MedStaff Sum 2011 EVANS

8/3/2019 MedStaff Sum 2011 EVANS

1/16

Summer 2011 Medical Staff News 1

Pain will impact you at some point in your life.Whether its a lingering back or neck strain,

an old foot injury, joint pain, neuropathy or

fibromyalgia, patients are finding relief at

Faulkner Hospitals Pain Clinic.

Faulkners Pain Clinic was established 17 years

ago under the medical directorship of Dr.

Dana Zalkind, who was recently named one of

Boston Magazines top doctors of 2010.

Dr. Zalkind and her partners from New

England Pain Management Consultants have

expanded the practice with the assistance of

the excellent nursing staff here at Faulkner

Hospital, comprised of Kathleen Armando,

Mary Jane Piro, Amie Kandalaft and Sara

Robart with the assistance of Maureen Schnur,

MS, RN, CPAN, Nursing Director.

The Nursing staff is ACLS certified with a

combined work experience of 91 years. The

clinic treats more than 5,000 patients annuallyfor various types of syndromes.

This interventional pain facility does a wide

variety of procedures for spinal pain, joint

pain and neuropathic pain. An average visit to

the pain management clinic can last between

30 minutes to two hours. Procedures are

done utilizing x-ray technology as well

as cardiovascular monitoring. Conscious

sedation is also available to alleviate anxiety.

Procedures are performed by physicians who

are board certified in anesthesiology and pain

management.

The staffs goal is to treat every patient with

respect, dignity and empathy while working to

improve the patients quality of life by making

their pain more manageable. The goal of

improving quality of life is very important to

everyone in the Pain Clinic.

N E W S F O R A N D A B O U T

F A U L K N E R H O S P I T A L P H Y S I C I A

INTHIS ISSUE

NEWSFAULKNERHOSPITALMEDICAL STAFF

Pain management at Faulkner Hospital

S U M M E R 2 0 1 1

From left, Sara Robart, Mary Jane Piro, Kathleen Armando, Dr. Dana Zalkind & Amie Kandalaf

continued on P2

P3: Sagoff Centre celebrates

40th anniversary

P4: Guidelines for teaching

physicians, interns and residents

P5: Health care unseen

P8: Reducing risk during patienthand-off communication

P11: New medical record

documentation policy

P12: Center for Robotic Surgery

helps women with

gynecological disorders

P14: Partnering to reduce avoidable

hospital readmissions

C.A.R.E.STANDARDS

C. Communicate your

commitment to providing

high quality service

A. Appear and act as a

professional

R. Respect all individuals

E. Extend yourself

Remember to plan for language

needs (interpretation, translation and

assistive devices) for all patients that

may require this extra service.


2/16

Medical Staff News Summer 20112

DEAR MEDICAL STAFF,

The past few months have been a time of

significant changes here at Faulkner Hospital.

As Dr. Stephen Wright, Chief of Medicine

and Chief Medical Officer, announced

his retirement we have needed to take

up the great challenge of considering his

replacement. It is no surprise it will take

more than one person to replace him so

the position of Chief of Medicine will be

separated from the Chief Medical Officer.

And still these are quite big shoes to fill.

I want to congratulate Dr. ONeil Britton

who will be taking on the role of Chief

Medical Officer. With his experience and

skill I think this will be an exciting time

for the development of that role. We are

fortunate to have someone so well respectedon both campuses who understands the

inner workings of Faulkner and our role

in the BW/F family. Please join me in

congratulating and assisting him in his

transition to this new role.

We have just initiated a search for a new

Chief of Medicine. The committee is

composed of myself, Pardon Kenny, ONeil

Britton and Mike Querner and is being

chaired by Dale Adler. We spent our first

meeting discussing the important aspects

of teaching and clinical excellence the role

requires and will start looking for candidates

in the immediate future. Please feel free

to contact any one of us with questions or

comments regarding the search.

I want to welcome our new Chief of

Radiology, Stephen Ledbetter. He comes to

us from Brigham Radiology where he was

the Director of Emergency Radiology. He has

shown great enthusiasm in the first few weeks

of his tenure and is known at the Brigham forhis excellent patient care and administrative

ability.

Finally, this year marks 40 years of the Sagoff

Centre, a true clinical center of excellence

in breast imaging and patient care. The first

of its kind dedicated to breast imaging, the

Centre has been the model so many other

institutions have tried to emulate. The

Sagoff Gala on May 20th was a celebration of

this and Dr. Norman Sadowskys 40 years of

service.

We are loosing two great leaders and

physicians in Steve Wright and Norman

Sadowsky and we should all feel lucky to

be able to call them our colleagues and

our friends. All the best to both of you in

retirement.

Sincerely,

Peggy Duggan,

MD, FACS

President, Faulkner

Hospitals Medical

Staff

Published by Marketing

and Public Affairs

(617) 983-7588

[email protected]

We welcome your feedback and

suggestions for future issues.

That could mean being able to play with ones grandchild, to be

able to return to work, or simply to be able to perform ones daily

activities comfortably.

In addition to these interventional procedures, Dr. Zalkind and

the other physicians in the clinic utilize many other services at

Faulkner Hospital, such as Physical and Occupational Therapy,

Psychiatry, Social Work, and Addiction Recovery when needed.

They try to assist the patients with the additional avenues of care

and act as liaisons between the two to ensure the highest quality

of care is given.

Using a multi-modality approach, we are able to look at

a patients problem from all angles and provide the most

comprehensive treatment possible in order to make their pain

more manageable, says Dr. Zalkind.

