June/July/August 2010 - Holy Name Medical Center
Transcription
June/July/August 2010 - Holy Name Medical Center
News from and for Holy Name Medical Center’s Medical Staff Also available online at: www.holyname.org/md360 June/July/August 2010 Medical Staff Officers President: Patricia Burke, M.D. Vice President: Thomas Birch, M.D. Secretary: Mihran Seferian, M.D. Treasurer: Ronald White, M.D. Members-At-Large: Medical Chiefs Representative: Joel Goldfarb, M.D. Surgical Chiefs Representative: Harris Sterman, M.D. Member At Large: Giuseppe Condemi, M.D. Member At Large: Rosanna Modesto, M.D. Medical Staff Department Directors and Division Chiefs Dept. of Anesthesiology: Alan Gwertzman, M.D. Dept. of Emergency Medicine: Richard Schwab, M.D. Dept. of Family Practice: Joseph Cassotta, M.D. Dept. of Interventional Radiology: John Rundback, M.D. Dept. of Medicine: Joseph Schuster, M.D. Allergy: Patrick Perin, M.D. Cardiology: Stephen Angeli, M.D. Dermatology: Jeffrey Rapaport, M.D. Endocrinology: Mark Wiesen, M.D. Gastroenterology: Joel Goldfarb, M.D. Infectious Disease: Thomas Birch, M.D. Internal Medicine: Lewis Attas, M.D. Nephrology: David Levin, M.D. Neurology: David VanSlooten, M.D. Oncology: Beata Pieczara, M.D. Psychiatry: Sharad Wagle, M.D. Pulmonary Medicine: Stuart Silberstein, M.D. Radiation Oncology: Charles Vialotti, M.D. Rehabilitative Medicine: George Gombas, M.D. Rheumatology: Ralph Marcus, M.D. Dept. of Obstetrics & Gynecology: Christopher Englert, M.D. Dept. of Pathology: Drew Olsen, M.D. Dept. of Pediatrics: Harry Banschick, M.D. Dept. of Radiology: Jacqueline Brunetti, M.D. Dept. of Surgery: John Poole, M.D. Dentistry: Steven Haber, D.D.S. General Surgery: Joseph Manno, M.D. Neurosurgery: Patrick Roth, M.D. Ophthalmology: Christopher Brown, M.D. Orthopedics: Jeffrey Steuer, M.D. Otolaryngology: John Poole, M.D. Podiatry: Ritchard Rosen, D.P.M. Plastic Surgery: Harris Sterman, M.D. Thoracic Surgery: Ignatios Zairis, M.D. Urology: George Klafter, M.D. Vascular Surgery: Kenneth Fried, M.D. MD360º from the president/CEO Welcome New Chief Medical Officer Please join me in welcoming Adam D. Jarrett, MD to Holy Name Medical Center as our new Executive Vice President and Chief Medical Officer. Dr. Jarrett brings a distinguished background as both clinician and administrator, having practiced internal medicine in Bergen County for 13 years before pursuing hospital leadership opportunities in upstate New York. We’re pleased that he has returned to this area and joined our Medical Center. As CMO, Dr. Jarrett will be an essential member of our team, a physician/adminis- trator whose experience will help us address the challenges we face in today’s dynamic healthcare environment, while acting as a liaison between the medical staff and administration. His role entails formulating policies, procedures and practices that are aligned with our organization’s long-range planning and development, as well as with newly emerging national healthcare initiatives. He will oversee medical staff services to ensure delivery of the highest standard of patient care, with a focus on clinical effectiveness, patient safety and quality. 718 Teaneck Road • Teaneck, NJ 07666 Michael Maron is President/CEO of Holy Name Medical Center. Adam D. Jarrett, MD, MS, FACHE Adam D. Jarrett, MD, MS, FACHE has been named Executive Vice President and Chief Medical Officer of Holy Name Medical Center. Dr. Jarrett, an internal medicine physician, possesses a broad and valuable skill set that encompasses hospital leadership experience, clinical expertise, practice management experience and formal management education. He has demonstrated proficiency in performance and quality improvement, medical education, conflict management and negotiation, managed care contracting and corporate compliance. He comes to HNMC from ClaxtonHepburn Medical Center in Ogdensburg, NY, where he has been Chief Medical Officer since 2005. Dr. Jarrett is also President of Claxton Medical P.C., and Medical Director of Cardiopulmonary Rehabilitation at Claxton-Hepburn Medical Center. He is a peer reviewer for the New York State Department of Health Office of Professional Medical Conduct and, until recently, also served as the Medical Director of United Helpers Nursing Home for United Helpers in Ogdensburg. Storms-a-Comin’ As I sit basking in the early morning warmth of the sun on this Labor Day weekend, my dog sits companionably by my side. Despite all predictions to the contrary, “Earl” has not harmed us, except for our peace of mind and our finances. Pool parties, barbeques and vacations were summarily cancelled with the announcement of the potential force of hurricane “Earl.” Along the Eastern Seaboard, propane tanks and grills were battened down, patio furniture stacked or moved to shelter, and large glass doors and window panes protected. Jones Beach officials, anticipating the worst, closed the beaches, toppled lifeguard stands and dragged them to high ground fearing their loss, awash at sea. Even the Outer Banks vacationers and residents alike were evacuated. Fortunately, and unfortunately, all these preparations and evacuations came to naught. The unfortunate “naught” was, of course, the vacation industry. Up and down the East Coast, in an economy thin Prior to his work with Claxton-Hepburn, Dr. Jarrett was Managing Physician of Prospect Medical Offices in Midland Park, NJ and a Collaborating Physician for Valley Community Care in Hawthorne, NJ. During that period, Dr. Jarrett was affiliated with The Valley Hospital in Ridgewood, where he was a member of the Department of Medicine. Prior to that, he was a member of the voluntary teaching staff of New York Hospital-Cornell Medical College, where he had completed his residency in internal medicine/primary care and won the award for top primary care physician. Dr. Jarrett earned his medical degree from George Washington University School of Medicine and his master’s of science in health care management from New York University’s Robert F. Wagner School of Public Service. Save These Dates from the president of the medical staff Indicia or Postage Here US Postage PAID Over the next several months, Dr. Jarrett will be getting to know Holy Name better. It would be helpful for him to meet as many of our physicians as possible, so I encourage you to stop by his office and introduce yourself. with discretionary spending monies, the owners of hotels, motels (oh, that great portmanteau word), restaurants and boardwalk auctioneers, were looking forward to this last hurrah of summer. Having this last wave of vacationers, who scrimped and planned for this final summer weekend, could have buoyed their final balance sheets. And so another opportunity for a small, but important part of our economic recovery has not come to fruition. The fall season abounds with hurricanes—Earl and fabled Fiona have wrought no havoc. But remember, and with any luck, storms-acomin’, perhaps in early November! Annual Physicians’ Cocktail Party Honoring Physician Leadership Saturday, October 2, 7-10 p.m. Marian Hall Conference Center Cocktails, hors d’oeuvres and music RSVP by Sept. 28 to 201-833-7220 Founders Ball Honoring David Butler, MD, Timothy Finley, DO, & Alan Gwertzman, MD for their relief efforts in Haiti Patricia A. Burke, M.D., Ph.D., is President of the Medical Staff and an ophthalmologist on staff at Holy Name Medical Center. Saturday, November 13 Cocktails at 6:30; dinner & dancing to follow Cipriani Wall Street, NY, NY RSVP by Nov. 8 to 201-833-7143 New Medical Student Program Trains Tomorrow’s Doctors at HNMC Physician/Teacher Benefits • D.O. faculty are afforded Category 1 credits for teaching the students • M.D. faculty are given Category 2 credits. • All teaching faculty are given an academic title through the medical school. Medical students from the Touro College of Osteopathic Medicine (TouroCOM) began rotations at Holy Name Medical Center on July 1. Located in Harlem, New York, this brand-new medical school admitted its first class of students in September 2007. TouroCOM is the nation’s 24th college of osteopathic medicine and Touro’s third. With over 400 students currently enrolled at Touro, the school has set a goal of training primary care physicians to fill the nationwide shortage. Holy Name will train approximately 20 to 30 medical students a month. “To partner with Holy Name Medical Center provides an exceptional opportunity for our medical students,” says Robert B. Goldberg, DO, Dean, Touro College of Osteopathic Medicine. “Holy Name’s commitment to medical excellence, patient safety, and quality care sets