Progress Notes Extra

Transcription

1 Medical Staff Office Cathy Crabtree : (937) Deb Charles: (937) Josie Hall: ( Tanya Webber: (937) September 2013 Progress Notes Extra Fall General Medical Staff Meeting Sinclair Conference Center Charity Earley Auditorium Thursday, September 26, :00 p.m. to 9:00 p.m. 6:15-7:00 p.m. Registration, Cocktails & Hors d oeuvres will be complimentary 7-7:45 p.m. Medical Staff Meeting 7:45 p.m. 9:00 p.m. Social Networking Please RSVP by phone to the Medical Staff liaison at Or fill out the form at the bottom and send in the Self-addressed envelope enclosed. Parking passes for the garage will be provided RSVP Name (please print) Guest (please print) For inquiries concerning the meeting, Contact the Medical Staff Liaison@ (937) Please RSVP by Thursday, September 19, 2013

2 IMPORTANT INFORMATION: PLEASE READ Date: 08/27/13 To: All GSH Physicians & Allied Health Professionals From: Daniel L. Schoulties, MD, VPMA & CMO Subject: New Government Audit Our government payers have begun conducting pre-pay audits on 3 day qualifying inpatient stays prior to a subsequent nursing home admission. The intent of the audit is to review both medical necessities for the entire stay as well as if all 3 days were medically necessary from an inpatient perspective. The standard for medical necessity of a 3 day qualifying stay, (all three days must have documented medical necessity for inpatient status) has not changed. Rather, this is simply a new audit focus for the government. Required Action Ensure Physician documentation accurately portrays the patients reason for inpatient admission if appropriate. Continue scrutiny of medical necessity of inpatient criteria by CSI Team. Ensure ongoing review of continued need for inpatient services is conducted by Case Management Team. If you have questions or concerns, please feel free to contact me.

3 Please Read Very Important Epic Radiant Implementation Summary Go-Live 9/21/2013 Important Imaging Information: On Saturday, September 21, Premier Health will transition our ordering and scheduling for ambulatory imaging and inpatient imaging at AMC, GSH, MVH and MVHS to the Epic Radiant product. This will enhance the integration of our imaging orders with the rest of our clinical EMR. UVMC will make this change in late October. This is the second phase of our imaging upgrade, following our PACS upgrade earlier this year. In addition, at this time there will be some standardization and clean-up of the imaging orders in our system. The purpose of this is to help align the ordering at all of the institutions within Premier. This could impact the personal preference lists of some users. What this means at AMC, GSH, MVH and MVHS: Radiant Implementation The new Radiology Information System (Radiant) will be implemented on Saturday, September 21, This new system will be replacing the current IDX Radiology Information System. Technical and Operational staff will be available to provide support during this upgrade. If you require support related to this this implementation, please follow your normal support channels. You may also contact the IT Customer Support Desk at to report any issues directly Medical Imaging Order Changes As part of our ongoing efforts towards increasing standardization an initiative was undertaken to standardize a number of Medical Imaging orders. This standardization effort will provide benefits related to streamlining the ordering process and ensure that standardized ordering conventions are being used across the system. The changes will also occur in conjunction with the Radiant implementation. As a result of this standardization effort it is possible that some Medical Imaging order may need to be re-created on personal preference lists. If you have questions about this process please contact your normal support channels. You may also contact the IT Customer Support Desk at for assistance regarding these issues. What this means at UVMC: The new Radiology Information System (Radiant) will be implemented on Saturday, September 21, 2013 AMC, GSH, GSN, MVH, MVS. This will also include all Ambulatory Clinics and Patient information Partners sites that utilize IDX for Medical Imaging. This new system will be replacing the current IDX Radiology Information System. This implementation is currently scheduled to occur later in Fourth Quarter for UVMC. The Radiant implementation September 21st is not expected to impact workflows at UVMC. However, should you experience any issues please follow your normal support processes. You may also contact the IT Customer Support Desk at to report any issues directly.

