Anew program at WilmingtonHospital’s Acute Care of the

Elderly (ACE) unit has patients,families and care providers workingtogether to achieve optimumpatient care.

The “One Voice” program is basedon the concept of integrating patientsand their families into the health careteam. The ACE unit, with its largenumber of patients with adult chil-dren who are deeply concernedabout their parents’ care, was a natu-ral place to inaugurate the program.

“Our emphasis has been on

improving communication,” saysJanine Jordan, M.D., physician advisorin the Office of Quality and PatientSafety.

Last fall, a team from Christiana Caretraveled to the Medical College ofGeorgia to study its program, and stafftraining began in January 2009.

Natural team building

“We put systems into place so patientsand families know what’s going onwith their care at all times,” says PaulaTomanovich, RN, BSN, BC, nursemanager of the ACE unit. “We’re find-ing that making patients and families

‘One Voice’ concept puts patientsand families on the health care team

C O N T I N U E D N E X T P A G E

3

Helen F. Graham CancerCenter expands 6

New test sought forinherited cancer genes

As a member of his own health care team, Wilmington campus ACE unit patientRichard H. Hurst talks to Elvina Kipoto, RN (right), and Samantha Eannone, RN,about “how the patient is doing.”

20505_V7:Layout 1 6/17/2009 2:29 PM Page 1

2 ● F O C U S J u n e 1 8 , 2 0 0 9

Christiana Care Health System’sefforts to optimize the number of

tests doctors order and the amount oftime patients spend in the hospitalearned a 2009 Healthcare AdvantageAward from Thomson Reuters, anationally known provider of healthinformation.

Christiana Care was one of only fiveorganizations in the U.S. honored inthe health and clinical outcomescategory.

Engaged staff and physicians

“What's really behind this award isthe commitment and engagement ofstaff and physicians in making sure allpatients receive the care they need,when they need it, in the appropriatesetting and in accordance with best-practice standards,” says VirginiaCollier, M.D., the Hugh R. Sharp, Jr.Chair of Medicine.

After analyzing clinical results ofpatients admitted to the hospital withspecific diagnoses and comparing theinformation to national bench marks,an interdisciplinary Christiana Careteam shared physician-specific datawith doctors who admit patients tohospital medical units. At the sametime, subspecialty experts talked tothe doctors about evidence-based bestpractices for patients with those samediagnoses.

Reducing tests and LOS

When combined with feedback on thedata, this training, which took placeover six months in 2007, helped toreduce the number of diagnostic teststhe doctors ordered by 12 percent andshorten length of patient stay by upto 34 percent. Savings amounted to$256,000.

part of the team comes naturally.”

New procedures include givingreports at the patient’s bedside,empowering the patient to becomepart of the discussion. Carts now carrylaminated cards with bullet pointsdescribing the 24 most commonly pre-scribed medications to aid nurses ineducating patients on medicationside effects.

Plan of care in plain language

Larger white boards allow for greaterdetail in each daily plan of care, writ-ten in language patients can readilyunderstand. Wall racks with literatureabout each patient’s condition havebeen installed in rooms, clearlylabeled for patients and their families.

And caregivers on the unit now putgreater emphasis on anticipating whatpatients will need for a healthy recov-ery after they are discharged so theywon’t have to be readmitted as often.

Seeking grant to widen the circle

“One Voice has brought a lot of peopletogether to talk about patient andfamily-centered care,” Dr. Jordan says.“Sharing ideas, feeling that exchangeof energy is exciting.”

To widen the scope of the program,Christiana Care has applied to thePicker Institute Challenge Grant pro-gram for a grant to educate internalmedicine and family and communitycare residents in the principles of fami-ly- and patient-centered care.

“It’s a long journey, changing the waywe care for patients,” Tomanovichsays. “But in the end, everyonebenefits.”

O N E V O I C E , C O N T I N U E D

“Our goal is for 100 percent of ourpatients to receive 100 percent of bestpractice interventions 100 percent ofthe time,” says Dr. Collier. “Throughour collective efforts, we have madesignificant progress. As we focus onexcellence in inpatient care, our teamis working harder than ever to achievecontinued improvement.”

Staff recognition

Several Christiana Care physiciansand staff were instrumental in theeffort: Robert Dressler, M.D., vicechair of the Department of Medicine;Diane Bohner, M.D., medical directorof Utilization Management; JulieSilverstein, M.D., director of PatientSafety and Performance Improvementfor the Department of Medicine; andDonna Mahoney, director of DataAcquisition and Measurement.

