout the world.
One of the primary goals is to identify sepsis signsand symptoms early since we know that sepsis is arapidly progressing condition with high mortalityrates. WakeMed patients who meet the strictinclusion criteria for the protocol quickly have a
central venous catheter placed to measure thefilling pressure and oxygen saturation of bloodgoing into the heart. Depending on the values, thegoal directed protocol guides the resuscitation teamto provide intense medical therapy, more oxygen orblood transfusion(s) to improve the patient’sperfusion of vital organs and tissue. By bundlingthese therapies to meet the needs of individualpatients, the protocol has shown significantimprovement in clinical research studies.
“A study to measure the efficacy of the early goaldirected therapy protocol reveals that the risk of in-hospital mortality from sepsis can be reduced by16 percent,” notes Anita L’Italien, MD, WakeEmergency Physicians, PA. “We hope the protocolwill help us recognize septic patients early andprovide focused and aggressive treatments toimprove their outcomes.”
Plans are being developed to implement theprotocol at all WakeMed EDs in the future.
New Protocol Aimed at Improving Outcomes for
SEPSIS PATIENTS
This fall, Cary Hospital unveiled an important newservice for patients with the introduction of spinalsurgeries performed by experienced physicians. Thisnew service comes to Cary Hospital through thecollaboration of orthopaedic spine surgeons
Gurvinder Deol, MD, (Wake Orthopaedics) and SameerMathur, MD, (Cary Orthopaedic) as well as Maria Maag, RN,director, (Operative Services - Cary Hospital) and the Cary
Hospital Operating Room (OR) staff.
Since the introduction of the new service inOctober, numerous successful spinal cases have
been conducted in Cary Hospital’s OR,varying from minor to more complex.Offerings include procedures to treat chronicback pain; minimally invasive lumbarfusions, which relieve pressure on the spinalcord or nerve roots; minimally invasivekyphoplasty surgeries to repair fractures thatoccur when part of the spinal columncollapses; and minor laminectomies, themost common type of surgery to relievepressure on the spinal cord or nerve rootscaused by age or to treat spinal injuries,herniated discs or tumors.
Of the more complex proceduresperformed by Dr. Deol and Dr.Mathur is the anterior cervical fusion,a procedure that treats nerve root or
spinal cord compression. All spinalsurgeries have incorporated fluoroscopy, a
moving X-ray used to obtain real-timeimages of the patient’s internal structure
and target areas of concern.
“We are so pleased to be able to offer this elevatedlevel of care to patients in and around the Carycommunity,” commented Maag. “Our patients willtruly benefit from receiving treatment closer to
home, which presents a safer, more comfortableand more convenient option when undergoing a
surgical spinal procedure.”
In conjunction with Dr. Deol and Dr.Mathur, Maag and her team look forwardto supporting the continued growth ofCary Hospital’s spinal surgery program.
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Cary Hospital Introduces
SpinalSurgeryServices
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WakeMed is currently draftingprocedures and policies relatedto Stark II, Phase 3, whichprohibits WakeMed fromproviding non-monetary
compensation to physicians, their immediate familymembers and their office staff. The type ofnonmonetary compensation referenced in the law isconsidered a Business Courtesy. BusinessCourtesies include gifts, entertainment (includingdining) and educational or business activities thathave monetary value and are offered free or at adiscount to the recipient. There are threeexceptions related to Business Courtesies:
1. Non-monetary Compensation – WakeMed canextend a Business Courtesy to a physician, amember of the physician’s immediate family orthe physician’s staff if the Business Courtesy hasnothing to do with past or expected volume,value of referrals or business generated by thephysician. In addition, the Business Courtesycannot exceed an aggregate limit of $355 in acalendar year.
2. Medical Staff Incidental Benefits Exception –In general, WakeMed can extend BusinessCourtesies to its hospitals’ medical staffmembers as long as the value of the BusinessCourtesy is less than $30 per occurrence, and itis extended to (but not necessarily accepted by)all medical staff members in the same specialty.The following examples meet this exceptioncriterion:• Free parking on WakeMed campuses• Modest meals and snacks in physician lounges
3. Compliance Training Exception – WakeMedcan sponsor compliance training for physiciansand their staff as long as the provider practicesin the local service area. The training must berelated to basic compliance program elements orrequirements of federal and state health careprograms, or federal, state or local laws,regulations or rules governing provider conduct.The exemption applies if compliance training isthe primary purpose of the program. Costs ofrefreshments must be tracked.
