Satisfaction scores for 15 specialties at Stevens were also improved and increased significantly in the following areas:

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1 17 February 2010 Medical Staff Stevens Hospital VitalSigns this issue P.1 Physician Satisfaction Medical Staff Hears About Swedish Affiliation Close to 80 members of the Stevens Hospital Medical Staff attended a special medical staff meeting in January to discuss the Stevens Hospital affiliation with Swedish. The meeting was held in the auditorium of Stevens. Mike Carter, CEO and president of Stevens Hospital, Cal Knight, COO and president of Swedish and Rod Hochman, CEO, Swedish addressed the medical staff and answered questions. P.2 CME Corner Urgent Documentation Request P.3 Hospital Statistics P.4 Patient Satisfaction Survey Comments P.5 to P.7 New Emergency Department Medical Staff P.5 Hemoglobin A1C Now Approved For Diabetes Diagnosis P.8 Welcome New Medical Staff Members Physician Satisfaction Increases at Stevens Physician satisfaction increased at Stevens Hospital according to results from the 2009 Press Ganey Physician Satisfaction Survey. According to the survey, there was an overall mean score of 6.2 points over results from the 2008 Press Ganey Survey. This ranks Stevens in the 91st percentile for improvements with other Press Ganey hospitals. Survey results were presented at January s Stevens Leadership Development Institute (LDI) for hospital managers and directors and most of you should have received an e- mail the first week of February from Stevens Physician Relations and Development detailing the 2009 results. Satisfaction scores for 15 specialties at Stevens were also improved and increased significantly in the following areas: Hospital and physicians working together to improve care Communication is more transparent and Stevens administration is more accessible according to a strong majority of surveyed physicians. There is also overall increased physician satisfaction with Stevens Emergency Department and the availability of emergency care. Physicians would like to see even more focus on communication to referring physicians from the ED as well as maximizing opportunities for physicianhospital-nursing collaboration for improved care. Identifying physician priorities for CME improvement was also viewed as important. Detailed results of the satisfaction survey are being sent to all the physicians who were invited to take the survey, says Timothy Roddy, MD and Stevens chief medical officer. Plans are already underway to analyze and develop a work plan to further improve overall physician satisfaction. Physicians being involved in decisionmaking Nursing collaboration with medical staff Please see Physician Satisfaction on Page 4

2 CME Corner John Arveson CME Program Coordinator About 35 physicians participated in the Grand Rounds conference on professional liability on February 3. The speakers, Tom Fain and Michele Atkins, from the law firm of Fain, Anderson and Vanderhoef, discussed the recent history of professional liability in Washington state, a brief review of the types of claims they see as defense lawyers, the issue of informed consent, as well as other issues. Fain noted that the most common cases his firm sees involve allegations of missed or delayed diagnoses, delays in seeing the patient, and of course, unanticipated bad outcomes. He further commented that the easiest ways to avoid claims is to establish a good relationship with your patients, communicate clearly and effectively, and have good documentation in the medical record. He also noted that Washington state adopted an apology law that allows physicians to apologize when an unfortunate event occurs without it being admissible or used as an admission of wrong doing. Atkins discussed the elements of informed consent, which under Washington law requires physicians to inform patients of material risks of treatment. A material risk is defined as one that a reasonably prudent person would think is significant in deciding whether to agree to the treatment. She also noted that it is her opinion that more detailed consent forms are generally better that general ones, that it is better that they are signed in advance rather than right before the procedure, and that the doctor performing the procedure obtain the consent rather than a nurse. Exceptions to the duty to obtain informed consent include when risks are not reasonably foreseeable or commonly known, emergency situations when the life or well-being of the patient is at risk and a few other situations. She Please see CME Corner on Page 3 Urgent Documentation Request! The Department of Health recently conducted a survey at Stevens Hospital. The overall results of the survey were positive. However, the DOH survey identified a number of documentation deficiencies. To correct these deficiencies, please be sure to do the following: Include date and time with your signature when signing progress notes and orders. Authenticate co-signed telephone orders that include medication within 24 hours. Authenticate co-signed telephone orders that are not medication orders within 48 hours. Authenticate physical and chemical restraint orders with time, date, and your signature in the same pen and handwriting every 24 hours. Fill out the restraint order form, do not write "Restrain PRN" on the chart. Please contact Loree McGill, RN, CDS, CPDI program manager, at with any questions. 2