“The key to our success is teamwork.This award acknowledges that every-one is working on behalf of thepatient to achieve better clinicalresults while at the same time manag-ing costs more effectively,” Dr. Colliersays.

Christiana Care wins Thomson Reuters’2009 Healthcare Advantage Award

20505_V7:Layout 1 6/17/2009 2:29 PM Page 2

Studies show improved outcomesand decreased lengths of stay forpatients in ICUs managed by physi-cians who specialize in critical care.

Yet, a current shortage in critical carephysicians makes keeping them onsite 24 hours a day difficult for mosthospitals.

Oon May 18, Calvert MemorialHospital in Prince Frederick, Md.,

became the first of six hospitals in theMaryland eCare network to connect inreal time to critical care physicians andnurses at Christiana Care’s eCareCentral.

“We are thrilled to bring ruralMaryland patients this enhanced levelof care,” says Marc T. Zubrow, M.D.,Christiana Care’s director of CriticalCare Medicine and medicaldirector of Maryland eCare.“We are looking forward toproviding all the hospitalsin the Maryland eCareNetwork with this special-ized care.”

Two more in 2009

Later this year, PeninsulaRegional Medical Center inSalisbury and St. Mary’sHospital in Leonardtowncome online. By 2011,Christiana Care will con-nect to almost 80 ICU bedsin the Maryland eCare net-work.

The eCare team uses a sophisticatedeICU® program in use at ChristianaCare’s own intensive care units since2005. Christiana Care was the firsthealth system in the country to adoptthe technology to monitor critically illpatients in its Emergency Departmentsand post anesthesia care units.

eCare connects physicians, nurses andpatients virtually via voice, cameraand data, enabling hospitals to pro-vide the highest level of specializedcare around the clock. Calvert

Memorial will work most closely witheCare on nights, weekends and holi-days, times typically difficult for localspecialists to remain on site.

Providing care close to home

With eCare, patients benefit fromreceiving timely, critical care whenthey need it and where they are mostcomfortable: close to home. Moment-by-moment monitoring quicklydetects changes in patient condition,

watching trends in crucial indicatorssuch as blood pressure, heart rate,oxygen levels and respiratory rates,allowing remote staff to alert andwork with on-site staff to improvepatient status.

eCare does not take the place of bed-side staff. Rather, it provides an extraset of eyes and ears, adding a layer ofsafety to prevent a medical crisis.

For on-site caregivers, in-room help isavailable at the push of a button.

Christiana Care’s eCare team beginsconnecting across Maryland

Maryland eCare hospitals are: Atlantic

General Hospital, Berlin; Calvert

Memorial Hospital, Prince Frederick;

Civista Medical Center, La Plata;

Peninsula Regional Medical Center,

Salisbury; St. Mary's Hospital,

Leonardtown; and Washington County

Health System, Hagerstown.

20505_V7:Layout 1 6/17/2009 2:29 PM Page 3

4 F O C U S J u n e 1 8 , 2 0 0 9

Expanded services

Gordon Reed, M.D., received the VisionaryAward from the International Association ofForensic Nurses (IAFN). Dr. Reed has beenthe medical director of the forensic nurseexaminer team at Christiana Care since 1996.

Forensic nurse examiners earn praise andgrant money for excellent service to community

Often subpoenaed

The University of Delaware’s VDay chapter executive board members—fromleft, Bailey Kung, Sam Withrow, Jessica FitzPatrick and Bess Davis—presentAnita Symonds, RN, center, with a $4,500 gift for the Forensic Nurse Examinersprogram. VDay is a global movement to end violence against women and girls.

20505_V7:Layout 1 6/17/2009 2:29 PM Page 4

Coming to the Helen F. GrahamCancer Center was a lifesaver,

for both Daniel Cheeseman and his4-year-old son.

Following nerve surgery in 2008, asmall lump under Cheeseman’sleft knee grew to softball size. Fora year, excruciating pain compro-mised his mobility and threatenedhis job as a forklift operator.

After diagnosing a malignantnerve tumor, surgical oncologistJoseph Bennett, M.D., suggestedCheeseman join him at theSarcoma Multidisciplinary DiseaseCenter (MDC) to explore treatmentoptions.

With Dr. Bennett, the SarcomaMDC team included medicaloncologist Kathir Suppiah, M.D.,radiation oncologist ChristopherKoprowski, M.D., orthopedic sur-geon Mihir Thacker, M.D., andoncology rehabilitation and painspecialist Theresa Gillis, M.D.