it apart from its peers. We are thrilled to offer Holy Name as an affiliate training site for the students at the Touro College of Osteopathic Medicine.” A Well-Rounded Education Third- and fourth-year medical students rotate through all the medical and surgical subspecialty areas at Holy Name for one or two months, depending upon the rotation. Some of the students will spend their entire year here, while others will undertake only specific rotations. The students are assigned to attendings or other department staff, and spend time both in the Medical Center and in outpatient offices. I meet weekly with all the students for an academic conference, in which we review any issues with the rotations and the students learn how to present. Several Holy Name staff members have volunteered to lecture to the medical students on their areas of expertise. At the completion of each rotation, students take a standardized exam and undergo an exit interview. Over 50 Holy Name medical staff members are involved in the Touro Program and mentor the medical students. Attendings find that teaching medical students “keeps them fresh” and up-to-date on medical topics and is a way to give back to the next generation of physicians. D.O. faculty are afforded Category 1 credits for teaching the students and M.D. faculty are given Category 2 credits. All teaching faculty are given an academic title through the medical school. Positive Feedback The initial feedback from students and supervising medical staff has been excellent. Students find Holy Name to be a wonderful learning environment and, to my delight, the medical and nursing staffs have welcomed the students with open arms. The program has been received positively by patients, as well, as they often find that medical students are able to spend quality time with them, as well as their families, when busy attendings are sometimes not able to do so. “We are delighted and thrilled to have the medical students from Touro at Holy Name Medical Center,” says Craig Hersh, MD, Assistant Vice President of Medical Affairs. “Thus far, it has been a rewarding experience for our doctors and nurses, and has only served to improve the overall patient experience. An environment of continuous learning is a benefit to all.” My hope is to eventually develop residency training programs at Holy Name Medical Center as a natural progression in medical education. The expectation is not only to train excellent future physicians, but to ensure the next generation of Holy Name physicians. We have found that a significant number of medical students and residents will practice in the area where they train. It’s A Different World Medical education is in a constant state of evolution. The traditional approach of teaching at large academic institutions with multiple residency programs and specialty fellowships is, in some cases, being replaced by smaller community-based programs, which are more akin to the environment in which most graduating students will practice. This new model will, hopefully, produce primary care physicians, rather than the “super-specialists” who may not satisfy the needs of future generations. Our students will use their electives to gain exposure to these larger clinical settings but, based on overall experience and objective markers such as board scores, the different approaches appear to deliver an equivalent experience overall. While prior generations of physicians trained with large textbooks and spent hours reading in the library, this new generation of medical students utilizes their cell phones, laptops and PDAs to review anatomy, look up medication dosages, investigate topics, and formulate differential diagnoses. The students don’t carry beepers; they simply text their attendings and fellow students. Lectures and notes are streamed to their computers. It’s quite a different world. I would like to thank Dr. Craig Hersh for helping me develop the program and Dr. Judith Kutzleb for her invaluable, ongoing assistance. If any medical staff member is interested in precepting the medical students or giving lectures, please email me at maurizio. [email protected]. Maurizio Miglietta, DO, is Director of Medical Education for the TouroCOM Program and a general surgeon on staff at Holy Name Medical Center. Broken System More than 25 years ago, I walked through the doors of Holy Name Hospital (now renamed Holy Name Medical Center). I was immediately amazed by the warmth, professionalism and compassion of the entire staff of this hospital. I continue to be amazed. It is a special place founded 85 years ago by the Sisters of St. Joseph of Peace to provide a level of care to the sick which placed the patient first and foremost, the type of care surprisingly lacking in many medical facilities even today. I know that many of the physicians who come to Holy Name feel this way. This year, I joined the Founders Circle to give something back to the hospital that helped me to be a better physician. I believe in the mission of our founding sponsors and am committed to ensuring that their vision stays the course for another 85 years. The Founders Circle supports Holy Name Medical Center’s pursuit of excellence and helps to ensure that programs and services continue to meet the diverse needs of our community. We as physicians are often not acknowledged by the media or the public, for the charity we provide in the form of free services. Many of us think that this is giving enough. However, I would encourage all members of the medical staff to donate to the Holy Name Health Care Foundation. Please put them on your charity list, maybe at the top of the list. Please join me in the Founders Circle. For more information about the Founders Circle and its member benefits, visit www. holyname.org/founderscircle or contact Kathy Minarik at 201-833-3014 or email: minarik@ holyname.org. 2 Joel Goldfarb, MD, is a gastroenterologist on staff at Holy Name Medical Center and a member of the Holy Name Health Care Foundation’s Founders Circle. I had heard before the sentiment of a heart falling into a stomach, of the giving way of what held them apart, distinct from, each other. I had heard of this before. But I wondered when it happened to me why no one had elaborated on the phenomenon. Why no one ever mentioned that it wasn’t a sinking feeling, akin to losing your stomach on a roller coaster, but that it was a hot iron mallet pounding your heart, decimating it until it melted into the lower recesses of your abdomen. And just like on the roller coaster, when you start to head back upward on the track and find your stomach suddenly in your throat—it wasn’t like that either. My heart stayed on the floor. My first year of medical school was the hardest year of my life for more reasons than simply that it was my first year of medical school. A good portion of my pain during that year came from watching my very best friend in the world, Amy, become more and more ill. Worse, I watched her become less and less her. We were nine when she was diagnosed with Type I diabetes mellitus, and after the ravaging effects took over her body, the sickness began to creep into her soul. Her kidneys were the first to begin to fail, but more organs began throwing in the white towel as her body and spirit became exhausted. I remember the last meal I had when the world was still normal and not broken. After finishing our last final on the last day of our first year, my friends and I went to eat cheese and drink wine to celebrate. We left there full of the richness of the meal and of the communion with friends who had survived so much together. As I walked down the street, I listened to the voice mails that had accumulated during the meal. My best friend had gone to the hospital again. Nothing new; she was probably vomiting again, and only the hospital had drugs strong enough to calm her stomach and soothe the pain. She had to be resuscitated. This was different. But, I had sat beside her during dialysis a few times and watched her erratic blood pressure and respiratory rate. Once, as the number continued to fall as I stared at it, I looked at her alarmingly and called out, “Amy! Are you breathing?” She suddenly sat up and said she was trying. She was in a coma. And everything stood still. It was as if the wind quit ripping around the buildings of Manhattan. My friend’s voices became blurry murmuring in the background. And my heart fell into my stomach. I boarded a plane. I laid my head in my own lap during the long flight home and seeped soft and continual tears into my pillow. I knew I was going home to say goodbye, and