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Physician Focus Spring 2010 

In This Issue

WANTED: 8 Medical Staff Leaders for Future of Hospital
First Upgrade to Epic Adds More Kick
Heparin Infusion Monitoring Changes for Select Patients
We Need Your Help! 2E and 5E to Pilot Hand Hygiene Project
NICU will Gain State-of-the-Art Incubators
Direct, Verbal Communication Still Reigns
Exchange of Out-of-System Patient Data Being Piloted
Two New Leaders Help in Transition to Care Management
Improvements in Patient Care Take Next Step
Hospital Comparisons Provide Transparency
Physician Profile: Dr. Fliegel
Pediatric Rapid Response Implemented
New Law Puts Heart Back into Volunteering
Facilities News: Private Rooms, Edgerton Hospital Affiliation
Emergency Care Next Topic in Best Practices Series
Welcome New Medical Staff Services Coordinator
Honors and Recognitions

May 19 - Medical Staff Redesign Forum
7 a.m., Dining Room A
May 24 - Medical Staff Redesign Forum
7 a.m., Bay 1 
May 28 - Steal Shamelessly Series,
12:40 p.m., St. Mary's Hospital
June 3  - Grand Rounds, 7 a.m.,
St. Mary’s: “Inpatient Glycemic Control”

Grand Rounds
CME Offerings

What's New From...
Quality & Safety
UW Family Medicine




WANTED: 8 Medical Staff Leaders for Future of Hospital 

That’s the headline we will post very soon as our Medical Staff Redesign moves into the implementation phase. The Steering Committee is excited about the progress of our move to a more dynamic, strategic and integrated physician leadership structure at St. Mary's, and we hope you will begin thinking about how you might play a role.

At the April meeting, the Medical Executive Committee endorsed a recommendation from the Steering Committee to proceed with the following:
1. Hold forums for the Medical Staff to engage in discussion and to hear a brief presentation about the proposed redesign. These will occur May 19, May 24, June 15 and June 24, all at 7 a.m. at St. Mary's. 
2. After fine-tuning based on input from these forums, seek final approval of the redesigned structure from the MEC in June or July.
3. In July, begin recruiting for and accepting nominations for 8 new Medical Staff Leaders.
4. Update the bylaws and make necessary changes in August and September with subsequent approval by the MEC. Present to the Medical Staff for a vote in October.

These new medical staff leaders will serve a key strategic, governance and clinical operational role at St. Mary’s Hospital. This position allows physician leaders the time, compensation and defined operating structure to contribute physician expertise and skills toward the betterment of St. Mary’s Hospital. They will work closely with the Vice President of Medical Affairs, an energized group of physician colleagues and the elected medical staff leadership (Chief of Staff, Vice Chief and Secretary/Treasurer).

A restructured Medical Executive Committee and a Physician Leadership Council will be formed to lead the medical staff by developing effective collaboration, communication and accountability as well as an atmosphere of professionalism.

We want to encourage you to participate in the discussion during this very exciting time for the physicians at St. Mary's.

Al Musa, MD,
Chief of Staff

John Butler, MD,
Vice President/Medical Affairs

Comments? Contact Dr. Butler.

    First Upgrade to Epic Adds More Kick
    After nearly two years into using Epic's electronic health record, St. Mary's will encounter its first routine upgrade on May 22. A 30- to 45-minute e-Learning module is available on the DeanSource Epic Upgrade training website, and a broad overview of the changes that affect physicians are outlined here.

    "This is not as intensive as the initial go-live," says Annette Fox, who oversees clinical systems for WIITTS (a partnership between SSM Health Care of Wisconsin and Dean). "The look and feel of the system will change and it has new features that users have asked for, but the learning curve is much smaller."

