DECEMBER 2010 Medical Staff - Lucile Packard Children's Hospital · 2010-12-10 · As Lucile...

Medical Staff D E C E M B E R 2 0 1 0

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Tackling the Gestational Diabetes EpidemicIn September, Congress passed HR 5354,

which would establish a government advisory committee on gestational diabetes—and in turn provide grants for researching and reducing incidence of this increasingly common condition. The legislation underscores an ever-present reality at Lucile Packard Children’s Hospital: We’re in the midst of an epidemic, with over half of our pregnant patients overweight or obese. As a result, the number of patients requiring management of their gestational diabetes or pre-gestational diabetes is growing steadily. We’re fortunate to have an extremely strong gestational diabetes program, led by Jeffrey Faig, MD, FACOG, medical director of the diabetes and pregnancy program, who is board-certified in diabetes, endocrinology and metabolism, as well as obstetrics and gynecology.

Foremost among concerns for women

with gestational diabetes is preventing birth trauma, including shoulder dystocia, in which the baby’s shoulder—larger than average, due to the mother’s high blood sugar—gets stuck during

delivery. The stakes are high. In such cases, Faig says, the delivery team has a four- or five-minute window in which to deliver the baby before serious problems may occur.

“Put simply, our goal is to prevent the baby from becoming too large,” he says. “We do this by diagnosing as early as possible, sometimes even at the first visit. Other patients are screened at 28 weeks, by giving them a 50-gram glucola drink,

and followed by additional blood testing shortly afterward if they don’t pass that test.”

Once patients are diagnosed with gestational diabetes, a major goal becomes control of the diet. The focus is carbohydrates.

“The average American portion size for carbs

CHRISTY SANDBORG, MD Chief of Staff

Johnson Center

Obstetrical Leadership

Team

Family-Centered Rounds Launch into SuccessFor years, the revolutionary idea of family-centered rounds within the

medical-surgical units was just that—an idea. In August, it became a

reality here at Lucile Packard Children’s Hospital, when a pilot team in General

Pediatrics began conducting its rounds alongside any patients’ parents who

wished to participate. Perhaps just as noteworthy as the advent of family-

centered rounds: how smoothly it’s gone so far.

We’re in the midst of an epidemic, with over half of our pregnant patients overweight or obese.

L U C I L E P A C K A R D C H I L D R E N ’ S H O S P I T A L

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Since 2000,

our patient

discharges

have

increased by

11 percent.

We’ve

doubled our

clinic visits,

increased

inpatient days

by a full third,

and added 30

percent more

licensed beds.

It was wonderful

to speak with many of you at the State of the Hospital Address on September 29. A video and discussion questions are posted on the intranet. This article provides a brief recap.

As Lucile Packard Children’s Hospital prepares to celebrate 20 years of advancement and leadership in care, research and education, we’ll take a look at our past, present and future.

Almost 100 years ago, in 1917, pediatric patients from Stanford Medical School, located in San Francisco at the time, were transported down dirt roads to convalesce in the sunny farmlands of Palo Alto. The Stanford Home for Convalescent Children opened in 1919, serving 270 children in its first year. Over the next 50 years, the “Con Home” increased its patient volume, services, teaching and research, and in 1969 moved into the new 60-bed Children’s Hospital at Stanford. Eleven years later, in 1980, the 27 clinics of the Stanford–Children’s Ambulatory Care Center, located at Children’s Hospital at Stanford, opened.

In the early 1980s, the hospital board decided that a new hospital would be built to consolidate all inpatient pediatric services. Lucile and David Packard pledged $70 million, and builders broke ground in 1988. Lucile Packard Children’s Hospital—a $110 million, 143-bed facility—opened its doors on June 9, 1991.

Since then, our progress has been exponential, much of it happening in the last decade. In 2001, we established six centers of excellence: the Children’s Heart Center, the Johnson Center for Pregnancy and Newborn Services, the Bass Center for Childhood Cancer & Blood Diseases, the Center for Brain & Behavior, the Center for Transplant & Tissue Engineering, and our Pulmonary Biology Center.

Shortly after the new hospital opened, we began planning to expand clinical programs. In 1998, with the very generous support of the David and Lucile Packard Foundation, we launched the Children’s Health Initiative. The CHI was a $500 million campaign designed to dramatically expand services available to the children of our community and throughout the country. As part of this campaign, we recruited 60 faculty leaders along with expert staff to build preeminent and sustainable clinical research and training programs in child and obstetric health. We committed ourselves to providing family-centered care, making families part of our care teams.

In 2002, we launched our Quality and Safety Initiative, which achieved dramatic progress. We are now nationally recognized as a leader in quality and safety. In 2004, we began developing a pediatric-dedicated Emergency Department service. By 2005, we were recognized by U.S.News

& World Report as one of the top 10 children’s hospitals in the country. Our programs continue to be ranked among the very best.

We’ve helped to foster better health in our community by increasing our community benefits programs and strengthening our networks to ensure better access to care. Progress like this can be achieved only when an entire staff is united in its dedication to excellence.

Our growth over the past decade has been dramatic. Since 2000, our patient discharges have increased by 11 percent. We’ve doubled our clinic visits, increased inpatient days by a full third, and added 30 percent more licensed beds. Our growth has also required a dramatic 85 percent increase in staff across many departments—primarily to attend to patients who are some of the sickest, smallest and most complex.

Packard Children’s has come of age through a period that was fairly stable for the health care industry. But today’s revolution in health care and the current economy is changing that. At Packard Children’s there will be less money from commercial payers and the government; reimbursements for services will not increase at the same rate, and may level off or even drop. Locally and nationally, we’re seeing a consolidation of health care providers, with more

From the Desk of CHRISTOPHER G. DAWES, CEO

Fall 2010 State of the Hospital

Medical Staff U P D A T EMedical Staff U P D A T E

3D E C E M B E R 2 0 1 0

Join the ConversationNo matter where you practice or what your specialty, your

perspective can make a difference at Lucile Packard Children’s

Hospital. In Christopher Dawes’ Medical Staff e-mail communi-

cation, A Conversation with Christopher Dawes, your

questions, comments, ideas and success stories can be part of

the conversation. Get the conversation going, and let Chris

know what’s on your mind. Send your questions, concerns,

comments, topic ideas, news, awards, honors and success stories to

[email protected]. Chris wants to hear from you!

and more physicians joining group practices. With the advent of the Web and an increasing concern about the cost of health care, more and more consumers are demanding transparency and increasing their awareness of outcomes, costs and choices.

As consumers become savvier, patient satisfaction as well as managing costs will become ever more important. In Obstetrics, Inpatient Pediatrics, and Outpatient Clinics, our patient satisfaction scores are the highest they’ve ever been. But our competitors are improving at the same rate, which leaves us continuously behind. Our challenge is to break out of our status quo and make the same rapid advances in patient satisfaction as we have in clinical care. We’ve done this already, for example, by shortening wait times for appointments.

