V ita lStatistics - WordPress.comThe Good Doctors are at Henrico DoctorsÕ Hospital. V ita lStatistics Fall 2006 V o lume 5/ Issue 3 HDH news 1 For est Expansion 1 Parham Orthopedic

VitalStatisticsH e n r i c o D o c t o r s ’ H o s p i t a l P h y s i c i a n M a g a z i n e

Volume 5 Issue 3Fall 2006

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Treating Basal Joint Arthritis

Affordable CTLung Cancer Screenings

TB Screening Guidelines

Travel Clinic

Special Section: Quality Initiatives

VitalStatisticsHenrico Doctors’ Hospital

Physician MagazineFall 2006 Vol. 5/Issue 3

Lisa Acquaye

Director of Physician Services

(804) 289-4951

[email protected]

Karen Wormald

Editor

Kew Publications

(804) 379-8503

[email protected]

Jennifer McGuire

Physician Services Coordinator

(804) 289-4951

Jennifer.McGuire@

HCAHealthcare.com

Jeanne Minnix

Design and Layout

Jeanne Minnix Graphic Design

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[email protected]

Henrico Doctors’ Hospital

Marketing & Communications

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Richmond, VA 23229

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© 2006 Henrico Doctors’ Hospital

Vital Statistics is published quarterly by

the Henrico Doctors’ Hospital Physician

Services and Marketing &

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The Good Doctors are at

Henrico Doctors’ Hospital.

VitalStatisticsFall 2006Volume 5/ Issue 3

HDH news

1 Forest Expansion1 Parham Orthopedic Center of Excellence1 Travel Clinic

Medical Staff news

2 Teresa Stadler, MD, Inducted into ACSM2 Smith NAHQ’s President-Elect2 Rick Stauffer, MD, Completes Zurich Triathlon3 Lonny Green, MD, Joins Virginia Women’s

Continence Center3 Heart Failure Core Measure:

Reporting of Discharge Meds3 Meintel, Patient Access Director4 Accashian, Assistant Administrator4 Clostridium Difficile-Associated Disease5 Heart Health from Within by Cliff Morris, MD5 More Affordable CT Scan Lung Cancer

Screenings6 My Thumb Hurts! by Sanjay S. Desai, MD7 TB Screening8 Dave the Date: Colorectal Cancer Conference8 Kidney Transplant Center Grows9 Restless Legs Syndrome: Diagnosis & Treatment

by Pamela Hamilton-Stubbs, BSN, MD

Special Section: HDH Quality Intitatives

10 Special Section: HDH Quality Initiatives

HCA news

11 New West End Outpatient Imaging Center11 Giving Back

Featured columns

12 Finance: Providing a Retirement Plan to Your Employees Can Be Simple by Montford J. Corley, CFP®, CPA

13 Information Gumbo by Gerard P. Filicko, MHA, CMPE

Physician Services update

14 Help Patients Find You14 New Chest Conference CME Program15 HDH/UVA Education Series & Health Fair15 Where to Find Unrestricted Internet Access

Pharmacy news

16 Drug Shortages

Regular features

16 New Appointments18 Calendar of Events

BY CLIFFMORRIS, MD

5 Heart Health from Within

BY SANJAY S. DESAI, MD

6 My ThumbHurts!

BY PAMELA HAMILTON-STUBBS, BSN,MD

9 Restless LegsSyndrome

1VitalStatisticsFall 2006 • Vol. 5/Issue 3

HDH news

ENRICO DOCTORS’ HOSPITAL ISforging ahead with another majorconstruction project to takepatient care to an even higherlevel. In June, HDH announced a

$20 million land acquisition to increasethe size of the Forest Campus by about 50 percent.

Honey Tree Apartments, to the west of thehospital on Forest Avenue, have sold 8.8acres, or 156 of their 544 units, to allowthe HDH room to expand. BecauseRichmond area communities are growing,all area hospitals are feeling the need toprovide more beds and better emergencyresponse.

The construction plan, which is slated forcompletion in phases over five years,includes a new Medical Office Building for physicians, an expandedEmergency Department, additional surface parking, and renovation tothe outpatient lobby. Our on-campus parking capacity will increase byabout 418 spaces. A new inpatient tower housing private rooms will bebuilt over the underground parking deck, and there will be additionalrenovations to other departments within the hospital.

Today, the Forest Campus has 340 licensed beds. Adding private roomswill greatly increase the ratio of private to semiprivate rooms,recognizing patients’ preference for care in a more private setting. Thisis a growing trend that healthcare facilities are seeing across the nation.

About 140 of the affected Honey Tree apartments are now occupied,and those tenants have been given more than 120 days to relocate.HDH will be razing the apartment units to make way for the expansion.

Once the expansion is complete, the Forest Campus will have grownfrom its present 17.1 acres to 25.9 acres.

Forest Campus Expansion in the Works

HDH–Parham Plans Orthopedic Center of Excellence

Also announced in June was HDH’s 18-month project tocreate an Orthopedic Center of Excellence on the ParhamCampus. The facility, which will include a joint-replacementunit, physical therapy, and inpatient rehabilitation, will offerleading-edge amenities. These include a plush lobby,concierge and shuttle services, private rooms that canaccommodate companions who wish to stay with patients, adedicated dining room, and a reading and computer room.

The goal is to make patients feel as if they’re healing in aluxury hotel, rather than a hospital. COO DamondBoatwright said, “We will be able to expand our care andoffer it in a setting that treats patients like hotel guests whoare temporarily sidelined with an orthopedic problem.”

H

Travel ClinicAvailable atHDH–Parham

The Travel Clinic at HenricoDoctors’ HospitalMonday – Friday8:00 a.m. – 4:30 p.m.(804) 747-5627

ORLD TRAVELERS SHOULD NEVERoverlook the possibility of life-threatening health risks overseas.The HDH Travel Clinic can provide

one-stop protection. In addition to an arrayof vaccines, prescriptions for anti-malarials,anti-diarrheals, sleep aids, and medicationsfor altitude sickness are available, as well ascounseling on specific concerns such astraveling with children or the elderly.

Our Travel Clinic is one of few local providersfor yellow fever vaccine, which is required forvisiting certain countries. Ideally, it should be

administered 10 days prior to arrival.

Since the goal of any vaccine is to allow therecipient to develop immunity beforeexposure to the disease, it’s ideal to bevaccinated several weeks or more beforedeparture. However, travelers can still benefitfrom vaccines given on short notice.

Before visiting the Travel Clinic, it’s advisableto call first and find out if vaccination isrequired for a particular itinerary. All overseastravelers should keep routine vaccinations up-to-date, including tetanus/diphtheria.

