Download September is Sepsis Awareness Month

August / September
2015
INSIDE THIS EDITION:
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Dept Meetings/Conf
New Appointments
Feature Stories/
Announcements:
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ICD-10 Champions
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ICD-10 Hotline

ICD-10 Raffle Winners
Valley Receives GoldLevel Recognition

Physician Inspires
Philanthropy

Update on Dense
Breasts and Screening
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
On Track with the PAC
Electrophysiology Educational Event
September is Sepsis Awareness Month
Sepsis historically has been a condition that is difficult to identify and diagnose. As
far back as 100 BC, Marcus Terentius Varro, the ancient Roman scholar and writer
(116 BC–27 BC), was quoted as noting that “small creatures, invisible to the eye,
fill the atmosphere, and breathed through the nose cause dangerous diseases.”
Perhaps the most prescient description of sepsis was by the historian, philosopher,
humanist and Renaissance author Niccolo Machiavelli (1469–1527), as reported in
his treatise, The Prince, in 1513. He very eloquently stated that, “hectic fever, at
its inception, is difficult to recognize but easy to treat; left unattended it becomes
easy to recognize and difficult to treat.” Although hectic fever is not the name by
which we know sepsis now, the description of a disease that is difficult to recognize
in its early stages, at a time when the condition may be amenable to treatment,
and more difficult to treat in its later more obvious stages is a clear description of
the more severe forms of sepsis.
In an attempt to better clinically understand sepsis, in the past century, a variety of
definitions have been developed. Among the earliest concepts was to consider
sepsis as a systemic host response to an infection. In fact, it was classically described by the eminent American physician William Osler (1849–1919) in his seminal observation that the patient appears to die from the body's response to an infection rather than from the infection itself.
Ignaz Semmelweis (1818-1865) was an obstetrician at the Vienna General Hospital at a time when the death of women in childbed from puerperal fever was a common complication. Semmelweis discovered that it was common for medical students to examine pregnant women directly after pathology lessons. Hygienic
measures such as hand washing or surgical gloves were not yet customary practice.

Save the Date: Valley
Hospital Foundation
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Save the Date: The
Holiday Soirée
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Editors
Elizabeth Leahy
[email protected]
Margaret (Peggy) Moran
[email protected]
Joseph Yallowitz, MD
[email protected]
Semmelweis deducted that childbed fever was caused by "decomposed animal
matter that entered the blood system". He succeeded in lowering the mortality rate
by introducing hand washing with a chlorinated lime solution before every gynecological examination. However, in spite of this clinical success, these hygienic
measures were not accepted, and colleagues harassed him, forcing him to leave
the city. It took him until 1863, more than 15 years after his findings, to publish his
work "Aetiology, terminus and prophylaxis of puerperal fever.”
Although antiseptic procedures meant a huge medical breakthrough, it soon became apparent that a number of patients still developed sepsis. In this preantibiotic time, the death rate was very high. Only with the introduction of antibiotics after WW II could the death rate of sepsis be reduced.
While the literature continues to evolve, the mainstay of treating sepsis is prompt
recognition and early goal-directed therapy. September is Sepsis Awareness
month and you can learn more about efforts to raise awareness at
http://www.sepsisalliance.org
Joseph Yallowitz, MD
Editor
SEPTEMBER 2015 DEPARTMENT MEETINGS
Otolaryngology
Family Practice
Anesthesia
Surgery
Pediatrics
Medicine – CME
Neurology
Podiatry
Emergency Medicine
Neurology
Anesthesia
Surgery
Orthopedic Surgery
Pediatrics
Neurology
OB/GYN
Thursday, Sept. 3
Friday, Sept. 4
Tuesday, Sept. 8
Tuesday, Sept. 8
Tuesday, Sept. 8
Wednesday, Sept. 9
Monday, Sept. 14
Tuesday, Sept. 15
Wednesday, Sept. 16
Monday, Sept. 21
Tuesday, Sept. 22
Tuesday, Sept. 22
Tuesday, Sept. 22
Tuesday, Sept. 22
Monday, Sept. 28
Wednesday, Sept. 30
8:00 a.m.