    The biggest change will be the look of the Epic screen and the ease of access to functions, which will be combined under one button at the top left and will keep the most recently accessed and/or user favorites at the top. Other useful features for physicians include:

    • Sidebar report allows Chart Review reports to remain open while navigating the system.
    • Additions to Order Sets are easier without having to scroll.
    • Reprinting prescriptions is more streamlined.
    • A "shopping cart" is available for order entry.
    • Multiple Provider Schedule allows users to double-click on a patient name to directly open the surgical case.
    • Misspelled words in the Notes Activity are underlined for easy correction.
    • Accordion report allows easier drill-downs, ability to view only columns where data exist, and ability to see flowsheet comments.
    If you have not attended training, e-Learning is available on the DeanSource Epic Upgrade training website for you to complete at your convenience. Using your CryptoCard to log into the Dean Intranet homepage, please type the following URL address into your web browser to access the Epic Upgrade Training website: http://www.deanhealth.com/dmc/training/new/EpicUpgrade/apps/ecinpproviders.asp. The training takes approximately 30 to 45 minutes to complete.

    The upgrade will happen in the early morning hours of Saturday, May 22. Super users will provide support on each unit for the following five days.

    Heparin Infusion Monitoring Changes for Select Patients
    The Pharmacy Department will implement a new tool this summer to monitor heparin infusions in select patients while current protocols remain in effect for all other patients. The change is in response to the department’s goal to achieve therapeutic aPTT in 90% or more of patients receiving heparin therapy within 24 hours of initiation. This goal is based on data demonstrating improved outcomes when a therapeutic aPTT is achieved and maintained in the goal range. Read more.

      We Need Your Help! 2E and 5E to Pilot Hand Hygiene Project
      A new hand hygiene quality improvement project will be piloted this spring on two cardiovascular units: CVICU (2E) and 5E. The project seeks to improve the rate of hand hygiene before and after patient contact while also strengthening the means of measuring hygiene practices. Medical Staff hand hygiene practice has improved since starting the push in 2002 (from 14% to 59% before patient contact, and from 38% to 67% after patient contact), but there is much work to be done to reach 100% -- which is the goal of the pilot program on 2E and 5E for the month of June. This simple and often-overlooked habit of exceptional care requires your engagement and personal motivation to ultimately reduce the number of hospital-acquired infections. When measurable improvements in hand hygiene are noted, the project will roll out to the rest of the units.

      NICU will Gain State-of-the-Art Incubators
      State-of-the-art incubators will improve care and provide additional benefits to families and caregivers when St. Mary’s Neonatal Intensive Care Unit undergoes a major renovation in 2011. St. Mary’s Foundation is working closely with the unit’s medical director, Dr. Mary Bussey, and nursing director Diane Buss to improve on an environment that is both high-tech and high-touch. Supported in part by the recent community-wide Merrill Lynch Grand Gala, the Foundation’s fund-raising efforts will result in 12 Giraffe® Omnibed incubators, each costing $40,000. The Gala brought in $286,000 -- enough for seven incubators. The Omnibeds will take the place of several pieces of equipment – the L&D Warmer, the Transport Incubator, the Neonatal Warmer and the Neonatal Incubator. In addition, the equipment offers fast, easy access to the infant – something very important for both caregivers and for the families.

      Direct, Verbal Communication Still Reigns
      By Al Musa, MD, Chief of Staff

      Patients depend on our ability to inform and educate them as well as to direct and manage their medical care. How effectively are we communicating with colleagues and patients to achieve these shared goals? For important and timely clinical issues, I cannot emphasize enough the need for direct, verbal provider-to-provider communication. Using technology to communicate is often more convenient, but because our work in health care is so complex, we must not forget the human side of the equation. Our effective interactions fuel improvements and efficiencies, reduce adverse events and provide a rewarding collaboration with colleagues. In the interest of providing exceptional patient care, I welcome additional thoughts and solutions: albert.musa@deancare.com
      Exchange of Out-of-System Patient Data Being Piloted
      Emergency and urgent care patients at St. Mary’s, Dean Clinic, Group Health Cooperative, Meriter and University of Wisconsin Hospital and Clinics are the focus of a pilot program called Care Everywhere, which stems from the Epic electronic health record. During the 120-day pilot, providers will be able to exchange information only with the organizations listed above. Patients will be informed of the program and have the opportunity to sign a consent form to authorize access of their information. After the pilot ends July 31, each organization will decide whether it wants to continue the Care Everywhere program as part of a national network that will also expand to other care situations.