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2 www.henricodoctors.comVitalStatistics

Medical Staff news

Rick Stauffer, MD, Completes Zurich Triathlon

VER THE FOURTH OF July weekend,anesthesiologist RickStauffer, MD, traveled toZurich, Switzerland, to

participate in an Ironman Triathlon.

The event included a 2.4-mile swim, a112-mile bike ride, and a 26.2-milemarathon. These endeavors ranconcurrently, and it typically takesbetween 13 and 14 hours to complete them.

This was Dr. Stauffer’s third triathlon. He finished in 12 hours, 43 minutes.HDH Nurse Anesthetist Amy Morton was one of his fellow competitors, andshe finished in approximately 12 hours, 20 minutes.

About two dozen Ironman Triathlons are held around the world each yearand attract approximately 1,800 participants. Stauffer reported that Zurichin the summer was particularly beautiful and the weather was perfect.

Smith Named NAHQ’sPresident-Elect

O

THOMAS M. SMITH,RN, MA, CPHQ,who joinedHenricoDoctors’Hospital thissummer asPerformanceImprovementand CaseManagementDirector, has been selected2006-07 president-elect for the NationalAssociation for Healthcare Quality (NAHQ).Smith began serving in September andwill assume the president’s duties at the2007 NAHQ annual meeting in Boston.

“Thom has the experience and academicachievements to provide great leadership tothis organization,” said CEO DaveWilliams.

Smith joined NAHQ in 1996, has served asdirector of professional development on itsboard of directors, and played a role inconference planning and strategic planning.He was president of the board of directorsfor the Virginia Association for HealthcareQuality in 2001 and named the Out-standing Quality Professional in Virginia for 2004.

Smith has more than 20 years of experiencein nursing administration, nursingeducation, clinical bedside nursing, andutilization and case management. He holdsa master’s degree in administration/education from West Virginia Universityand studied nursing science as anundergraduate at West Virginia WesleyanCollege. Smith also completed an executivefellowship in patient safety at VirginiaCommonwealth University.

NAHQ, founded in 1976, is the nation’sleading organization for healthcare qualityprofessionals, with more than 5,000individual members and 100 institutionalmembers. Its goal is to promote continuousquality improvement in healthcare byproviding educational and developmentopportunities to a broad range of healthcareprofessionals.

TERESA STADLER, MD, FACSM, was one of 37 new Fellows inductedthis year into the American College ofSports Medicine at a ceremony inDenver, Colorado.

“The staff at Henrico Doctors’Hospital applauds Dr. Stadler onachieving this distinction,” said CEODave Williams. “Dr. Stadler’s personalcommitment to health, fitness andeducating the community is atremendous asset to our patients.”

Teresa Stadler, MD,INDUCTED INTO ACSM

Dr. Stadler received her medical degreefrom Albany Medical College inAlbany, New York, after undergraduatestudies at the University of Costa Rica,Kansai Gaidai University in Osaka,Japan, and the University of Madrid.She has presented papers in the U.S.and Canada and has been published inthe American Journal of Knee Surgeryand Orthopaedic Transactions, amongothers.

In addition to her practice Dr. Stadler isan active member of the AmericanMedical Society of Sports Medicine andan avid marathon participant, finishingthe National Championship IronmanTriathalon in Hawaii in 2000.

Founded in 1954, ACSM is the largestsports medicine organization in theworld, with over 20,000 members.Only a few hundred have beeninducted as Fellows.


Medical Staff news

EART FAILURE PATIENTS’ NON-COMPLIANCEwith their medications and diet is an importantreason for changes in their clinical status andpotential re-admission. Clear and complete

discharge instructions are all extremely important inproviding the best possible care to those who sufferfrom this chronic disease.

Measuring compliance with the indicator DischargeInstructions Address Medications for Heart Failure CoreMeasures at HDH according to CMS/JCAHO guidelinesrequires the abstractor to review the discharge instructionsheet given to the patient and match that list with anothersource in the medical record, such as the dischargesummary. If the two sources don’t match, we must answer“No” to that indicator, showing non compliance with thatmeasure set.

Discharge instructions must list, at a minimum, the nameof each medication. General terms such as “insulin” or“nebulizers” are not acceptable. This ensures that thepatient and physician have the complete and accurate listof ALL medications.

In cases where the patient’s discharge instruction sheetdoes not list medication names, but only instructs thepatient to “Continue same meds” or “Resume meds,” theabstractor must answer “No” on that measure.

To comply with this standard, it may be helpful to dictatedischarge summaries from the discharge instruction sheetgiven to the patient.

H Changes in Data Abstractionfor AMI/HF Core Measures

Comfort Measures Only

If there is physician documentationthat a patient was receivingcomfort measures at any timeduring a hospital stay, that patientwill be excluded from our AMI/HFCore Measures. Exclusions include:

• Comfort measures only• Comfort measures provided• Hospice care• Maintain treatment for

comfort/terminal care• Palliative care• Supportive care only

If any of these terms are foundwithin the medical record, thepatient will be exempt from theAMI/HF Core Measures. If the onlymention of comfort measures orhospice is at discharge, the patientwill be included.

If you have questions about coremeasures, please Laura Mancini at 289-4763.

Heart Failure Core Measure: REPORTING OF DISCHARGE MEDICATIONS

Lonny Green, MD, JOINS VIRGINIA WOMEN’S CONTINENCE CENTER

LONNY S. GREEN, MD, HAS JOINED VIRGINIAWomen’s Center as Director of the VirginiaWomen’s Continence Center. The Centeraddresses all aspects of female urology, and Dr.Green is one of a few physicians in CentralVirginia certified to perform Interstim, aprocedure that treats frequency, urgency andurge incontinence using neuromodulation.

Dr. Green earned his medical degree from UCLASchool of Medicine and holds a bachelor ofscience degree in biology from StanfordUniversity. He also obtained an MBA from theUniversity of St. Thomas in Minnesota. He

serves as an associate clinical professor with theDepartment of Surgery for the Medical Collegeof Virginia Hospitals.

Dr. Green completed postgraduate training atMonash University in Melbourne, Australia,where he served as senior registrar at the AlfredHospital. He also completed the Harvardprogram in urology through Beth IsraelHospital, Children’s Hospital, West RoxburyVeteran’s Hospital, and Brigham & Women’sHospital, where he also performed his secondyear of general surgery and conducted researchon male infertility.

MeintelJOINS HDH ASPATIENT ACCESSDIRECTOR

TERI MEINTEL HAS JOINEDthe HDH staff as PatientAccess Director for theForest and Parhamcampuses. She waspreviously Support ServicesManager for RichmondPatient Account Services,and had responsibility forthe Mid-West Division,Southwest Virginia, NewHampshire and WestVirginia.