Faulkner Hospitals Pain Clinic is located on the 7th floor of the

hospital and is open to schedule appointments Monday Friday

from 8 am 4 pm. To make an appointment, call 617-983-7080.

Pain management at Faulkner Hospital

continued from P1


3/16


ONeil A. Britton, MD, was

recently appointed Chief

Medical Officer at Faulkner

Hospital, effective June 1.

Dr. Britton is a highly respected leader both

within and outside the BW/F community, says

BWH President Betsy Nabel, MD. I am confident

that he will help position Faulkner Hospital for

even greater success, ensuring that we maintain

the quality for which we are known as we venture

forward to face the new and pressing health care

challenges ahead.

Dr. Britton is a leader who upholds the highest

standard of personal integrity. Early on in his

career, Dr. Britton was identified as an individual

with incredible medical acumen and insightful

leadership abilities. With a wealth of experience in

clinical operations, he has demonstrated a deep

commitment to quality improvement and mentoring

the next generation of physicians. He is also serving

as Vice President of Professional Services and

Associate Chief of Medicine at Faulkner Hospital, as

well as a vice chair of Medicine at BWH. He remains

clinically active as a hospitalist at Faulkner.

A graduate of the City College of New York, Dr.

Britton completed his medical degree at New

Jersey Medical School and did his Internal Medicine

training at BWH. He was the first associate director

of the Office of Minority Career Development at

BWH, prior to the creation of the Center of Faculty

Development and Diversity. He left BWH to serve as

medical director of Horizon Healthcare of New York,

and returned two years later as a Deland Fellow.

Dr. ONeil Britton

Chief Medical Officer appointed at Faulkner Hospital

Even from the outside, Faulkner

Hospitals Sagoff Breast Imaging

and Diagnostic Centre looks

noticeably different. While a fresh

coat of paint and weeks spentrevitalizing the brick work has left

the building looking brand new,

its the changes inside the Centre

that are the most striking.

We recognized that we needed

to listen to the feedback our

patients were providing and

make improvements based on

what they wanted, states Brian

McIntosh, Director of Radiology.

The timing was right in that

it coincided with our fortieth

anniversary as a Centre.

When patients first enter the Centre on the

second or fourth floors of Belkin House, they

will find natural light filling the registration

and waiting areas, along with new furniture,

privacy doors, updated carpeting and

modern lighting. The sign-in desk has been

moved closer to the entrance doors so that

patients are greeted immediately, and three

new registration areas specific to the second

floor offer more privacy than before.

New patient lockers have also been installed

in the refreshed handicapped accessible

changing areas. The renovated gowned

patient waiting areas have also

been updated to allow for more

privacy, a digital flat screen

television and comfort amenities,

such as a coffee machine and abottled water station.

Perhaps whats most notable about

the renovations that took several

months to complete is the calming

and peaceful atmosphere of the

entire Centre. New doors prevent

much of the noise from exam and

reading rooms from reaching the

waiting areas. In addition, carts

and personal items that were

previously stacked in halls have

been permanently moved to out of

sight storage areas.

Our breast care services have always been

among the best in the country, states

Jeanne Staunton, Breast Imaging Manager.

Now we have a top notch facility to match

the top notch services we offer.

Hospital administrators and members of Faulkner Hospitals Sagoff

Breast Imaging and Diagnostic Centre cut a ceremonial ribbon

marking the completion of renovations.

SAGOFF BREAST IMAGING AND DIAGNOSTIC CENTRETURNS 40 AND GETS A FACE LIFT


4/16


Dr. Raymond Murphy, former Chief of Faulkner

Hospitals Division of Pulmonary Care, recently

donated five original pieces of his artwork to

Faulkner Hospitals Patient/Family Resource

Center.

Dr. Murphys donated artwork is of birds, flowers

and other things found in nature, which he has

recreated using pastels and watercolors. The

paintings were done over the last five years and

donated to the hospital in 2010.

I donated them as an expression of my thanks

to the wonderful people Ive worked with, as w

as to the patients and their families who have

benefited from the excellent care they received

at Faulkner Hospital, says Dr. Murphy.

It is Dr. Murphys hope that viewers of his artwo

are able to see the beauty in the world despite

the many problems life throws at them.

FAULKNER PHYSICIAN DONATES ORIGINAL ARTWOR

The article provides teaching physicians,

interns, and residents information about

the following:

Payment for physician services in teaching settings;

General documentation guidelines; and

Evaluation and management documentation (E/M) guidelines.

Payment for Physician Services in Teaching Settings

Services furnished in teaching settings are paid under the Medicare

Physician Fee Schedule (MPFS) if the services are:

Personally furnished by a physician who is not a resident;

Furnished by a resident when a teaching physician is physically

present during the critical or key portions of the service.

Medical and Surgical services furnished by an intern or resident withinthe scope of his or her training program are covered as provider

services and paid by Medicare through direct Graduate Medical

Education (GME) Program and Indirect Medical Education (IME)

payments, and the services of the intern or resident may not be billed

or paid for using the MPFS.

Services Furnished by an Intern or Resident Outside the Scope of

an Approved Training Program (Moonlighting)

Medical and surgical services furnished by an intern or resident that

are not related to his or her training program and are furnished

outside the facility where he or she has the training program are

covered as physician services when the requirements in the first two

bullets listed below are met. Medical and surgical services furnished

by an intern or resident that are not related to his or her training

program and are furnished in an outpatient department or emergency

room of the hospital where he or she is in a training program are

covered as physician services when the requirements in all three

bullets listed below are met. When these criteria are met, the services

are considered to have been furnished by the individual in their

capacity as a physician, not in their capacity as an intern or resident.