8:00 a.m.
7:00 a.m.
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9:00 a.m.
6:00 p.m.
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SEPTEMBER 2015 COMMITTEE/CONFERENCE MEETINGS
Palliative Care
Lung Management Conference
Credentials Committee
Endoscopy Committee
Palliative Care
Pediatric Critical Care
GYN Cancer Conference
Officers’ Council
Breast Management Conference
Surgical Control Committee
Cancer Committee
Patient Safety
Palliative Care
Infection Committee
Breast Management Conference
GI Liver Conference
Medical Board
Pharmacy and Therapeutics
Palliative Care
Medical Record Committee
Breast Management Conference
Hematology/Onc. Cancer Conf.
Palliative Care
Wednesday, Sept. 2
Thursday, Sept. 3
Tuesday, Sept. 8
Tuesday, Sept. 8
Wednesday, Sept. 9
Wednesday, Sept 9
Wednesday, Sept. 9
Friday, Sept. 11
Monday, Sept. 14
Wednesday, Sept. 16
Tuesday, Sept. 15
Tuesday, Sept. 15
Wednesday, Sept. 16
Wednesday, Sept. 16
Monday, Sept. 21
Monday, Sept. 21
Monday, Sept. 21
Tuesday, Sept. 22
Wednesday, Sept. 23
Thursday, Sept. 24
Monday, Sept. 28
Tuesday, Sept. 29
Wednesday, Sept. 30
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SEPTEMBER 2015 PEER REVIEW COMMITTEES
Surgery
Cardiovascular
MSQAIC
Neuroscience
Women & Children’s Services
Musculoskeletal
Medicine
Anesthesiology
Tuesday, Sept. 1
Monday, Sept. 7
Monday, Sept. 7
Thursday, Sept. 10
Monday, Sept. 14
Thursday, Sept. 17
Wednesday, Sept. 23
Wednesday, Sept. 23
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NEW APPOINTMENTS TO THE MEDICAL STAFF
Name:
Department:
Medical School:
Residency:
Practice:
Office:
Irwin Z. Benzel, DO
Pediatrics
Touro College of Osteopathic Medicine, NY
Winthrop-University Hospital, NY—Pediatrics
Pedimedica
870 Palisades Avenue, Suite 204, Teaneck, NJ
Name:
Department:
Medical School:
Residency:
Advay G. Bhatt, MD
Medicine
Albert Einstein College of Medicine, NY
Boston University Medical Center, MA—
Internal Medicine
Boston University Medical Center, MA—
Electrophysiology, Cardiovascular Disease
VMG Arrhythmia Associates of NY & NJ
1 Linwood Avenue, Paramus, NJ
Fellowships:
Practice:
Office:
Name:
Department:
Medical School:
Residency:
Fellowship:
Practice:
Office:
Name:
Department:
Medical School:
Residency:
Fellowship:
Practice:
Office:
Name:
Department:
College:
Residency:
Practice:
Office:
Neha D. Chheda, MD
Medicine
State University of New York School of Medicine,
NY
Thomas Jefferson University Hospital, PA—Internal
Medicine
Johns Hopkins Hospital, MD—Nephrology
Bergen Hypertension and Renal Associates
44 Godwin Avenue, Midland Park, NJ
Shiau H. Chin, MD
Emergency Medicine
New York Medical College, NY
New York Hospital at Queens, NY—Emergency
Medicine
New York Hospital at Queens, NY—Ultrasound
Valley Emergency Room Associates
223 North Van Dien Avenue, Ridgewood, NJ
Emily F. Fischer, MD
Pediatrics
Temple University School of Medicine, PA
St. Christopher’s Hospital for Children, PA—
Pediatrics
North Jersey Pediatrics
17-10 Fair Lawn Avenue, Fair Lawn, NJ
(Continued on next page)
NEW APPOINTMENTS TO THE MEDICAL STAFF (CONT.)