it wasn’t the way it was supposed to be. I needed answers to what had suddenly happened to my friend, why she had lost this fight, why no one seemed to have been able to help her win this battle. The truth rolled out, just as the CT scan print-out did so I could read the words that said my friend might be lying in that bed and her heart might be beating and her lungs might be expanding, but she wasn’t really there anymore. Amy was alone at the emergency room, and although she was a “repeat offender,” and her ejection fraction was recently as low as 6%, she was not hooked up to any kind monitoring system. They couldn’t say why her heart had failed, or how long it had been since it had done so by the time they looked in and noticed she was unresponsive. They just knew that she had not taken a breath on her own since, and this was over. My heart still pummeled, numbness gave way to a staggering rage, coming all the way up from my toes and threatening to explode out my ears. My questions went unanswered, partly because there was no record of the actual event that ended her consciousness and partly because only a devoted nurse was there to offer support. I never saw a doctor, either while Amy was on life-support nor after her heart slowly stopped beating again and she slipped away. I don’t know if her blood sugar was checked initially; I don’t know her potassium level; I don’t know if she was scared, if she sat up suddenly, trying to catch her breath or if she simply nodded off to sleep on the pain medicine. And sadly, no one else does either. My friend died alone. No one was sitting beside her in the emergency room watching her numbers because no numbers were being monitored. Amy’s heart was only this sick because when she told her family doctor that she was having problems breathing when supine, her doctor told her it was just panic attacks, ignoring the obvious sign of congestive heart failure. This proceeded for months before a routine heart test for being on the kidney transplant list found the severely depressed heart function. Although she had more doctors than most people have keys on a keychain, there was no cohesiveness to her care, and her health suffered. Just as she slipped away with the ED unaware, Amy slipped through the cracks of medical care in the grander scheme. My broken friend was treated by a broken system and failure transpired. A heart stopped, and hearts broke. And it’s time for the breakage to stop. The holes must be tended and the cracks mended. We must repair this system and find a way to grasp tighter to our patients and hang on for dear life. Holly Foote is a third-year medical student at TouroCOM-NY, with a pediatric rotation at Holy Name Medical Center. report from the Chief nursing officer Effective Case Management for Better Outcomes How do we help our patients navigate an increasingly complicated continuum of care? How can we change our processes to accommodate physicians’ needs for communication with various members of the case management team? How do we all ensure that patient interventions are timely and appropriate? How do we make best use of our resources and, at the same time, maintain a high level of satisfaction among patients, families and healthcare professionals alike? While there are many paths we might take to answer these questions, effective case management might be the single most important avenue to success. A Patient Advocacy Model for Outcomes Management To address our institutional and patient care priorities, Holy Name Medical Center has redesigned our case management program using the “patient advocacy model.” This model emphasizes the coordination of services on the continuum of care from the patient’s perspective by focusing on quality and increased satisfaction. We’ve renamed the Medical Management Department—it is now known as the Outcomes Management Department, which better reflects our goals. Maritza Gonzalez, RN, MA, who has been Quality Manager and Utilization Review Specialist at Holy Name for the last five years, is the department’s new Administrative Director. Outcomes Management will address all aspects of the patient care continuum by combining quality, utilization and discharge planning tasks. Rather than unit-based, the new expanded program is team-based and hospital-wide, tapping the broad skill sets of social workers, discharge planners, and nurse clinical coordinators to individualize care according to each patient’s condition, rather than having a single staff member attempt to address all the patient’s case management needs. Look forward to extended coverage by the clinical care coordinator/social worker team, including more evening hours and weekends, in an effort to enhance communication between our staff and the physicians, and between the staff and patients/families. We’re also conducting daily discharge planning rounds by case managers, along with the unit director and clinical coordinator, to ensure that all the needs of all the patients are addressed in a timely, quality-driven, cost-efficient manner. Benefits All Around Better role definition and extended coverage will allow all tasks along the continuum of care to be performed more thoughtfully and thoroughly. Team members will ask, What do we really need to do to help this patient? They will consider the need for psychosocial intervention, whether tests necessitate an overnight stay or can be performed on an outpatient basis, how we can keep this health event from recurring in this patient, and what information the family needs to help smooth the transition to home or another level of care. They will continue to work with insurance companies, coordinate necessary tests and procedures, review complete chart documentation, which will maximize reimbursement and the patient’s understanding of the discharge instructions, and address any number of issues to produce the best outcome possible. That’s going to elevate quality, and from there, flows everything else—patient satisfaction, sound financial performance, and so forth. What can we expect from this fresh perspective on Outcomes Management? Decreased payer denial rates, shorter Medicare length-of-stay, a reduction in 30-day readmission rates, maximum reimbursement, a decrease in avoidable delays and wait times when transitioning between facilities or to home, and increased patient and staff satisfaction. The staff of our Outcomes Management Department looks forward to working with you and your patients toward our mutual goals of quality and satisfaction. Please don’t hesitate to contact me or Maritza Gonzalez at ext. 6053 with your questions and feedback. Sheryl Slonim, DNP, RN-BC, NEA-BC is Executive Vice President for Patient Care Services and Chief Nursing Officer at Holy Name Medical Center. The Doctors’ Dilemma (One of Them, Anyway) The medical profession was toppled from its pedestal when healthcare reformers succeeded in entrenching the concepts of “healthcare provider,” healthcare industry,” and “medical-industrial complex” into our cultural vocabulary. This newspeak effectively cast medical practice into the realm of big business, on a par with ExxonMobil, BOA and Enron. The “industry’s” will and intent was no longer to heal patients, but to make money at their expense, driven by the profit motive. Perceived as such, it has become a system subject to ever-increasing oversight and regulation. We in the profession can only arch our backs and hiss at this cultural sea change. Alas, our collective teeth and claws, the AMA, opts to follow the political piper. But enmeshed within this odious cultural fabric runs a thread of truth we cannot avoid. The elitist reformers were motivated by a major factor—escalating cost. Cost containment has traditionally not been a factor in the healing arts equation. It is not taught in medical school. After all, money is no object when someone’s health is at stake. Not long ago, cost control was not a consideration for practicing doctors or hospitals. Third party carriers simply paid, and ratcheted up their rates. This scenario is obviously no longer sustainable. Hospital administration now works diligently at cost containment. It operates under a prospective payment system in which prolonged hospital stays and expensive inpatient testing and procedures are financially damaging. Your administration strives constantly to provide maximum patient satisfaction and to expedite and simplify your hospital activities in a congenial and efficient work environment. You can help it meet these goals and enhance its financial position without sacrificing your own financial objectives. Try