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Physician Focus Spring 2011 

In This Issue

Advancements Will Improve Your Jobs and Ability to Care for Patients
Continuing Strides in Electronic Health Record
Improving Outcomes Through Care Pathways
Ethics Consultations Open to All
Take Note of Shift in Oral and IV Administration
Medical Resources Available by Smart Phone
St. Mary’s Plans Ronald McDonald Family Room
Physician Spotlight: Ammar Nasrallah
Welcome, New Medical Staff Services Coordinator
Save the Date: 2011 SSM Physician Leadership Conference
Honors and Recognitions

May 19, June 16, July 28 - Physician Breakfasts
(dates subject to change)

May 21 - Pediatric Obesity Symposium,
8:30 a.m. - 3:30 p.m.
HSLC 1345 UW Campus

CME Calendar

June 2 -
New Anticoagulant Therapies, 7 - 8 a.m., Bay 1

View April 7, 2011 “Advances in the Management of Severe Sepsis”

Interested in viewing previous Grand Rounds? “On Demand” tapes and/or materials are available through Gale Garvey, CME program gale_garvey@ssmhc.com

News From...
2010 Progress Report
UW Family Medicine


Advancements Will Improve Your Jobs and Ability to Care for Patients 

Great news abounds for physicians and patients alike. We have a new Physician Resource Center about to open, and we’ll be launching a palliative care consult service and an SBAR communication process. This month also takes engagement of our medical staff to new heights through restructured governance.

Our new Physician Resource Center will open soon, thanks to a generous donation from St. Mary's Foundation. Plan on joining us for a reception in this beautiful new space on A South. It will be a debut for Chef Rachel Labeots, who joins St. Mary’s as a culinary specialist dedicated to serving physicians in the center. She grew up in Baraboo, graduated from the Culinary Institute of America in New York, worked in several regions of the country (most recently at Otto’s in Madison), and brings expertise in local organic foods.

The Physician Resource Center will provide a space for physicians to congregate, relax, grab a snack, speak with the coordinators in the Medical Staff Office and visit our CME office. Our library professionals will be available in a library annex in this area to answer questions, help with reference materials and perform focused literature searches. Two conference rooms are included for medical staff meetings and will be able to accommodate some additional meeting needs coordinated through the Medical Staff Office. Because of your input at meetings, in casual hallway conversations and on the physician satisfaction survey, this project became a priority for St. Mary's Hospital.

St. Mary's Hospital Palliative Care Consult Service is just a few months away. A Palliative Care Service design team has been formed and is working diligently to implement the service by July 1. We have welcomed Dr. Lu Marchand, a board-certified palliative care physician and faculty member of the UW Family Medicine Department, as the medical director of this program. We are now recruiting for a full-time palliative care nurse practitioner. Additionally, the team will incorporate social services, pharmacy and pastoral care. The Palliative Care Service has articulated a vision of improving the quality of life for patients with advanced chronic illness. Through an interdisciplinary team approach, this service will bring evidence-based treatment and clinical expertise to the management of difficult symptoms and collaborate with patients, families, physicians and the entire care team to help develop a plan of care that is fully informed by our patients’ wishes. This personalized plan of care will encompass the physical, spiritual and emotional needs of patients and their families. Our steering team has had broad input and is very passionate about bringing this program to our patients and our care teams. Dr. Kris Catrine (Pediatrics), Dr. Todd Eckelberg (Hospitalist) and Dr. Peter Beatty (Oncology) have represented the Medical Staff on the steering team.

An SBAR will be opening soon in your neighborhood! In response to your feedback and the input that you provided in the physician satisfaction survey, the nursing staff will be implementing a more efficient, standardized process of communication with physicians. After a review of best practices and a concerted, collaborative effort, our nursing staff leadership has endorsed the Situation-Background-Assessment-Recommendation communication format. This format will result in the calls to you being more consistent, better organized and accompanied by an assessment and a requested intervention from the nurses’ perspective. This should provide you with more complete, precise information and clarity about the nurses’ concerns. While there may be a few glitches in the early phases, this process should greatly streamline and improve the accuracy of communication and hence facilitate patient safety. Your feed back will be critical to the success of this endeavor; you will be hearing more in the next month or two.

On May 1, our new Medical Staff Directors officially assumed their roles. (See Honors and Recognitions section below.) This leadership team is committed to enhancing communication with the medical staff, significantly improving physician engagement and voice in the clinical operations of St. Mary's, and helping to lead our journey to become one of the nation’s leaders in delivering exceptional patient care. These medical staff leadership positions replace our previous department chair structure so that each physician on the medical staff is aligned with one of these medical staff directors. The Medical Staff Office will be sending you a communication about this change within the next few weeks. These Medical Staff Directors will be reaching out to all of you, either individually or through your department. This team of medical staff leaders will provide an effective vehicle for your voice to be heard and for your input to inform decision making at St. Mary’s.