Clinically, we are doing an extraordinary job. Out of 43 other children’s hospitals in the Child Health Corporation of America (CHCA) during the year ending March 31, 2010, we had the highest Case Mix Index. Still, we consistently maintain statistically high outcomes, even compared with hospitals that see less-sick children. Our mortality ratio is routinely one of the very lowest in this same CHCA group.

Providing such high-acuity care in an area with such a notoriously high cost of living adds up to high costs. We must therefore work extra hard to keep costs down. For example, our Clinical Resource Management Program helps ensure that we’re reducing unnecessary tests and procedures and keeping our costs at an appropriate level. The Value Analysis Program also helps the

cost-reduction effort. Both of these programs have been successful because physicians and staff have teamed up to make them happen.

The next decade at Packard Children’s will see a new era of employee engagement, continued innovation and education, and an expanded network of care. More and more patient services will be provided in outpatient settings both on and off campus. We’ll also have increased partnerships with other providers. We’ll maintain and grow our leadership as an institution where our research benefits not only our own patients, but also patients and hospital practice across the country and around the world.

In our commitment to deliver and enhance the health care that children and expectant mothers in our region require, we’ll partner and create alliances with regional hospital peers to improve health care quality, outcomes, patient satisfaction and efficiency, and to increase access to pediatric subspecialty services, general pediatric services and maternity care.

We’ve accomplished a great deal over the past 20 years and intend to recognize all of our achievements with a season of celebration. This year, you’ll be invited to participate in many events and activities that will mark this anniversary, including a community-wide birthday party, an employee giving campaign, photo shoots, employee videos, advertising and special events. There is so much to be proud of, and I look forward to celebrating with you.

Our challenge

is to break

out of our

status quo

and make the

same rapid

advances

in patient

satisfaction

as we have in

clinical care.

mailto:[email protected]


4 D E C E M B E R 2 0 1 0

“In the past, of course, the care team would meet prior to going into the patient’s room, then let them know what the plan of care was. Now parents are being asked for their input in the plan of care,” says Karen Wayman, PhD, director of family-centered care. “This means parents can easily track their child’s medical status while they’re in the hospital, as well as bring important information that the care team might not otherwise have—how a child has responded to a certain procedure in the past, for example.”

The initiative has been remarkably successful, particularly for a first run, says Joe Kim, MD, medical director of the Acute Care Unit, and the physician lead for implementation of family-centered care there.

“The feedback I’ve been getting from parents and nurses and residents and those involved has been pretty positive. We thought we might get push-back, but that’s not been the case,” he says.

Among the initial concerns was that family-centered rounds would present a greater drain on staff and physician time. In fact, the pilot team has reported the opposite to be true in many cases. In addition to introducing parents to the conversation, the initiative also standardizes rounds in a broader sense. Communication happens in real time, with ancillary care providers present during rounds and nurses helping coordinate care overall. The net result is a process that’s been streamlined on several fronts.

“It’s asking staff to make a time commitment to come be part of this. But when they do come, they report that it’s actually a really efficient way to exchange information,” Wayman says.

Kim notes that the new approach doesn’t

appear to consume more time in any significant way. He adds that the families involved so far have been extremely pleased. He recalls one instance in which a Spanish-speaking father had his child’s plan of care explained to him during rounds. A couple of hours later, the attending went into the child’s room and found that the mother had a perfect grasp of the plan for the day. Not only did the father understand the plan of care perfectly, but he understood it well enough to explain it to his wife clearly. Needless to say, that kind of successful communication is invaluable in a hospital, whether it’s on the patient’s side or ours.

It’s been no small feat to introduce such a sea change, and everyone involved deserves recognition. In addition to Wayman and Kim, Erin Vera, RN, MPH, served as project lead; Susan Herman, director of the Magnet Program, BLS, RN, served as nurse representative; Cathleen Hedges, MSN, RN, served as nurse educator for relationship-based nursing practice; and Michele Ashland, parent lead, did the crucial work of coordinating with parents. None of this would have been possible without their dedication—not to mention the cooperation of everyone who’s participated so far.

The data points to a terrific achievement. As Wayman notes, over 75 percent of parents present at bedside have been attending—a figure well above the average elsewhere in the country. In January, another team will roll out with family-centered rounds, and eventually all medical teams will be on board. We’re thrilled about this dramatic step forward at Packard Children’s.

On Saturday, October 16, 2010, the CVICU went live with computerized prescriber order entry and electronic clini-

cal documentation. As a result of careful planning and strong activation support, the transition from paper to computer has been safe and efficient, and both medical and nursing staff managed this major change effectively and with enthu-siasm. The CVICU has preserved its high-quality patient care while at near-capacity census with a typically high acuity level that has included surgical and medical admissions, resuscita-tions and mechanical circulatory support. Though still on

the steep learning curve, the staff is already generating new ideas for leveraging the electronic medical record (EMR) for process and workflow improvements. We thank the rest of the hospital for their support and encouragement.

Alice Rich, RN, Nursing Lead for CVICU ActivationStephen Roth, MD, Medical Director, CVICUAndy Shin, MD, Physician Lead for CVICU Activation Luanne Smith, RN, Clinical Informatics Manager for CVICU ActivationEllie Taft, RN, Manager, CVICU

“ The

feedback

I’ve been

getting from

parents and

nurses and

residents

and those

involved has

been pretty

positive. We

thought we

might get

push-back,

but that’s

not been the

case.”

CVICU Go-Live

5

Medical Staff U P D A T E

D E C E M B E R 2 0 1 0

is probably double for what’s appropriate—rice, bread, pasta,” Faig says. “The portion sizes have increased so much, and people have become used to it.”

Patients diagnosed with diabetes are taught to do home blood sugar monitoring and encouraged to take walks after meals, to bring down the blood sugar. But the first step after diagnosis is for the patient to see a dietitian, and Packard Children’s has a stellar one in Susan Carter, MS, RD, CDE. In addition to her broad expertise, she brings a crucial cultural sensitivity to her work, with different dietary recommendations for, say, Indian patients than Latino patients. Carter asks all patients to keep a diary of everything they eat, which then gets reviewed at subsequent appointments. In many cases, diet will take care of the problem. When it doesn’t, insulin is recommended. Our excellent diabetes nurse Mary Badel, BS, RN, CDE, and nurse practitioner Erlinda Stern, NP, MSN, CDE, also work very closely with patients to foster improved blood sugar control.

Meanwhile, Packard Children’s is doing outstanding work with pre-gestational diabetes too—cases where the patient has type 1 or type 2 diabetes before pregnancy. Babies from those pregnancies also are at risk for congenital anomalies, owing to high blood sugar levels in the first trimester. We take care of complex patients with type 1 diabetes, including use of multiple daily insulin injection, use of new types of insulins or insulin pump therapy.

“Sometimes patients are shocked—they show up for their very first visit and we tell them we recommend hospitalization,” Faig says. “For us, it’s an emergency.”