Exceeding expectations“I didn’t expect so much care,”Cheeseman recalls. “All these doctorswere there in the room to talk with meabout my condition. It made me feelmore confident about our decisionsmoving forward.”

At that meeting, Cheeseman learnedthat the growth under his left knee aswell as growths on his right leg andneck were a symptom of neurofibro-matosis, a genetic nervous system dis-order. Cheeseman was born with thisdisease, and from his family medicalhistory, doctors suspected that his sonwas, too.

“Neurofibromatosis causes tumors toform anywhere in the body wherenerve tissues are present, includingthe brain, spine and peripheralnerves,” Dr. Gillis explains. “They

sometimes cause severe pain andimpair function if they grow.Although there is no cure, we cantreat the effects of the disease forgood quality of life.”

Brighter futureThe MDC team developed a treat-ment plan and referrals forCheeseman and connected his sonwith doctors in the neurofibromato-sis specialty program atNemours/A.I. DuPont Hospital forChildren.

On doctors’ advice, Cheesemandecided against surgical attempts tosave his leg. Just one month after hisamputation, Cheeseman’s prostheticleg is fully functional and ready forphysical therapy. Now he has muchless pain, and he and his son havemore of what fathers and sons likebest—more time together.

Cancer Center’s Sarcoma MDC helps father and son with rare genetic disorder

Daniel Cheesman and his son, Daniel Jr., findthe care they need at the Helen F. GrahamCancer Center.

20505_V7:Layout 1 6/17/2009 2:29 PM Page 5

6 ● F O C U S J u n e 1 8 , 2 0 0 9

Accelerating cancer research

rapidadvances in cancer stem cell biologyand human cancer genetics,

Fast-tracking initiatives

Cancer Genetics and Stem CellBiology and CTCR associate director,says h

is one of the leading pro-grams of its kind in the country,” Dr.

Expansion of Helen F. Graham Cancer Center bringsmore world-class services under one roof

A view from across the pondshows the full expanse of theHelen F. Graham CancerCenter. With the expansion,the Graham Cancer Centerhas more than tripled in size,bringing together the entirecontinuum of cancer careresources. Having all of apatient’s related care in oneplace facilitates interactionamong specialists and pro-motes the transfer of knowl-edge about new technolo-gies, drug regimens andtreatments for cancer, whichis the essence of ChristianaCare’s multidisciplinaryapproach to cancer.

20505_V7:Layout 1 6/17/2009 2:30 PM Page 6

Developing new programs

Boman adds. “This

Ali-Khan Catts, MS, CGC,directs the program.

Getting care is easier

In the Oncology Data Center on thesecond floor, a staff of seven collects,analyzes and conducts lifetime fol-low-up for all cases of cancer andbenign central nervous systemtumors newly diagnosed or treatedat Christiana Care. “Our databasecontains 50,600 analytic cases, with23,600 cases actively followed,” saysManager Robert McBride. “Accessto treatment information is easiernow, which helps keep the registrydata complete.”

More specialists

CTCR Associate Director

Cancer Genetics and Stem CellBiology at the Helen F. GrahamCancer Center, CTCR researchers arefocusing on two specific genes, MSHZand MLH1, known as DNA mismatchrepair genes.

“I

cancer,” Dr. Boman says.

Researchers are developing a better test to identify two inherited cancer genes

20505_V7:Layout 1 6/17/2009 2:30 PM Page 7

C L I N I C A L N E W S

Risk factors

Therapeutic Notes

8 ● F O C U S J u n e 1 8 , 2 0 0 9

20505_V7:Layout 1 6/17/2009 2:30 PM Page 8

500 mg once 650 mg once

1000 mg once 975 mg once

500 mg daily 650 mg daily

1000 mg daily 975 mg daily

500 mg BID 650 mg BID

1000 mg BID 975 mg BID

500 mg every 4 hours or as needed 650 mg every 6 hours or as needed

1000 mg every 4 hours or as needed 650 mg every 4 hours or as needed

500 mg every 6 hours or as needed 650 mg every 8 hours or as needed

1000 mg every 6 hours or as needed 650 mg every 4 hours or as needed

500 mg every 8 hours as needed 650 mg every 8 hours as needed

1000 mg every 8 hours or as needed 975 mg every 8 hours or as needed

500 mg TID 650 mg every 8 hours

1000 mg TID or as needed 975 mg TID or as needed

1000 mg QID or as needed 975 mg QID or as needed

Formulary Update

20505_V7:Layout 1 6/17/2009 2:30 PM Page 9

What costs physicians ‘ownership’ of their patients’ care?