3 CME Corner (continued from page 2) also noted that a recently enacted state law encourages shared decision-making where the physician provides a description of the services being provided and uses decision aids written in lay language that outlines the risks and benefits of the proposed treatment. Shared decision-making also includes a statement that the patient signs indicating that he/she understands the seriousness of the condition, the treatment being proposed, available alternatives and the risks and benefits to the proposed treatment and the alternatives. While this process is cumbersome, it does shift a plaintiff s burden of proof that he/ she was not informed of risks to clear and convincing a higher standard than just preponderance. Members of the Stevens medical staff attend CME Grand Rounds held in early February. Seattle attorney and guest speaker, Tom Fain, discussed trends in professional liability. Coming Soon for CME What: Vitamin D deficiency presentation and discussion with guest speaker Dr. Ian De Boer from the University of Washington When: April 7, 12:30 p.m. to 2 p.m. Where: Stevens Auditorium B What: Physicians Insurance presentation on electronic fetal heart monitoring When: March 25, 5:30 p.m. to 8:30 p.m. Where: Stevens Café Mark your calendar and plan to attend! December Hospital Statistics December-09 December-08 % Change Average Daily Census % Admissions % Total ER Visits 3,555 3, % Total Surgeries % Deliveries % Days of Cash % 3

4 Physician Satisfaction (continued from page 1) This chart reflects physician satisfaction scores for 15 specialties at Stevens that were above 70 percentage points. Press Ganey Rank Order of Specialty Satisfaction Psychiatry 85.4 Radiology 81.9 Opthalmology 81.4 Medical Spec Surgical Spec Urology 78.5 OB/Gyn 78.4 Family Med Infectious Dis Pulmonary 74.2 General Surg Hospitalist 70.5 Anesthesia 70.5 GI Congratulations These individuals were mentioned by name in the November Press Ganey Patient Satisfaction Surveys and complimented for their great work. Catherine Rogers, MD Charles Daly, MD Radia Imaging Daniel Timmons, MD Darcy Foral, MD Edmonds Orthopedic Center David Fuhrmann, MD Birth & Family Clinic Debora Sciscoe, MD Edward Lee, MD Radia Imaging Jeffrey Bray, MD Jeffrey Remington, MD Edmonds Orthopedic Jon Pazevic, DO Emergency Department Judith Babcock, MD Birth & Family Clinic Keith Luther, MD SCIM Kimberly Dickey, DO Linda Brunson, MD SCIM Linda Strong, MD SCIM Matthew Matko, MD SCIM Maurene Cronyn, MD Birth & Family Clinic Melissa Chinn, DO Robert McCoy, MD Sleep Center 4