As the prevalence of gestational diabetes grows, the response from Packard Children’s will continue to evolve. Already, more intensive management has been shown to have clear benefits—more intensive glycemic control, more intensive diet. And diagnosis itself could potentially shift in the months ahead. As Faig notes, a new test recommended by the International Association of Diabetes and Pregnancy Study Groups would likely increase the population diagnosed with gestational diabetes—a number that’s been steadily rising to date. Thanks to the stellar contribution of all the doctors in the Obstetrical Clinic, the Packard Children’s Diabetes in Pregnancy Program will continue to be on the cutting edge of these changes, working with our diabetes patients closely and with great care to bring about the best result: a healthy and happy mom and newborn baby.

“ Sometimes

patients are

shocked—they

show up for their

very first visit

and we tell them

we recommend

hospitalization.

For us, it’s an

emergency.”


6 D E C E M B E R 2 0 1 0


Four improvement projects completed in four months by four multidisciplinary teams!

That’s the plan for the first-generation Local Improvement Teams (LITs) from the PICU, CVICU, NICU and clinics. This is an ambitious proposal, as many health care organizations have the best of intentions to improve their outcomes but fall short of their goals because they lack the internal expertise needed to execute quality improvement strategies. For this effort, Lucile Packard Children’s Hospital is partnering with the Institute for Healthcare Improvement (IHI) to provide onsite training to establish the foundational knowledge for effectively carrying out improvement initiatives now and into the future.

Improvement Science in Action is an IHI program designed to help hospital staff develop the skills and resources they need to carry out successful improvement projects. This extended course includes an orientation conference call, a three-day onsite workshop in November, monthly follow-up Webcasts, and a one-day onsite closing meeting in March 2011. It combines brief lectures and demonstrations with frequent interactive group exercises to reinforce key concepts and tools. At the end of the course, these teams that have formed will have the skills to transition to tackling improvements on the local level.

The four projects, along with their teams, are as follows: 1 Reducing Catheter-Associated Blood Stream

Infections in the CVICU Andy Shin, MD; Alice Rich, ANM CVICU; Kit Leong, Quality Manager; Kathleen Carney, Infection Prevention and Control; Winnie Yung, CNS CVICU

2 Improving Handoff of Care in the PICU Patty Decesare, PCM; Deb Franzon, MD; Paul Sharek, Chief Patient Safety Officer; Sandy Trotter, Dir. Patient Safety; and Erin Vera, Dir. Performance Improvement

3 Improving the Efficiency and Patient Flow in the Bass Center / Day Hospital and Clinics and the Pain Clinic Pam Simon, PCM; Neyssa Marina, MD; Vicki Link, Dir. Quality; Lyn Garrett,

Quality Manager; Kathleen Davidson, Dir. Operations, Pediatric/Obstetric Family Practice Organization; Elliot Krane, MD

4 Decrease Overall Costs Associated with Respiratory Therapist–Administered Pulmonary Vasodilators Vicki Arnolde, RCP; Mike Henry, Dir. Respiratory Care; Bob Poole, Dir. Pharmacy; Patti Pilgrim, Dir. Financial Plan and Decision Support Services; Katherine McCallie, MD; Cordelia Jewell, PCD; Lee Kwiatkowski, Performance Improvement

Several publications provide information and support to those interested in learning more about process improvement. They are provided here for your reference.

■■ Berwick, D.M. (1996). “A primer on leading the improvement of systems.” BMJ 312(7031): 619–22.

■■ Benneyan, J.C., R.C. Lloyd, et al. (2003). “Statistical process control as a tool for research and healthcare improvement.” Qual

Saf Health Care 12(6): 458–64.

■■ Solberg, L.I., G. Mosser, et al. (1997). “The three faces of performance measurement: improvement, accountability, and research.” Jt Comm J Qual Improv 23(3): 135–47.

■■ Nelson, E.C., P. Batalden, et al. (2007). “Developing High-Performing Microsystems.” In E.C. Nelson, P. Batalden and M.M. Godfrey, eds., Quality By Design. San Francisco, CA: Jossey-Bass.

■■ Conklin, J. (2005). “Wicked problems and social complexity.” In J. Conklin, ed., Dialog

Mapping: Building Shared Understanding of

Wicked Problems. Chichester, England: John Wiley & Sons.

■■ Langley, G.J., K.M. Nolan, et al. (2009). The

Improvement Guide: A Practical Approach

to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass. Please read or review chapters 4–8.

Ready, Set, Improve! IHI’s Improvement Science in Action

Improvement

Science in

Action is an

IHI program

designed to

help hospital

staff develop

the skills and

resources

they need

to carry out

successful

improvement

projects.

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D E C E M B E R 2 0 1 0

Diagnostic

tests also

revealed

themselves

to be a

scheduling

challenge, as

they often

required

coordination

of a facility’s

availability

with the

availability

of the

anesthesia

team.


Improving Our Management of Complex Care Patients

Each year, Lucile Packard Children’s Hospital treats around 300 complex care patients—

defined as those patients who see at least three subspecialists per year or are hospitalized at least three times per year. Recently the Faculty Practice Organization (FPO) was tasked with examining the model of care delivered to this population. The result is a broad assessment of how we manage such patients at Packard Children’s and a series of recommended improvements.

Daniel Murphy, MD, director of the pediatric cardiac clinical program, worked with Karen Kemby, director of business development, and Pam Molano, chief administrative officer of the FPO, in putting together a task force to examine the care provided to this population. With broad representation among health care professionals and administrators at Packard Children’s, the task force identified nearly 20 areas where care for complex patients could be improved.

In a setting where we provide family-centered care, Murphy says, patients or their families should always know the members of their care team and what the care plan is. Someone should also be available 24 hours a day to triage symptoms and help patients navigate the system at Packard Children’s. Care coordination roles and responsibilities can be more clearly defined, and overlap of efforts reduced. In addition, transition from the inpatient setting to outpatient can be coordinated more efficiently.

Half of the areas identified for improvement were related to information systems—the need for a comprehensive care plan in the electronic medical record, for instance. Virtually all of these issues are already being addressed by current projects, such as the hospital’s transition to the electronic medical record system in Cerner/LINKS. The task force also found that scheduling systems could be streamlined. They worked to develop “super schedulers,” as well, capable of scheduling multiple types of visits—something that single schedulers can’t do.

Diagnostic tests also revealed themselves to be a scheduling challenge, as they often required coordination of a facility’s availability with the availability of the anesthesia team. Many complex

care patients also face repeat procedures that require anesthesia. As a result, the anesthesia department has proposed identifying a primary anesthesiologist to work with the family, effectively becoming the patient’s advocate from the anesthesia service.