to optimize hospital stays beginning on day one with a proactive care plan. Focus on the acute issue and limit inpatient testing to evaluation of the immediate clinical problem. Secondary, non-acute issues are often better handled postdischarge as an outpatient. Your patient with uncomplicated community-acquired pneumonia and a stable BUN of 25mgm% probably doesn’t need inpatient nephrology consultation with associated daily chemistries, renal ultrasound, renal MRA, and three additional days in the hospital. Start thinking “lean”—and if physician capitation is on the horizon, you’ll be better positioned to deal with it! Joseph A. Frascino, M.D. is Vice Chairman of the Holy Name Medical Center Board of Trustees and a retired nephrologist. My Doctor and His Diagnosis Less than a decade ago, Dr. A sought out an insightful colleague in psychiatry. “Rich, I feel so bad. (sic) I’m depressed all the time. I took the leading selling antidepressant, in escalating dose according to the package insert. I don’t feel any benefit,” he reported. His new doctor got right down to business, taking a careful history of his life, his health, family, career, hopes and dreams. Adam told about the four medical malpractice lawsuits pending and his looming un-insurability. He talked about his kids who wanted to go to college and the lifestyle that he thought that he would enjoy as “a Doctor.” At the end, the psychiatrist said: “Adam, you’re not depressed. You need to leave your medical group practice and go it on your own. Otherwise you will never be happy.” This was not at all what Adam had expected. He thought he would have his diagnosis confirmed, receive some insight-based therapy and a fresh prescription. “My partners are my mentors, my recruits and my dear colleagues. Besides, I have a restrictive covenant. I can’t leave,” Dr. A protested. Dr. Richard’s eyes narrowed, his voice deepened and he directed: “Adam, you think about it. In addition, I am going to waive professional courtesy and charge you $200; otherwise, you will not take my advice seriously.” Adam stopped the medication and after a moderate amount of consternation and delay, he went out on his own. The lawsuits were dropped after the depositions, the constriction was released and in time, he felt better. Less than a month ago, the same colleague in psychiatry visited Dr. A in the office. “Adam, I feel so bad. I have FUO (fever of unknown origin). Every night I have sweats. I’ve measured fevers to 100.8, I’m down four or five pounds and now my blood work shows a normocytic anemia with elevated CRP and a sedimentation rate of 108. My shoulders ache, though I do have a history of cervical radiculopathies. I took the most popular antibacterial, a 5-day pack usually used for non-bacterial afflictions and some amoxicillin that we had in the house, but I didn’t get any benefit.” FUO is a classic challenge to the mettle of any diagnostician with a differential diagnosis running over 100 possibilities in the Principles and Practice of Infectious Diseases. Dr. A felt that this was a particular challenge to deliver the professional benefit that he had received years earlier. He got right down to business by taking a careful history of exposures, travel, hobbies, dental work and all of the usual questions. The physical came next. No fever now, temporal arteries OK, a little gingivitis, no: cardiac murmur, adenopathy, splenomegally, etcetera. Undeterred, they went on to more blood tests, serologies, CT scans from top to bottom, bone marrow biopsy and a transesophageal echocardiogram. Dr. A was contemplating blind temporal artery biopsy and/or an empiric course of steroids. Finally, he said: “Rich, I think that your teeth are bad.” “My dentist says my teeth are fine.” Adam’s eyes narrowed, his voice deepened and he said: “You need a new dentist. In addition, I am going to waive professional courtesy and charge you $200; otherwise you will not take my advice seriously.” Out of a sense of duty or to justify his expenditure, his colleague found a new dentist. He had an extraction and a root canal and all of the signs and symptoms resolved, including the anemia and the inflammatory markers. Dental abscess is a very satisfying FUO diagnosis because it is obscure, benign and easily treatable. Physician, Heal thyself? I am trying to remember the source of that quote: “The doctor who treats himself has a………..for a patient.” At least we can take care of each other. Thomas Birch, MD is Chief of Infectious Disease at Holy Name Medical Center 3 Report from The Infection Prevention Team Grand Rounds M e d i c a l S ta f f Location: Marian Hall Time: 9:00 - 10:00 a.m. September 21: “Treatment Advances in Colorectal Cancer” Dr. Marwan Fakih September 28: “Obama Care and You; Perfect Together” John Poole, MD October 5: “Skin Cancer and Cutaneous Signs of Systemic Disease” Chang Son, MD October 12: “Update on Clinical Research, Infection Control and Antibiotic Management” Thomas Birch, MD October 19: “Smoking Cessation” Jill Williams, MD October 26: “Robotic Thyroidectomy” Emad Kandil, MD November 2: “Optimum Diabetes Management: From the Intensive Care Unit to Home” Mark Wiesen, MD, Randy Cole, MD and Maria Soper, RN November 9: Host “Patient Blood Management: Proactive Approaches to Reduce Transfusions” Areyh Shander, MD November 16: “Infection in Total Joint Arthroplast” Ari Seidenstein, MD November 30: “From Clinical Use to Meaningful Use” Deb Ross, RN and Mike Skvarenina December 7: “Wound Healing” Felix Raymond Ortega, MD December 14: Host “AFIB” James Reiffel, MD SAVE THE DATE HNMC Medical Grand Rounds October 26, 2010, 9 a.m. Marian Hall “Robotic Thyroidectomy” presented by Emad Kandil, MD Assistant Professor of Surgery Clinical Assistant Professor of Medicine Chief, Endocrine Surgery Tulane University School of Medicine SAVE THE DATE 2010 General Medical Staff Meeting Wednesday, December 8, 12 noon Marian Hall Conference Center Find out what’s happening at Holy Name and in the medical community. Enjoy lunch. 4 The Role of Metronidazole in Preventing Clostridium Difficile Infections Clostridium difficile (C.diff) is a major cause of nosocomial infections and diarrhea. It is caused by the use of broad spectrum antibiotics, especially penicillins, clindamycin, fluoroquinolones and cephalosporins, which can eradicate the normal flora in the gut. Under such conditions, C. diff can grow freely without any restrictions, releasing toxins that can damage intestinal mucosa and cause inflammation, which then leads to frequent diarrhea. The standard treatment of choice for C. diff infection is metronidazole (Flagyl), along with oral vancomycin, which is usually reserved for severe cases or non-response to metronidazole therapy. A study was conducted at Holy Name Medical Center to examine the hypothesis that the presence of metronidazole in an antibiotic regimen can protect the patient against C. diff infection. This study is a retrospective case controlled study identifying two groups of patients who received anti-bacterials within a selected time period. Patients were enrolled consecutively and then separated into two groups: patients who got C. diff infection and patients who did not get the infection. From there, patients who received metronidazole were identified. Inclusion • Total of 173 patients • 140 patients who did not get C. diff infection • 33 patients who got C. diff infection Exclusion • Patients with a prior history of C. diff infection • Patients who came to the hospital with C. diff infection Results Out of 172 patients total, 89 patients received metronidazole, along with other antibiotic treatment and 83 patients received antibiotics other than metronidazole. • Among the 139 patients who did not get the infection, 82 patients (59%) received metronidazole and 57 patients did not receive metronidazole. • Among the 33 patients who got the infection, 7 patients (21%) received metronidazole and 26 patients did not receive metronidazole. These results show very high statistical significance with a p value less than 0.0001 and support the hypothesis that patients who receive metronidazole in an antibiotic regimen may be protected against C. diff infection. Further prospective studies are needed to support prescribing of empiric metronidazole. In the interim, it may be worthwhile to include metronidazole in most antibiotic regimens which otherwise require anaerobic therapy in an attempt to gain a dual benefit. Issues of tolerability and resistance remain a concern. Jae Jo-Cho, Ernest Mario School of Pharmacy 2010 PharmD. Candidate; Lori-Ann Iacovino, MS, RPh and Thomas