Medical Staff news

CLOSTRIDIUM DIFFICILE IS AN OPPORTUNISTIC PATHOGEN PRESENT IN HEALTHY ADULTS ANDchildren. When the intestinal microbiota is altered, toxogenic C. difficile production increases. C. difficile produces two toxins, enterotoxin (toxin A), and cytotoxin (toxin B).

Disease History• The most frequent cause of hospital

diarrhea.• Accounts for 25 percent of antibiotic-

associated diarrhea.• Accounts for most cases of

pseudomembranous colitis associated withantimicrobial therapy.

Risk Factors• >65 years of age• Hospitalization• Exposure to antimicrobial agents; most

frequently, clindamycin, 2nd and 3rdgeneration cephalosporins, and, mostrecently, fluoroquinolones

• Anticancer treatments• Proton pump inhibitors

Mode of TransmissionTransmission of C. difficile occurs when theorganism or its spores are ingested orally. Thismay occur because of direct contact, person-to-person spread on hands, or from theenvironment. Nosocomial transmission hasbeen documented.

Diagnostic Testing• Approximately 3 percent of healthy adults

and 20–40 percent of hospitalized patientsare colonized with C. difficile. (Testing willnot be performed on non-diarrhealspecimens, i.e., stools that are not soft orliquid.)

• Fifty percent of infants are asymptomaticcarriers. (Testing of infants <1 year of age

is not recommended due to lack ofspecificity.)

• CDT (C. difficile toxins A/B assay) is anenzyme immunoassay for the detection ofboth toxins A and B.

• Failure to detect toxin A or B in patientswith suspected CDAD may be due toimproper specimen collection, handling,and storage or due to toxin levels in thesample below detection limits of the assay.

• A negative result alone may not rule outthe possibility of CDAD. Testing specimensx 3 (obtained >12 hours apart) improvesdetection by 72–93 percent.

• Once a positive result is obtained, it is notnecessary to continue testing.

• Testing should not be used for “test ofcure” because results can remain positivefor up to three to six weeks post-therapy.

Treatment• Prompt discontinuation of the implicated

agent.• Treatment with oral metronidazole or oral

vancomycin.

Infection Control• Strict adherence to Contact Precautions.• Washing hands with soap and water

(alcohol-based hand sanitizers do noteradicate C difficile).

• Cleaning of environmental surfaces in C difficile-positive patients’ room withsporicidal agents.

• Antibiotic stewardship with restrained useof implicated antimicrobial agents.

Controlling Clostridium Difficile-Associated Disease (CDAD)

AccashianJOINS HDH ASASSISTANTADMINISTRATOR

CHRIS ACCASHIAN HAS joined the HDHmanagement team asAssociate Administrator, andhe is currently participatingin HCA’s COO DevelopmentProgram.

Most recently, Chris spent 5 1/2 years at HCA'scorporate offices, serving asFinance–Planning Directorof Operations. Before HCA,Chris was an administrativeresident at Wake ForestUniversity Baptist MedicalCenter in Winston-Salem,NC, and a planning analystwithin the Bon SecoursRichmond Health System.

Contributors’ GuidelinesVital Statistics welcomes reader contributions. Wecontinually seek articles about our physicians’ professionalaccomplishments and activities.

Articles should be no more than 500-750 words. They may besubmitted in the body of an e-mail or as attached Worddocuments that contain no special formatting. Articles shouldbe sent to editor Karen Wormald at [email protected].

However, polished writing isn’t a requirement. If you canprovide the facts, we can write the article. All articles arereturned to their originators for an accuracy check andapproval before they are printed.

If you have a photo to accompany your article, it must be inhigh-resolution JPG format. Submit it as an attachment in aseparate e-mail.


Medical Staff news

HDH OFFERS MORE AFFORDABLE

CT Scan Lung Cancer Screenings

CT Scans at HDH–ParhamMonday through Friday7:30 a.m. – 11:00 p.m.

Weekends7:30 a.m. – 11:30 p.m.

Call (804) 200-7001 to scheduleappointments.

ESEARCH HAS SHOWN A significant increase in early lungcancer detection from screeninghigh-risk individuals with the CTscan,” said Dr. Peter Buckman,

oncology specialist and thoracic surgeon atHenrico Doctors’ Hospital, but the $1,200price tag is often prohibitive.

HDH now offers this screening for $375.

Lung cancer is the leading cause of cancerdeaths in both men and women. Tobacco use

is expected to kill 1 billion people in the 21stcentury if current smoking trends continue,according to the American Cancer Society.The Virginia Department of Health estimatesthat 1.2 million Virginians are smokers, withthe highest concentration in Central Virginia.

Esther Muscari, Director of The CancerCenter at HDH, said, “By reducing the price,we hope to encourage high-risk individualsto call us and get their questions answeredabout risk factors and possible candidacy forthis very effective screening method.”

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BY CLIFFMORRIS, MDVirginia Cardiovascular Specialists

“How things look on the outside of us dependson how things are on the inside of us.”

Parks Cousins

Heart Health from Within

ACT! 70–90 PERCENT OF MEDICAL ILLNESS IS STRESS-related. Stressful events that occur on the outside of us canultimately have disastrous effects on the inside. Everyonecan take effective steps to maintain good heart health bothon the inside and on the outside. These suggestions are

also designed to build self-esteem and help you enjoy yourexercise time. Better fitness truly comes from within.

Nourish your mind as you would your body. Feed your bodyhealthy foods to keep it strong. Feed your mind daily with healthythoughts to keep it vibrant and positive. This, ultimately, leads toa healthy lifestyle.

Find a role model. Find someone who is getting the results thatyou want, and emulate them. Talk with them and find out whatthey are doing.

Use exercise for mental energy. Use the rhythmic andrepetitive nature of aerobic exercise as a platform for consciouslyfocusing on ideas you want to see happen in your life. Askyourself, “What do I want?” Do you need to be creative at home,

to be more kind to others, or achieve a certain goal? Whatever itis, attach a positive verbal or visual image to it, and rehearse itduring your aerobic exercise session. You will finish your exercisetime energized with the mental energy needed to achieve thosegoals.

Burn calories while getting your mail. Instead of just goingto the mailbox and back, walk down the street a block or two.Recite a positive affirmation, like, “I feel great! I feel strong!”over and over until you get back to the house.

Laugh out loud! Ever notice how you feel after a genuine,hearty laugh? Laughter actually lowers blood pressure bylowering stress. Laughter is healing. If you are afraid of lookingsilly, you are likely the person that needs it the most. You aretaking yourself too seriously!

Create entertaining distractions. Listen to audio books ormusic. Watch your favorite sporting events or television showswhile on the treadmill or elliptical machine at home.

Breathe! Take time for focused breathing to fill your body withnew life and energy.

Create social opportunities. Exercise with a partner whether itis a human, dog or someone on the other end of your cell phone.

Remember to EXERCISE WITH PASSION!