Ultimately the task force proposed solutions involving anesthesia, scheduling and information systems. An explicit care coordinator will be provided to patients: a liaison, essentially, to ensure that any questions are answered. He or she will likely be a specially trained nurse coordinator, Murphy says, and be part of a complex care team that will include a parent mentor, social worker, designated scheduler and in some cases at least one physician. Access to ancillary parts of the team is also crucial: a pharmacist, for instance, and an anesthesiologist.

Packard Children’s has put together a steering committee to bring this program into existence in the months ahead. John Mark, MD, has been identified as medical director, and other positions will be filled soon.

Similar programs have been assembled in a couple of other places across the country—notably at the Children’s Hospital of Wisconsin—but for the most part we’re in new territory. The relatively small population of complex care patients face the biggest challenges at our hospital. But as Murphy notes, we hope this program will serve as a broader model and raise the level of care coordination and communication for all of our patients.

As Murphy explains, “This program has the potential to positively change the way we care for patients in the hospital, and to dramatically improve outcomes, patient satisfaction and physician satisfaction.”

KENNETH COX, MD

Chief Medical Officer

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L U C I L E P A C K A R D C H I L D R E N ’ S H O S P I T A LL U C I L E P A C K A R D C H I L D R E N ’ S H O S P I T A L

D E C E M B E R 2 0 1 0

One of the key advances at Lucile Packard Children’s Hospital is the recent recruitment of a number of pathology faculty members who are trained in pediatric pathology, increasing the depth and breadth of this expertise at the hospital. There are now four such individuals, and their training complements the stellar work being done for our pediatric patients by faculty throughout pathology.

As with many disciplines within pediatrics, the significance of this training is rooted in recognition of the unique physiology and pathology of fetus, neonate, infant and child.

“In the past, a lot of people regarded children as little adults. The problem with that is you miss a lot of the special developmental issues—tumors that specifically affect

children, for example,” says Kim Hazard, MD, director of pediatric surgical pathology. “Pediatric pathology focuses just on children, and diseases and disorders that affect children. Built into the discipline is an understanding of the particular way children develop, the most common ways this development goes awry and the various neoplasms that may result.”

Hazard’s specialty is diagnosing diseases based

on tissue examination. If, for example, a patient has a tumor in the abdomen, an intraoperative frozen section diagnosis can be made to help guide surgery. Her main interests are tumors that affect children; metabolic disorders and how they affect children’s organs; and abnormalities that affect the gastrointestinal tract, such as inflammatory bowel disease and celiac disease. Hazard supervises the processing of all pediatric tissue samples that come into the department and serves as a liaison with the pediatricians and pediatric surgeons.

Meanwhile, Hannes Vogel, MD, director of neuropathology, focuses on a wide range of issues involving the central and peripheral nervous systems. This includes fetal and perinatal autopsy brain pathology; brain anomalies, including surgical resections for epilepsy; and brain tumors unique to children. He also has a strong commitment to special processing and interpretation of muscle and nerve biopsies, as an internationally regarded expert in pediatric neuromuscular diseases. He serves as a consultant to pathologists and pediatric neurologists throughout the West Coast.

“Because of their unique predispositions and development, children are a moving target in terms of treatment options. So you have to have someone who understands all these diseases in a developmental context, and who has experience dealing with them,” Vogel says.

Terri Haddix, MD, clinical assistant professor of pathology, has developed a forensic neuropathology consultation service. Postmortem examination of infants and children who are possible victims of nonaccidental trauma provides a specialized and tremendously important service to the community, and to victims and their families.

Amy McKenney, MD, director of perinatal pathology, is an expert in fetal and infant autopsy pathology, as well as placental pathology. She offers an invaluable service to obstetricians and families anxious to understand what happened in the case of a failed pregnancy or stillbirth, and contributes to the recognition of diseases that may affect genetic counseling. In addition, she

Pediatric Pathology Training Brings Valuable Focus to Department

HUGH O’BRODOVICH, MD

Chairman of Pediatrics Physician in Chief

“ Pediatric pathology focuses just on children, and diseases and disorders that affect children. Built into the discipline is an understanding of the particular way children develop, the most common ways this development goes awry and the various neoplasms that may result.”— Kim Hazard, MD, director of

pediatric surgical pathology

Medical Staff U P D A T EMedical Staff U P D A T E

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Please

make sure

you select

the active

inpatient

encounter in

LINKS/Cerner

when creating

your notes.

D E C E M B E R 2 0 1 0

has a special interest in pediatric acute myeloid leukemia (AML), reviewing cases of AML from around the world for children enrolled in Children’s Oncology Group (COG) clinical trials. She serves as vice chair for the pathology discipline within the COG and is devoted to this multidisciplinary collaboration in helping to bring cures to children with cancer.

“Her work is very important in terms of quality of care for our neonates. We can learn a lot about their prenatal history from the placenta, and this diagnostic evaluation provides clues to guide the diagnostic and therapeutic approach to the sick premature or neonate,” says Sharon Geaghan, MD, chief of pediatric pathology and co-medical director of the Stanford Hospital & Clinics clinical laboratory for pediatrics. “We are looking to capture more placentas submitted for this purpose, and are working with outside institutions for placentas to be transferred along with newborns transferred to our facility.”

As Geaghan notes, pediatric pathology cuts across many disciplines and demands a strong collaboration throughout the department; indeed, the diverse backgrounds and specializations of the rest of the faculty make for essential contributions to pediatric and obstetric care at Packard Children’s.

“We’ve got a real matrix here, with various faculty specialized by organ system, diagnostic technologies or pediatric pathology training, and each making important contributions,” Geaghan says. “That’s a large part of what makes it such a strong department, from the fetus to geriatric patients.”

LINKS Phase 3

MD Documentation

Phase 3 rollout continues with the activation of new services each

month. Over one-third of the services at Lucile Packard Children’s

Hospital have gone live. Physicians and other providers on these services

are actively creating and editing inpatient documents online in LINKS/

PowerChart. Approximately 5,000 online notes were created in October

2010. Four more services will go live before the end of 2010. The rest of

the inpatient services will go live in 2011.

We have also created document templates for medical students that

will enhance their ability to learn and practice online documentation.

We would like to remind the medical staff that medical student notes

are used primarily for education and should not replace primary

documentation by the providers. Medical student

notes should not be forwarded to the teaching

attending to support documentation requirements

for billing.

It is also important to create an online document

on the correct encounter. Please make sure you

select the active inpatient encounter in LINKS/

Cerner when creating your notes.

In addition, an electronic “Problems and

Diagnoses” module is available online in LINKS. This

tab allows a comprehensive and dynamic profile of

a patient’s problems and diagnoses. Service-specific

folders with common diagnoses and problems are

being developed.

A new online billing tool is being developed for faculty physicians.

By allowing attending physicians to send their inpatient and outpatient

charges directly through the billing system, the tool will simplify

billing, improve compliance with regulatory requirements, and enhance

revenue capture. A pilot will be available early 2011.

Training documents for clinical documentation are available on

https://intranet.lpch.org/CTP/training/reference/index.html. Online

training will be available soon at http://learnlinks.lpch.org.