      Care Everywhere affects all Epic users who have access to review patient charts, even if they do not work in Emergency Services or Urgent Care. Once a Care Everywhere link is established, the exchanged information becomes part of the patient record and a Care Everywhere tab shows up on the Epic screen, near Chart Review. Information may include lab and other test results, medications, allergies, problems list and provider notes from outside organizations.

      Epic’s Care Everywhere ultimately links with all other organizations that also use Epic software, whether across town or across the country. The idea is improve health care and clinical information access for patients who may find themselves receiving care within different health systems.

      Examples from the Front Lines:

      • A patient from another health plan came to St. Mary’s ER because of an allergic reaction and could not recall the name of her medications. The physician immediately accessed her records and got the name to provide better care.
      • UW’s ER was able to avoid ordering an expensive test on a patient after they queried the patient’s records from another organization and found the information they needed.
      • 24/7 electronic access has improved the care of many patients who come from organizations whose medical records department is not open nights and weekends.

      Two New Leaders Help in Transition to Care Management
       Dr. Jim Goodsett has assumed the half-time position of Physician Advisor for Care Management at St. Mary’s while retaining duties as a hospitalist. In his new role, he will be working with Eileen Scalise, who will begin in June as director of Patient and Family Services.

      In his new role as Physician Advisor for Care Management, Dr. Goodsett will support care coordination activities, serve as a clinical resource for the care managers, share in the accountability for the results of care coordination, interact with important payors regarding utilization issues and assist in the appropriate admission status designation. He will also serve as an important resource for physicians in the areas of documentation, utilization, care coordination and effective collaboration with care management staff.

      Dr. Goodsett’s background includes clinical care in Internal Medicine at Riverview Clinic in Janesville and Dean Clinic East as well as his continuing work as a hospitalist at St Mary’s.

      As Patient and Family Services transitions to a model of care management, Eileen Scalise will provide the leadership starting in early June, after wrapping up her current position at Aurora Medical Center in Oshkosh. Eileen comes with a nursing degree from New York and a master’s degree from the University of Wisconsin-Oshkosh. In the interim, Cyndi Benson-Lein and Rosanne Derdula continue in their roles as RN and social work leads in the department.

      Improvements in Patient Care Take Next Step
      Care Coordination may sound like a detached administrative term that does not focus on patients, but nothing could be further from the truth. Care Coordination puts our patients first as the most important members of our health care team. Here’s an overview of our project and a look at next steps as they relate to physicians.

      Over the past year, a multidisciplinary team has been working on the Care Coordination Project. A significant amount of important groundwork has been laid to design, test and implement the Care Coordination Plan, and we are now ready as a system to maintain and build on the improvements that have been already accomplished.

      Many of you have been part of care coordination long before this project even started. For example, some care coordination occurs when an astute nurse alerts the attending physician that, despite plans to change the patient’s antibiotics, the physician did not place the order; or when pharmacy alerts the care team that the antibiotics that were ordered will adversely interact with some of the patient’s other medications.

      In short, the foundation of care coordination is all of us working together to provide the best care possible to our patients. However, the Care Coordination Plan takes that foundation many steps further by deliberately planning, coordinating and integrating all aspects of the care we provide to achieve the safest, most cost-effective, high-quality care that still recognizes each patient as an individual with unique needs. The next steps will involve implementing illness-specific care pathways and continual efforts to standardize and refine our day-to-day processes of care.

      In the coming months, Dr. Butler, myself and the Department of Patient and Family Services will meet with each of the units in the hospital as well as attend monthly physician department meetings to communicate the broad outline of these next steps as we continue together to embark on our never-ending journey to provide every patient with an exceptional patient experience every time.

      James Goodsett, M.D.
      Dean Internal Medicine Hospitalist
      and Physician Advisor for Care Management – St. Mary’s Department of Patient and Family Services

      Hospital Comparisons Provide Transparency
      Patients at St. Mary’s give high marks to St. Mary’s Hospital for overall quality of care in an annual nationwide survey of patient satisfaction. Conducted by the Centers for Medicare and Medicaid, the Hospital Consumer Assessment of Healthcare Providers and Systems shows St. Mary’s well ahead of the statewide average and even higher when compared to the national average for patients who would recommend the hospital and rate it 9 or 10 on a 10-point scale. In response to the statement “Doctors always communicated,” St. Mary’s physicians tied with the national average of 80% favorable responses but fell two percentage points short of the Wisconsin average. Comparisons among specific hospitals for various elements and types of care may be searched on www.hospitalcompare.hhs.gov. Comparisons of quality and costs are also available at WisconsinHealthReports.org.