In the Works: Compliance PolicyWhile WakeMed’s final Stark Law compliancepolicy is in development, we know that the lawrequires us to better track and monitor allnonmonetary compensation and benefits we offerto our physicians, their office staff and families.WakeMed is committed to following federalguidelines. Therefore, physicians may begin tonotice some changes related to the provision ofnonmonetary compensation such as meals,seminars, CME credits, etc… Stay tuned fordetails. As always, thank you for choosingWakeMed and for your commitment to caring forour community.
STARK LAW UPDATE Its Impact on Medical Staff
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In an industry as complex as health care, planning for the future isn’t easy, especiallywhen you consider the growth predicted for Wake County and the Triangle areaduring the next 20 years. We want to be sure WakeMed continues to meet the growingdemand for health care services and that we offer the services and capabilities ourpatients want and need.
That’s why we’ve enlisted the help of our physicians in numerous specialties as we evolveour strategic plan. Over the past few years, physicians have become actively involved in theBoard’s Strategic Planning Committee, and strategic service line planning teams in severalkey areas including pediatrics, women’s services, ambulatory services and neurosciences,among others, to share their thoughts and ideas to determine the best processes for ourpatients, the community and the physicians who support WakeMed. The informationwe’ve learned through this process has been invaluable and has helped us establish asuccessful model for involving our physicians in our planning process.
PediatricsHeavily involving our physicians in the strategic planning process began several years agowhen we began discussing the future expansion of our pediatrics services. At this time, weestablished an interdisciplinary Pediatrics Planning Committee that included physiciansfrom all specialties involved in caring for children, including orthopaedics, pediatricsurgery, emergency, neonatology and obstetrics, among others. With numerous keyphysician leaders, including Jerry Bernstein, MD, an organized committee came togetherto discuss the needs of our patients and how physicians and WakeMed could worktogether to expand capacity and services to meet the growing demand for care. This groupis responsible for the development of the children’s hospital currently under constructionon the fourth floor of the new Raleigh Campus Patient Tower. The committee continuesto evaluate and plan for the introduction of new children’s services needed in WakeCounty over the next several years.
“The Pediatric Planning Committee has been an outstanding success and helped usestablish a well-thought-out plan that we feel confident will allow us to better meet theneeds of our pediatrics patients for decades to come,” explains Deb Friberg, executive vicepresident and chief operating officer. “After months of meeting, the committee establisheda shared understanding of the needs of our patients, our physicians and WakeMed. This
Physicians Help Guide SERVICE LINE STRATEGIES
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planning model has really helped us do a better job of preparing tomeet the health care needs of the community, and we sincerelyappreciate the time and energy offered by our physicians.”
Women’s ServicesThe success of the Pediatric Planning Committee has led to thedevelopment of a number of planning groups. One of these groupshelps to guide the future direction of our Women’s Services.Involving numerous specialties including obstetrics, gynecology,radiology, gynecologic oncology, urology and general surgery,among others, this committee has been working for the past severalmonths to discuss how we can best meet the growing demand forwomen’s services in the community. While the group is fairly new,there is already significant interest and enthusiasm among thecommittee, and we anticipate great ideas to emerge that will allowus to better serve our patients.
NeurosciencesIn late 2008, a group of Medical Staff representatives, service lineleaders and administrative support staff conducted an organizationalreview of neurosciences-related services, technology, staffing andcosts as an analysis of the market position. The preliminary findingsrevealed that WakeMed has a lot to offer, especially in the areas ofphysician expertise, breadth of specialization, technology, dedicatedinpatient facilities and nursing staff.
Because many physician specialists are involved in the care of aneurosciences patient, representatives from numerous areas will beengaged in the neurosciences planning process as it unfolds atWakeMed.
WakeMed North HealthplexAn interdisciplinary steering committee is in place at NorthHealthplex. The committee is addressing the expansion of thefacility into a full-service women’s hospital after WakeMed receivedCON approval for an additional 41 beds. The preliminarycommittee includes physicians from numerous specialties, includingobstetrics and gynecology, general surgery, pediatrics, neonatology
Physicians Take ActiveRoles in WakeMed’sStrategic Planning
“The Physician’s Perspective.”That was the theme of the mostrecent annual planning retreat ofthe WakeMed Board of Directorsand Medical ExecutiveCommittees. WakeMed MedicalStaff members took center stageto share with Board members thechallenges, issues and prioritiesthey face and how addressingthem within the strategic plan willhelp shape the future success ofWakeMed, particularly from anoperational perspective.