Please contact Jin Hahn, MD, at [email protected], or Chris Longhurst,

MD, at [email protected], if you have any questions.

https://intranet.lpch.org/CTP/training/reference/index.html

http://learnlinks.lpch.org




10 D E C E M B E R 2 0 1 0

PHYSICIAN DOCUMENTATION TIPSCODING CORNER

All diagnosis codes have a default severity-of-illness level (SOI) assigned to them in the APR-DRG

classification system (used in benchmarking care provided at Lucile Packard Children’s Hospital with other pediatric acute-care facilities and public agency assessments such as HealthGrades, etc.).

Current pediatric documentation practice is to use “chronic lung disease” interchangeably with “bronchopulmonary dysplasia.”

These terms have different severity-of-illness defaults:

■■ 518.89—Chronic lung disease SOI default: 2/Moderate

■■ 770.7 —Bronchopulmonary SOI default: dysplasia 3/Major

DOCUMENTATION TIP:Including the diagnosis of “bronchopulmonary dysplasia” in your documentation will ensure that the severity of illness of your patient is accurately captured, thereby attesting to the level of care you are providing.

Inpatient Clinical Documentation Improvement: Why Does It Matter?

ICD-9 diagnosis codes are assigned on the basis of physician documentation.

■■ Imprecise, vague, conflicting or missing documentation does not capture your patient’s severity of illness.

■■ There must be a language match between diagnoses you specify and what is in the code books for the condition to be captured.

If there is no language match, then the condition can’t be coded. Examples:

Impact of accurate severity-of-illness capture: Accurate severity-of-illness attests to the complex level of care provided here at Lucile Packard Children’s Hospital. It provides a better correlation with resource consumption and can also contribute to a higher case-mix rate, resulting in the following:

■■ Accurate, appropriately risk-adjusted data for our submissions to such agencies as NACHRI, AHRQ and CHCA

■■ Improved benchmark scores among our CHCA peers

■■ More accurate risk adjustment of our mortality data and other outcomes assessments

■■ Better bargaining leverage for managed-care contracts and the ability to attract highly qualified practitioners to Packard Children’s due to improved contractual rates and reimbursement

Complete, accurate coding assists Packard Children’s and you in providing a detailed picture of the care provided to your patients.

Packard Children’s/HIMS Physician Documentation Improvement Efforts:

■■ Specialty-specific coding/documentation presentations at division meetings

■■ Monthly documentation-tips article publication in physician newsletters and email distribution to medical staff

■■ Robust physician query process

Severity Level Descriptor

1 Minor

2 Moderate

3 Major

4 Extreme

Bronchopulmonary Dysplasia vs. “Chronic Lung Disease”

Uncodeable documentation Codeable documentation

Midline shift on head CT Compression of brain

Hemodynamic instability Shock

Ejection fraction 30% Cardiomyopathy

Platelets 48K Thrombocytopenia

Altered mental status Acute delirium

For coding/documentation questions or concerns, contact Jean Stone, RHIT, CCS, Packard Children’s coding manager, at (650) 724-6275 or [email protected]. For additional questions about documentation best practices, please contact Chantel Susztar, RHIT, CCS, CCS-P, director of hospital billing integrity, at (650) 723-0433.


LINKS PowerChart Gets a Facelifte-Prescribing Phase 2: LINKS/Cerner Enhanced View

Under the leadership of Becca McKenzie, MD, Lucile Packard Children’s Hospital is preparing to go live with Cerner’s “enhanced view” in April 2011. This facelift will make PowerChart more Web-like and easier to use,

particularly for ambulatory/clinic workflow, and includes a new Message Center that will allow for electronic refills of prescriptions.

This project will also include the following:

■■ Electronically transmitted prescriptions—the ability to directly transmit prescriptions to the Pharmacy system utilizing SureScripts interfacing technology

■■ Electronic consult referrals—the ability to request ambulatory provider and radiology consults electronically with a “closed loop” approach so that the provider is aware of the status of the consult

The new “enhanced view” will include the following features:

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D E C E M B E R 2 0 1 0

1 An enhanced tool bar will show both icons and titles,

providing quick access to other applications, websites,

or patient lists.

2 Three locator tools to locate and open a patient chart

will include

a. “List” button

b. “Recent” button

c. Name search

3 A new and improved Refresh button will show how

long it has been since the last current page refresh.

4 A Menu or Table of Contents (TOC) will replace the tab system previously located across the top of a patient’s chart. The TOC is designed for easier chart navigation.

5 Some sections will include a Quick Add feature , which will take you directly to the Add Order, Add Prescriptions, or Add Allergy window.

6 External medication history will be available from other pharmacies where patient has filled prescriptions, as well as access to insurance eligibility and copays.

For more information and for questions, please contact Becca McKenzie, MD, at [email protected].

1➜

4➜

3

5

2

6

➜

➜



12 D E C E M B E R 2 0 1 0

LEGISLATIVE UPDATE

Republicans picked up 60 seats and regained control of the House of

Representatives, while the Democrats retained control of the Senate, though

by a much smaller margin. It is too early to determine the full extent of the

potential impacts this will have on health care reform.

E L E C T I O N R E S U LT S

F E D E R A L I S S U E S

S TAT E I S S U E S

By Sherri Sager

State BudgetThe state finally passed the budget. The main impact on Packard Children’s is a four-year freeze on Medi-Cal reimbursement for fee-for-service patients. The California Hospital Association (CHA) is planning a lawsuit to overturn the freeze on reimbursement.

Short-Term Provider FeePackard Children’s received its first supplemental payment as a result of the provider fee in October. All provider fee supplementals for the current program should be received by January 31, 2011. The Medi-Cal fee-for-service program will distribute all funds by December 31, 2010, and the Medi-Cal Managed Care plans have until January 31, 2011. The current program lasts until December 31, 2010. Packard Children’s should net approximately $33 million.

Congress passed a scaled-down extension through June 30, 2011, of the enhanced Federal Match for Medi-Cal in early August. When the state Legislature reconvenes in January, CHA will take the lead on extending

the current provider fee for six more months. Significant work must be done on modeling. Early estimates are for a total supplemental from this extension of roughly $5 million for Packard Children’s.

1115 WaiverThe state was notified on November 2 that

the Centers for Medicare & Medicaid Services (CMS) approved the Medi-Cal Section 1115 Waiver for five years.

Through the Section 1115 comprehensive waiver, California will receive approximately $10 billion in federal funds to invest in its health care delivery system to prepare for national health care reform. These investments also are designed to help slow the rate of growth in health care costs within the Medi-Cal program. Key elements of the waiver include the following:

■■ Expanded coverage. The waiver builds on the existing coverage initiative offering participation to all the counties in the state to cover as many as 500,000 uninsured individuals.

Through the Section 1115 comprehensive waiver, California will receive approximately $10 billion in federal funds to invest in its health care delivery system to prepare for national health care reform.