The services are identifiable physician services, the nature of which

require performance by a physician in person and contribute to the

diagnosis or treatment of the patients condition.

The intern or resident is fully licensed to practice medicine,

osteopathy, dentistry, or podiatry by the state in which the services

are performed.

The services furnished can be separately identified from those

services that are required as part of the training program.

General Documentation Guidelines

Both residents and teaching physicians may document physician

services in the patients medical record. The documentation must be

dated and contain a legible signature or identity and may be:

Dictated and transcribed;

Typed;

Hand-written; or

Computer-generated.

The teaching physician may use a computer generated macro(predetermined text not edited by the user) as the required personal

documentation if he or she personally adds it in a secured or

Guidelines For Teaching Physicians, Interns, and Residents


5/16


password protected system. In addition, to the teaching physicians

computer generated macro, either the resident or the teaching

physician must provide customized information that is sufficient to

support a medical necessity determination. The note in the electronic

medical record must sufficiently describe the specific services

furnished to the specific patient on the specific date.

Evaluation and Management Documentation Guidelines

For a given encounter, the selection of the appropriate level of E/M

services is determined according to the code of definitions in the

American Medical Associations Current Procedural Terminology (CPT)

book and any applicable documentation guidelines.

When teaching physicians bill E/M services, they must personally

document at least the following:

That they performed the service or were physically present during

the critical or key portions of the service furnished by the resident;

andHis or her participation in the management of the patient.

The combined entries into the medial record by the teaching

physician and resident constitute the documentation for the service

and together must support the medical necessity of the service.

Documentation by the resident of the presence and participation of

the teaching physician is not sufficient to establish the presence and

participation of the teaching physician.

Evaluation and Management Documentation Provided by

StudentsAny contribution and participation of a student to the performance

of a billable service must be performed in the physical presence of

a teaching physician or resident in a service that meets teaching

physician billing requirements (other than the review of systems

[ROS] and/or past, family, and/or social history [PFSH], which are

taken as part of an E/M service and are not separately billable).

Students may document services in the medical record; however, the

teaching physician may only refer to the students documentation

of an E/M service that is related to the ROS and/or PFSH. The

teaching physician may not refer to a students documentation of

physical examination findings or medical decision making in his or her

personal note. If the student documents E/M services, the teaching

physician must verify and redocument the history of present illness

and perform and document the physical examination and medical

decision making activities of the service.

To find additional information about documentation guidelines for

E/M services, visit http://www.cms.hhs.gov/MLNEdWebguide/25_

EMDOC.asp on the CMS website.

Questions or comments regarding this article can be address to

Patrick V. Cerce, Director of Compliance at (617) 983-7470.

As you may have heard, the Federal government

has mandated changes to the 4010 HIPAA trans-

action standards (claims and eligibility) and the In-

ternational Classification of Diseases (ICD) codingsystem. All covered entities, including health care

providers, must convert from ICD-9 to ICD-10-CM

(diagnosis) and ICD-10-PCS (procedure) codes by

the compliance date of October 1, 2013.

How will this change impact Faulkner Hospital,

Partners HealthCare, the health care industry and

you? Working with Partners, Faulkner Hospital

has a project plan in place for this mandatedchange. In the weeks and months ahead, you will

be receiving more formal communication about

this project as it relates to your department,

including an initial training survey that you will

receive by the end of March.

If you have any questions, please contact Debra

Torosian at 617-983-7458.

IMPLEMENTATION OF

HIPAA 5010/ICD-10


6/16


A friend of mine from college, knowing I had

decided to transfer to pharmacy school,

would goad me, saying I heard pharmacists

take pills from big bottles and put them into

little bottles, and start laughing. Hed been

admitted to dental school. I may have to

count pills, Id respond, but youll be

staring down throats the rest of your life.

Dispensing medications counting pills

is a fundamental activity in pharmacy. Patients

need correct medications, need them

promptly, and require appropriate education.

But there are other parts to the job, just as

important.

Pharmacists help patients every day by

intervening in their medication orders,

discovering and correcting drug interactions

and therapeutic duplications, educating

other health care workers and patients, and

helping to ensure the best outcomes. From

an outsiders perspective, most of these

actions are under the radar.

A few years ago I received an urgent phone

call from a medical resident covering the

intensive care unit at my community teachinghospital in the Boston area. His patient had

attempted suicide by drinking an extremely

poisonous substance.

The conventional treatment for such a poison

was to administer intravenous ethyl alcohol in

amounts to keep the patient intoxicated. By

competing with the substances metabolism,

the alcohol prevents toxic metabolites from

forming, avoiding renal failure and metabolic

abnormalities and allowing time for it to be

removed by dialysis.

I had encountered an identical situation years

earlier at a different hospital. At that time,

Poison Control helped us determine the

concentration of the ethyl alcohol needed

and how to prepare and filter these infusions.

That patient survived with no permanent

adverse effects, and when the physician on

the case called days later to thank us, it felt

great.

Ten years later, the same poisoning had

occurred, but there was a new antidote with

fewer side effects than alcohol. Working with

two other pharmacists, we acquired enough

of the antidote to get the patient through this

crisis, conferred with the resident to ensure

correct dosing and appropriate duration of

treatment, and prepared and delivered it to

the patients nurse, describing its mechanism

of action and side effects. Over the next few

days, we delighted in the fact that our patient

survived with no permanent physical injury.