Name:
Department:
College:
Residency:
Practice:
Office:
Fernande Josias, MD
Emergency Medicine
Drexel University College of Medicine, PA
York Hospital, PA—Emergency Medicine
Valley Emergency Room Associates
223 North Van Dien Avenue, Ridgewood, NJ
Name:
Department:
Medical School:
Residency:
Practice:
Office:
Dominique Kalil, MD
Medicine
University of Texas Health Science Center, TX
Cabrini Medical Center, NY—Internal Medicine
Westchester County Medical Center, NY—Internal
Medicine
Valley Medical Services—Hospitalists
223 North Van Dien Avenue, Ridgewood, NJ
Name:
Department:
Medical School:
Residency:
Practice:
Office:
Julia J. Lee, MD
Pediatrics
Drexel University College of Medicine, PA
North Shore LIJ, NY—Pediatrics
Valley Pediatric Associates
201 East Franklin Turnpike, Ho-Ho-Kus, NJ
Name:
Department:
School:
Practice:
Office:
Marianne M. Longo, APN
Medicine
Rutgers University, NJ
Valley Physician Services—Valley Heart Group
1200 East Ridgewood Avenue, Ridgewood, NJ
Name:
Department:
Medical School:
Residency:
Practice:
Office:
Heather Shafi, MD
Pediatrics
University of Medicine and Dentistry of NJ, NJ
Yale-New Haven Hospital, CT—Pediatrics
Pediatricare Associates
20-20 Fair Lawn Avenue, Fair Lawn, NJ
ICD-10 Physician Champions
The Clinical Documentation Improvement Department would like you to meet the ICD-10 resource
physicians. These physicians recognize the importance of high quality and accurate documentation
and are a contact for questions and clarification for their peers.
Nicholas Alexander, M.D.
Years at Valley: 21 years, Education: University of Pennsylvania, PA, University of Medicine and
Dentistry, NJ, Board Certification: American Board of Orthopedic Surgery, Specialty: Orthopedic
Surgery
Jeffrey P. Barasch, M.D.
Years at Valley: 31 years, Education: Yale University, CT, New York University School of Medicine,
NY, Board Certification: American Board of Internal Medicine, Subspecialty Board of Pulmonary
Disease, American Board of Sleep Medicine, American Board of Int. Med. Sub of Sleep Medicine,
Specialty: Pulmonary Medicine, Sleep Studies
Joshua Bernheim, M.D.
Years at Valley: 12 Years, Education: Yeshiva University, NY, Albert Einstein College of Medicine,
NY, Board Certification: American Board of Surgery, Special Qualifications in Vascular Surgery,
Specialty: Vascular surgery
Anthony L. D’Ambrosio, M.D.
Years at Valley: 8 Years, Education: University of North Carolina, NC, Vanderbilt University School
of Medicine, TN, Board Certification: American Board of Neurological Surgery, Specialty: Neurosurgery
(continued on next page)
Annie Lee, M.D.
Years at Valley: 9 years, Education: New York University, NY, Ross University, West Indies, Board
Certification: American Board of Internal Medicine, Specialty: Internal Medicine
Jin S. Lee, M.D.
Years at Valley: 1 year, Education: Columbus College, GA, Medical College of Georgis, GA, Board
Certification: American Board of Internal Medicine, Subspecialty Board of Medical Oncology, Specialty: Oncology
Jonas Mansson, M.D.
Years at Valley: 4 years, Education: University of South Florida, Fl, Ross University School of Medicine, WI, Board Certification: American Board of Surgery, Specialty: Surgery
John J. McGreal, M.D.
Years at Valley: 13 years, Education: Georgetown University, Washington D.C., Georgetown University School of Medicine, Washington D.C., Board Certification: American Board of Internal Medicine,
American Board of Pediatrics, Specialty: Emergency Medicine
Dan L. Musat, M.D.
Years at Valley: 7 years, Education: Carol Davila University of Medicine & Pharmacy, Romania, St.