      Physician Spotlight: Jonathan Fliegel, MD, FAAP
      Dr. Jonathan Fliegel is a pediatric hospitalist at St. Mary’s, director of Pediatric Hospitalist Medicine at American Family Children's Hospital and an assistant professor in the Department of Pediatrics at the UW School of Medicine and Public Health. Prior to moving to Madison, he worked in Michigan for 14 years, providing health care and education for the community setting, in a hospital and in an outpatient setting. Beyond his resume, he offers a peek at what makes him tick. 

      Special interests: Professionally, my interests include medical education, supporting and teaching skills in Evidence-Based Medicine and developing skills in medical leadership. My personal interests include reading (I particularly like presidential biographies), enjoying good food (my wife and I have many favorite restaurants), watching movies from our DVD collection (mostly 1930s to ‘50s), biking and especially walking. We hope to walk around each of the Madison lakes – Wingra, Monona and Mendota at least once a year. So far, so good!

      Something needing change:
      I truly hope that we all can continue to collaborate and work more in tandem to improve the health care for children in Madison and our surrounding communities.

      Awards and recognitions:
      I have been honored to receive several teaching awards, including the UW Lobeck Pediatric Student Teaching award in 2009.

      Best thing about St. Mary’s:
      The people and the mission. I have already met people at all levels who are dedicated to caring and healing the patients we care for and their families. Since I and my group of hospitalists began providing inpatient coverage in September 2009, we have felt welcomed. I feel blessed to have had superb support from the nursing staff on Pediatrics, including Director Barb Behrend, the intensivists, Jeff Benson and Neil Connor, and administrators John Butler, Joan Beglinger and Frank Byrne.

      Pediatric Rapid Response Implemented
      Nurses in Pediatrics now have a Rapid Response Team available to them by calling 7777. The Pediatrics Rapid Response Team (PRRT) structure is similar to the adult RRT and includes the pediatric intensivist on-call, nursing supervisor, respiratory therapist covering for the adult RRT, the pediatrics charge nurse and the Family Medicine Department resident on-call. The addition of the PRRT is owed to the Pediatric Service Coordinating Council, a collaborative group of nurses, St. Mary’s two intensivists and pediatric hospitalist Dr. Jon Fliegel.

      New Law Puts Heart Back into Volunteering
      By Calvin S. Bruce, MD
      Wildwood Family Clinic

      Despite the promises of meaningful health care reform, it is safe to assume that many in our community will fall between the cracks of our health care non-system. Madison has a wealth of opportunities for physicians to work in volunteer settings to fill the gap (read more). Small commitments of time – 3 hours every month or two – can mean a lot when many of us lend a hand. One concern, however, is the ever-present worry about malpractice. The state legislature recently enacted a “Good Samaritan” law, which should allay physicians' fears about lawsuits in volunteer clinics.

      According to the new statute, a physician working in an approved volunteer clinic is considered to be an agent of the state for liability purposes. Physicians who volunteer for MEDiC, for example, are given a volunteer appointment with the University of Wisconsin-Madison, School of Medicine and Public Health. If suit is brought against a physician in the scope of their work within the MEDiC program, the Department of Health and Human Service would direct the Department of Justice to defend the physician, regardless of the physician’s own malpractice coverage. As an agent of the state, the physician’s liability would have the same restrictions as any other state-employed physician.