The chairman of the WakeMedStrategic Planning Committeecreated a special Physician TaskForce to determine the key pointsthat were presented anddiscussed during the retreat. Thetask force included 15 physiciansfrom 15 different specialties.WakeMed administrators are verypleased to have physiciansactively engaged in planningprocesses.
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and anesthesia. The committee will likely expand toinclude other specialties such as cardiology andurology. The committee meets regularly to guide thestrategic direction of the first women’s hospital inWake County.
“Hearing from our physicians early in the strategicplanning process has been invaluable, and willultimately benefit our patients and the community,”explains Friberg. “Our physicians understand theirpatients, the market and the demand for services, andthey offer a different perspective that is truly criticalto the planning process. We appreciate the time and
commitment we have received from the dozens ofphysicians who have participated in these committeesand teams, and welcome involvement from all of ourMedical Staff.”
Get InvolvedGroups will continue to form to discuss service linesand strategies. Operational plans will be developedfrom the information that is shared in these groups.Do you have ideas to share? All physicians arewelcomed and encouraged to get involved. ContactDeb Friberg directly at 350-8104 [email protected].
SERVICE LINE STRATEGIES c o n t i n u e d
In 2008, WakeMed distributed a survey to morethan 200 surgeons throughout the WakeMedsystem to gather feedback on how well WakeMedmeets their needs related to equipment, staffing,OR throughput and management, among other
topics. More than 40 percent of those surveyedresponded, providing valuable feedback that wasshared with Surgical Services leadership teams. Fromthere, individual action plans based on surgeonfeedback were developed specifically for each facility.Teams throughout the system have been workinghard during the past six months to implementchanges and improve operations to better meet theneeds of our surgeons, and each facility has madegreat progress. In fact, since the survey wasconducted, Cary Hospital has updated 100 percent ofsurgeon preference lists and has made outreach visitswith each surgical specialty. Similarly, the Raleigh
Campus implemented a new surgical tray/tooltracking system that has helped standardize processesand improve operations. At North Healthplex,surgeons appreciate that the staff is being educatedon surgeon’s individual preferences and that thoseneeds are being met.
Dr. Lisa Roberts and her colleagues at Gynecology &Laparoscopic Surgeons are now meeting with theNorth Healthplex Surgical Services leadership teamon a quarterly basis to discuss OR operations. “We'vebeen very pleased with the leadership and staff ’sresponsiveness to our concerns and suggestions,” saysDr. Roberts.
Thank you to all of our surgeons for your valuablefeedback. We will continue to work together toenhance our operations to meet your needs.
Surgeon Preferences Influence Change
Following a comprehensivenational search that attractedhundreds of well-qualifiedapplicants, WakeMed is pleasedto announce that Scott Raynes,MA, MBA, has been named thenew senior vice president andadministrator of Cary Hospital.
Raynes will begin his role at WakeMed Cary Hospitalon May 4.
As senior vice president and administrator of CaryHospital, Raynes will be responsible for leading,defining, and executing the overall direction of CaryHospital. Raynes clearly stood out among theapplicants because of his dynamic leadership style andproven ability to enhance a hospital’s success bygrowing market share, services and medical staffmembership. On the ambulatory side, Raynes bringsa successful track record of leading 15 surgery centersacross three states. Finally, he has a strong interest in
fully engaging as a business leader in the community –all of which are critical factors for Cary Hospital today and in the future.
Raynes joins WakeMed from Northcrest HealthSystem in Springfield, TN, where he has been servingas president and CEO since 2005. Northcrest hasbeen very successful as a stand-alone facilitycompeting in the highly competitive Nashville, TNmarket area. Prior to this role, Raynes served aspresident and CEO of Preston Memorial Hospital inKingwood, WV. He brings more than 15 years ofexperience in health care leadership.
Raynes holds a bachelor of arts degree in businessadministration from the West Virginia Institute ofTechnology, a master of arts degree from MoreheadState University in Morehead, KY, and a master ofbusiness administration degree specializing in healthcare from West Virginia University. He and his wife,Shawna are natives of West Virginia, and they havetwo daughters.