Lukes-Roosevelt Hospital Center, NY, Board Certification: American Board of Internal Medicine,
Subspecialty Board of Cardiovascular Disease, Subspecialty Board of Electrophysiology, Specialty:
Electrophysiology, Cardiac
(continued on next page)
Amit S. Tibb, M.D.
Years at Valley: 1 year, Education: Lokmanya Tilak Municipal Medical College, India, Temple University School of Medicine, PA, Board Certification: American Board of Internal Medicine, Subspecialty Board of Pulmonary Disease, Subspecialty Board of Critical Care, Subspecialty of Hospice &
Palliative Care, Specialty: Critical Care, Pulmonary
The ICD-10 Hotline is now open!
Monday through Friday 8:00 am—5:00 pm with any ICD-10 related
questions. From outside the Hospital, you can call (201)447-8114.
Internally, you can call ext. 8114.
ICD-10 Raffle Winners!!
Jonas Mansson, MD—Department of Surgery and
Deborah Ungerleider, MD—Department of Pediatrics
The Valley Hospital Receives Gold-Level Recognition from the U.S. Department of Health
and Human Services for Promoting Organ Donation
The Valley Hospital was recently awarded gold-level recognition from the U.S. Department of
Health and Human Services (HHS) for the hospital’s efforts in promoting organ donation. The
hospital was recognized as part of the national Workplace Partnership for Life Hospital Campaign, sponsored by HHS’s Health Resources and Services Administration.
The Valley Hospital’s awareness and registry campaigns educated staff, patients, visitors, and
community members on the critical need for organ, eye, and tissue donors and thereby increased the number of potential donors on the state’s donor registry.
“Organ donation is such an important issue,” said Bettyann Kempin, Assistant Vice President for
Medical and Surgical Services at Valley. “We’re proud to partner with the NJ Sharing Network to
be a part of this national campaign to increase awareness about the importance of organ donation.”
Of the 1,856 hospitals and transplants centers enrolled in the campaign, 736 were awarded
gold, silver or bronze recognition for effort to promote organ donation during Phase IV of the
campaign, between August 1, 2014 and April 30, 2015.
Dr. Grau’s Confidence in Care Inspires Philanthropy
As the scar on her chest gradually fades from her operation performed at Valley over a
year ago, Vita Zola reflects on the care and treatment leading up to and following the
removal of an aneurysm on her aorta.
It started out as a visit to the eye doctor, which consequentially led to an MRI of the
head and chest and resulted in Mrs. Zola landing in Valley's Department of Cardiac
Surgery. “I was shocked!” Mrs. Zola recalls of her first meeting Juan Grau, M.D., a board certified cardiac surgeon for the Valley's Department of Cardiac Surgery and Director of Cardiovascular Translational Research. “When he came into the room with his assistant and told me there was an aneurism
on my aorta, I really thought he had the wrong patient.”
Mrs. Zola was not in pain and did not feel symptomatic, which is one of the reasons why this news was
so distressing and perplexing. But Dr. Grau’s absolute certainty regarding treatment of this aneurism,
involving an aortic procedure to replace the aneurysm while preserving the patient’s native aortic
valve, helped her come to grips with the reality that this 5-hour operation was imperative. “My husband
and I responded well to Dr. Grau’s assurance,” Mrs. Zola reasons, “and we felt very confident under
his care.”
John and Vita Zola have been part of the Valley Hospital family for years, having lived in Ramsey for
the past 45 years. The Zolas have tapped into the many services of Valley, including the Emergency
Room for stitches and bumps and the Maternity floor for their youngest child, now in her 40s. Through
the years, as their three children grew, so has Valley.
The care that Mrs. Zola received from Valley clinicians during this time spanned the gamut from the
cardiac consult, to the OR, to home with a visiting nurse, and then through three months of rehabilitation. “I cannot say enough about Valley! I recommend Valley Hospital to people all the time.” Mrs. Zola adds “When I was going through all of this, the cardiac nurses were unbelievable, so attentive,
helped me in and out of bed. Every day I felt a little better.”