5 New Medical Staff in the Emergency Department There are some new faces at Stevens Emergency Department. Below are profiles featuring the hospital s newest ED physicians and physician assistants. Since many patients are admitted to the hospital via the ED, these profiles will assist other physicians and members of the medical staff with knowing who is caring for ED patients. Please take a moment to review the information. Some of it is fun and may be surprising! Taddele Ambachew, PA-C Originally from Ethiopia, Physician Assistant Taddele Ambachew, who is the Emergency Department lead PA is a graduate of MEDEX Northwest; Physician Assistant Training Program, University of Washington School of Medicine in Seattle. He chose Emergency Medicine as his specialty because it s among the areas of healthcare that see the greatest need. Emergency medicine is my passion, says Ambachew. So many people come to the ED in need of care. It s important to me to provide quality, accessible medical care regardless of income. Also, I m a very strong advocate of educating people about healthy, non habit forming ways to take care of themselves and manage chronic pain. Working in the ED provides opportunities to reach out to people in crisis and make a difference. Taddele very much enjoys volunteering. He s a member of the board of directors for Urban Impact, Rainier Valley an organization whose mission is to strengthen families and raise servant leaders by building lifechanging relationships that encourage good health, quality education, economic opportunity, and a Christcentered faith. Taddele is also a member of CARE International, a humanitarian organization dedicated to fighting global poverty. Additionally, he s a member of the American Academy of HIV Medicine (AAHIVM) which focuses on education, prevention and treatment. Taddele also dedicates his time as CEO and Medical Director of the children s orphanage WABE in Ethiopia. Taddele is married with two daughters. Dave Bender, PA-C Physician Assistant Dave Bender is a graduate of MEDEX Northwest; Physician Assistant Training Program, University of Washington School of Medicine in Seattle. Bender began his career in medicine as a United States Navy Hospital Corpsman. He has been a physician assistant working in emergency medicine since Please see Emergency Department Staff on Page 6 Hemoglobin A1C Now Approved For Diabetes Diagnosis By: Mark Silver, MD, endocrinologist The American Diabetes Association (ADA) now recommends an A1C of 6.5 percent or greater as a diagnostic test to diagnose diabetes. The prior criteria of a fasting blood sugar (FBS) of 126mg/dl or higher, or a two-hour glucose of 200mg/dl or higher, on a 75 gram oral glucose tolerance test still may apply. In addition, a random glucose of 200mg/dl when accompanied by severe classical hyperglycemic symptoms is sufficient to make the diagnosis. For a diagnosis of prediabetes, the ADA defines an A1C between 5.8 and 6.4 percent as an increased risk for developing diabetes. Those patients should be monitored more closely than usual practice. If their FBS is 126mg/dl or greater, on two separate occasions, they would be diagnosed with Type 2 Diabetes. It is important to understand that the A1C can be falsely low in patients with some forms of anemia, hemoglobinopathies and pregnancy. In those situations, the diagnosis must use glucose criteria exclusively. Stevens Diabetes Education Program offers classes in diabetes and prediabetes monthly. Call for more information or referral forms. 5

6 Emergency Department Staff (continued from page 5) I enjoy the fast pace of emergency medicine, performing procedures and being able to make a difference in a patients lives in the amount of time that I m with them in the Emergency Department, says Bender. I like the interaction with patients and in every encounter I use a greeting that acknowledges the patient, explains who I am, why I m there and what will be involved in their treatment. Good communication with patients is important. Bender is certified by the National Commission on Certification of Physician Assistants. He is a fellow of the American Association of Physician Assistants and of the Society of Emergency Medicine Physician Assistants. Marc Burdick, DO Dr. Marc Burdick completed his doctorate of Osteopathic Medicine at Midwestern University, Arizona College of Osteopathic Medicine and his residency in Emergency Medicine at the University of Nevada School of Medicine where he was the chief resident. He is a member of the American Academy of Emergency Physicians and his personal interests include serving as an Emergency Physician on ice breaker ships that travel to polar regions. Dr. Burdick is also a pilot and he enjoys mountaineering, canoeing, kayaking, snowboarding, skiing, scuba diving, photography and astronomy. He has traveled the world including to India, Nepal, Rwanda, Ethiopia, Uganda, and Cambodia to name a few. Gregory Burke, MD Dr. Gregory Burke received his medical degree from Loma Linda University School of Medicine in Loma Linda, California. He completed his residency at Loma Linda University Medical Center and was chief resident. Dr. Burke is Board Certified in Emergency Medicine and is a fellow of the American College of Emergency Physicians. I just love emergency medicine. It s so diverse and I enjoy helping patients in that moment when they first arrive at the ED, says Dr. Burke. Dr. Burke s wife Laurie is a pediatrician and they have a three-year old daughter. Dr. Burke s favorite pastime is mountain biking. Shari Engstrom, MD Dr. Shari Engstrom is a graduate of the University of Southern California School of Medicine in Los Angeles, California. She completed her residency in Emergency Medicine at Loma Linda University Medical Center in Loma Linda, California. Dr. Engstrom had a fascination for physiology in college which sparked her interest in medicine. I was attracted to the fast paced environment of the ED and it s variety of patients of all ages and illnesses from surgical, medical, psychiatric and traumatic. It is gratifying to be part of the safety net of the community, says Dr. Engstrom. Michelle Gill, MD Dr. Gill is the Medical Director of Stevens Hospital Emergency Services. She is a graduate of Northeastern Ohio Universities College of Medicine in Rootstown, Ohio. Dr. Gill completed her residency in Emergency Medicine at Maricopa Medical Center in Phoenix. She is a diplomate of the American Board of Emergency Medicine and a member of the American College of Emergency Physicians. Dr. Gill says she knew early on in her training that she wanted to work in the emergency department. I picked emergency medicine because as a student I loved aspects of all the different fields of medicine. It was the perfect fit and I ve never looked back, says Dr. Gill. Dr. Gill s hobbies include running, traveling, 6