We are working with N.A.C.H. to resolve two major issues before the end

of the year. The first is a technical correction on the 340B program to

allow children’s hospitals to utilize the program for orphan drugs. Without

this correction, Lucile Packard Children’s Hospital’s potential support from the

program drops from $3 million to $4 million annually to less than $1 million. The

second issue is the appropriation for fiscal year 2011 for the Children’s Hospitals

Graduate Medical Education (CHGME) Program. In September, Congress passed a

continuing resolution to fund the federal government through November, which

had CHGME funding at last year’s level. Depending on what happens in the lame

duck session, this amount could be reduced by as much as 10 percent. Packard

Children’s share was roughly $7 million annually for the past year. The program

must also be reauthorized in this fiscal year.

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D E C E M B E R 2 0 1 0

O T H E R I S S U E S

■■ Increased funding for uncompensated care. The waiver expands the existing Safety Net Care Pool to provide additional support to finance uncompensated care.

■■ Improved care for vulnerable populations. The waiver provides for enrollment of seniors and persons with disabilities in managed care to achieve better care coordination and management of chronic conditions.

■■ Promotion of public hospital system transformation. The waiver implements a series of improvements in public hospitals and their delivery systems to strengthen their infrastructure and prepare them for full implementation of health reform.

Voters in Santa Clara County failed to approve Measure A by the necessary two-thirds vote, though it did have a large majority in favor. This means that the Healthy Kids program is in danger of being reduced significantly, with children going back on a waiting list, or even eliminated.

If you would like more information on health-related legislation or the state budget, please contact Sherri Sager, Packard Children’s chief government relations officer, at [email protected].

Personal Health Record (Google Health) Pilot Project Update

The project to integrate the Lucile Packard Children’s Hospital electronic medical record—based in LINKS, the “LPCH Information and Knowledge

System”—with the Personal Health Record (PHR), powered by Google Health, is off to a great start. We successfully enrolled and connected our first early adopters, including family advisory council members, in September. Early adopter feedback has been overwhelmingly positive.

We recently enrolled and linked several patients from the Endocrine and Transplant Clinics, and are making plans for enrolling patients in other services. Pilot families and patients are selected by their physicians and will be surveyed by the PHR team for feedback on their user experience as well as perspective on this project’s impact on their health habits. The project team will also survey physicians on their experience with viewing their PHR.

What Is the PHR Google Health Pilot?The PHR pilot provides a bi-directional interface between Google Health

and LINKS, allowing patients in the pilot group to download a subset of their clinical data from Packard Children’s into their Google Health account, and allows physicians to drive straight from LINKS/PowerChart directly into a patient’s PHR. The project team’s goal is to have at least 100 patients enrolled by the end of the year and complete the pilot evaluation by spring 2011.

For more information on this innovative pilot project or to participate in this project, please contact the physician lead, Arash Anoshiravani, MD, at [email protected], or Christopher Longhurst, MD, at [email protected].

A Note About Schedule 2 Prescriptions

There have been intermittent issues with some pharmacies not accepting

our printed schedule 2 prescriptions, which account for fewer than 200 of the 7,000 prescriptions generated electronically each month at Packard Children’s. We have recently revised the format to comply with all new regulations, including the addition of a designated institutional prescriber (Chris Longhurst, MD) on the tamper-proof paper as an attestation of LINKS system security. For e-prescribing questions or support, please contact Kevin Nishioka at [email protected] or pager 18359 during business hours.





14 D E C E M B E R 2 0 1 0

New Outpatient Rehabilitation Facilities Open House

Outpatient Rehabilitation

Services at Lucile Packard

Children’s Hospital is moving to its

new home and invites physicians

and their families to a special open

house. The expanded facility will

reduce waiting lists for popular

services such as speech therapy,

and accommodate a wider range

of therapies such as sensory

integration for children with

autism, biofeedback therapy,

cardiac rehabilitation and sports

medicine. Join us and meet the

Outpatient Rehab team, tour the

clinic and participate in interactive

demonstrations.

Invitations to follow.

Saturday, January, 22, 2010

10 am–3 pm

321 Middlefield Road, Menlo Park

1Eating and drinking in the patient care

areas is not allowed. This is an Occupational

Safety and Health Administration (OSHA)

regulation, designed to keep clinicians safe

from inadvertently acquiring an infection while

visiting patients in the patient care units. Coffee

and food are not allowed on rounds except in

designated break areas.

2It’s time to get a flu shot. Flu shots are now

required by law. Immunization is available

through the Occupational Health Department,

now located on the ground floor of Stanford

Hospital & Clinics in Room H0124. Please call

(650) 723-5922 to make an appointment.

3California law requires that certain patients

be screened for MRSA upon admission to the

hospital. When a patient is nares-screen positive,

it is the responsibility of the physician to inform

the patient. Nursing can provide an information

letter. Documentation of notification of parents

and patients is critical.

Infection-Prevention Reminders

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D E C E M B E R 2 0 1 0

Viral testing

does not

rule out all

viral illness;

therefore,

patients with

respiratory

symptoms

should

remain in

isolation

even if viral

respiratory

tests are

negative.

Diagnosis

Patients with respiratory signs, fever or apnea should have one nasal swab submitted for

a respiratory virus direct flourescent antibody (DFA) panel with reflex polymerase chain reaction (PCR) (order code DVERVR). If the DFA is negative, testing for influenza by PCR is automatically performed. The DFA has excellent sensitivity compared with PCR for human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) (94–96 percent). In selected circumstances, the clinician may wish to order an RSV or hMPV PCR test if the DFA is negative for these viruses.

To obtain an adequate specimen, collect one flocked swab in viral transport media. Flocked swabs are available in the viral respiratory testing kit. These kits are provided by Micro/Viro Accessioning at (650) 724-8632. If a viral culture is required, submit an additional flocked swab in a second viral transport media tube. If pertussis is also in the differential diagnosis, use the Pertussis Diagnostic Kit for specimen collection.

LABORATORY TESTING SCHEDULE AND TURNAROUND TIMES

1 DIRECT FLUORESCENT ANTIBODY:• Received by 8 am, DFA results by 1 pm• Received by 4 pm, DFA results by 9 pm• Received by 10 pm, DFA results by 10 am

2 FLU A/RSV/hMPV PCR: Set up daily (once on weekends), results 48 hours from DFA collection

3 FLU A SUBTYPING & RESISTANCE TESTING: Set up three times per week, results in approximately five to seven days

Infant Placement and Isolation

If an infant under 2 months of age is critically ill and requires urgent admission before screening

results are available, the patient should be placed on contact/droplet isolation in a single room in the PICU (first choice), a small PICU room (second choice, initiating a cohort), or an isolation room in the NICU (third choice) or NICU Room 2 (fourth choice, initiating a cohort there). Critically ill infants with confirmed seasonal influenza should be admitted to an isolation room in the PICU and placed on droplet precautions. Admission to a multipatient room is not acceptable unless directed by Infection Prevention and Control (IPC), e.g., during a community outbreak of influenza.