Months later, having fully recovered from the successful operation, Vita attended a dinner at Brassarie
Brandman restaurant in Park Ridge where Dr. Grau spoke to a room filled with veteran cardiac patients of all ages. “It was quite a night. He seems to know each and every one of his patients.”
Following that evening, Mr. and Mrs. Zola felt inspired to sponsor a grateful patient gift [link to https://
www.valleyhospitalfoundation.org/sslpage.aspx?pid=298] to the Valley Hospital Foundation towards
Dr. Grau’s Cardiology department. “I am so thankful that it all went so well, and that is what compelled
me to give back.”
If you have a grateful patient that you would like the Valley Hospital Foundation to highlight in a story, please contact Trisha
Sullivan, Foundation Writer, at x6377 or [email protected]
Update on Dense Breasts and
Supplemental Screening
Lauren Levy, MD
Department of Diagnostic
Imaging
The Valley Hospital and Radiology Associates of Ridgewood,
Member of the NJ Department of
Health Breast Imaging
Options Workgroup
New Jersey enacted its breast density notification law in May 2014. To date, 23 states
have laws requiring notification of breast density
be given to patients so that they can discuss the
option of supplemental imaging with their health
care providers. Similar bills are pending in Congress. The language of the mandatory notification legislation varies by state. Approximately
50% of women who undergo screening mammograms have dense breasts, therefore a national
law would affect tens of millions of women yearly.
Dense breast tissue increases breast cancer risk,
but more importantly decreases the sensitivity of
mammography. Supplemental imaging after a
normal mammogram increases cancer detection
in dense breasts; however, this is associated
with increased false positives and unnecessary
biopsies.
The breast density debate includes the
amount of screening women with dense breasts
should get and whether all women with dense
breasts should undergo supplemental
screening. A recent report in the Annals of Internal Medicine concluded: “breast density
should not be the sole criterion for deciding
whether supplemental imaging is justified
because not all women with dense breasts have
high interval cancer rates.” The objective of this
study was to identify women who would benefit
most from supplemental imaging by determining
which combinations of breast cancer risk and BIRADS density category are associated with high
interval cancer rates to better inform the discussion of supplemental imaging between clinicians
and their patients.
This prospective cohort study was set in
Breast Cancer Surveillance Consortium (BCSC)
facilities over a nine-year period. The data set
included 365,426 women from ages 40
through 74 who underwent 831,455 digital
screening mammograms. The measured
parameters were BI-RADS breast density, BCSC
5-year breast cancer risk and interval cancer rate
(defined as invasive cancer diagnosed in less
than or equal to 12 months after a normal mammography result). Interval cancers are associated with more aggressive tumor biology. A high
interval cancer rate was defined as more than 1
case/1000 exams. The results of this study suggest that women with invasive cancer were more
likely to be older and white and to have heterogeneously or extremely dense breasts, a BCSC 5year risk of at least 1.67%, and a family history of
breast cancer. In this study 47% of the women
ages 40 -74 had dense breasts. High interval
cancer rates were observed for women with a 5year risk of 1.67% or greater and extremely
dense breasts (47% of extremely dense breasts)
or a 5-year risk of 2.5% or greater and heterogeneously dense breasts (19.5% of heterogeneously dense breasts). These two groups comprised
24% of all women with dense breasts or 12% of
all women undergoing screening. Half the women with heterogeneously dense and half the
women with extremely dense breasts were at low
to average 5-year cancer risk (0% - 1.66%). The
interval rate of advanced stage disease was
highest among women with a 5-year risk of 2.5%
or greater and heterogeneously or extremely
dense breasts (21% of all women with dense
breasts). The current Legislation Notification encourages all women with dense breasts to discuss supplemental screening with their health
care providers. For the vast majority of women
undergoing screening digital mammography, the
rate of interval cancer is low and not all women
with dense breasts have high interval cancer
rates as indicated above. However, women with
high interval cancer rates are at higher breast
cancer risk and are at higher risk for advanced
breast cancer. The authors found that using combinations of breast cancer risk and density to
identify those women with a high likelihood of interval cancers would more efficiently identify
women who are more likely to benefit from supplemental imaging after a normal mammogram.