Cliff Morris, MD, is a cardiologist with Virginia CardiovascularSpecialists, the Medical Director of Cardiac Rehabilitation at JohnRandolph Medical Center in Hopewell, and cardiology advisor to Muscle& Fitness magazine.

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Medical Staff news

BY SANJAY S. DESAI, MDWest End Orthopaedic Clinic

My Thumb Hurts!

HE OPPOSABLE THUMB IS A UNIQUELY HUMAN ORGAN.No other species possesses the strength, dexterity and finemotor coordination of the human thumb. The human brainreserves a disproportionate amount of space responsiblefor the hand, and particularly the thumb.T

Thumb pain due toosteoarthritis is one of the mostcommon reasons that patientsseek medical attention in a handsurgery practice. Frequentcomplaints include difficultyholding a cup of coffee,manipulating buttons andzippers, and writing. Inaddition, golf, tennis andgardening can also becomeimpossible. The pain is typicallydue to inflammation andcartilage degeneration in thecarpo-metacarpal joint of thethumb. This is also known asbasal joint arthritis. The forcethat is exerted at the tip of thethumb is bio-mechanicallymultiplied by a force of 10 atthe base of the thumb. Thiscreates a significant amount ofstress on this joint with use. Agenetic predisposition plus laxligaments are felt to becontributing factors indeveloping osteoarthritis at thebase of the thumb. Women aremore frequently affected thanmen. This is generally acondition that affects peopleover age 40.

In addition to a history andcareful physical exam,radiographs are helpful indiagnosing this condition.Normal x-rays do not rule outthe presence of earlyosteoarthritis in the thumbbasal joint.

Initial treatment consists ofsplinting, oral anti-inflammatory medication andsteroid injections. For patientswho do not improve with thisinitial treatment, surgicaltreatment is sometimesnecessary.

The traditional surgicaltreatment has been basal jointarthroplasty. This consists ofremoving the entire trapezium,reconstructing the majorligament that suspends thethumb, and using a tendonfrom the forearm asinterposition material. This isalso referred to as a ligamentreconstruction tendoninterposition arthroplasty(LRTI). Its benefits includeusing the patient’s own tissuesand good pain relief. Itsdisadvantages include thepossibility of the repairstretching out and, in somepatients, prolonged recoverytime and a need for handtherapy.

Newer approaches to thetreatment of painful basal jointarthritis are currently available.A less invasive approach whichconsists of removing only thediseased portion of thetrapezium is being used atHDH–Forest. This is inconjunction with the use of aspacer (Artelon) which placesan interposition materialbetween the thumb metacarpal

and the remaining trapezium.Recovery is much quicker, andstudies in Sweden havedemonstrated that the pinchstrength of the thumb is betterthan with the traditionaltechnique. This approach ismost useful in patients in theearlier stages of osteoarthritis.In patients with advancedarthritis and dislocation of thethumb, this technique is lesshelpful.

It is possible to regain functionin the most important digit in

the hand. It can frequently bedone without surgicalintervention. However, in themost painful cases newertechniques are available toallow many patients to returnto pain-free activities.

Sanjay Desai, MD, has been areconstructive hand, wrist andelbow surgeon with West EndOrthopaedic Clinic for over 12years. He is also an assistant clinicalprofessor at the VirginiaCommonwealth University Medical Center.


Medical Staff news

TB Screening FOR MEDICAL STAFF AND ALLIEDHEALTH PROFESSIONALS

HENRICO DOCTORS’ HOSPITAL HAS IMPLEMENTED A POLICY FORTB screening of Medical Staff and Allied Health Professionals toachieve early detection, isolation and treatment of active TB,and to minimize the risk of TB transmission.

Tuberculosis skin testing is required upon initial appointment andat reappointment. Copies of results of tests applied and read atanother healthcare facility are acceptable.

The Infection Control Department will be notified of new positive PPDresults (conversions).

Practitioners are responsible for completing the PPD test (positive ornegative) and forwarding documented results to Physician Services. Allresults will be maintained in the practitioner’s credential file.

TB Skin Testing

Parham CampusOccupational MedicineMonday – Friday, 8:00 a.m. – 4:00 p.m.After-hours test results can be interpreted in the EmergencyDepartment. To schedule an appointment, call 747-5627. Walk-ins are welcome.

Forest CampusEmployee Health OfficeMondays and Tuesdays, 7:00 – 8:00 a.m. & 2:30 – 3:30 p.m. duringwalk-in hours. Call 289-4507 to schedule an appointment for othertimes. After hours, test results can be read and documented in theEmergency Department.

• Chest x-ray required forall new conversions.

• Chest x-ray results withinlast 12 months for newevals with history ofpositive PPD.OR

• TB health questionnairefor symptoms, assessmentand screening (CXR maybe indicated for + reactorswith symptoms of activedisease)

PPD Skin TestRead within 48 – 72 Hours

NEGATIVE REACTION POSITIVE REACTION(history, initial, or conversion)

Documentation required:• Date PPD administered

and interpreted.• Reaction measurement

in millimeters (no reaction = 0 mm).

• Signature of person interpreting the result.

COLORECTAL CANCER CONFERENCE

March 2, 2007Jefferson Hotel

The Cancer Center at Henrico Doctor’s

Hospital has been awarded a $10,000

Targeted Community Investment Grant

from the American Cancer Society to

support a colorectal cancer conference

scheduled for March 2, 2007 at the

Jefferson Hotel in Ricnmond, Virginia

Save the Date


Medical Staff news

O ACCOMMODATE THE INCREASE IN KIDNEY

transplants performed at Henrico Doctors’

Hospital, the Virginia Transplant Center has expanded. In

early July, the Kidney Transplant Evaluation Center

moved from Suite 110 in the Forest Medical Office

Building to Suite 105 of the Glen Forest Medical Office

Building, next to Sports and Occupational Rehab. At the

end of July, the Post-Transplant Center moved into the

Evaluation Center’s former space in MOB Suite 110.

“We are very excited tomove into larger officespace to accommodate ourgrowing number of kidneytransplant patients,” saidGigi Spicer, Director ofKidney Transplant Services.“It’s wonderful to see theprogress the program hasmade since its inception in1990.”

Referrals are up 57 percentfrom the Virginia

Transplant Western Branchoffice in Roanoke. TheEvaluation Center’s largerspace at Glen Forest willallow staff to hold on-siteclasses for patients, livingdonors, and families.Currently, 200 patients arein the evaluation processand 300 are on the waitinglist. The Evaluation Centerorganizes all requiredpatient education,interviewing, and testingprocesses that must bescheduled for patientsthroughout the Forest andParham campuses.

The Post-Transplant Centermove increased their exam-ination rooms from two tothree to accommodatemore than 450 post-transplant patients arrivingfrom all over the state.