      With this new law in place, physicians can focus on providing quality health care to those less fortunate but who are usually incredibly grateful for the services provided. Following are some organizations worthy of your time:

      The Benevolent Specialists Project was started by retired Dean physicians but is now staffed by many specialists from throughout the area—some retired, some still in active practice. These physicians donate their time and expertise to see patients with problems requiring specialty care on referral from other physicians. They have lab and X-ray capabilities and can often make arrangements for patients to get more involved care on a reduced or free basis. 608-827-2308

      MEDiC was originally started 20 years ago by UW medical students. Staffed by students with volunteer physician preceptors, six clinics serve a variety of populations: homeless mothers and children, homeless men, women in transition back to society after incarceration, legal and illegal immigrants whose employers offer no insurance, the chronically mentally ill. MEDiC receives lab and X-ray support from St. Mary’s Hospital and has recently been approved as an official program of the UW School of Medicine and Public Health. In addition to providing "first contact" acute care, there are on-site monthly UW dermatology and physical therapy clinics, and MEDIC can facilitate referrals to BSP, Planned Parenthood and certain primary care and UW specialty clinics as well as other community resources. Working in these settings with idealistic and eager students from many health disciplines is its own reward. 608-265-4972 or MEDiC@med.wisc.edu

      The HEALTH Program (“Helping Educate and Link the Homeless Program”) was started by Dr. Cate Ranheim, a hospitalist at Meriter, who was moved to action by seeing so many patients admitted with serious illnesses that might have been avoided if they had earlier access to medical care and follow-up. Thanks to the generous support of the Meriter Foundation, the HEALTH program has a full-time nurse, a medical director and a budget for medical supplies, laboratory and imaging studies. Volunteers with the HEALTH Program work in a variety of outpatient settings treating the homeless and other vulnerable populations. They provide basic health screening (including blood glucose monitoring) and foot care, arrange primary care and specialty (BSP) follow-up, offer social work services, provide disease/medication education, assist with applications and review/update medication regimens. In a dedicated building called the “Hut” at St. Vincent de Paul, they can provide physical and occupational therapy and cardiac screening. In addition to outpatient work, Dr. Ranheim and her colleagues flag inpatients at Meriter who would qualify for the program at discharge to bridge them to available services as quickly as possible. 608-516-1322 or health@healthprogram.us

      So, any of you out there who have been considering signing up to volunteer, but have been holding back because you weren’t sure where to go or were afraid of malpractice liability, the time is ripe and the opportunities to be of service abound.


      Facilities News: Private Rooms, Edgerton Hospital Affiliation
      Two milestones were reached earlier this spring when double rooms were eliminated, and St. Mary’s affiliated with a fifth hospital in the region.

      Private Rooms: As of this spring, semi-private rooms at St. Mary’s are a thing of the past. The final seven double rooms, located on 3SW and 4SW, have been converted into single rooms. The change is possible, in part, because of the Care Coordination initiative, which has resulted in a decreased length of stay for many patients. The shorter length of stay means that up to 10 fewer beds may be needed on the average day—thus reducing the potential of a bed shortage. The contingency unit on 6 West will be opened as needed. With the elimination of double rooms, all patients are afforded more privacy and a better experience, enhancing our ability to provide exceptional patient care.

      New Affiliate: An expanded affiliation agreement with Edgerton Hospital and Health Services gives SSM Health Care of Wisconsin a 49 percent financial interest in the critical access hospital. This brings to five the number of hospitals now affiliated with St. Mary’s in Madison. The others are Boscobel Area Health Care, Columbus Community Hospital, Stoughton Hospital and Upland Hills Health in Dodgeville. A few days before this new agreement was signed, Edgerton finalized the financing it needed to start construction on a new 18-bed hospital on Hwy. 59 near I-90. Construction is expected to be complete in fall 2011.

      Emergency Care Next Topic in Best Practices Series
      A monthly series sponsored by SSM Health Care’s Quality Resource Center showcases best practices among SSMHC facilities, and the next tele-seminar will be from 12:20 to 1:40 p.m. on Friday, May 28, focusing on “Improving Abdominal CT Turnaround Time for the Emergency Department” and “Medication Reconciliation in the Emergency Department.”

      The CQIplus Steal Shamelessly Speakers Series occurs every fourth Friday of the month via Live Meetings. St. Mary’s presents the series in a dedicated room, which is listed, along with past and future topics, on the St. Mary’s Intranet.

      St. Mary’s Hospital opened the series with “Care Coordination: A Framework for Exceptional Service.” A link to the PowerPoint file for each presentation already given is available online. Other topics included “Improving Care to Severe Sepsis and Septic Shock Patients,” “Reducing Hospital-Acquired Aspiration Pneumonia” and “Improving Insurance Authorization and Pre-Billing Processes.”