I once sprinted up four flights of stairs

carrying gingerly the life-saving clot

buster Alteplase (TPA) in order to get it into

the nurses hands so she could administer it

to a patient suffering a heart attack. The

sooner it gets infused, the greater the

amount of heart muscle saved, and the better

the chances are of a successful outcome.

After handing it over, I relaxed and caught my

breath, then walked past the nurses station

towards the elevator. The cardiologist who

ordered it looked up from the patients chart

and smiled, a silent thank you crossing his

lips.

I remember an anesthesiologist once asking

me to mix a new type of preparation, an

infusion to be administered into the epidural

space. He wanted to use it on an inpatient

with terminal cancer who, despite receiving

high doses of narcotics intravenously, had

intractable pain. Epidural analgesia is a

technique where the tissue space around the

spinal cord is injected or infused with an

analgesic. Benefits include enhanced pain

relief (the drug is administered directly to the

central nervous system), and fewer side

effects (the amount needed is small so less

drug gets into the systemic circulation). The

preparation in this case would be a mixture o

a local anesthetic and a narcotic. We figured

out the amounts of each drug in the mix,

ensuring compatibility, stability, and correct

dose. It was administered to the patient with

great pain-relieving results. Our epidural

analgesia program had begun and quickly

spread to include many other patients.

Epidural analgesia would become an

important tool in the world of pain relief.

Several months later, while checking

medication stock on the intensive care unit,the chief of anesthesia pulled me into a

patients room and introduced me as the

guy responsible for relieving your pain. I

thought it a kind and overstated gesture

by a nice guy, but Ive remembered it through

the years.

A few years ago there was a patient admitted

to a surgical floor with an exceptionally

confusing drug regimen. She claimed to have

allergies to the excipients (inactive

ingredients) in medications, was on morethan ten different drugs, took them

throughout the day, and had set up a finicky

system of self-medication. This patient

requested to take her own medications.

Hospitals have a policy requiring that only

those medications purchased and stocked by

that hospital can be used while the patient is

under its care. This makes certain the drugs

have been obtained from a reputable

Health Care UnseenBy Joe ODay, Director or Faulkner Hospitals Pharmacy


7/16


supplier, have been stored properly, and are

still in date. However, sometimes an

exception is made, and only i the patients

medications are properly labeled, can be

identifed by the pharmacy, and will be

administered by the patients nurse.

This patients physician said that her certainty

o reacting badly to the hospitals drugs

(many identical to the ones she had brought

in) was causing her great angst. We

acquiesced and picked up the patients

Tupperware container with her medications

inside. They were a mess, mixed together in

various prescription bottles. Another

pharmacist and I spent hours sorting through,

organizing, and identiying as many as wecould.

As we fnished up, I noted the time: 6 pm. I

hoped to make my hospitals medical book

club meeting that night. We were to discuss

Anne Fadimans book The Spirit Catches

You and You Fall Down. It tells a harrowing

story o a Hmong amily in Caliornia, how a

lack o cultural understanding contributes to

the tragic death o a child to seizures, and

highlights the importance o understanding

the patients side o an interaction, o the role

o empathy in the healing process. The group

was to meet at 6:30 pm.

My assistant had to leave, so I brought the

patients reorganized medications to the

nursing unit to review them with the nurse

and physician. I needed something clarifed

and asked the medical resident i I could see

the patient. As we entered the room and the

resident introduced me as The Pharmacist,

the patient became agitated, pointed at me

and shrieked, thats the guy whos screwing

me up! I had the impulse to say I just wasted

three hours fguring out the meds just to

make her happy. But there was nothing to

fght against. My job was to help. When I

gently reassured her that she could take her

own medications and that I only needed one

question answered, she settled down.

Arriving at the book club at 7:30 pm, I

mentioned the irony o having read a book

about the dangers o miscommunication

between patients and caregivers and what I

had just experienced. I was upset, but had

respected her ear about someone tampering

with her system. The book had done its

job.

One evening I got a call that a patient had

reractory thrombocytopenia (abnormally low

platelet level), a potentially lie-threatening

condition, and that the physician wanted to

try a seldom used medication. We worked

out the dose with the patients resident and

consulting hematologist, and prepared it and

educated the nursing sta about its

administration. This, o course, occurred at

the end o the day, making a long day longer.

Finishing up aterwards, I thought o the

stressul hours the process took, how the

pharmacy had reacted quickly and

successully, and as I threw on my coat and

walked outside into the damp, cold, winter

night toward my car, I clenched my fst and

punched the air in victory.

The drug was administered with good results

the patients platelets rose to sae levels.

Days later, I asked our two pharmacy

students, who rounded with the residents,

about the patient. Shes a proessional

singer, they said. She sang O Danny Boy

or St. Patricks Day, to thank everyone. I elt

a wave o resentment. Surely we also

deserved to receive this git o thanks. No

one knew that three o us had stayed hours

ater our shit to ensure her treatment went

perectly. Then I caught mysel: We dont

work or accolades; we work to get our

patients well.

. . . After handing it over, I relaxed and caught my

breath, then walked past the nurses station towards

the elevator. The cardiologist who ordered it looked up

from the patients chart and smiled, a silent thank you

crossing his lips.

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enews.html


8/16


Everyone understands, in principle at least, how important hand-off

communication is during patient care transitions from one physician

to another, or from one medical setting to another. Although the

hand-off process is routine, it may become a potentially risky event for

providers when the hand-off is incomplete or fumbled.