7 snowboarding, relaxing with family and friends, bird watching and studying insects. Some of her family s pets include Madagascar hissing cockroaches! Robert Glazewski, PA-C Physician Assistant Robert Glazewski is a graduate of MEDEX Northwest; Physician Assistant Training Program, University of Washington School of Medicine in Seattle. He is certified by the National Commission on Certification of Physician Assistants and is a fellow of the American Association of Physician Assistants. Glazewski is committed to quality medical care, compassion and ethics. He enjoys camping, skiing, fishing, and spending time with his family. Eric Harrington, DO Dr. Eric Harrington is Board Certified in Emergency Medicine and received his doctorate in Osteopathic Medicine from Kansas City University of Medicine and Biosciences in Kansas City, Missouri. He completed his residency in Emergency Medicine at Case Western Reserve University, MetroHealth Medical Center, Cleveland Clinic Foundation in Cleveland, Ohio. Dr. Harrington is from Brighton, Michigan. His interests in emergency medicine include trauma cases, international emergency medicine, burn injuries and the use of ultrasound. Shamik Jain, MD Dr. Shamik Jain is trained in Emergency Medicine and is a graduate of Johns Hopkins University, School of Medicine in Baltimore, Maryland. Johns Hopkins is also where Dr. Jain completed his residency in Emergency Medicine. Dr. Jain says he chose emergency medicine as his specialty because he s interested in improving ED flow and providing patients with quality, comforting medical care quickly. No other specialty allows me the privilege and satisfaction of performing rapid intervention in a patient s time of acute crisis regardless of time or day, says Dr. Jain. Dr. Jain is a member of the American College of Emergency Physicians. He grew up in India and Venezuela. Outside of medicine, Dr. Jain s interests include traveling, listening to classical music and reading. Timothy Z. Jones, PA-C Physician Assistant Timothy Z. Jones has more than a decade of experience working in Emergency Medicine and Urgent Care. Originally from Wyoming, Jones is a graduate of the physician assistant program at the University of Washington, School of Medicine. He is certified as a physician assistant by the National Commission of Certification of Physician Assistants and chose emergency medicine as his specialty because it s often the first point of medical care for patients. It is a specialty that allows providers a lot of opportunity to do work-ups that support early or rapid diagnosis for patient illnesses and enables you to provide informed and meaningful treatment to them, says Jones. Jones says he s committed to compassion, service and healing within the community. For five years, he lived in Alaskan villages working with indigenous populations. In addition to his work as a PA, Jones is also a medical illustrator and an artist. His professional memberships include the Washington Academy of Physician Assistants and the American College for Emergency Physicians. 7

8 Newsletter Access Vital Signs is available on our website. Select For Physicians from left menu of our home page: then click Printable Documents on the right menu. WELCOME New Stevens Medical Staff January 2010 Name Group Specialty Kenji Asakura, MD Hospitalist Service Hospitalist Yap-Yee Chong, MD CellNetix Pathology Jeffrey P. Gress, MD Providence Physician Group Cardiology Joel S. Tanedo, MD Providence Physician Group Cardiology Contributions Any medical staff member with an article or item for the newsletter should contact Amy Morrow, marketing copywriter, at (425) or by the 1 st of the month. To Admit a Patient to Stevens, Call Vital Signs Issue 17 February th Avenue West, Edmonds, WA 98026