PHYSICIAN PIPELINE. Improve care with antibiotics.

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1 Page 1 of 5 Dear Colleagues: I'm pleased to share with you this inaugural edition of a new communications tool we're introducing to share hospital-related information with our medical colleagues in the region. This has been developed under the leadership of a physician editorial advisory board, and I thank them for their guidance. If you are interested in serving on the advisory board or have article ideas or other feedback, please let me know. We welcome your input. view as webpage PHYSICIAN PIPELINE Improve care with antibiotics The appropriate use of antibiotics is the focus of a unique program at Sacred Heart that aims to reduce antibiotic resistance, decrease risk for C. diff, and improve outcomes through lower toxicity and shorter lengths of stay. "Anytime you avoid complications and reduce the length of stay which is what could happen if infection runs rampant or if treatment backfires you improve the quality of care," says Bob Pelz, MD, who oversees the program and leads the infectious disease department at PeaceHealth Medical Group with Rob Barnes, MD. One of only a handful in the country, the Antimicrobial Stewardship program was established in May 2008 after two infectious disease professional organizations one physician, one pharmacist released guidelines for the development of such programs. About 20 percent of the 25,000 patients admitted annually to Sacred Heart receive antibiotics, and national figures estimate that 30% to 50% of prescribed antimicrobial courses are inappropriate defined as using the wrong drug, wrong dose frequency or wrong route for drug administration. Here's how the program works: A computerized system searches medical charts and flags certain conditions, diagnoses or prescriptions for antibiotic use. Jarrod Brubaker, an ID pharmacist who coordinates the program, reviews the flagged charts. If the team has recommendations for possible improvement in antibiotic usage or other issues related to infection management, he follows up with physicians by leaving "blue notes" in the charts to seek more data, provide the latest information on antibiotics and ask physicians to follow up and possibly revisit the treatment course prescribed. Brubaker has left more than 700 blue notes so far, and says his recommendations are accepted in 60% of the cases. His role is one of information sharing, not policing. The overriding reason for the program is quality improvement. "Several studies have demonstrated that antibiotic stewardship programs are one of In this issue: Antimicrobial Stewardship New Technology: davinci H1N1 update Patient Placement RiverBend at One PeaceHealth Laboratories People CME courses Editorial Advisory Board Hans Notenboom, MD, Chair Ray Englander, MD Julie Hughes, MD Kirk Jacobsen, MD Rick Padgett, MD Ron Stock, MD David Tsai, MD For information on the Physician Pipeline Editorial Advisory Board, contact Hans Notenboom, MD. Physician Pipeline Physician Pipeline is produced by PeaceHealth for physicians in southern Oregon. News of interest to your physician colleagues is welcome. To submit article ideas, news items, questions or comments, contact Jenny Ulum, or call

2 Page 2 of 5 the only ways to reduce the rate of C. diff in hospitals," Dr. Pelz says. Further, under new Joint Commission guidelines that go into effect in October 2010, C. diff will be added to the list of treatments that will not be reimbursed. The antimicrobial stewardship team is available at Sacred Heart weekdays between 8 a.m. and 9:30 p.m., and after hours by phone, for consultation and approval of antibiotic prescriptions in certain cases. Latest generation davinci delivers Sacred Heart's new third-generation da Vinci Si the first of its kind in Oregon debuted for surgery Aug. 11 in a cardiac case. Best known for its use in urological surgery 80% of all prostate surgery is now done robotically the da Vinci robot is also being used in cardiothoracic, gynecologic, gynecological oncology and general surgery. With advanced high-definition 3D visualization and up to 10 times magnification, the equipment provides an immersive view of the operative field that represents a 60% improvement over previous generation da Vinci devices. To date 22 gynecologic, cardiac and urologic procedures using the da Vinci have been performed. Sacred Heart credentials robotic surgery as a separate privilege. Women's Care physicians Paula Jewett, M.D., and Catherine York, M.D., (pictured, above) are certified on the robot. On Aug. 12 they performed hysterectomies on two patients who were the hospital's first robotic gynecology cases. "The dexterity of the robotic instruments and the visibility are absolutely incredible," Dr. York said. "I can see things with the robot that I've never seen in surgery before from the path of tiny blood vessels to the micro layers of tissue planes." With da Vinci, small incisions of typically one to two centimeters are used to introduce miniaturized instruments and a high-definition 3D camera. Seated at the da Vinci console, the surgeon views a magnified, high-resolution 3D image of the surgical site. The technology translates the surgeon's hand