Problems with hand-off communication account for the root cause

of up to 70 percent of adverse events, according to The Joint

Commission. Failure to communicate important information in

a timely manner may cause or substantially contribute to patient

injury or death. In such cases, the hand-off failure also may lead to a

malpractice claim against all providers involved in the hand-off.

Vulnerability to hand-off failure rises with the increasing segmentation

of care in our healthcare system. Hospitalists who may have no prior

relationship with your patient now hold day-to-day responsibility for

in-patient assessment and care. Consultants who provide specialized

care for your patient rely upon your consultation request to determine

how you wish them to assist you in the diagnosis and treatment of

your shared patient. An incomplete or hastily written request may

result in a diagnostic test not being ordered or failure to perform

follow-up care, resulting in a delayed diagnosis and treatment for the

patient.

Medical schools do a poor job of teaching hand-off communication,

so when new house staff arrive at the hospital, it is necessary for

attending level physicians and senior house staff to teach the hand-of

and to assess the level of competency of the trainee before placing

patients in their care. Using a standardized approach with checklists i

recommended to assure that all essential data points are covered.

As a primary care physician, the provider should inform patients when

a hospitalist will care for them. This will avoid additional stress upon

your patient who may be admitted urgently to the hospital, and be

distressed to encounter a complete stranger on the unit, seeing no

sign of you. By resetting patient expectations in advance, you can

head off a misinterpretation by the patient and family that you were

ignoring the patient and correct a misinterpretation that you have

essentially abandoned the patient.

Be sure to communicate essential information about the patient

to the accepting hospital team, in a clear and concise manner,

allowing time for questions. Information about allergies, difficult

airway/intubation status, and need for follow-up care require explicit

instructions, and may benefit from a standardized communication

tool. If you receive notification that your patient was recently

admitted or discharged from a hospital, be sure to have a system

in place at your office to document your receipt and review of the

discharge summary, especially regarding follow up care. Your office

should have a system in place that logs in the documents and a place

for signature or initials that prove you have seen it.

Reducing Risk During Patient Hand-Off CommunicationJoanne C. Locke, RN, JD

Director, QI and Risk Management

Prior to joining

Faulkner, Dr.

Ledbetter was

the Section Head

of Emergency

Radiology and

the Director of

the NightWatch

Teleradiology

Program at Brigham

and Womens

Hospital, both of which he founded in 1999

and 2004, respectively.

Dr. Ledbetter brings a progressive patient-

centric vision to our department that will

strengthen every aspect of care we provide,

says Jeanne Staunton, Breast Imaging

Manager. Under his leadership, every

decision we make as a department will

enhance the quality and efficiency of the

services we provide, she adds.

Among the goals Dr. Ledbetter hopes to

accomplish at Faulkner are to increase

the level of radiology sub-specialization

to better meet the needs of our patients

and referring physicians, strengthen the

professional relationships and interactions of

radiologists across the BWF enterprise, and

reinvest in the Sagoff Centres remarkable

history of innovation in breast imaging and

interventions.

When asked why he decided to come to

Faulkner, Dr. Ledbetter said I came to

Faulkner because of its reputation as a

best-in-class community hospital, because

of its ties with BWH, and because I thought

there were tremendous opportunities for

my personal and professional growth as a

radiologist and as a radiology administrator.

Dr. Ledbetter graduated from the Bowman

Gray School of Medicine, now the Wake

Forest University School of Medicine in

Winston-Salem, NC. He completed his

residency in Radiology followed by a

fellowship in Emergency Radiology, both

at Brigham and Womens Hospital. Dr.

Ledbetter obtained his Masters of Public

Health from Harvard in 2005.

In his spare time, Dr. Ledbetter enjoys

spending time with his family, cooking,

running, listening to music and dabbling in

real estate.

NEW CHIEF OF RADIOLOGY

Stephen Ledbetter, MD, MPH, was recently named Chief of Faulkner Hospitals Radiology Department.


9/16


When sending a patient out for a consultation, be sure that your own

request is clearly written, with explicit tests and examinations you wish

performed. A referral to a gastroenterologist may not automatically

include a colonoscopy without the PCP documenting this expectation.

If both the GI consultant and the PCP do not notice that a patient

is overdue for a screening colonoscopy and fails to perform it, this

creates a liability gap for both physicians if a later claim of delayed

diagnosis of colon cancer is brought a year after the two practitioners

saw the patient. If you recommend a test and the patient refuses, it

becomes especially important to document the risks of refusing the

test, and advising the patient to reconsider. You always must avoid a

tone of frustration, but be sure to document your attempt to change

the patients mind, and be sure that the patient signs an informed

refusal, to demonstrate the patient understood the implications of his

or her decision.

Telephone conversations or curb-side consults are to be avoided

when possible. If engaging in these practices, it is essential to

document what was said and done in response to the request.

Many malpractice cases hinge on the lack of a note during such

conversations.

At every hand-off, check and re-check medications. Five steps should

occur:

Create a list of current medications

Create a list of medications to be prescribed

Compare the medications in each list and make a clinical

determination of compatibility based on your review. Calling

the pharmacy or checking the PDR can be helpful, but be sure to

document that you did so.

Communicate the new list to the next providers.

Creating a standardized hand-off checklist will provide proof that

important information was communicated to the next team caring for

the patient.

Whenever possible, communicate face to face without interruption

and provide an opportunity for both parties to ask questions and

clarify any ambiguities. Confirm that what you said has been heard

and understood by using a teach back method or asking thereceiving provider to summarize with you what is expected and

what will be communicated. Finally, document the substance of this

conversation in the medical record.