Identifying those women with low mammographic
sensitivity can also direct a discussion of the
benefits of supplemental imaging in extremely
dense women even in those women with low
rates of interval cancer.
(continued on the next page)
High mammographic density does indeed
decrease the cancer detection rate of digital
mammography and increases the risk that the
cancers detected are larger and at a more
advanced stage. Women with extremely dense
breasts therefore may benefit from supplemental
screening exams such as whole breast screening
ultrasound or breast MRI. For any woman at high
risk for breast cancer (lifetime risk >20%), supplemental yearly breast MRI should be considered beginning as early as age 25. Supplemental
3D mammography (a.k.a. tomosynthesis) can be
beneficial in women with heterogeneously
dense breasts, low to average breast cancer risk
and those at higher risk for false positives. Digital
mammography has a sufficiently high breast cancer detection rate and reasonably low rate of
false positives for routine screening use even in
patients with dense breasts and should be the
first line screening exam starting at age 40. The
authors suggest that primary care doctors and
gynecologists can easily calculate the 5-year
breast cancer risk using the BCSC calculator
since it requires only 5 risk factors (age, first degree relatives with history of breast cancer, history of breast biopsy, BI-RADS density, and race/
ethnicity). The primary doctors can then use this
5-year risk score in conjunction with the mammographic density to guide their patient’s consultation for supplemental imaging for women with
dense breasts.
One limitation of this study was that it did
not specifically assess whether there is a benefit
to supplemental screening in women with high
rate of interval cancer or false positive mammogram result. The authors’ findings provide a starting point for identifying women who may have the
most to gain from supplemental screening and
help inform clinical decision-making about recommending supplemental imaging in women with
dense breasts.
In response to this study, the NY Times
published an article in the Health section May 18,
2015, titled: Study Suggests Dense Breast Tissue Isn’t Always a High Cancer Risk. A similar
article was published in Time Magazine the same
day titled: Why Women With Dense Breasts May
Not Need More Screening. Both of these articles
were geared to the lay public summarizing this
study.
An additional controversy raised by dense
breast notification legislation is “who” should
discuss breast density results with patients – the
primary doctor or the radiologist. Since radiologists are assigning the breast density based on
the mammogram, many suggest that radiologists
notify the patient of her density. Realistically, the
vast majority of mammograms in the United
States are interpreted after the patient has left
the imaging facility. A recent editorial in the Society of Breast Imaging Newsletter (2015/Issue2),
warned: “a recommendation of additional screening by radiologists may be seen as self serving.”
Because the assessment of a woman’s risk for
breast cancer involves more than breast density,
the primary doctor is in the unique position to assess multiple risk factors for an individual patient
as well as discuss options such as systemic antiestrogen therapy and prophylactic mastectomy.
Unfortunately, educating the primary
health care provider has lagged behind mandated legislation. Many primary clinicians are unaware of legislation in their state or feel uncomfortable discussing breast density with their patients.
The California Breast Density Information Group
created an evidence-based website to educate
clinicians and patients about breast density, risk
assessment and supplemental imaging options.
In NJ, the American Congress of Obstetrics and
Gynecologists created a tool kit to assist and
educate gynecologists in managing their patients
with dense breasts. The patient advocacy group,
Are You Dense, in conjunction with Dr. Wende
Berg, has recently launched a website geared
toward patient understanding of breast density
and available options.
The article referenced above is: Kerlikowske K,
Zhu W, Tosteson AN, et.al. Identifying Women
With Dense Breasts at High Risk for Interval Cancer – A Cohort Study. Ann Intern Med.
2015;162:673-681.
To learn more about BCSC 5-year risk calculator
clinicians can visit
http://breastscreening.cancer.gov. The calculator
is also available as an app on a mobile device
downloadable at the app store.