If the infant is not critically ill and admission is required before viral test results are available, or if the infant is RSV-positive by DFA or PCR, he/she should go to a single room at Packard Children’s El Camino (PEC) (first choice), a single room at Packard Children’s on the third floor (second choice), or an NICU isolation room (third choice), or should join or initiate a cohort in NICU Room 2 (fourth choice). It is highly recommended that placing RSV-positive patients in any of the special care nurseries—e.g., IICN, PSCN—be avoided. A consultation with the unit medical director and IPC is required before RSV-positive patients can be placed in these units.

Infants that are not critically ill and are influenza-positive by DFA or PCR should be placed in a single room at PEC (first choice) or a single room on the third floor at Packard Children’s (second choice); admission to an NICU isolation room should be a last resort. Admission to a multipatient room is not acceptable unless directed by IPC—e.g., during a community outbreak of influenza.

Viral testing does not rule out all viral illness; therefore, patients with respiratory symptoms should remain in isolation even if viral respiratory tests are negative. Consult with Infection Prevention and Control, at (650) 497-8447.

A physician order for droplet/contact isolation is required until test results are returned. For confirmed influenza, including H1N1, droplet precautions alone are required.

Diagnosis, Patient Placement and Isolation During Viral Respiratory Season


16 D E C E M B E R 2 0 1 0

Yvonne (Bonnie) Maldonado, MD, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases, along with her co-principal investigators, Michele Barry, MD, senior associate dean for global health and professor of medicine at Stanford Hospital & Clinics, and Dr. David Katzenstein, professor of infectious diseases, have received a $10 million grant from the NIH Medical Education Partnership Initiative to improve medical education at the University of Zimbabwe over the next five years. Congratulations to Dr. Maldonado and her colleagues.

Alejandro Sweet-Cordero, MD, has been awarded a $100,000 pediatric oncology research grant from the St. Baldrick’s Foundation, a nonprofit organization dedicated to raising money for childhood cancer research. With only 3 percent of all federal funding for cancer research dedicated to pediatric cancer, the St. Baldrick’s Foundation grant funds are critical to continue the battle against this devastating disease. Dr. Sweet-Cordero’s research focuses on Ewing’s sarcoma, one of the most common sarcomas in children.

Eric Sibley, MD, PhD, associate professor of pediatrics (gastroenterology), has been elected to the American Clinical and Climatological Association. He will be inducted into membership during the organization’s 123rd meeting October 21–24 in San Antonio, Texas.

Richard Barth, MD, radiologist in chief at Packard Children’s, was named as number eight among the “25 most influential people, institutions, or events that shaped radiology in 2010” by rt image magazine.

Thomas Krummel, MD, professor and chair of the Department of Surgery at the School of Medicine and Susan B. Ford surgeon in chief at Lucile Packard Children’s Hospital, has been elected to two positions in the James IV Association of Surgeons: international vice president and president of the U.S. division. The association, named for a surgically minded English monarch, sponsors travel fellowships and other activities to improve communication between surgeons in English-speaking countries.

Michael Hsieh, MD, PhD, from pediatric urology, won second prize in the basic science category at the 2010 American Academy of Pediatrics, Section on Urology meeting for the paper “The Bacterial General Stress Response Confers Antibiotic Resistance to Uropathogens in Vivo.” The research was in collaboration with Dr. A.C. Matin at Stanford.

Christopher Longhurst, MD, chief medical information officer, was named by ModernHealthcare.com as one of the top 25 clinical informaticists of 2010. Longhurst has led the hospital’s implementation of computerized physician order entry and, after serving as physician lead and medical director for clinical informatics, was named Packard Children’s chief medical information officer this year.

Faculty Updates

Eric Sibley, MD, PhD

Richard Barth, MD

Alejandro Sweet-Cordero, MD

Yvonne Maldonado, MD


1717D E C E M B E R 2 0 1 0

Christopher Longhurst, MD

Michael Hsieh, MD, PhD

Thomas Krummel, MD

Packard Children’s Heart Center and UNM Children’s Hospital Heart Center Hold Reunion with Families

The University of New Mexico Children’s Hospital celebrated its successful affiliation with Packard Children’s and our Children’s Heart Center on

October 2. Packard Children’s specialists traveled to New Mexico for this special family reunion in honor of the lifesaving care these kids have received from both institutions’ cardiology teams and Packard Children’s leaders in cardiothoracic surgery.

Innovations in Patient Care Grant Awards

The Innovations in Patient Care

(IPC) Grant Program has been supporting research across all disciplines at Lucile Packard Children’s Hospital since 1997. IPC seeks to enhance patient care research from all caregivers and clinicians at Packard Children’s, and provides funding for basic science, clinical, or systems creative ideas that represent departures from conventional thinking. Many funded projects have changed clinical practice here at Packard Children’s as well as led to external funding. The program is made possible by a grant from the Lucile Packard Foundation for Children’s Health. This year’s winners are as follows:

Kristen Beckler, CTRS, CCLS, for her research study “Decreasing patient anxiety through PREP during heart transplant evaluation”

Anna Bruckner, MD, for “An Investigational Pilot Study to Evaluate Sildenafil for the Treatment of Lymphatic Malformations”

Deborah Franzon, MD, for her research study “Evaluating the Effect of Implementation of an Electronic Medical Record (EMR)-linked PICU Dashboard: Adherence to Patient Safety Guidelines and the Impact on Staff Communication”

Kevin Pieroni, MD, for his research study “Aluminum Content of Parenteral Nutrition Solution Products”

Kristine Taylor, RN, for her research study “Certification of Pediatric Nurses Improves Nursing Environment”

Kristen Beckler, CTRS, CCLS, with Yurelia and Fiorella

Rocha-Arias and their mother, Maria Elizabeth Arias.


18 D E C E M B E R 2 0 1 0

Jonathan Berek, MD, professor and chair of obstetrics and gynecology, has been given the 2010 John C. Fremont Pathfinder Award. The annual award “honors native Nebraskans who have made outstanding contributions to mankind that exemplify the vision and courage of John C. Fremont.” The award was conferred in July at a special ceremony in Fremont, Nebraska. Berek is also the director of the Women’s Cancer Center of the Stanford Cancer Center.

Deirdre Lyell, MD, has been promoted to associate professor of obstetrics and gynecology, in the Division of Maternal-Fetal Medicine, as of October 1. She is interested in prevention of prematurity, prenatal diagnosis and complications of cesarean delivery. Lyell also is the associate fellowship director for the Division of Maternal-Fetal Medicine, is director of the Center for Placental Disorders, and serves on the quality assurance committee of the Department of Obstetrics and Gynecology.

Mary Norton, MD, has been appointed professor of obstetrics and gynecology, effective October 1. Norton is interested in maternal and fetal medicine, prenatal diagnosis and reproductive genetics.