Compliance with these basic rules of hand-off communication will

maintain the patients safety and protect the providers from costly

hand-off fumbles that may result in patient injuries and subsequent

liability claims.

Faulkner Hospitals Radiology Department recently began

using an eight-channel wrist coil in their MRI service to

optimize both the patient experience and the images

produced.

The wrist coil utilizes eight channels, or frequencies, to

provide more specific, high resolution images of the wrist

and its components, as well as to maximize the comfort of

the patient throughout the imaging process.

These optimized images provide physicians with a more

detailed view of the wrist, allowing them to better diagnose

and treat the symptoms more accurately. The noise, or

motion some images show, is also greatly reduced.

Since we have implemented the coil we have seen a

reduction in test time and patient satisfaction, says

Catherine Brockington, RTRMR, Staff Technologist.

NEW TECHNOLOGY ALLOWS RADIOLOGISTS TO OPTIMIZE IMAGES


10/16


My father suffered a horrible fall and I immediately brought

him to Faulkner Hospitals Emergency Room for evaluation and

treatment. From the moment we entered the hospital to the

time we left every staff member we encountered treated us withgenuine kindness and compassion. Beth Gangemi greeted us

as we walked in and she immediately took our information and

called for someone to get ice for his injuries. Lorraine Traft, RN

immediately assessed my fathers condition and was very kind

and warm to him while treating him. My father was immediately

brought into an exam room and Anthony Paglia, PA was very

thoughtful and caring while treating my father and made him feel

very comfortable. There was a sweet nurse named Karen White

that came in and sat next to my father on the stretcher and talked

to him and made him feel cared for. Our final encounter was

with Kelly Mastroianni, RN who cleaned and treated my fathers

wounds. Kelly communicated with my father before she treated

him just so he was aware of what was going to be done and shewas very gentle and sweet with him.

It was a difficult situation to be in with my father and the

treatment that he received at Faulkner Hospital made a bad

situation more endurable. We are very grateful that we can count

on Faulkner Hospital to treat our valued family members with

respect, kindness and compassion. I am happy to tell you that my

father is recovering very quickly and feeling much better. Thank

you all for being there when we really needed you.

Dear Faulkner Hospital,

I am writing to thank you for the wonderful care of my mother

while she was hospitalized at Faulkner Hospital. Most of the staff

was helpful and measured up to expectations of a world class

hospital, however, there were certain staff members on 6 south

who were exceptional.

Dr. Chalfin was quite impressive not only as a skilled physician,

but also as a leader and teacher. She advocated for her patient,

managed the care team and listened to the concerns of the

family and responded as quickly as possible. Her competence

and awareness of cultural differences was outstanding. Not only

was she respectful and kind to all involved, she did this with ease.

There was also a nurse whose name I do not recall. She

attempted to meet my mothers every need, making her feel as

if she was her only patient. The nursing supervisor whom I had

the opportunity to meet was also a superb employee. She was

competent, caring and very professional.

My family and I are truly grateful for the treatment received at

your hospital.


My father was recently hospitalized at Faulkner Hospital and I am

writing to commend the staff on the expert, compassionate care

that they provided. From the nurse in the ED to the nursing staff

and PCSs on 6 South, the care provided was outstanding. I would

also be remiss if I did not mention the high level of customer

service provided by transport, dietary and phlebotomy staff.

Staff was respectful and welcomed the input of family members

in my fathers care. Two residents, Katherine Rose and Michelle

Morse, exemplified the essence of patient- and family-centered

care in their interactions with my father and his family.

Your staff exceeded my expectations in the high quality and safe

patient care provided and, as such, should be recognized for

their efforts.



11/16


Dr. Ali Bahadori is the new Manager

of Medical Informatics at Faulkner

Hospital. He is responsible

for evaluating and introducing

improvements to the Meditech system

to enhance the clinician experience.

In his short time in his new role, Ali has

already begun improving the clinical

end-user experience on Meditech and

his skills and expertise will be very

valuable for Faulkner Hospital going

forwards, says Dr. ONeil Britton, Chief

Medical Officer and Vice President of Professional Services at Faulkner

Hospital.

Dr. Bahadori attended medical school at Penn State College ofMedicine in Hershey, PA. He did both his residency and internship

in Internal Medicine at Penn State/Hershey Medical Center before

coming to Boston in 2008.

Before joining Faulkner Hospital, Dr. Bahadori was the Physician Lead

on the Acute Care Documentation project, a joint venture between

Brigham and Womens Hospital and Massachusetts General Hospital.

He also practices clinically both Faulkner and Brigham and Womens

as a hospitalist physician.

I came to Faulkner because I wanted to use my skills in technologyand workflow improvement to make the clinical areas of the hospital

the best they can be, says Dr. Bahadori.

Dr. Bahadori was born in Tehran, Iran and now lives in the Boston area.

NEW MANAGER OF MEDICALINFORMATICS AT FAULKNER HOSPITAL

Dr. Ali Bahadori

Faulkner Hospitals Patient/Family Resource

Center (PFRC) recently received a digital

talking book player on permanent loan from

the Perkins Braille and Talking Book Library.

The player utilizes book cartridges and

downloads from the Library of Congress

digital book collection. Each month, the

Perkins Library will send the PFRC a new

cartridge for their collection.

With this player, we are now able to expand

our offerings to patients who cant see or

have difficulties reading print, says Cara

Marcus, Director of the P/FRC.