4 To All Physician and Licensed Independent Practioners: Good Samaritan Hospital was awarded designation as a JCAHO certified Primary Stroke Center in May JCAHO requires that all stroke patients receive the same evidence-based standard of care. At Good Samaritan Hospital, we utilize order sets to ensure evidence-based care. It was cited during our recent JCAHO survey in August that order set usage requires improvement. Order set utilization ensures that best practices for evidence-based stroke care are utilized on each and every patient. IT IS IMPERATIVE THAT THE APPROPRIATE STROKE ORDER SET IS UTILIZED UPON PATIENTS ADMITTED WITH A SUSPECTED DIAGNOSIS OF STROKE. The Acute Ischemic Stroke/TIA order set (# 24543) is the most frequently required order set. If an Acute Ischemic Stroke/TIA is diagnosed after admission please utilize the Abbreviated Ischemic Stroke order set (#24908). If a patient has an Intracerebral Hemorrhage please utilize the Intracerebral Hemorrhage Admission order set (#24187). These order sets are developed by clinical experts and are updated annually to assure that they are in accordance with American Heart Association/American Stroke Association guidelines. A specific concern at the recent JCAHO survey was the inconsistent use of permissive hypertension during the acute phase of ischemic stroke. This is specifically addressed in the order sets. Dramatic reduction in blood pressure during the acute phase of stroke may extend the infarct and worsen patient outcomes. The following recommendations are from the most recent acute stroke treatment guidelines: In patients with markedly elevated blood pressure who do not receive fibrinolysis, a reasonable goal is to lower blood pressure by 15% during the first 24 hours after onset of stroke. The level of blood pressure that would mandate such treatment is not known, but consensus exists that medications should be withheld unless the systolic blood pressure is >220 mm Hg or the diastolic blood pressure is >120 mm Hg (Class I; Level of Evidence C). Evidence from one clinical trial indicates that initiation of antihypertensive therapy within 24 hours of stroke is relatively safe. Restarting antihypertensive medications is reasonable after the first 24 hours for patients who have preexisting hypertension and are neurologically stable unless a specific contraindication to restarting treatment is known (Class IIa; Level of Evidence B) If you would like to read the AHA/ASA Stroke guidelines you may do so by visiting the below link: Guidelines_UCM_320600_Article.jsp Please feel free to contact Dr. Bradley Jacobs at pager (937) or Erin Greene, RN, CCRN, CNS-BC at (937) if you have any questions or would like further information. Thank you for your anticipated cooperation in providing outstanding care for our stroke patients. Respectfully, Bradley Jacobs, MD, MS, GSH Stroke Program Medical Director Dan Schoulties, MD Vice President of GSH and Chief Medical Officer

5 ICU Order Sets The ICU Order Sets listed below have been updated and are scheduled to be put into Production at the next I.T. Predictive Change, which is October System ICU Admission System mechanical ventilation Favorites After the new Order Sets have been placed into Production, you will need to remove the old Order Sets (e.g., GSH ICU Admission) from your Favorites and add the new System Order Set to your favorites. Note: If you go to multiple hospitals, you will have to do this for each facility. User Order Sets It is highly recommended that you review the Order Set defaults. If you would like to set your own defaults, go to the Main Toolbar in Epic and select User Order Sets (reminder: if you don t readily see this choice, look under the chevron >> more button). From there, you can select the Order Set, change what is checked or un-checked, and modify the details. You cannot add orders to an Order Set. Individual orders will have to be ordered ad hoc. Merging The new design of admission order sets is to use them in conjunction with the Base Admission Order Set. When admitting a patient, check BOTH the Base Admission and also the diagnosis-specific admission order set. This will merge both order sets together. Note: It is critical that you select the Base Admission order set, as the Base Admission order set contains bed placement, code status, etc. Show All Orders In order to view ALL of the orders in an Order Set, regardless of what is checked or un-checked, RIGHT mouse where the title of the Order Set is displayed and select Show all by group. Contact the Customer Support Desk at (937) , option #2, or the hospital s medical staff liaison if you have any questions or concerns.

6 New Physician Meet & Greet Thursday, September 26, :00 am 1:00 pm GSH Physicians Lounge Plan to come and meet your new colleagues! ************************************************************ GSNHC - North Campus Wednesday, October 9 11 a.m. 2 p.m. at Ed Ctr. Rm A Tuesday, October 15 - Noon 2 p.m. at Ed Ctr. Rm D GSH Main Campus GSH Physicians Lounge Wednesday, October 16, 2013 Noon -2 p.m. Tuesday, October 22, a.m. -1p.m. If you have any questions or concerns regarding EPIC or any information provided in Progress Notes Extra please contact Deb Charles at ext Thank you.