1 0 ● F O C U S J u n e 1 8 , 2 0 0 9

C L I N I C A L N E W S

Christiana Care’s Cynthia E. Barlow named Pharmacist of the Year

20505_V7:Layout 1 6/17/2009 2:30 PM Page 10

Guest lecturer Lori Mosca, M.D., encourages listeners to care for their hearts

20505_V7:Layout 1 6/17/2009 2:59 PM Page 11

between Feb. 1 and March 14, 2009.

Winners were selected by a panel ofjudges based on their creativity, qual-ity of service, reach and impact oftheir work and their direct ability tohelp educate women on the impor-tance of lowering their cholesterol.

Circle of Helping HeartsThe grants are part of Cheerios Circle

of Helping Hearts® broader heart-health initiative, which provides con-sumers with important informationon heart disease prevention and pro-vides steps to a heart healthylifestyle through diet, exercise andregular cholesterol and blood pres-sure screenings.

The spirited commitment and ded-ication of Christiana Care

Community Health and FaithMinistries Outreach Program col-leagues Rhonda Coleman andLavaida Owens-White, RN, hasearned a $5,000 grant from the makersof Cheerios breakfast cereal.

Coleman, the Community Outreachcoordinator, and White, the HealthMinistries coordinator, over the pasttwo years have helped to serve 987high-risk African Americans living inDelaware.

Coleman arranges community eventsto provide cholesterol testing andheart education and white, a faithcommunity nurse, provides outreachat faith organizations, communityevents and state service centers.

The program reaches the most vulner-able individuals with the message tomake lifestyle changes for cardiachealth.

Leading by exampleBoth Coleman and White exemplify aheart healthy lifestyle by often wear-ing pedometers, always “knowingtheir numbers,” and by adoptinghealthy lifestyle changes. They leadby example, having an impact onfamilies, friends and everyone elsethey encounter.

The grant has been gifted toChristiana Care Health System.

Cheerios received nearly 100 nomina-tions for individuals andorganizations from across the U.S.

1 2 ● F O C U S J u n e 1 8 , 2 0 0 9

Cheerios $5,000 grant recognizesdedication to community outreach

C O N T I N U E D , P. 1 9

On June 30 at 5 p.m., Alex Bodenstab,M.D., and Steven Dellose, M.D., willwebcast two knee-replacement surger-ies, back-to-back, from WilmingtonHospital. Leo Raisis, M.D., medicaldirector of the Center for AdvancedJoint Replacement, will host the web-cast.

During the event, an online chat willbe held on Twitter featuring TerryForaker, nurse manager of the Centerfor Advanced Joint Replacement, andseveral former patients.

This educational event will celebrate amajor milestone, the Center forAdvanced Joint Replacement’s10,000th patient.

To view the this webcast, visitwww.or-live.com/kneesurgery or fol-low the link from the home page ofour Web site, www.christianacare.org.

Knee surgery live webcast isJune 30 at 5 p.m.

20505_V7:Layout 1 6/17/2009 2:30 PM Page 12

Perez has gone from a size 20 dressto a size 14. As the pounds havecome off, her doctor has reduced thedosage for her blood pressure med-ication.

“I’m at a very good number rightnow,” she says.

Tried and failed before

Perez has worked at Christiana Carefor 29 years, starting as an aide in thedietary department when she was 16.Before taking advantage of the on-site fitness center and $100 per yearreimbursement for Christiana Careemployees, she had tried and failedto lose weight several times.

“There always seemed to be some-thing that got me off track, takingcare of the kids, all sorts of things,”she recalls.

In her 40s, Perez decided she owed itto herself to take responsibility forher well-being.

Perez says she has blossomed over thepast two years, losing 64 pounds andgaining self esteem. “I feel better than Iever thought I could,” she says.

Monday through Thursday, Perezheads to the fitness center on theChristiana campus, where she exercis-es for about an hour and a half. Shespends 45 minutes on the treadmill orelliptical trainer, followed by workwith free weights. Every Saturday, shewalks for at least three miles.

“It was very difficult at first, but Ilearned to stick with it,” she says.

In addition to exercise, Perez attendsweekly Weight Watchers meetings. Athome, she weighs food on a kitchenscale so she can accurately track calo-ries. Measuring portions each eveningfor the next day’s meals, she sets her-self up for success.