RESOURCE CENTER OFFERS NEW DIGITAL BOOK PLAYER

Faulkner Hospital has a new Medical Record Documentation Policy,

aimed at removing certain documentation standards from the

medical staff bylaws, making them more easily changeable if and

when necessary. The policy mimics a similar policy at Brigham andWomens Hospital that was recently identified as a best practice by

Partners Internal Audit Services.

The policy was developed by the Health Record Policy Committee

and the Medical Staff QI Committee and approved by both the

Medical Executive Committee and the Bylaws Committee.

This policy went into effect January 1, 2011 and can be found

on Faulkner411.org by clicking the following links: Policies and

Procedures Administrative Health Information Services

Medical Record Policies and then click on Faulkner Hospital Medica

Record Documentation Policy.

Please share this information will your colleagues as there are some

significant changes involving timing of operative notes, frequency of

progress notes and sanctions that are imposed for non-compliance.

Contact Deb Torosian, Director of Health Information Services and

Chief Privacy Officer, at 617-983-7458 with any questions.

New Medical RecordDocumentation Policy


12/16


At Brigham and Womens Center for Robotic

Surgery at Faulkner Hospital, gynecologists

are using cutting edge technology to treat

and care for many gynecological conditions

using state-of-the-art robotics to improve

reproductive surgery outcomes.

At Brigham and Womens Center for Robotic

Surgery at Faulkner Hospital, physicians use

the da Vinci Surgical System to perform a

wide variety of gynecological procedures

including:

Hysterectomies (benign or cancer)

Myomectomy (removing fibroids but

preserving the uterus)

Tubal Reversals (after prior tubal ligation)

Endometriosis

Ovarian cysts and masses

Under the direction of Dr. James Greenberg,

the Center is led by Dr. Antonio Gargiulo

and Dr. Serene Srouji who are pioneers in the

field of gynecological robotic surgery, having

performed New Englands first successful

robot-assisted laparoscopic tubal sterilization

reversal, as well as Bostons first robot-

assisted hybrid myomectomy for the removal

of very large myomata. They have since

continued this accomplished partnership

to perform more than 350 robot-assisted

surgeries.

Traditional open surgery requires one large

incision and retraction to accommodate

human hands, but only small incisions are

required for the robots hands, states Dr.

Gargiulo. In fact, these hands are attached

to four arms - one guides a high definition

3-D camera, two act as the surgeons main

arms, and an optional arm is often used for

holding back tissue. The movements of the

robot are always guided by a doctor, never

programmed.

This miniaturization, increased range of

motion, enhanced vision, and mechanical

precision ultimately allow for virtually all

reproductive surgeries to be performed

laparoscopically, translating into added

benefits for the patient, such as:Less blood loss

Less post-surgical pain/less medication

Quicker recovery and return to normal

activities

Less scarring

Less likelihood of complications

Many of our patients are still in their child-

bearing years, states Dr. Srouji. Of all the

gynecological procedures performed today,

the precision of robotic surgery allows us

more opportunities to effectively preserve the

fertility of our patients.

If you have any of the symptoms described

above, call us at 617-983-7500 to schedule a

consultation.

Center for Robotic Surgery helps women with gynecological disorders

Dr. Antonio Gargiulo and Dr. Serene Srouji

Hand hygiene is the #1 way to prevent thespread of infections

Stopping infections is in our hands.


13/16



14/16


HEALTH STATUSCOMMITTEE

The Health Status Committee of th

Medical Staff is a resource availabl

to all Faulkner Hospital physicians.

The committee can assist withresources for medical, psychiatric

and substance abuse issues, which

may be affecting a physicians

health status and/or practice.

The committee can be accessed

directly through contacting any of

its members or through your servic

chief.

2011 Committee Members:

Geoff Sherwood, MDRic Larson, MD

Stephen Wright, MD

Pardon Kenney, MD

Laura Miller, MD, MD

Michael Querner, MD

Michael Wilson, MD

Peg Duggan, MD

John Lewis, MD

Joanne Locke, RN, JD

Edward Liston-Kraft, PhD

Kerstin Palm, an Occupational

Therapist and Certified

Hand Therapist and Kathy

Belanger, a Licensed Physical

Therapist in Faulkner Hospitals

Rehabilitation Department,have been accepted into

Brigham and Womens/

Faulkner Hospitals Leadership

Competencies for Managers

Program, a nine month

leadership and development

program based on best

practices for management and

leadership.

After seeing how therapists helped my grandmother after she broke both her hips, I knew I

wanted to be a part of the rehabilitative healthcare team, Belanger recalled when asked whyshe chose to be a physical therapist.

For Palm she was inspired to become a therapist because of the ability to work meaningfully

with a diverse group of people.

Both Palm and Belanger had to submit an application outlining their career path and goals, a

CV/resume, a recommendation by the department director, references and undergo a formal

interview to gain admission to the program, which was highly recommended to them by fellow

Faulkner colleague Melissa Joseph, RN, Nurse Manager, 6 North.

When asked what they hoped to accomplish by participating in the program, both emphasized

a commitment to quality of care and acquiring new skills for leadership focused on providingexcellent clinical care in a manner that is patient-centered and optimizes resources.

REHABILITATION SERVICES EMPLOYEES ACCEPTEDINTO LEADERSHIP PROGRAM

Kerstin Palm, left, and Kathy Belanger.

Faulkner Hospitals

Food and Nutrition

Department has

signed the Healthy

Food in Healthcare

Pledge, which was

created by Health

Care Without Harm and is a framework that

outlines steps to be taken by the health care

industry to improve the health of patients,

communities and the environment.