The transplant programprovides case managementfor both the inpatient’s stayand the outpatient follow-up for a successful long-term outcome. Thesepatients will be served atHDH for the rest of theirlives.

More than 760 kidneytransplants have beenperformed at HDH to date,including 42 this year.

Kidney Transplant Center Grows

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The Post-Transplant team in MOB Suite 110 at Forest.


Medical Staff news

BY PAMELA HAMILTON-STUBBS, BSN, MD,Director, Sleep Clinic for Children and Adults

Restless Legs Syndrome:Diagnosis & Treatment

ESTLESS LEGS SYNDROME, A SENSORIMOTOR DISORDERcharacterized by annoying sensations, was firstdescribed in 1685 by Thomas Willis. In 1861, RLS wasreintroduced into the medical literature as a psychiatric

disorder. This definition was maintained until the 1940s whenKarl Ekbom wrote a detailed description of the organic featuresof RLS. In 1995 a group of RLS researchers formed theInternational RLS Study Group (IRLSSG). The IRLSSG establishedconsistent diagnostic criteria to aid physicians and to facilitateresearch efforts. The diagnostic criteria was revised andexpanded in 2003 at the IRLSSG/National Institutes of Healthworkshop.

Initially thought to be a rare disorder, RLS is now known to affect

10 percent of the population1 at all ages. Most do not seek

medical treatment before age 40, but when they do, their most

common complaint is insomnia. The physician or nurse

practitioner may only become aware of RLS by specifically

looking for symptoms suggestive of RLS.

The hallmark of RLS is an urge to move the legs, usually

accompanied by annoying sensations. RLS can affect any part of

the body, but it is most commonly found in the lower legs.

Symptoms follow a circadian pattern, begin or worsen during

periods of rest or inactivity, and are partially or totally relieved by

movement. Almost all patients with RLS have periodic limb

movements.

Restless Legs Syndrome can be primary or secondary to other

diseases. Iron deficiency has been identified as a common cause of

secondary RLS.

“Postmortem studies of brain tissue from patients with RLS

document abnormalities in the substantia nigra. These

abnormalities include abnormal distribution or reduction of

ferritin, reduced iron transporters, and possibly a basic

impairment of cellular regulation of iron.”2 Iron dysregulation

may also be responsible for dopamine abnormalities associated

with RLS.

Almost all people with RLS respond to dopaminergic agents.

Other pharmacologic agents include dopamine agonist, clonidine,

anticonvulsants, opioids, benzodiazepines and nonbenzodiazepine

hypnotics. Ferrous sulfate with vitamin C may be helpful in

people with a ferritin level below 50 mcg/L.

Nonpharmacologic treatments include good nutrition, exercise in

moderation, mental distraction and good sleep hygiene. It may be

helpful for people with RLS to avoid some dietary substances

(caffeine, alcohol and nicotine) and medications (neuroleptics,

SSRIs, Tricyclic Antidepressants and some calcium-channel-

blocking agents).

Living with RLS is challenging for the patient and the physician.

Symptoms wax and wane. Some patients benefit greatly from

medical treatment. Others find little relief. Although good medical

care is the foundation for treatment, patients must learn coping

strategies. A support group can offer valid medical information,

an opportunity to share personal experiences, and help people

stay informed about relevant medical discoveries. Consider

advising your patients with RLS to join an RLS support group.

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1. Slevin R. et al, “Restless Legs Syndrome,” American Journal of Health-System Pharmacy 63 (17): 1599-1612, 2006.

2. American Sleep Disorders Association, International Classification of Sleep Disorders, Diagnostic & Coding Manual (Rochester MN).

Additional References

Allen R, Earley C., “Restless Legs Syndrome A Review

of Clinical and Pathophysiologic Features,” Journal of

Clinical Neurophysiology 18(2): 128-147, Lippincott

Williams & Wilkins, Inc., Philadelphia, 2001.

“Restless Legs Syndrome Detection and Management

in Primary Care,” March 2000, NIH Publication No.

00-3788.


SPECIAL SECTION: HDH Quality Initiatives

Y CHOOSING TO WORK IN HEALTHCARE, WE CHOOSE to deal with making decisions and taking actions thataffect other people’s lives. All of us want to do a good job.We want to deliver “Perfect Care.” If 99.9% were good

enough:

• 2 million documents wouldbe lost by the IRS this year.

• 12 babies would be given tothe wrong parents each day.

• 18,322 pieces of mail wouldbe mishandled in the nexthour.

• 291 pacemaker operationswould be performedincorrectly this year.

• 107 incorrect medicalprocedures will be performedeach day.

• 20,000 incorrect drugprescriptions would bewritten in the next 12months.

Is this okay? Of course not. Ashealthcare workers, we shoulddeliver the best care. One waywe can do that is by looking atspecific actions that have beenproven to ensure the best care isgiven to the patient for a specificdisease. This is called “evidence-based practice.”

HDH participates in “CoreMeasures.” In the past, JCAHOlooked at a “snapshot” of eachhospital’s performance everythree years. Now they wouldlike hospitals to give them anongoing picture of how we are

doing. Numerous studies haveshown that when these measuresare in place, patients’ healthoutcomes and quality of lifeimproves.

Core measures allow us to focuson performance improvementon a continual basis. Each coremeasure relates to a specificdisease, and for each diseasethere are specific actions thatshould be taken to reduce thechance that a patient’s conditionwill deteriorate or result indeath. If all of the recom-mended actions are done, wehave given “Perfect Care.” Isn’tthat what we would want forourselves or our familymembers?

Measurement requirements andperformance expectations will bemodified over time to reflect theapplication of evolvingtechnologies and care practicesas they impact the quality andsafety of care. Additional coremeasure sets will be identifiedand implemented for acute carehospitals and specialty hospitalsto provide a greater scope ofselection options.

Significant efforts have focused

on development of an approachfor assuring ongoing relevance ofmeasures and identifyingmeasures or measure sets thatshould be deleted once dataindicate that they no longerprovide substantive oppor-tunities for improvement. Acomplementary plan to assurethat performance is maintainedin these areas will also bedeveloped and implemented. It isenvisioned that the main-tenanceplan will rely on randomizeddata collection activities for asubset of the retired measure set;this subset of measures would becharacterized as “SpotlightMeasures.”

Measurement of patientperception of care will be addedto the Joint Commission’s coremeasure complement over thenext several years. It isanticipated that the JointCommission will adopt thestandardized CMS supportedhospital patient experience ofcare tool (HCAHPS) as soon asit is available.