(continued on the next page)
Resources available on line:
www.breastdensity.info - The California Breast Density Information Group website for
physicians and patients www.acr.org - The American College of Radiology (a brochure is available
for patients), www.acog.org - The American College of Obstetricians and Gynecologists,
www.Areyoudenseadvocacy.org - Are You Dense Advocacy Group,http://www.densebreast-info.org Are You Dense and Dr. Wende Berg’s dense breast website geared specifically for patients
Venous Thromboembolism Prophylaxis in Meditech
The Valley Hospital faces many challenges related to venous thromboembolism (VTE) management,
including identifying patients at highest risk of VTE; prescribing prophylactic and therapeutic anticoagulant therapies for these high-risk patients in a timely manner; and monitoring and reporting the
VHS performance on VTE prophylaxis to national agencies.
Six VTE measures are currently reported by Valley.
1. Patients receiving VTE prophylaxis
2. ICU patients receiving VTE Prophylaxis
3. VTE patients with anticoagulation overlap therapy
4. VTE patients receiving unfractionated heparin with dosage/platelet monitoring by protocol
5. VTE patients receiving appropriate discharge instructions
6. Incidence of potentially preventable VTEs
To identify patients at risk for VTE, the admitting order sets all contain a VTE Risk Assessment
screen. This screen provides a list of the risk factors for VTE; prompts the provider to enter the risk
level of the patient; and recommends appropriate (mechanical and pharmacologic) prophylaxis
based upon national guidelines. The entry of the prophylaxis will generate orders for those VTE
prophylaxis measures automatically. Patients are assigned 1 of 3 risk levels based upon their score:
low (0–2), medium (3–4), or high (> 4). Risk factors are given a score (using the Caprini scoring system). Examples are: Age 41–60 = score: 1; age 60–74 = score: 2; age >75 = score: 3; family history
of thrombosis = score: 3; recent stroke = score: 5; major lower extremity arthroplasty = score: 5. The
VTE assessment screen lists all of the risk factors and their scores to facilitate picking the appropriate risk level by the provider.
All of the risk factors are summed and based upon the total score of all of the relevant risk factors;
the overall risk score is assigned to the patient by the provider. Note that the Meditech screen
recommends the appropriate prophylaxis based upon the risk level identified.
(continued on next page)
The use of this screen provides four benefits:
1. Provides the information needed to assign a risk score to the patient
2. Provides recommendations on appropriate prophylaxis based upon the patient’s risk score
3. Generates orders for the prophylaxis medications and interventions
4. Provides the data to monitor and report VHS adherence to VTE prophylaxis guidelines
Our goal is to use the new Meditech system to improve performance on VTE quality measures.
The changes to our VTE approach represent evidence-based guidelines for the best patient care.
In the future, we will try to apply rules within Meditech that help the physician to remember to
always address prophylaxis.
More from the PAC:
Discharge Process
As we continue to address issues and improve workflows within the new Meditech system, Information Systems is addressing the questions and concerns of our physicians regarding the new Discharge Process. Below you will see answers and explanations for some of the most frequent inquiries we are receiving.
Why is the discharge documentation more complicated than it was in the old system?
Instead of being spread throughout the system, all discharge activities have been consolidated into
a single, more complex document. There are more than a dozen discharge plans, which have been
customized to meet the needs of specific services or types of patients. Each discharge plan supports all of the provider steps necessary to perform the discharge (medication reconciliation, discharge instructions, diet, activity, the discharge order, problem list, etc.). This streamlined approach
will help providers perform the discharge as efficiently as possible.
When do I need to dictate a discharge summary?
Discharge summary information can be placed by using either traditional dictation or a template in
Meditech, with or without the assistance of Dragon Voice Recognition. The discharge summary must
contain the following elements (taken from the Medical Staff Rules and Regulations):
• the reason for hospitalization;
• significant findings;
• the final diagnosis;
• procedures performed and care, treatment and services provided;
• the patient’s condition at discharge;
• a complete list of medications;
• a medication reconciliation list is communicated to the next healthcare provider (within or outside
the organization);
• information given to the patient and family (as appropriate); and signature on the medical record(s).