Cary Hospital to Welcome Senior Vice President and Administrator
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Of Note
WakeMed Names New Senior VicePresident of Physician Practices
WakeMed is pleased to announcethat Susan Weaver, MD, has beennamed senior vice president ofWakeMed physician practices. Inthis role, Dr. Weaver oversees theoperations of WakeMed’s multi-specialty physician practicesincluding WakeMed Faculty
Physicians, Wake Specialty Physicians and WakeOrthopaedics. She will provide oversight for ourteaching programs with Wake AHEC and theUniversity of North Carolina (UNC) School ofMedicine.
New Wake Specialty Physicians PracticeWakeMed is pleased to announce a new companyunder the WakeMed corporate umbrella – WakeSpecialty Physicians, LLC, which is a “spin-off ” ofWakeMed Faculty Physicians (WFP). WakeMed’sgrowing physician practice network now includes WakeSpecialty Physicians, WakeMed Faculty Physicians andWake Orthopaedics.
The new Wake Specialty Physicians includes theprivate, community-based practices that have grownout of WFP over the years. This new model wasestablished to differentiate them from the WFP
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practices and to give our physicians the opportunity topractice in a variety of settings. Thus, the new WakeSpecialty Physician practices include many of the samephysicians who practice at WakeMed FacultyPhysicians. The new Wake Specialty practices include:
WakeMed North Healthplex• Wake Specialty Physicians – ENT, Head
& Neck Surgery• Wake Specialty Physicians – Facial Plastic
Surgery and Premier Med Spa• Wake Specialty Physicians – General Surgery• Wake Specialty Physicians – Urology
Wakefield HealthPark• Wake Specialty Physicians – Women’s Center
WakeMed Brier Creek Medical Park• Wake Specialty Physicians – Gastroenterology &
Hepatology
The WakeMed Faculty Physicians name will remainwith the practices based on the Raleigh Campus. TheseWFP practices will continue to:• Serve patients at our Raleigh Campus-based clinics;• Provide 24-hour call coverage;• Offer specialty physician services to inpatients; and • Provide graduate education for our UNC residents.
Breast MRI Now Available at Cary HospitalWakeMed Cary Hospital’s Imaging Services providersnow offer breast magnetic resonance imaging (MRI) toimprove the search for malignancies. The AmericanCancer Society now recommends an annual MRI – inaddition to a mammogram – for women who have a 20 percent or greater lifetime risk of breast cancer. Thetechnology’s ability to provide sharper soft tissuecontrast than radiation-based equipment is the primaryreason it is becoming a first-line screening tool.
Hospitalist Program Changes at Cary HospitalChristy Henry, MD, has assumed the administrativefunctions of the hospitalist program at Cary Hospitalas the interim program director. Dr. Henry replacesDavid C. Thurber, Jr., MD, who recently stepped
down. Dr. Thurber, who was named Cary Hospital’sfirst full-time hospitalist in 2003, will continue hisclinical patient care responsibilities at Cary Hospitaland participate in other hospital activities. Recruitmentfor a permanent director of the program is ongoing.
The program welcomes two new hospitalists, Dr. JamesCho and Dr. Saif Afridi. The practice has alsoimplemented a 24/7 on-call pager that can be used toreach the on-call hospitalist at 393-0425. This pagershould be used for all new admissions, consults oroutside transfer requests, as well as after-hours cross-cover on hospitalist patients. A swing shift has beenadded to expand coverage during the busy hours ofapproximately 2 pm to 12 am.
Just For Kids Kampaign UpdateThe WakeMed Foundation’s Just For Kids Kampaign toraise funds for the creation of Wake County’s firstdedicated children’s hospital, got off to a great startwith the generous donation of $1.5 million made byRaleigh-based General Parts International Inc. To datedonations total $4.2 million. Another $15.8 million isneeded by 2011 to bring the new WakeMed Children’shospital-within-a-hospital project to fruition. For moreinformation about the WakeMed Just For KidsKampaign, call 350-7656.
Outstanding Bond Market PerformanceIn just three days, WakeMed sold approximately $170million in fixed rate bonds and has issued an additional$75 million in variable rate bonds. Combined, thesebonds will fund numerous construction projects andprovide us with a higher level of cash on hand.