Diseases and Core MeasuresCurrently Reported by HDHAcute Myocardial Infarction(AMI)• Percent of Lytics

administered in less than 30minutes

• Percent of PercutaneousCoronary Intervention in lessthan 120 minutes

• ACE inhibitors (ACEI) orAngiotensin II ReceptorBlocker (ARB) for LeftVentricular SystolicDysfunction (LVSD)

• Aspirin at arrival• Beta Blockers at arrival• Beta Blockers at discharge• Smoking cessation advice

Pneumonia• Appropriate antibiotic

selection for ICU and Non-ICU patients

• Percent of patients receivingantibiotics within four hoursof arrival at hospital

• Percent of patients receivingantibiotics within eight hoursof arrival at hospital

• Blood cultures drawn beforefirst antibiotic

• Blood cultures within 24hours of arrival at hospital

• Influenza screening andadministration

• Oxygen assessment• Smoking cessation advice• Pneumococcal screening and

administration

Heart Failure (HF)• Left ventricular assessment• ACE inhibitors (ACEI) or

Angiotensin II ReceptorBlocker (ARB) for LeftVentricular SystolicDysfunction (LVSD)

• Detailed dischargeinstructions

• Smoking cessation advice

Surgical ImprovementProcess (SIP)• Prophylactic antibiotic

discontinued within 24 hourspost-surgery end time

• Prophylactic antibioticreceived within one hourprior to surgical incision

• Appropriate prophylacticantibiotic selection forsurgical patients

• Cardiac surgery patients withcontrolled postoperativeserum glucose

• Surgery patients withappropriate hair removal

• Surgery patients withimmediate postoperativenormothermia

Pregnancy and RelatedConditions• VBAC (vaginal delivery after

cesarean section)• Neonatal mortality (live born

neonates who expire within28 days after birth)

• Third or fourth degreelaceration

For more information on HDH’sQuality Initiatives, contactCourtney, Cosby, RN, MN, MS,Administrative Director ofQuality Management, at (804)289-4587, or Denise Weisberg,RN, MS, CNAA, Director ofPatient Safety and PerformanceImprovement, at (804) 289-5638.

BStriving for Perfect Care: WHEN 99.9% IS NOT GOOD ENOUGH


HCA news

NDEPENDENCE PARK IMAGING CENTER, WHICH OPENED INJuly, gives patients in Richmond’s West End access to advanceddiagnostic services in a convenient outpatient setting.

HCA Virginia OpensNew OutpatientImaging Center IN RICHMOND’S WEST END

Independence Park Imaging Center9930 Independence Park Dr., Suite 100(Near I-64 and Gaskins Road)Richmond, VA 23233

“Independence Park highlightsHCA Virginia’s commitment tomeeting the evolving needs ofpatients,” said Patrick Farrell,president of HCA’s RichmondDivision. “The center is animportant addition to ournetwork that complements oursix hospital campuses.”

The facility has a 64-slice CTscanner, an MRI scanner, anddigital mammographyequipment with softMammoPad for patientcomfort. It also features four-

I

S THE COMMONWEALTH’S ONLYstate-wide hospital network andthe state’s fifth largest employer,HCA Virginia is striving to raise

awareness of its presence in thecommunities it serves by actively seekingout opportunities to be a positive influence.

To this end, a brochure called Giving Back isbeing distributed to physicians, chambers ofcommerce, leaders in business andgovernment, and other organizationsthroughout the state. It provides details on

HCA Virginia Gives Back

HCA Virginia 2005 Contributions

Taxes Paid $113,441,000Charity Care Provided 105,974,000Charitable Contributions 3,000,000+

dimensional ultrasound andgeneral x-ray capabilities.Patients often are seen within24 hours of calling the center,and results are usually availablethat same day or the next.

Tammy Dorfman, the center’sadministrator, said, “Our 64-slice CT equipment enables usto complete in five secondscertain scans that take severalminutes with other technology.Our digital mammographyoffers high-resolutioncapabilities that assist our

radiologists in diagnosingpathologies at very earlystages.”

The center was also designedwith patient comfort in mind.Its MRI suite is one of only afew in the country withwindows, creating an open andbright environment that helpspatients relax during theirprocedure.

Independence Park operates ina virtually film-free environ-ment, thanks to HCA Virginia’sPicture Archive CommunicationSystem (PACS) technology.PACS links HCA’s Richmond-

area hospitals, outpatient centersand affiliated physician offices socaregivers have instant access todigital radiological images onhigh-resolution computerscreens. The images can bemanipulated so physicians arebetter able to diagnosis medicalproblems.

Independence Park ImagingCenter joins ChesterfieldImaging Center on Hull StreetRoad in the Harbour PointeVillage shopping center andBuford Road Imaging Center inBon Air as part of the HCAVirginia network.

A HCA Virginia’s commitment to philanthropy,charity care, volunteer work, education andfree clinics.

If you haven’t yet received a copy, GivingBack is available in Physician Services.

12 www.henricodoctors.com

Featured columns

VitalStatistics

BY MONTFORD J.CORLEYCFP®, CPA

MALL BUSINESS OWNERS COMPETE FOR EMPLOYEEtalent with larger corporations that can offergenerous compensation packages, which typicallyinclude a 401(k) plan. A 401(k) plan can be expensivefor a small business to administer, in that it must

adhere to government-imposed testing guidelines. As a result,the business typically hires a third-party administrator toensure that the plan meets all of the guidelines established bythe government. Many small businesses cannot afford theadministrative cost of providing a 401(k) plan. The good newsfor small businesses is that plans can be established withsimplified administrative requirements; however, the tradeoffis less customization.

Thanks to retirement plans like the savings incentive match plan(Simple IRA), small businesses can compete for talented employeesby offering an employer-sponsored retirement plan while eliminatingthe administrative costs associated with 401(k) plans. A Simple IRAplan is a salary reduction retirement plan established in the form ofan employee-owned traditional IRA (but with a higher contributionlevel). To qualify, the business cannot maintain another employer-

Providing a Retirement Plan to Your Employees Can Be Simple

S

sponsored retirement plan andmust have no more than 100employees who earned at least$5,000.

Simple IRAs work much like a401(k) in that the plan acceptsvoluntary employee contri-butions that grow tax-deferred.Employees (including self-employed individuals) areeligible if they have earned atleast $5,000 from the employerduring any two preceding years(whether consecutive or not)and are expected to earn at least$5,000 in the current year. For2006, the maximum employeecontribution is $10,000, and ifthe employee is age 50 or older,an additional contribution of$2,500 is allowed.

The employer must make eithera matching contribution or anon-elective contribution everyyear that the simple plan ismaintained. One of twocontribution formulas can beused:

• A matching contributionmust equal the amount (ifany) that each employeechooses to contribute, up toa maximum of 3 percent ofthe employee's annualcompensation (with properemployee notification, theemployer’s 3 percent matchcan be lowered to as little as1 percent in any two of fiveconsecutive years).