Adopted routines

“Portion control works for me,” shesays. “It’s my routine now.”

She also is making healthier choices.She eats oatmeal or scrambled eggwhites for breakfast, and cottagecheese and fruit for lunch, or perhaps alow-fat frozen meal. Dinner is typicallychicken and vegetables.

“And I have my Weight Watchers icecream every night,” she says. “That’smy treat.”

“Both my parents suffered from heartdisease,” she says. “They were bothoverweight.”

Helps motivate others

Alisa Carrozza, an exercise technicianwho helps Perez train at the gym, saysthe active wife and mother of twogrown daughters is an inspiration toothers who want to lead healthierlives.

“She notices when people are new anduncomfortable in their exercise pro-gram and offers her personal storyand strategies for success,” Carrozzasays.

On a recent afternoon, Perez reachedout to a fellow employee who was dis-couraged because she had little stami-na.

“When I first started on the elliptical, Icould only do seven minutes,” sherecalls. “I tell people that it takes time.But if you stick with it, you will feelbetter than you ever thought possible.”

Determined Sandra Perez dropped three dress sizes

Cardiac cath technician Sandy Perez lost 64 pounds over two years by practic-ing a healthy lifestyle, including exercise, diet and joining Weight Watchers.

20505_V7:Layout 1 6/17/2009 3:00 PM Page 13

Your T-shirt design could be the one thatall your Christiana Care colleagues wear!

To enter your T-shirt design:

■ Draw your art work on plain white (unlined) 8.5 x 11-inch paper.

■ Draw and submit two sketches for judging.- One sketch should be a simple black outline of

your design. - The other should be a color version of the

black-and-white sketch.

■ Send computer drawings or files via e-mail as .pdf attachments. Please be pre-pared to provide separations or black-and-white artwork.

■ Send your entry to Joanne Matukaitis, RN, MSN, CNA, BC, director, PatientCare Services, Cardiovascular/Critical Care in Suite 1003. If you need more informa-tion, call 302-733-2633.

All entries must be received by July 20.

Win a pizza party

1 4 ● F O C U S J u n e 1 8 , 2 0 0 9

Join the American Heart Walk Sept. 13

20505_V7:Layout 1 6/17/2009 2:31 PM Page 14

Memories of Porcupine

20505_V7:Layout 1 6/17/2009 3:00 PM Page 15

1 6 ● F O C U S J u n e 1 8 , 2 0 0 9

The PEP Department congratulates AliciannBuffington on attaining her MSN. Way to go Alicia.We are very proud of you!

Congratulations to Mary T. Williams, RD. onachieving certification as a Specialist inGerontological Nutrition.

The Professional Advancement Council congratu-lates and welcomes new RN IIs Mercy Badu-Nkansah (Joint Replacement Center), PatriciaBriggs (5E), Ruth Garibian (L&D), Lori Smith(L&D), and Jamie Bailey (CICU).

Wilmington Hospital Nursing Leadership Teamwould like to congratulate the following PCCs forpassing their certification exams!

Sarah Breitenbach, Rehab, Clinical NurseSpecialist-GerontologyArlene Peirce, 5 E/W, Progressive Care (PCCN)Sherry Mars, WACE, Gerontology Lauri Mahoney, 3 Med-Surg, Medical SurgicalSteve Beltran, 3W, Psychiatric & Mental Health

20505_V7:Layout 1 6/17/2009 2:31 PM Page 16

Follow the flip-flops

20505_V7:Layout 1 6/17/2009 3:01 PM Page 17

Christiana Care and Delaware Techgraduate 64 new allied health professionals

1 8 ● F O C U S J u n e 1 8 , 2 0 0 9

Danya Johnson (Mount Pleasant), right, andAriana Kathryn Gibson, (A.I. du Pont)received high school diplomas at graduationceremonies at the First State School

20505_V7:Layout 1 6/17/2009 2:31 PM Page 18

Screening recommendedfor those over age 50

‘Virtual colonoscopy’ to be added as a covered benefit

20505_V7:Layout 1 6/17/2009 3:02 PM Page 19

Steve Elliott of Sunoco (left) and Rochelle Sparks of NuclearMedicine, celebrate Sparks’ knowledge and ability of CPR enablingher to come to the aid of another stricken in the marketplace.

20505_V7:Layout 1 6/17/2009 2:31 PM Page 20