“Our ability to sell so many bonds in such a shorttimeframe demonstrates the community’s pride andconfidence in WakeMed,” says Dr. Bill Atkinson,president & CEO. “Thank you to all of our employees,physicians and friends who work hard every day toinstill this confidence in our community.”
Of Note
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Transition to Soarian by March 15Please see the following overview of severalimportant changes that have been made toWakeMed’s clinical information systems.
Moving from MIM to SoarianBecause ED charts are now available in Soarian, wewill stop using MIM as of March 15. Please contactDr. Alexander at 630-5207 if you need training or ifyou have a problem related to the transition. Hereare the latest Soarian features.• The Ability to View Full ED Charts – The chart is
generated after the patient is dispositioned in theED. It will appear in the Documents list in theSoarian Clinical Summary or Patient Record.Active patients who are still being seen by EDphysicians will not have ED records in Soarian forthe current visit.
• The Ability to View ECG Images – Access ECGimages the same way you access X-ray images:Click the icon in the Results section to view thereport and then click View Image.
• Assessments – Case management, dietarycounseling and respiratory assessments are now onSoarian.
HMED AccessIf you would like HMED access to view active ED patient information, contact Julie Phipps at 350-7762 or [email protected]. Access theHMED chart from the EPR dashboard once youhave a user ID.
Remote AccessPlease use https://access.wakemed.org to access theEPR dashboard and all clinical systems from aremote location. Older remote access gateways (i.e.medstaffapplications.org; apps.wakemed.org) arenow inactive. Please contact Ben Hoch at 350-0623or [email protected] if you need assistance.
For Cary UsersThe medication administration system (MAK) is notavailable to you through remote access. InformationServices hopes to resolve this problem soon.
E P R U P D A T E
CMS Retires AMI-6 Beta-blocker at ArrivalEffective March 31, the Centers for Medicare andMedicaid Services (CMS) will no longer track theadministration of a beta-blocker within 24 hours ofarrival for acute myocardial infarction (AMI) patients.
In 2005, trial results revealed that while beta-blockersreduced the risk of death from arrhythmia andreinfarction, they significantly increase the risk ofcardiogenic shock within 24 hours of admission in somepatients with a heart failure history. In 2007, theAmerican College of Cardiology and the AmericanHeart Association in their updated guidelines forpatients with ST-elevation AMI acknowledged thatsome patients are not appropriate for early beta-blockertherapy. In addition, the guideline stated that the
current evidence base for the administration of oralversus intravenous beta-blockers differs. The newguideline recommends that early intravenous beta-blockers should specifically be avoided in some patientpopulations. These factors make decision-making toocomplex for performance measurement. Thus, themeasurement has been retired.
Mechanisms are now in place to suppress publicreporting of measure AMI-6 and cease submission ofdata elements unique to it. Providers are encouraged touse the “Reason for No Beta-blocker on Arrival”exclusion to remove high-risk patients from themeasure. After March 31, data elements associatedwith AMI-6 will no longer be required for submissionby CMS or The Joint Commission.
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Durga Alahari, MDDepartment of PediatricsSpecialty: PediatricsWakeMed Cary Hospital
Doctors’ Day 2009MONDAY, MARCH 30Join us as we thank you, our valued physicians, for all you do.
Cary Hospital Conference CenterPhysician Appreciation Breakfast Buffet7:30 to 10 am
Raleigh Campus Medical Staff LoungePhysician Appreciation Lunch11:30 am to 2 pm
North Healthplex and Apex HealthplexCupcakes will be provided during the week of March 30.
We love our
doctors!We love
our doctors!
WakeMed Goes Green – Stay Connected OnlineThis is the last issue of Stethoscope that you will receive. As wemove toward becoming more environmentally friendly, WakeMedwill use electronic communications to stay connected with ourMedical Staff. This will allow us to share information in a moretimely and efficient manner, while saving resources and paper.
Wakemed.orgKeep up with what’s going on at WakeMed by visitingwww.wakemed.org and clicking on “For Our Physicians.” We willsoon launch a new and comprehensive Web site, and we hopeyou’ll visit us regularly for important physician news and updates.
Email CommunicationWe know you get a lot of email. With your permission, we’d like torespectfully share relevant, timely news and information with youabout once a month. Our updates will be short and sweet, andyou can opt out any time. If you are interested, please send youremail address to [email protected].