• A contribution of 2 percent(non-elective contribution) ofannual compensation foreach eligible employee, evenfor those employees whochoose not to contribute tothe plan.

An employee (including theowner) who makes awithdrawal from a Simplebefore age 59 1/2, will incur afederal 10 percent penalty andpossibly a state penalty, too,unless an exception applies. Inaddition, if an employee makesa withdrawal before partici-pating in the plan for two years,the federal pre-age 59 1/2-penalty tax is 25 percent.

The business owner can deductemployer contributions in thecalendar year they are made.Some businesses may be eligibleto receive a tax credit of up to$500 (50 percent of the first$1,000 of qualified start-upcosts to create or maintain theplan) in three tax years.

Determining which retirementplan best fits your business canbe a difficult task. A financialprofessional can help youdetermine which type ofretirement plan is right for youand your business. This articleis not intended to provide taxadvice. Be sure to consult yourtax professional regardingindividual circumstances.

Montford J. Corley, CFP®, CPA isan Investment AdvisoryRepresentative* and the owner ofCorley Capital Strategies, LLC,2025 East Main Street, Suite 008,Richmond, VA 23223, 804-788-1022

*Investments and advisory servicesoffered through Jefferson PilotSecurities Corporation, 7501Boulders View Dr., Suite 440,Richmond, VA 23225, 804-272-0014. Jefferson Pilot SecuritiesCorporation and Corley CapitalStrategies are not affiliated.

which concerned functionality,security and reliability.Vendors receiving fullcertification who are com-monly found in Richmond-area practices includeAllscripts/A4, GE Healthcare,Misys, and NextGen. A fulllist of certified products isavailable at www.cchit.org.

Professionalism: PeerLearning

Medical practice managementis an increasingly complex anddemanding occupation. Onelocal resource where practicemanagers can benefit frompeer learning to stay abreast oftrends in healthcare is theRichmond Medical GroupManagement Association. Formore information, contactLindsay Catlett, ChapterAdministrator, [email protected].

Gerard Filicko is a board-certified medical practiceexecutive with over 20 years’experience in healthcareoperations and consulting. Heserves on the Board of theRichmond Medical GroupManagement Association andcan be reached [email protected].


Featured columns

BY GERARD P.FILICKOMHA, CMPE

UTUMN PUTS US IN THE MOOD FOR STEWS, GUMBOand chili. Skillful chefs are able to turn a heap ofingredients into something unique. The same can besaid of practice managers. But instead of food, theseprofessionals blend expertise in financial management,

strategic planning, governance, human resources, and otherareas unique to medical management. Information is a criticalingredient in success, so here are some recipe secrets to help youprepare your “practice gumbo.” Bon appetit!

Financial Management:Medicare

The Centers for Medicare &Medicaid Services (CMS)recently published theproposed 2007 Medicarephysician fee schedule.Providers anticipated a 4.6percent payment reduction, butrevisions to the sustainablegrowth rate (SGR) calculationincreased the cut to 5.1percent. This formulacontinues to penalizephysicians due to increasingutilization, economic trends,and prescription drug inflation.Medical group administratorsare lobbying to replace theSGR with an alternativeformula that tracks changes inpractice costs.

In addition, CMS advancedproposals amending the Starkregulations, developing supplierstandards for independentdiagnostic facilities, andaffecting reimbursement forimaging services.

Business Operations:Medicaid

Physicians accepting Medicaidpatients have dwindled overthe past decade, according to anational study released by the

Center for Studying HealthSystem Change (HSC), aWashington, DC, policyresearch organization fundedprincipally by the RobertWood Johnson Foundation. In2004-05, more than 20 percentof physicians reportedaccepting no new Medicaidpatients. Most cited inadequatereimbursement as the principlereason. Billing requirementsand paperwork were cited by70 percent, and about two-thirds cited delayed reim-bursement. The findingsindicate that Medicaid care isincreasingly concentratedamong physicians who practicein large groups, hospitals andcommunity health centers.

Regulatory Compliance:HIPAA Updates

Most practices are wellacquainted with HIPAAsecurity and privacyregulations, but the Office forCivil Rights reports receivingalmost 20,000 privacyviolation complaints since thelaw was passed. If anyemployee, independentcontractor, volunteer or traineein your practice violatesHIPAA, the government canhold you responsible, as well.Your practice should conduct

annual compliance audits andregular training.

Practices have less than oneyear to comply with the latestregulatory provision thatrequires most Medicareparticipants to obtain anational provider identifier(NPI). NPIs are permanentidentifiers assigned tohealthcare providers andmedical practices in perpetuity,and must be obtained by May 23, 2007.

Information Technology:EMR

This summer, the CertificationCommission for HealthcareInformation Technology(CCHIT), a national nonprofitgroup, announced that 22ambulatory EMRs had met itscriteria for a fully functioning,secure system. This was notjust a “best practice” ranking;the Commission actuallytested and certified products aspart of a federal governmentcontract. Government leadersbelieve certification will helpaccelerate EHR adoption andlead to interoperability. Toqualify for certification,vendors had to be 100 percentcompliant on more than 300rigorous criteria, most of

Information Gumbo

A

HR: Employment Law by the Numbers

3 Years a Virginia employer should keep payrollrecords.

15 Employees required for employer compliancewith the ADA.

40 The age after which individuals are protectedfrom age discrimination.

50 Employees required for employer compliancewith the FMLA.

7,000 Dollars a practice can be fined for each seriousviolation of an OSHA regulation.



New ChestConference CMEProgram Offered

ENRICO DOCTORS’ HOSPITAL IS

offering a new quarterly Chest

Conference CME program series.

Participants in each session, directed by

Dr. Kenneth Haft, will earn two CME/CEU

credits.

The target audience includes medical and

nursing staff in pulmonary medicine,

critical care medicine, internal medicine,

and thoracic surgery.

Learning Objectives

• Disseminate the most up-to-date

information in pulmonary and critical

care medicine and thoracic surgery

through a case presentation format.

• Provide a forum where physicians may

present and discuss with their peers

difficult pulmonary and critical care

medicine and thoracic surgery cases.

• Review in-depth selected topics in

pulmonary and critical care medicine or

thoracic surgery.

Program sessions will be held at the Forest

Campus. Dates and times will be

announced. If you have questions, contact

Jill Habibi at 747-5679.

H

WHEN PATIENTS LOOK FOR A PHYSICIAN,

Help Them Find YouHDH IS UPDATING THE FIND A PHYSICIAN MODULE ON ITS WEB

site to make it more convenient for the public to find the right

physicians. Please take a moment to check your information on

the site and let us know if any changes or additions are needed.

You might want to add such information as your Web address,

languages spoken, or other facts that prospective patients might

find helpful.

You can access Find a Physician at www.henricodoctors.com.