Check out the latest hand hygiene data. Click the thumbnail below to enlarge.

John Butler, MD
VP/Medical Affairs 

Continuing Strides in Electronic Health Record
Quality improvements have been and are being made in discharge medication lists and hospital problem lists.

Erroneous discharge medication lists continue to be a potentially serious quality-of-care issue. Errors occur when medication changes are made late in a hospital stay after the discharge summary has been completed. The late changes are then not incorporated into the discharge summary medication list. This can lead to a patient making a medication change after discharge that was not intended. Discharge summaries either dictated or directly entered into Epic will soon include a disclaimer warning of the potential inaccuracy of the medication list. Links will be available that will display within the EHR the final medication list that the patient was given and instructed to follow upon discharge.

The hospital problem list is the basis for much of the clinical decision support and reporting capability of the EHR. Unfortunately, when it is incomplete or inaccurate, the quality of decision support and reporting is greatly diminished. Two projects are under way to improve the usefulness of the problem list.

Improved reporting that affects core measures (heart failure, pneumonia, acute myocardial infarction). St. Mary's will soon begin using trained nurse case managers, clinical nurse specialists and quality department nurses to add the above problems to the hospital problem list. This will allow the EHR to present the specific orders to physicians that must be addressed to meet reporting criteria.

Addition of outpatient problems and clinical history. A modification to all inpatient problem lists now allows outpatient problems to be added to the hospital problem list with a single click, and clinical history can be added to the problem by opening the overview section with a single click. The hospital problem list, if updated and elaborated on, could become a very efficient tool to focus attention on the patient's issues that are being addressed during the hospital stay. This will help avoid mistakes that occur when different members of the care team are unaware of other important diagnoses and also support appropriate coding based on the complexity of care. Please make it a habit to review the hospital problem list before reviewing the medical record. When you visit with patients, update it as part of your daily progress note. A number of Epic SmartPhrases like .H Prob List or .H Prob Com allow what is in the hospital problem list to be brought into your progress note to make charting more efficient. Give them a try.

Jim Porter, MD
Medical Informatics Director


Improving Outcomes Through Care Pathways
External pressures continue to grow on health care systems to provide greater health care value by controlling costs and improving quality. There is a continually increasing need to demonstrate measurable improvement in metrics, such as length of stay and readmission rate, while also improving patient satisfaction. Development of care pathways represents a promising way to support team-oriented ways of caring for patients that incorporates evidence and standardization to improve outcomes.
Read more.


    Ethics Consultations Open to All
    St. Mary’s Ethics Committee provides guidance on ethical issues at the request of any staff member for a patient or ethical matter within our hospital.

    Our Ethics Committee is advisory and is available to provide guidance on ethical issues. The committee is utilized by our staff to help guide patients and families in difficult health care decisions. Moral distress is quickly identified by staff as a symptom of need for an ethical discussion. Any staff member at St. Mary’s may request an Ethics Consult for a patient or ethical matter within our hospital. Last year many consults occurred, eight of which were taken before our Ethics Task Force Committee. Involved nursing staff are invited to attend and participate in the discussion. Our evaluations show a very positive response to those who have used our committee as a resource.

    On June 1 our Ethics Committee will be rolling out our Ethics Committee communications flow process. In keeping with our Corporate Ethics quality improvement guidelines, we will use our hospital switchboard operators as the primary means through which employees, physicians and others can initiate an ethics consultation. We want a reliable and consistent process for all and feel this will improve our process for obtaining Ethics Consults.

    Please take the time to review our communication flow chart.
    Any questions, call Ethics Committee member Peg Weber, RN MSN, at x5038.

    Take Note of Shift in Oral and IV Administration
    Pantoprazole (Protonix) is now the Proton Pump Inhibitor of choice for oral and IV administration. Read about the rest of the changes in this Therapeutic Interchange Policy inside. Click here.

    Medical Resources Available by Smart Phone
    PubMed Mobile (http://www.ncbi.nlm.nih.gov/m/pubmed/) is a new offering from the National Library of Medicine designed specifically for your smart phone. You can reach the same content as the standard web-based PubMed but with a simplified search box. Read more.


    St. Mary’s Plans Ronald McDonald Family Room
    Madison’s very first hospital-based “home away from home” for families with sick children is being planned for St. Mary’s Hospital, and Dean orthopedic physician David Wolff is among the supporters.