Birch, MD, Chief of Infectious Disease Cryoablation of the Prostate Being diagnosed with prostate cancer may be one of the most difficult and frightening experiences of a man’s life. Prostate cancer is one of the most common cancers in men and traditional forms of treatment with surgery or high dose radiation can result in serious side effects. Fortunately, an advanced treatment called cryoablation offers new hope for a cancer-free future. Best of all, it is minimally invasive and virtually free of side effects that can occur with surgery or radiation. Cryoablation requires no radiation beams or six-week time commitment. When compared with radical prostatectomy, cryoablation is equally effective in select patients, without risk of major surgery or blood loss and allows a faster, easier recovery. Cryoablation is a Medicare-approved minimally invasive procedure that kills prostate cancer by freezing the cancer cells. Suitable candidates are patients with tumors localized to the prostate. Even patients with high-risk tumors or those more likely to fail radiation can be cured with cryoablation. Recent advances have made cryoablation extremely patient-friendly and highly effective. Ultrasound images allow precise positioning of the cryoprobes. Temperature monitors continuously record the freezing process, determining when the target temperatures have been reached and protecting vital structures. The benefits include a choice of general or regional anesthetic, a shorter hospital stay (usually overnight) and a fast recovery and return to normal activities. Incontinence is rare, and many patients can be treated with a nerve-sparing approach that also preserves erectile function. Focal Therapy has allowed a smaller volume of tissue to be targeted, and would permit maintaining all urinary and sexual functions with a rapid return to normal activities. Cryoablation is not major surgery. It is truly minimally invasive. Laparoscopic surgery, by contrast, is minimal access and is not minimally invasive. There are risks of incontinence and impotence, as well as tumor recurrence. Most patients who undergo cryosurgical ablation of the prostate can return to normal activities within days to weeks. Blood transfusions, incisional pains or stress incontinence are just not seen with cryoablation. Erectile function can be preserved in selected instances. Contact or visit our office and get the facts. Gene S. Rosenberg, MD Kevin R. Basralian, MD Gene S. Rosenberg, MD, FACS, Kevin R. Basralian, MD, FACS and Daniel R. Lowe, MD are on staff at Holy Name Medical Center and practice with University Urology Associates PA, 20 Prospect Ave., Suite 719, Hackensack, NJ 07601. They can be reached at 201-343-0082. Website: hifumedicalcenter.com. Daniel R. Lowe, MD Medical Library Database Services • BMJ Case Reports and Clinical Evidence (on-campus access only) The Medical Staff Library is located in the Marian Conference Center and is open with badge-swipe access 24-7-365. The library offers a selection of print journals, on-line journals and numerous electronic databases, most of which can be accessed from your off-site location. HNMC’s medical staff members find the following references especially helpful: • Two databases geared to the physician at the point-of-care: • BMJ Point of Care (on-campus access only) BMJ Point of Care was developed jointly by BMJ Group and Epocrates. It features clear, concise expert opinion, as well as embedded, context-specific links to the most authoritative medical evidence to provide fast, credible answers to the most pressing patient care questions. • DynaMed DynaMed is a clinical reference tool containing clinically-organized summaries for more than 3,000 topics. It was created by physicians for physicians and other healthcare professionals. DynaMed may also be utilized on mobile devices. • Case Reports delivers a focused, peer-reviewed, valuable collection of cases in all disciplines, so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. • Clinical Evidence website summarizes the current state of knowledge about interventions used for prevention and treatment of important clinical conditions. Keydi Boss O’Hagan is HNMC’s Medical Librarian. Contact her for username and password, and for more information: 201-833-3395 or [email protected] or [email protected]. Percutaneous Discectomy Using the SpineView™ Interventional Discectomy System Introduction Percutaneous discectomy has long been accepted as a minimally invasive treatment alternative to open surgical procedures. The enSpire™ Interventional Discectomy System is a modern device indicated for use in disectomy procedures. It is typically used in the treatment of non-sequestered disc herniations. Lumbar disc herniation background Intervertebral disc herniation (bulging with nerve root compression) occurs as the result of degenerative and/or traumatic weakening in the fibrous outer wall of the disc (annulus pulposus). Most frequently seen in the lumbar spine, herniation can occur in escalating degrees of severity. In more severe cases, disc material can become “sequestered,” meaning that the disc bulge has advanced to the point of being fully displaced with no continuity with the parent disc. When disc herniation causes nerve root irritation or compression, patients require treatment due to back pain often associated with discomfort and neuropathy in the lower extremities. Management of disc herniation The management of disc herniation ranges from conservative, non-invasive rehabilitative therapy to open surgical intervention to achieve nerve root decompression. Conservative therapy consists of medication such as non-steroidal anti-inflammatory drugs (NSAIDS), oral steroids, and analgesics including opioids. In addition, bed rest and/or various forms of physical therapy are utilized. Benefits of conservative therapy are commonly seen in conjunction with epidural steroid injections, often resulting in only temporary pain relief, generally extending up to three months. Lumbar discectomy, a surgical procedure, is indicated when conservative measures do not offer relief and when sensory and/or motor deterioration is experienced. Lumbar discectomy is a surgical procedure that can be performed using various methodologies of escalating intervention. The most invasive method is the open, complete discectomy, which can be accompanied by fusion of the cephalad and caudal vertebral structures. These procedures, though effective in reducing pressure within the intervertebral disc and adjacent nerve root, often lead to significant morbidity and persistent pain. In addition, because the biomechanical integration of the spine is altered by these procedures, further vertebral deterioration can occur. Percutaneous lumbar discectomy Percutaneous lumbar discectomy (PLD) is a less invasive surgical procedure when compared to open procedures, and involves the removal of only part of the disc responsible for nerve impingement, and has been an effective treatment for disc herniation for more than 30 years. In its evolution, the procedure has been modified from the use of manual cutting forceps, to automated devices in which a mechanized cutting and sometimes suction apparatus is used to remove disc material. Several clinical articles over the last 20 years have been published supporting the clinical benefits of these devices. These studies indicate a 75-90% improvement in functional status. In addition, the studies indicate significant reduction in pain levels and consumption of pain killers. enSpire™ Interventional Discectomy System: Device and Intended Use SpineView’s enSpire™ Interventional Discectomy System is a modern percutaneous discectomy device granted clearance by the Food and Drug Administration (FDA) Your Patients After Hospitalization Take full advantage of Medicare reimbursement while your patient is receiving home health or hospice care. Once again, a Medicare regulation has put Holy Name Home Care into a quick compliance mode. This time, we are totally dependent on physician support. The PECOS (Provider Enrollment Chain & Ownership System) requires physicians referring their patients to home health services to be enrolled before the Medicare certified home health agency can be reimbursed for their services. We are, therefore, asking your help with this issue, which is so important to providing needed home care services to your patients. Are you enrolled? If you have not done so, please enroll on the website, www.cms.hhs.gov/ MedicareProviderSupEnroll, so your patients can receive home care services. Are you taking advantage of all Medicare