      Welcome New Medical Staff Services Coordinator
      Katie Dawiedczyk (pronounced daVEEcheck) has joined the Medical Staff Services department this spring. She previously held Medical Staff Office positions at Edgerton Hospital and Janesville Mercy Hospital. She holds a bachelor’s in business management and a master’s in health care administration. Please stop in and welcome Katie to her new role.


      New Medical Staff
      The SSM of Wisconsin, Inc. Board of Directors, acting on the recommendation of the Medical Executive Committee and Credentials Committee, recommended the appointment of the following physicians between February and April 2010. Click on the links below for more information. 

      Peterson, Andrew R., MD Courtesy Staff Pediatrics/Sports Medicine

      Tong, Harrison H., DO Associate/Active Family Medicine

      Musa, Ndidiamaka, MD Associate/Active Pediatrics

      Shahzad, Mian M., MD Courtesy Staff Ob/Gyn

      Catrine, Kristina E., MD Associate/Active Pediatrics

      Aguilar-Sincaban, Virginia, MD Associate/Active Psychiatry


      Honors and Recognitions
      Congratulations are in order for our colleagues who go above and beyond the duty of their day (or night) jobs. 

      Champion in Women’s Health: The Wisconsin Women’s Health Foundation recognized Susan Davidson as a 2010 Champion in Women’s Health in the general health category. As St. Mary’s director of perinatology and a physician for Dean Clinic, she has dedicated her career to improving the health of area women and their newborns. She founded the Perinatal Clinic at St. Mary’s Hospital 17 years ago because she recognized that the hospital’s Birth Center program was incomplete without expanded services for women with at-risk pregnancies. Recently, she has taken an active role in the Robert Wood Johnson Health and Scholar Project studying how to expand improved birth outcomes for African-American women in Dane County to other areas. She is also helping to plan a comprehensive center for women and children, providing coordinated and holistic health care for women and children throughout their lifespan.
      Statewide Leadership Role: Alan Schwartzstein became president-elect of the Wisconsin Academy of Family Physicians in February. In 2011, he will serve as president for a year, followed by a year’s service as chair of the WAFP Board of Directors.


      United Way Service Award: Cal Bruce (Family Medicine) received a Distinguished Service Award from the United Way of Dane County for his work with MEDiC clinics. He was nominated by the medical students involved in the program.

      Guardian Angels: Four physicians were recognized in the first quarter of 2010 by grateful patients and families for providing exceptional care. Administered by St. Mary’s Foundation, the Guardian Angel program recently added the following physicians to their list of St. Mary’s Guardian Angels:

      Roberta Kurtz (Cardiology)

      Lori Wendricks House (Obstetrics/Gynecology)

      Santiago Hernandez (Hospitalist)

      John Wilson (Pulmonology)

      Dean Health Plan ranks highest in member satisfaction among health plans in Minnesota and Wisconsin, according to the J.D. Power and Associates 2010 U.S. Member Health Insurance Plan Study. This is the second year in a row DHP achieved the top ranking, scoring favorably in coverage and benefits, information and communication, claims processing, and statements.

      Honoring Our Medical Staff:
      Snapshots from the annual dinner

      Photo 1

      Photo 2

      Photo 3

      Photo 4

      Photo 5

      1. Paul Schmidt, Jane Schmidt, Barbara Justl, Robert Justl, Bob McDonald, Gabriela Olson, Pam McDonald, Reid Olson
      2. Jeff Stitgen, Jeff and Nora Welch, Mary Starmann-Harrison and Greg Harrison
      3. Family Medicine Residents: At table, from left: Andy Zoldak, Samantha Sharp, Micah Puyear, Kristen Prewitt. Back three: Jo Nord, Kim Arndt and Brian Arndt (Family Medicine faculty)
      4. Madison Emergency Physicians: Siddhi Doshi (wife of Dr. Aaron Ray), Dr. Aaron Ray, Dr. Quinn Holzheimer, Sheila Halberg (wife of Dr. Michael Halberg), Dr. Michael Halberg, Beverly Martin (wife of Dr. Kyle Martin)
      5. Frank Byrne, Jon Temte and Al Schwartzstein

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