    St. Mary’s Ronald McDonald Family Room, among the largest in the nation, will have four bedrooms as well as shared spaces such as a kitchen, dining area, living room and laundry. It will serve families who have critically ill children in St. Mary’s pediatrics unit or NICU. The 3,500-square-foot facility will be built on the hospital’s third floor as soon as $1 million is raised through St. Mary’s Foundation and Ronald McDonald House Charities of Madison. Click the image on the right to view a larger image.

    Dr. David Wolff and his wife, Sally, have signed on as ambassadors for the campaign because of their own experience. Their young son, Alex, had been on life support and the couple had nowhere to go when doctors asked them to leave during critical procedures. They didn’t dare go far. Thankfully, Alex recovered. Today, the Wolffs are supporting the facility by contributing funds for a sleeping room.

    For more information about making a gift, contact St. Mary’s Foundation: 608-258-5600 or stmarysfoundation.org.


    Physician Spotlight: Ammar Nasrallah
    Dr. Ammar Nasrallah (infectious disease) began a new life in Wisconsin one year ago.

    My education: I graduated from medical school in 1999 at the University of Jordan. I came to the USA in 2001 and did an internal medicine residency and infectious disease fellowship at the University of Missouri-Kansas City. I am board certified in internal medicine and infectious diseases.

    My professional route: In 2006, I practiced within a multispecialty group in San Antonio, Texas, until I joined Dean Clinic’s infectious disease team in May 2010. I chose to be an infectious disease specialist because it is an intellectual and highly challenging specialty. It has a rewarding outcome when it comes to a patient's care. Being a good internist is the key to being a good infectious disease specialist.

    Favorite pastimes: On the Dean website I list reading, walking, traveling and spending time with family. But, to be honest, everything my wife and I do is mainly for our daughters, ages 5 years, 2.5 years and 5 months old. We are blessed to have them, and they are our world.

    Special thanks go to my colleagues, Dr. James Levin and Dr. Garry Jean-Louis, who helped me a lot during my adjustment to my new life and career at Dean and St. Mary's. I feel proud to be part of their team. I am proud of my association with St Mary's. It is a very well built and organized facility. All of its staff work together to provide patients with the best care and outcome.


    Welcome, New Medical Staff Services Coordinator
    Tami Reeson joined the Medical Staff Services department early this year as a coordinator. An employee of St. Mary’s for 10 years, Tami has experience in ER admissions, respiratory therapy and St. Mary’s Sleep Center. She graduated from St. Mary’s School at Work program and is now pursing credentials as a medical administrative assistant through Globe University. Please stop in and welcome Tami to her new role.

    New Faces on the Medical Staff – Click here


    Save the Date: 2011 SSM Physician Leadership Conference
    Mark your calendar for Friday and Saturday, Sept. 9 and 10 in St. Louis, where the 2011 SSM Physician Leadership Conference will offer development and networking opportunities tailored to current and future medical staff leaders, physicians, peer review members and administrative council members. For more information, contact Holly Pyatt, SSM University, at holly_pyatt@ssmhc.com or call 314-523-8784.

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

    Guardian Angels: Four physicians were among those honored as Guardian Angels between January and March 2011. The program, sponsored by St. Mary’s Foundation, invites patients and families to make a gift in honor of someone who provided them with exceptional care.

    John Phelan, MD 

    Alan Singer, MD
    John Snider, MD (cardiovascular surgery)

    Elizabeth Trinity, MD (hospitalist)



    Medical Staff Directors: Seven physician leaders have assumed their new roles as part of a redesigned medical staff structure that replaces the previous department chair structure. Devoting 25 percent of their time to the new roles, the directors are listed below along with their areas of responsibility:

    Kay Barrett, MD (Dean Cardiology) – Cardiology, Cardiovascular Surgery, Gastroenterology, Nephrology, Infectious Diseases, Oncology, Endocrinology

    Lee Carter, MD (Dean Neurosurgery) – Neurosurgery, Neurology, Anesthesia, Rehabilitative Medicine

    Tim Crummy, MD (Madison Radiology) - Radiology, Pathology, Neonatology, Psychiatry

    Jim Goodsett, MD (Dean & St. Mary’s Hospitalist) - Hospitalists, Pediatrics, Critical Care

    Anne-Marie Lozeau, MD (UW Family Medicine) - Family Medicine, General Internal Medicine, Dermatology, Allergy, Rheumatology

    Kyle Martin, MD (Madison Emergency Physicians) - Emergency Medicine, Obstetrics

    Jeff Welch, MD (Dean Orthopedic Surgery) - General Surgery, Orthopedics, Urology, Plastic Surgery, ENT, Oral Surgery



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