3 Page 3 of 5 movements into precise micro-movements of the da Vinci instruments. So while the surgeon is always in control, there is no longer a need for incisions large enough to accommodate the surgeon's hands. "The really exciting thing about robotic surgery is that it allows us to perform procedures in a less invasive fashion which of course decreases patient pain and time in the hospital," Dr. Jewett said. The entire $2 million cost of the da Vinci was paid for through private donations to the Sacred Heart Medical Center Foundation. H1N1 update As part of preparing for an active flu season, be sure to provide "respiratory etiquette stations" with masks, tissues and sanitizing gel in your waiting areas. Any patients with flu-like symptoms should be asked to wear a mask. According to infectious disease physician Bob Pelz, MD, early data suggests that H1N1 is a more virulent and contagious version of flu. From July 1 through mid-october Sacred Heart had 416 hospitalizations for flu, which is extremely unusual for that time of year. The symptom of diarrhea seems to be more common with H1N1. Although the earliest cases in the United States appeared less severe, that has changed over time. "Doctors should encourage influenza vaccination for immunocompromised patients, now and when the new H1N1 vaccination is available," Pelz says. For more information visit One stop for placement Admitting a patient to Sacred Heart is now handled with a single phone call to the Patient Placement Center, To help your patient's admission go as smoothly as possible, the center staff will contact the appropriate nursing unit, get a room assignment, and then confirm acceptance and details with you. Contact is Corinne Ginet-Yeager at New hospital boosts quality Since opening Aug. 10, 2008, Sacred Heart Medical Center at RiverBend has seen an increase in quality and volume. Comparing key quality indicators to other hospitals across the country, Sacred Heart consistently scores in the top 25%, trending toward the top 10% in clinical performance. Some examples: - Surgical Services consistently outperforms the nation in its efforts to prevent infections, blood clots and readmission. - For heart attack victims, the median "door-to-balloon" time has decreased

4 Page 4 of 5 to less than 60 minutes, far faster than the recommended minimum of 90 minutes, saving approximately 20 additional lives this past year. - Sacred Heart has embraced the use of clinical checklists where they are proven to improve outcomes and to prevent harm, particularly in the operating rooms and critical care units. Ventilator-associated pneumonia and central line blood infections are rare. Patient surverys show increased satisfaction with hospital services and amenities, and that translates into higher patient volumes: - Emergency Department visits are up 21% - Deliveries have increased 10% - Occupancy is averaging more than 80% - well above the state average of 62% and above our historical occupancy rate of 75%. New name, same lab Oregon Medical Laboratories has recently changed its name to PeaceHealth Laboratories. The lab serves Oregon, Washington and Alaska. For more information, visit People Steve Gordon, MD, of Eugene has been named chair of the new state Health Information Technology Oversight Council. Under legislation passed in 2009, the council's duties include developing a statewide strategic plan for electronic health information exchange, coordinating public and private efforts to increase adoption of electronic health records, creating a business plan to support use of health information technology to lower costs and improve quality of care. Dr. Gordon is chief quality officer for PeaceHealth Oregon Region. Please welcome the following physicians who are new to these practices: Eugene Emergency Physicians: Margaret Cronholm, MD; Jeffrey Salerno, MD Neurospine Institute: Gregory Moore, MD Northwest Anesthesia Physicians: Jocelyn Park, MD; Gerald Tanner, MD Oak Street Medical: Andrew Gilchrist, MD; Shehzad Jinnah, MD Oregon Bariatric Center: Jessica Folek, MD: Ngocthuy Hughes, DO Oregon Medical Group: Candye Andrus, MD, pediatrics; John Ford, MD, internal medicine; David Zollinger, MD, family medicine Pacific Plastic Surgery: Dustin Christiansen, MD PeaceHealth Medical Group: Sidney Davidson, MD, family medicine; Tatiana Guta, MD, hospitalist; M. Christine McKee, MD, pediatrics; Andrei San-Marina, MD, internal medicine PeaceHealth, Sacred Heart Hospitalists: Patrick Tandingan, MD Send notice of new physicians to Jenny Ulum. CME courses

5 Page 5 of 5 Continuing Medical Education offerings at Sacred Heart Medical Center at RiverBend through the end of the year: (1 Category 1 AMA PRA credit ) Medicine Grand Rounds, 7 a.m. to 8 a.m., Conference Room 200A Nov. 13: Matthew Trojan, MD, "Update in Heart Failure 2009" Pediatric Grand Rounds, 7:50 a.m. to 8:50 a.m., Conference Room 200A Nov. 9: James Kyser, MD, "Cardiac Outcomes" Nov. 23: Gary Young, MD, "Pediatric Emergencies" Nov. 30: Seshadri Balaji, MD, "Fainting in Children" Dec. 14: Dennis Diaz, MD, "Deafness in Children" Contact Treena Bell to register. unsubscribe send to a friend update your profile PO Box 1479, Eugene, To send this to a friend, click here.