reimbursement? There are two ways physicians can be reimbursed for their services while their patients are receiving home health and hospice services: 1.Care Plan oversight: Physicians who oversee complex care needs of Medicare home health and hospice patients can be reimbursed for these services. To receive payment, the physician must: • provide service to the Medicare beneficiary receiving home health services • have had a face-to-face encounter with the patient within the six months prior to billing 2.Certification and recertification: This includes contacts with the Home Health or Hospice staff, and review and signature of the Plan of Care and other documentation sent by the home care staff. Need more information? The National Association for Home Care & Hospice (NAHC) has recently updated a short guide, which includes the documentation requirements and billing codes for reimbursement of physician services. Copies of this publication are available by calling Holy Name Home Care at 201-833-3740. A more detailed publication, Physician Payment for Home Care & Hospice Services, includes specific definitions, documentation requirements, physician home visits, and coverage rules and is available on the NAHC website, www.nahc.org . Patricia M. Hunt, MS, RN is Executive Director of Home Care and DayAway at Holy Name Medical Center. AP view Lat. view enSpireTM device Enlarged enSpireTM tip in 2009. It is a single-use, non-thermal discectomy device using a 16g. cannula typically used in the lumbar spine. The enSpire™ device is introduced into the disc under fluoroscopic guidance, very similar to a diagnostic test called a discogram. It has a deployable wire with a 7mm sweep diameter to cut and grind disc material, and an auger mechanism to remove the disc material to a collection chamber (see figures above). This ability to collect excised material provides the physician with direct information about the amount of disc material removed. To date, there have been no reports of serious or unexpected patient adverse events attributable to the enSpire™ system. The author’s experience with this device has been very encouraging. I have used it on multiple patients and have had very encouraging results. The response has been from 30-40% relief to 100% relief. Only one patient has had no response. Samyadav Datta, MD is a pain management specialist on staff at Holy Name Medical Center and Director of the Center of Pain Management in Hackensack. He can be reached at 201-488-7246. Fraxel re:pair® Laser for Skin Rejuvenation Fraxel re:pair® is the new gold standard for fractional CO2 laser ablation, deep dermal coagulation and skin rejuvenation. The Fraxel re:pair® laser is the third generation of Fraxel lasers and accomplishes in one 30minute session what formerly required three or more treatments, several weeks apart. The device provides a laser facelift for patients with moderate to severe photo-damage and other age- and environmental-related damage, by shrinking the skin and dermis threedimensionally, as the treatment head is rolled over the face, neck and décolletage. Indications for use include fine rhytids or wrinkles, freckles or lentigenes, and general skin laxity. Ablation of textural irregularities, dyschromia, and acne scars are additional benefits derived. The device has also been approved for use on stretch marks and on the hands and extremities. The procedures are performed under IV sedation or topical anesthesia. Most patients are healed in three days, and they can resume their normal activities and social The Fraxel re:pair® laser is the third generation of Fraxel lasers and accomplishes in one 30-minute session what formerly required three or more treatments, several weeks apart. engagements several days later. I am the first plastic surgeon in both Bergen and Passaic counties to offer this skin rejuvenating modality. Both I and those patients I’ve treated are quite impressed with the results. I continue to offer Botox®, Juvederm® and Radiesse®, as well as face- and brow-lifting procedures, and breast and body contour surgery. Additionally, I am doing laser hair removal and treating acute acne with the Isōlaz IPL. Robert S. Fischer, MD is a plastic and reconstructive surgeon on staff at Holy Name Medical Center, with a private practice at 19-21 Fair Lawn Ave., Fair Lawn, NJ 07410. He can be reached at 201-796-4100 and RobertSFischerMD.com. 5 Service Anniversaries Welcome to the Medical Staff The Holy Name family extends its congratulations and gratitude to the following members of the medical staff for their association with our Medical Center. This list recognizes anniversaries during May, June, July and August, 2010. Appointments to the Medical Staff during May, June, July and August 2010 40 Years Richard J. Kossman, MD, Neurology Joseph Musa, MD, General Surgery Medical School: Columbia University School of Dental & Oral Surgery Internship and Residency: Columbia University – Pediatric Dentistry Practice: 23-00 Route 208 South, Suite 2-5, Fair Lawn, NJ 07610 Phone: 201-796-4111 35 Years Jacinto Fernandez, MD, Obstetrics & Gynecology 30 Years Robert Malovany, MD, Pulmonary Medicine Vincent Lanteri, MD, Urology 25 Years Josef Weisgras, MD, Internal Medicine 20 Years Lewis Attas, MD, Oncology Francis Forte, MD, Oncology Stephen Kamin, MD, Neurology Zvi S. Marans, MD, Pediatrics Michael Schleider, MD, Oncology Jeffrey Steuer, MD, Orthopedics Albert Tartini, MD, Nephrology 15 Years Raymond B. Andronaco, MD, Urology Sheila A. Bond, MD, Plastic Surgery Gerard T. Eichman, MD, Cardiology Steven D. Gillon, DO, Gastroenterology Anne J. Miller, MD, Orthopedics Raphael Novogrodsky, MD, Urology Austin M. Pattner, MD, Nephrology Gary D. Wasserman, MD, Urology 10 Years Kristin A. Concepcion, MD, Pediatrics Marc M. Egazarian, MD, General Surgery Amina Elkassir, MD, Pediatrics Stuart B. From, MD, Allergy Ziv Harish, MD, Pediatrics Jennifer L. Kmieczah, DPM, Podiatry Omana R. Mathew, MD, Pediatrics 5 Years Ananea Adamidis, MD, Nephrology Fang Chin Chiang, DO, Emergency Medicine Amy Fisch, DO, Anesthesia Tonel Leibu, MD, Internal Medicine Anne M. Shaftic, NP, Internal Medicine Dorene Soo-Hoo, DPM, Podiatry Zalmen L. Suldan, MD, Nephrology Daniel Walzman, MD, Neurosurgery Peter Ilowite, DO, Awarded “Teacher of the Year” Peter G. Ilowite, DO, dermatologist, was recently awarded “Teacher of the Year” by the dermatology residency program at Mount Sinai Hospital and Medical School in New York City, where he is an assistant professor of medicine. It is the second year in a row that Dr. Ilowite has received the honor. He has practiced in Saddle Brook, NJ for 15 years, and is also a consulting dermatologist for the Kessler Institute for Rehabilitation in Saddle Brook. Dr. Ilowite can be reached at 201-843-7177. 6 Purnima Hernandez, DDS Surgery/Pediatric Dentistry Nicholas Bevilacqua, DPM Surgery/Podiatry Medical School: New York College of Podiatric Medicine Internship: St. Vincent’s Catholic Medical Centers of NY – Podiatry Residency: St. Vincent’s Catholic Medical Centers of NY – Podiatry Practice: 730 Palisade Ave., 1st floor, Teaneck, NJ 07666 Phone: 201-353-9000 Jay Chun, MD Surgery/Neurosurgery Medical School: Columbia University College of Physicians and Surgeons Residency: University of California, San Francisco – Neurosurgery Fellowship: Emory Clinic – Neurosurgery/Spine Practice: 310 Madison Ave., Morris Township, NJ 07960 Phone: 973-285-7800 Janna Cohen-Lehman, DO Medicine/Endocrinology Medical School: New York College of Osteopathic Medicine Internship: North Shore University Hospital – Medicine Residency: North Shore University Hospital – Medicine Fellowship: North Short University Hospital – Endocrinology Practice: 229 Engle Street, Englewood, NJ 07631 Phone: 201-567-3674 Clenton Coleman, MD Medicine/Nephrology Medical School: University of Medicine & Dentistry Internship: St. Luke’s-Roosevelt Hospital – Medicine Residency: St. Luke’s-Roosevelt Hospital – Medicine Fellowship: Lenox Hill Hospital – Nephrology Practice: 177 North Dean St., Englewood, NJ 07631 Phone: 201-567-0446 Marina Cozort, MD Medicine/Psychiatry Medical School: Rostov State Medical University Internship: Rostove Regional Clinic Hospital – Ob/Gyn Internship: Bergen Regional Medical Center – Psychiatry Residency: Bergen Regional Medical Center – Psychiatry Practice: 111 Dean Drive, Tenafly, NJ 07670 Phone: 201-568-8288 Elizabeth Eapen, MD Pathology Medical School: University of Kerala, Medical College Internship and Residency: St. Luke’s-Roosevelt Hospital – Pathology Fellowship: Montefiore Medical Center – Gynecologic Pathology Fellowship: Westchester County Medical Center – Cytopathology Practice: Pathology Dept., Holy Name Medical Center, Teaneck, NJ 07666 Phone: 201-833-3246 Enrique Feoli, MD Medicine/Neurology Medical School: National University of Cordoba, School of Medicine Internship: Bronx-Lebanon Hospital Residency: New York University Medical Center - Neurology Fellowship: New York University Medical Center – Neurophysiology Fellowship: Presbyterian Hospital – Epilepsy Practice: 20 Prospect Ave., Suite 800, Hackensack, NJ 07601 Phone: 201-343-6676 Warren Glick, NP Family Practice Education: Fairleigh Dickinson University Practice: HNMC Clinic, 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-7183 Edmund Kwan, MD Surgery/Plastic Surgery Medical School: Georgetown University School of Medicine Internship: St. Vincent’s Hospital & Medical Center Residency: New York Hospital – Surgery Fellowship: Flowers Clinic – Plastic Surgery Practice: 302 East 72 St., NY, NY 10021 Phone: 212-734-4488 William Ko, MD Radiology Medical School: Boston University School of Medicine Internship: Framingham Union Hospital Residency: St. Vincent’s Hospital & Medical Center – Radiology Fellowship: Thomas Jefferson University Hospital – Radiology Fellowship: Brigham and Women’s Hospital – Breast Imaging Practice: HNMC Breast Center, 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-7100 Steve Kwak, MD Surgery/Orthopedics Medical School: University of Medicine and Dentistry Internship: Tuft’s – New England Medical Center – Surgery Residency: Tuft’s – New England Medical Center – Orthopedic Surgery Fellowship: Southern California Orthopedic Institute – Sports Medicine Practice: 730 Palisade Ave., Teaneck, NJ 07666 Phone: 201-353-9000 Francis Lee, MD Surgery/Orthopedics Medical School: Seoul National University, School of Medicine Residency: Jersey City Medical Center – Orthopedics Fellowship: University of Toronto – Pediatric Orthopedics Fellowship: Massachusetts General Hospital – Musculoskeletal Tumor Practice: 3959 Broadway, 8 North, New York, NY 10032 Phone: 212-305-3293 James Lee, MD Surgery/Otolaryngology Medical School: New York University School of Medicine Internship: Beth Israel Medical Center Residency: New York University Medical Center – Otolaryngology Practice: 219 Old Hook Rd., Westwood, NJ 07675 Phone: 201-666-8787 James Lim, MD Radiology Medical School: University of Medicine & Dentistry Internship: St. Vincent’s Hospital & Medical Center – Medicine Residency: St. Barnabas Medical Center – Radiology Fellowship: New York Presbyterian Hospital- Columbia Campus – Radiology/Nuclear Medicine Practice: 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-7023 Daniel Lowe, MD Surgery/Urology Medical School: Albert Einstein College of Medicine Internship: Montefiore Medical Center – Surgery Residency: Montefiore Medical Center – Urology Practice: 20 Prospect Ave., Suite 719, Hackensack, NJ 07601 Phone: 201-343-0082 Mindy Nestampower, MD Anesthesia Medical School: Albany Medical College/Union University Internship: Staten Island University Hospital – Medicine Residency: New York Hospital – Anesthesia Fellowship: Memorial Sloan-Kettering Cancer Center – Pain Management Practice: 350 Ramapo Valley Rd., Suite 18-282, Oakland, NJ 07436 Phone: 201-644-7700 Steven Novak, MD Anesthesia Medical School: Ohio State University School of Medicine Internship: Dartmouth Hitchcock Medical Center – Pediatrics Residency: New York Presbyterian Hospital – Columbia Campus – Anesthesia Fellowship: Cleveland Clinic – Clinical Research Practice: Bergen Anesthesia, 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-7149 Nitin Patel, MD Surgery/Urology Medical School: University of Medicine and Dentistry Internship: University of Medicine and Dentistry – Surgery Residency: University of Medicine and Dentistry – Urology Practice: 255 W. Spring Valley Ave., Suite 101, Maywood, NJ 07607 Phone: 201-487-8866 Ari Seidenstein, MD Surgery/Orthopedics Medical School: UMDNJ-Robert Wood Johnson Medical School Internship: Montefiore Medical Center – Orthopedic Surgery Residency: Montefiore Medical Center – Orthopedic Surgery Fellowship: Insall Scott Kelly Institute – Adult Reconstruction & Sports Medicine Practice: 10 Forest Ave., Paramus, NJ 07652 Phone: 201-291-4040 Mathew Silverman, DO Internal Medicine Medical School: Philadelphia College of Osteopathic Medicine Internship: Maimonides Medical Center – Medicine Residency: Maimonides Medical Center – Medicine Practice: 480 Market Street, Saddle Brook, NJ 07663 Phone: 201-845-4048 David Singh, MD Radiology Medical School: State University of New York, Syracuse Internship: Albany Medical Center – Medicine Residency: Albany Medical Center – Radiology Fellowship: Albany Medical Center – Vascular and Interventional Radiology Practice: 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-3310 Chang Son, MD Medicine/Dermatology Medical School: McGill University Internship: Brigham and Women’s Hospital Residency: Yale New Haven Hospital – Dermatology Practice: 2083 Center Ave., Suite 3A, Fort Lee, NJ 07024 Phone: 201-944-3800 Edward Strauss, RNFA Surgery/General Surgery Education: Bergen Community College – RN Practice: 24 Summit Ave., Butler, NJ 07405 Phone: 201-207-9487 Timothy White, PA Emergency Medicine Education: University of Medicine & Dentistry – PA Practice: HNMC Emergency Department, 718 Teaneck Rd., Teaneck, NJ 07666 Phone: 201-833-3210 Walk for Hope Connects with Hispanic Population Led by FOX News journalist/author Geraldo Rivera, 400 people hoofed their way through James J. Braddock North Hudson Park in North Bergen to raise funds for needy cancer patients on May 22. Conducted by the Medical Center’s Hispanic Outreach Program in association with the Celia Cruz Foundation, the event featured complimentary blood pressure screenings, cancer information and education, and the opportunity for informal consultations with bilingual physicians. Dr. Fernandez-Cos, Medical Director of the Hispanic Outreach Program, was on hand to answer participants’ medical questions, as were colleagues Dr. Juan Gonzalez, general surgeon; Dr. Gilberto Gastell, internal medicine; Dr. Yadyra Rivera, hematology/oncology; Dr. Mauricio Zapiach, gastroenterology; Dr. Octavio MelendezCabrera, ob/gyn; and Dr. Jorge Verea, internal medicine. The Hispanic Outreach Program is a culturally-sensitive initiative offering health information, referrals, educational programs, seminars, and screenings at Holy Name and off-campus locations for residents of Bergen, Hudson and Passaic counties in New Jersey. Destination Honduras for KMP Physicians A surgical team composed of physicians from Holy Name Medical Center’s Korean Medical Program conducted its annual medical mission to Progreso Hospital in Honduras in July, performing 45 surgeries over the course of four days. HNMC’s Hee K. Yang, MD, general surgeon, Tae Won Moon, MD, otolaryngologist, Edmund Kwan, MD, plastic surgeon, Sung K. Yun, MD, obstetrician/gynecologist, and Kenneth Park, MD, anesthesiologist, worked with their sponsoring organization, Kingdom Pioneering Mission, which provides physician expertise to third-world healthcare facilities that lack adequate staff. Honduras is the group’s first project, having commenced two years ago with the distribution of over-the-counter analgesics. After the team established their credibility with the staff at Progreso Hospital, “we passed the test,” says Dr. Yang, and they were invited back to operate on patients. Dr. Yang explains that the team undertakes procedures not routinely performed at Progreso, either because of their complexity or the lack of surgical supplies and materials. He says that while the government-run hospital charges an affordable fee for an open Dr. Kwan (standing) and Dr. Moon perform a facial reconstruction as a medical student looks on. Dr. Edmund Kwan (third from left), Dr. Yang (fifth from left) and Dr. Tae Won Moon (far right) join a medical student and staff members at Progreso Hospital. cholecystectomy, it charges $250 for the laparoscopic approach. “The people’s average monthly income is around $250,” points out Dr. Yang, “making a lap chole—which is easier on the patient—prohibitive.” In response to this need, the team performed the operation for only $25 per patient. Dr. Yang also performed complex hernia repairs that required the use of mesh which, because of its expense, is difficult to obtain at Progeso Hospital. Dr. Kwan performed many skin grafts and skin reconstructions on patients with nonhealing ulcers due to wound complications. Dr. Moon assisted with facial reconstructions, including cleft lips and