Submit all changes to Physician Services:

[email protected] at Parham (747-5649), or

[email protected] (289-4951) at Forest. You

may also have your photo included on the site by sending it in

digital format as an e-mail attachment or on a disk or CD to

Tina or Jennifer.



PHYSICIANS’LOUNGE PCPROVIDES

A PERSONAL COMPUTERwith unrestricted Internetaccess is now available inthe Forest Physicians’Lounge. HCA securitystandards typically don’tallow connectivity betweenthe HCA network andexternal e-mail systemssuch as AOL, Yahoo, etc.,and some Web-based sites.However, this PC runsindependently from theHCA network.

Physicians may now accessWeb sites that werepreviously off-limits due toHCA network firewallrestrictions. HDH hopes thatthis capability will make lifeeasier for our physicianswith Web-based practicesto communicate remotelywith their practicemanagement or eMARsystems.

The original PC is still inplace for access to HCA-related systems such asMeditech and our intranetresources.

HDH & UVA OFFER

Physician EducationSeries & Health Fair

LL ACTIVE AND ASSOCIATE MEMBERS OF THE medical staff in all specialties are invited toparticipate in this inaugural session, planned tobecome an annual event. It’s sponsored by HDH and

the Office of Continuing Medical Education of the Universityof Virginia School of Medicine.

Parham Campus, First Floor ClassroomThursday, October 26 7:00 – 9:30 a.m. and 11:00 a.m. – 12:30 p.m.

OR

Forest Campus, Williamsburg A & BFriday, October 27 7:00 to 9:30 a.m. and 11:00 a.m. to 12:30 p.m.

All activities comply with theEssential Areas and Policies ofthe Accreditation Council forContinuing Medical Education(ACCME). The UVA School ofMedicine is accredited by theACCME to provide continuingmedical education forphysicians. Designated for amaximum of 1 AMA PRACategory 1 Credit

TM,

physicians should claim thiscredit only to the extent oftheir participation.

The UVA School of Medicineawards 0.1 CEU per contacthour to each non-physicianparticipant for successfulcompletion. HDH maintains apermanent record ofparticipants who have beenawarded CEUs.

Hands-On Stations

Abbreviation UsageBlood product life span

& usageBronchodilator therapyDocumentation requirementsEMTALAGlove usageHand hygieneHigh-flow oxygen therapyHIPAA requirementsInformed consentLibrary resourcesMedication UseOrgan donation –

physician’s roleOSHA medical practice

standardsRestraintsSedationTB testingTranscriptionVerbal orders

Screenings

Blood pressureGrip strengthBody Mass IndexTotal Cholesterol Check

A

UnrestrictedInternetAccess


Pharmacy news

NEW AppointmentsJune & July 2006

Department of AnesthesiaSandra L. Barnes, CRNA Nurse AnesthetistRegina L. Bond, CRNA Nurse AnesthetistGwendolyn S. Braswell, CRNA Nurse AnesthetistLorie A. Hilliard, CRNA Nurse AnesthetistWendy Miller, CRNA Nurse AnesthetistSusan M. Van Manen, CRNA Nurse Anesthetist

Department of Emergency MedicineJohn A. Bantle, MD Emergency MedicineLucas B. English, MD Emergency MedicineDaniel E. McGee, MD Emergency MedicineGisa-Beate Schunn, MD Hematology and

Oncology

Department of MedicinePamela J. Daffern, MD Allergy and ImmunologyArnold Kim, MD Nephrology

Department of OrthopaedicsKurt Hossler, PA Physician Assistant

Department of RadiologyOlubunmi K. Abayomi, MD Radiation TherapyMichael Chang, MD Radiation TherapyMichael P. Hagan, MD Radiation TherapyLynn MacDougall, MD Diagnostic RadiologyShiyu Song, MD Radiation Therapy

Department of SurgeryGary C. Harrington, MD General SurgeryAngela Harvey, NP Nurse PractitionerNaveen H. Samuel, NP Nurse PractitionerDianne E. Wall, NP Nurse PractitionerAndrew Yale, PA Physician Assistant

These are the current drug shortages affecting practice at HDH.

Albumin 5% and 25% have been on shortage for over amonth, and the shortage is worsening. HDH is only able topurchase approximately 25 percent of our historical usage. It’sunknown how long this situation will continue. Reducing usageof these products as much as possible is requested.

Aztreonam (Azactam®) has been unavailable for severalweeks. The cause and the duration are unknown. Currently, pre-mixed frozen products are being used to alleviate the shortage.

Cefotetan (Cefotan®) for injection, all forms has beenwithdrawn from the market by its manufacturer, Astra-Zeneca.

Hyoscyamine (Levsin) for injection is currently unavailable.Oral product is available.

Intravenous Immune Globulin (IVIG) (all brands) is ablood-derived product on national shortage of unknownduration. Product is being allocated based on previous usage.This shortage is worsening.

Mivacurium (Mivacron®) for injection has been withdrawnfrom the market by its manufacturer, Abbott.

Penicillin G benzathine (Bicillin LA®) suspension for IMinjection is currently available in limited supply due tomanufacturing difficulties at Pfizer. The product is onintermittent back order. The duration of the shortage isunknown.

Piperacillin/tazobactam (Zosyn®) 2.25 grams and 3.375grams for injection has been difficult at times to obtain. Thisshortage is apparently worsening. Unasyn and Timentin arereasonable alternatives, depending upon the disease andpatient being treated.

Drug Shortages AS OF AUGUST 2006


1602 Skipwith RoadRichmond, VA 23229

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tel: (804) 289-4500 www.henricodoctors.com

O C T O B E R - D E C E M B E R 2 0 0 6

Calendar of events

Credentials Committee7:00 a.m.November 8 Forest, Williamsburg BDecember 13 Parham, 1st Floor Classroom

Family Practice/Medicine DepartmentNoonOctober 24 Forest, Williamsburg B

Medical Executive Committee7:00 a.m.November 15 Forest, Williamsburg BDecember 20 Forest, Williamsburg B

Multidisciplinary Conference12:00 p.m.December 12 Parham, 1st Floor Classroom

OB/GYN Department5:15 p.m.December 14 Forest, Williamsburg A** Note change in meeting location

Pediatrics Department8:00 a.m.December 14 Forest, Williamsburg B

Perinatal/Neonatal Case StudyNoonNovember 7 Forest, Williamsburg ANovember 21 Forest, Williamsburg ADecember 5 Forest, Williamsburg ADecember 19 Forest, Williamsburg A

Documents

V ita lStatistics - WordPress.comThe Good Doctors are at Henrico DoctorsÕ Hospital. V ita lStatistics Fall 2006 V o lume 5/ Issue 3 HDH news 1 For est Expansion 1 Parham Orthopedic