Jessica Rose, PhD, director of the Motion & Gait Analysis Lab at Packard Children’s, has been promoted to associate professor of orthopedic surgery, effective September 1. Her research focuses on the neuromuscular mechanisms underlying gait abnormalities in children with cerebral palsy and other pediatric orthopedic conditions.

Paul Sharek, MD, MPH, has been promoted to associate professor of pediatrics at Packard Children’s, effective October 1. His research focuses on hospital-based quality of care improvement, particularly pediatric patient safety. Sharek

has spent his early research career developing practical tools to more accurately identify adverse medical events and to establish national rates of these adverse events, and is presently identifying and implementing best practices to decrease these adverse events. He is a chief clinical patient safety officer and medical director of quality management at Packard Children’s.

Roland Bammer, MD, has been promoted to associate professor (research) of radiology as of August 1. One of Bammer’s research interests is the development of advanced imaging techniques that can be used for children and for fetuses. He is

also a member of Stanford Stroke Center, where he is investigating new imaging methods to improve triage and treatment of patients with cerebrovascular diseases.

Ritu Asija, MD, has been reappointed as clinical assistant professor of pediatrics, effective 7/1/2010.

Rebecca Blankenburg, MD, MPH, has been promoted to clinical assistant professor of pediatrics, effective 10/1/2010.

Melanie R. De Guzman, MD, has been appointed as clinical assistant professor (affiliated) of obstetrics and gynecology, effective 9/1/2010.

Abuse Awareness Awards

The Stanford Medical Center Family Abuse Prevention Council has announced the 2010 winners of the Abuse Awareness Awards. The

Clinical Prize this year is shared by three Packard Children’s members—Jack Komejan, LCSW; Sandra Trotter, MBA, MPHA, CPHQ; and Kiersten Wells, RN, PNP, SANE—who were instrumental in creating a SCAN (Suspected Child Abuse and Neglect) committee and on-call team. The purposes of this committee are to provide inpatient, Emergency Department and outpatient consultation/examination in cases of suspected child abuse or neglect; review the process of identification, handling and documentation of these cases at a monthly case conference; interact with county agencies to provide optimum patient care; and educate staff, residents and medical students about child abuse and neglect. Komejan, Trotter and Wells have shown their dedication through patience, persistence, and extensive time and effort beyond their “day jobs” to make this multiyear project a reality.

Jack Komejan, LCSW Sandra Trotter, MBA, MPHA, CPHQ

Kiersten Wells, RN, PNP, SANE

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D E C E M B E R 2 0 1 0

Cynthia L. Detata, MD, has been reappointed as clinical assistant professor of obstetrics and gynecology, effective 9/1/2010.

David R. Drover, MD, has been reappointed as associate professor of anesthesia at the Stanford University Medical Center, effective 11/01/10.

Manuel Garcia-Careaga, MD, has been reappointed as clinical professor of pediatrics, effective 4/1/2010.

Frederick Hopkins, MD, has been appointed as clinical associate professor (affiliated) of obstetrics and gynecology, effective 9/1/2010.

Joyce Hsu, MD, MS, has been reappointed as clinical assistant professor of pediatrics, effective 7/1/2010.

Nasha Nasim Sabery Khavari, MD, MPH, has been appointed as clinical assistant professor of pediatrics, effective 11/1/2010.

Tzielan Lee, MD, has been promoted to clinical associate professor of pediatrics, effective 10/16/2010.

John D. Mark, MD, has been promoted to clinical professor of pediatrics, effective 7/01/2010.

Elizabeth D. Mellins, MD, has been promoted to professor of pediatrics at Packard Children’s Hospital, effective 9/1/2010.

Janesta Noland, MD, has been promoted to adjunct clinical assistant professor of pediatrics, effective 7/01/2010.

Rajesh Punn, MD, has been appointed as clinical assistant professor of pediatrics, effective 10/16/2010.

Christopher Talluto, MD, has been promoted to clinical assistant professor of pediatrics, effective 8/1/2010.

Packard Children’s Clinics Celebrate Successful 2010 Accomplishments

Lucile Packard Children’s Hospital clinic services exceeded

the 50 percent target of services meeting the 10-day

third-next-available new-appointment goal in FY2010. That

target has now been raised to have 80 percent of our services

meet the same new-appointment goal. This is also a Faculty

Practice Organization (FPO) incentive for 2011. In September,

69 percent of services met this goal. Many services have been

successful in providing more appointment availability through

template redesign and review of referral demand data. Services

not meeting the target will be contacted to review their

performance and the available data to help them successfully

achieve this goal.

All clinics exceeded the 95 percent target for on-time clinic

starts for FY2010. This was accomplished through the hard

work of our clinic staff and the commitment of clinic providers

to start their sessions on time. We continue to look for ways to

improve the visit experience. Starting clinic on time is one way to

minimize delays later in the day. Congratulations to all for their

hard work on this effort.

The fourth-quarter Press Ganey mean score for “Keeping

Families Informed of Delays” was a high 76.6, and has been

positively trending over the last two years. This question

correlates with the caring and compassion associated with the

“Likelihood to Recommend” scores. Our Service Ambassadors

have been assigned responsibility to work with each service chief

and practice manager to refresh their patient satisfaction plans

with specific improvement goals established for each service.

x

Packard Children’s Medical Staff Update can also be found online by visiting http://medicalstaff.lpch.org. Click Communications and then Packard Children’s Medical Staff Update.

Upcoming CME Courses

PACKARD CHILDREN’S MEDICAL STAFF UPDATE is produced six times yearly by the Packard Children’s Marketing Department and Medical Staff Services. Comments and contributions, including notices of your honors and accomplishments, should be directed to:

Julie GreiciusMedical Staff Update [email protected]

Debra Green, MPA, CPMSM, CPCSDirector, Medical Staff [email protected]

Pediatric Otolaryngology Update

February 11–12, 2011

Li Ka Shing Center for Knowledge and Learning

Stanford University School of Medicine, Stanford, CA

19th Annual Pediatric Update and Pre-Conference

July 14–16, 2011

Frances C. Arrillaga Alumni CenterStanford, CA

For complete conference

and registration information

or to learn more about

other upcoming activities:

Tel: (650) 497-8554

Email: [email protected]

http://cme.lpch.org

PALS

The Center for Nursing

Excellence offers life support

training (PALS, NRP & BLS).

PALS is now certified for

CME credit.

http://medicalstaff.lpch.org




http://cme.lpch.org

http://www.lpch.org/forPhysiciansHealthProfessionals/centerForNursingExcellence/educationTraining/nursingEdclasses.html

http://www.lpch.org/forPhysiciansHealthProfessionals/centerForNursingExcellence/educationTraining/nursingEdclasses.html

DECEMBER 2010 Medical Staff - Lucile Packard Children's Hospital · 2010-12-10 · As Lucile...

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