palates, an otoplasty for severely protruding ears, and a corrective surgery for a young woman who had been partially scalped in a car accident and whose initial surgery had left her with a displaced eyebrow. Dr. Park administered anesthesia for all the surgical patients. The surgical team was accompanied by a youth group, composed of young people who are interested in pursuing medical school. When members of the youth group weren’t observing the surgeons in action, they were helping to teach English to the local school children and building classroom furniture, such as bookcases and desks. Are Hospitalists the Marcus Welbys of Today? Marcus Welby, MD, which aired on ABC from late September 1969 through midMay 1976, was one of the most popular doctor shows in U.S. television history. The program, starring Robert Young, was centered on the basic doctor show formula— the older physician-mentor tutoring the young man—and transferred it from the standard hospital setting to the suburban office of a general practitioner. According to the Museum of Broadcast Communications, the sicknesses that Dr. Welby dealt with— everything from drug addition, rape, tumors and autism—ran the same wide gamut that hospital-based medical shows did. In fact, many of the patients ended up in the hospital, and Dr. Welby ultimately moved his practice to a hospital toward the end of the show’s run. Fast forward to healthcare in Bergen County as a microcosm of our nation’s healthcare and one may see that Dr. Welby’s decision to move his practice to the hospital was, in fact, a harbinger of how medicine is now practiced. Unfortunately, healthcare today is beset by a shortage of primary care physicians, reduced physician reimbursements by the insurance companies, an aging boomer generation and the ever-increasing cost of patient care. So what is the answer to these thorny public health issues that we have all been hearing about, and how does this relate to our Bergen County community, which also happens to be the most populous county in the state of New Jersey? A partial healthcare solution for our community and its primary care physicians and specialists who need additional clinical support and relief is hospitalist medicine. That’s right, “hospitalist” medicine. So what is a hospitalist? A hospitalist is a physician who specializes in caring for patients during their stay in the hospital. In fact, hospitalists have been admitting patients at Holy Name Medical Center for the past year. Holy Name Medical Center readily recognized the value that hospitalists bring to its patients and their primary care physicians. Today, there are five hospitalists at Holy Name. These board-certified internal medicine specialists are available 24/7 to support area physicians and their patients who require inpatient hospital care. Mohammad Tehranirad, MD, the Lead Hospitalist of Teaneck Hospitalists at Holy Name, comments, “Our doctors are fullytrained physicians, board-certified in internal medicine, and work in close consultation with the patient’s primary care physician. We also work closely with other involved specialty physicians during their patient’s hospital stay. Our patients are culturally diverse and I not only love the patient interaction, but also the opportunity to work with the patient’s primary care physician.” According to Ronald Rigolosi, MD of Riverside Family Care in Lodi, “I have worked successfully with hospitalists since 2001 when I was in Kansas City. I am back home now in New Jersey and the hospitalists at Holy Name allow me to concentrate on my patients in the office, knowing that my patients in the hospital are receiving the level of care that I would provide and expect. The Holy Name hospitalists are there day and night, seven-days-a-week and that means a lot to me as a physician and of course, my patients.” Of course, the use of Teaneck Hospitalists is at the discretion of the primary care physician, and they are available to all Holy Name Medical Center physicians. They are invaluable members of the patient care team. Visitors to our Bergen County area, people who do not have a local physician or those whose physician does not have privileges at Holy Name also receive care from the hospitalist service. As in any medical situation, continuity of care from the time of admission to discharge is ensured by the hospitalist. What’s more, the hospitalists’ familiarity with the many specialists at Holy Name Medical Center and its departments allows them to efficiently coordinate care and monitor patient progress while continuing the consultant referral patterns for each patient. Since Teaneck Hospitalists do not have outside practices, they are at Holy Name throughout the day and are better able to follow up on tests and make necessary adjustments in a timely manner, based on clinical test results. Richard Joo, MD, an internal medicine practitioner with offices in Englewood Cliffs and Palisades Park, adds, “Hospitalist medicine is the only way to go. The hospitalists help streamline care for my patients and they give excellent care. There is never a time that a hospitalist is not at Holy Name for my patients and me. The fact is, my patients need me in the office. When they are at Holy Name Medical Center for whatever medical reason, we simply pick up where the hospitalists at Holy Name left off. It is that simple. Discharges happen when they are supposed to happen, and communication between hospitalists and myself is great. Patient bounce backs or readmissions are not a problem at Holy Name and that is important to me.” With our nation’s healthcare reform effort still being played out, at least here in Bergen County, there is no argument about the merits of the Hospitalist Program at Holy Name Medical Center. We think Marcus Welby, MD would be proud of this medical service in our community! Paul White is Vice President of Physicians’ Practice Enhancement, provider of Teaneck Hospitalists at Holy Name Medical Center. 7 Foundation Golf Outing Raises $245,000 The Holy Name Health Care Foundation held its 16th Annual Holy Name Classic Golf Tournament on June 14 at the Hackensack Golf Club, Oradell, and at the Arcola Country Club, Paramus. More than 200 golfers and other participants turned out, raising over $245,000 for the benefit of the Medical Center’s programs and services. “Each year, our Holy Name Golf Classic gathers new supporters and longtime friends for a wonderful day of golf and to raise significant funds for Holy Name Medical Center,” said Kevin McCarthy, Vice President of Development and Executive Director of the Holy Name Health Care Foundation. “This year was no exception. Golfers enjoyed a beautiful day thanks to a good forecast and a terrific awards program and dinner. All proceeds from this year’s Golf Classic will go directly to benefit the healing mission of the Medical Center.” Magnet Recognition From the American Nurses Credentialing Center. Places us among the top 5% of hospitals nationwide for excellence in patient care. Beacon Award From the American Association of Critical Care Nurses for exceptional acute and critical care nursing. J.D. Power and Associates Distinguished Hospital Awards For Emergency, Inpatient, Outpatient and Maternity Service Excellence. Accredited Chest Pain Center From the Society of Chest Pain Centers for our ability to diagnose chest pain and acute coronary symptoms. Primary Stroke Care Center Certification From The Joint Commission, the nation’s leading health care evaluation and accreditation organization. June/July/August 2010 MD360º is published bimonthly by Holy Name Medical Center’s Department of Marketing/Public Relations and is intended for use by the medical staff of Holy Name Medical Center. 8 HealthGrades® Specialty Excellence Award for Stroke Care™ Ranked in the top 10% of hospitals nationally for stroke services. HealthGrades® Distinguished Hospital Awards for Clinical Excellence™ Among the top 5% of hospitals in the nation for clinical excellence. Modern Healthcare magazine Ranked fourth in the nation on the “100 Best Places to Work in Healthcare” list. NJBIZ magazine Cited Holy Name among the “Best Places to Work in New Jersey.” Data Advantage, LLC Awarded for quality, affordability, efficiency, patient safety and overall experience. Patricia A. Burke, M.D., Ph.D., President of the Medical Staff Jane F. Ellis, Vice President, Marketing and Public Relations editor: Barbara Franzese Cron, Manager, Marketing Communications Please e-mail all comments and contributions to: editor [email protected] or call Jane Ellis, 201-833-3129 or Barbara Cron, 201-530-7904.