Faulkner Hospital committed to reporting

annually on our progress with implementing

recommended measures to provide more

nutritious, local and sustainable food, says

Susan Langill, RD, Director of Food and

Nutrition. Examples of these measures

include offering more whole grains, reducing

unhealthy fats, increasing availability of local

fresh produce and minimizing food waste.

The department has already removed fried

foods from the patient menu, increased

whole grains on patient and cafeteria menus,

held Farmers Markets to promote the local

produce we offer, reduced polystyrene

products, and added more meatless entre

options.

To date, over 250 hospitals around the

country have signed the Healthy Food in

Healthcare Pledge, and are implementing

policies and programs which demonstrate

a commitment to first, do no harm

and treating food and its production and

distribution as preventive medicine that

protects the health of patients, staff, and

communities.

In the coming year, we are looking to offer

a healthy alternative to fried foods in the

cafeteria, promoting and right-pricing the

healthier foods in our cafeteria, and exploring

the possibility of composting, states Langill.

Healthy food, healthy hospitals, healthy communities


15/16


Faulkner Hospital

and Ethos are

partnering in

a project to

try to reduce

avoidable hospital

readmissions,

defined as

unplanned

readmissions to a

hospital after a previous hospital stay. An

example of an unplanned readmission would

be a patient who is readmitted to a hospital

for a surgical wound infection that occurred

following their initial hospital stay.

Its important to recognize that there are

situations that can lead to unplanned hospitalreadmissions, states Dr. Ed Liston-Kraft, Vice

President, Professional and Clinical Services

at Faulkner Hospital. A hospital readmission

may or may not be related to the previous

visit and some unplanned readmissions are

not preventable.

As you may be aware, in the near future

hospitals will not be paid for avoidable

readmissions. This project is designed to

see if a tested, evidence-based model will

work in todays healthcare environment, says

Liston-Kraft.

The model currently being piloted is the

Coleman Care Transitions Intervention

model, which has been demonstrated to

be a proven method of reducing hospital

readmissions for a number of diagnoses,

including heart failure, diabetes and COPD.

The underlying issue is that each time

a patient transitions to a new setting,

such as from acute care to rehab or from

rehab to home, there are opportunities

for miscommunication of treatments and

medications. Using the Coleman Care

Transitions Intervention model, chronically illolder patients and their care givers are taught

how to ensure that their needs are met

during care transitions, which may reduce the

rates of subsequent readmissions.

The basis of the intervention is the Personal

Health Record that gives the patient a

portable, low-tech way to manage their

medications, identify red flags, set

personal health goals, and provide a place

to write down questions for their provider.

Coaches trained in the methodology work

with the patient to empower them to manage

their own health, which may reduce hospital

readmissions by meeting the needs of a

patient prior to them feeling as though they

need to go back to the hospital.

For the pilot project, selected patients

from the Faulkner Hospital will be referred

to Ethos for Care Transitions. Any patient

who participates in this pilot program does

so voluntarily. The coaches will meet each

patient in the hospital, explain the program

and follow-up with a home visit and a numbe

of telephone calls. The coaches have been

trained by Dr. Eric Coleman, the developer of

the program and have extensive experienceworking with older patients.

Ethos is a private, non-profit organization

dedicated to promoting independence,

dignity and well-being among the elderly

and disabled through quality, affordable and

culturally-appropriate home and community-

based care. For more information about this

program, please contact Faulkner Hospitals

Department of Social Work at 617-983-7932.

Partnering to reduce avoidable hospital readmissions

The Healthy Food in Healthcare Pledge

encourages organizations to:

Work with local farmers, community-based organizations and food suppliers to

increase the availability of locally-sourced

food.

Encourage our vendors and/or foodmanagement companies to supply us

with food that is, among other attributes,

produced without synthetic pesticides and

hormones or antibiotics given to animals

in the absence of diagnosed disease and

which supports farmer health and welfare,

and ecologically protective and restorative

agriculture.

Implement a stepwise program to identifyand adopt sustainable food procurement.

Begin where fewer barriers exist and

immediate steps can be taken. For

example, the adoption of rBGH free milk,

fair trade coffee, or introduction of organic

fresh fruit in the cafeteria.

Communicate to our Group PurchasingOrganizations our interest in foods that are

identified as local and certified.

Educate and communicate within oursystem and to our patients and community

about our nutritious, socially just and

ecological sustainable food healthy food

practices and procedures.

Minimize or beneficially reuse food wasteand support the use of food packaging

and products which are ecologically

protective.

Develop a program to promote andsource from producers and processors

which uphold the dignity of family,

farmers, workers and their communities

and support sustainable and humane

agriculture systems.

Report annually on implementation of thisPledge.


16/16

Faulkner Hospital

Marketing and Public Affairs

1153 Centre Street

Boston, MA 02130

Faulkner Hospital offers two options to pre-register:

Online:

www.FaulknerHospital.org

(24 hours a day)

Telephone:

BREAST IMAGING

617-983-7068

Monday - Thursday, 7 am - 8 pm

Friday from 7 am - 3:30 pm

Saturday from 8 am - 3 pm

ALL OTHER SERVICES

617-983-7010Monday - Friday from 6 am - 8 pm

Please have your insurance card available when pre-registering.

If you have pre-registered for your visit, please report directly to your appointment location.

If you are not pre-registered or unsure if you are, please stop at the Information Desk upon arrival.

They will directyou to your appointment or to registration as needed.

Documents

MedStaff Sum 2011 EVANS