What are the discharge templates and when do I use them?
The discharge (D/C) templates that have been designed in Meditech support the different possible
methods for discharge summary completion. They are named to represent their purpose. These are
designed to contain the mostly commonly needed information presented in a way that expedites the
completion of the steps necessary to perform a patient discharge.
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D/C Templates available for use:
D/C Plan: This template is used solely to complete the process of discharging the patient.
These plans are further customized to streamline discharges from many areas (i.e., “D/C Plan:
Endoscopy”). It is important to remember that this is not the discharge summary (per the R&R).
D/C Plan with D/C Note: This template is meant for consultants to utilize. It allows the
consultant to document their specific discharge plan needs, such as follow up, medications, and
prescriptions, but not actually do the discharge. It also allows a brief note that can act as
communication to the discharging physician, coordinating the discharge process. This document
does not qualify as a discharge summary.
D/C Plan with Discharge Summary: This template is meant for the discharging physician to
complete both the process of discharge and the true discharge summary at the same time.
Completing all of the required components of the discharge summary in this template qualifies as
the discharge summary described in the R&R.
Discharge Summary: This template is a stand-alone discharge summary template because
sometimes the physician will use a D/C Plan to have the patient physically discharged from the
hospital, and then, a short time later, return to the chart to complete the discharge summary.
What happened to my Endoscopy discharge plan document?
In order to streamline discharge documentation for endoscopy patients, the general Endoscopy
discharge plan has been broken down into three discharge plans, each of which is specific to the
type of procedure: bronchoscopy, colonoscopy and EGD/ERCP. Each document is customized to the
procedure that makes the process more efficient for the physician. It includes a pre-entered
statement that the medications have been reviewed and that there are no changes when the
patient gets discharged home. If the patient is going back to an inpatient floor, these should not be
used. Instead, the ‘manage transfer’ should be used to make sure all of the orders remain the
same and that the medications do not change.
Why am I getting deficiency notices on my discharge summaries?
If you are being asked for an addendum to your discharge summary, it is because of
missing/incomplete information such as a discharge date, hospital course narrative or physical
exam. It is NOT due to missing information such as vitals, lab values or medications. Additionally, if
the original discharge summary was dictated/created the day before the patient was discharged, an
addendum will be requested.
What are the common problems with discharge summary addendums?
When entering an addendum to the discharge summary, please make sure that you are adding the
addendum to the D/C Plan document (name will be “D/C Plan: XXXX” where XXXX represents the
particular type of patient, specialty or diagnosis). The HIM Department has noticed that several
addendums have been completed as requested; however, they are on the wrong document, thus
requiring another addendum put on the correct document. Also, a Progress Note is not identified or
labeled as a D/C Plan anywhere within the system, so it is not a substitute for a discharge
summary when requested by the HIM Department. Addenda should not say “see information
below” if the information is incomplete.
Gala Planned for the
35th Year Anniversary
of
the Valley Hospital Foundation
On September 25, 2015 at The Skylands Manor , 5 Morris Road in Ringwood, New Jersey,
The Valley Hospital Foundation will be celebrating 35 remarkable years of philanthropically
supporting Valley Health System’s vision of providing excellence in
patient and family centered care to this region.
The “black tie” gala will begin with cocktail hour at 7 p.m.
followed by dinner at 8 p.m.
The Valley Hospital is a fully accredited, acute care, not-for-profit hospital serving more than
440,000 people in 32 towns in Bergen County and adjoining communities. Valley Home Care,
the home health agency of the Valley Health System, provides in-home comprehensive,
quality healthcare by professionally trained staff. From the tiniest premature newborn to
the grandmother at the end of life, The Valley Hospital and Valley Home Care
provide compassionate and expert care.
As the fundraising body, The Valley Hospital Foundation ensures that The Valley Hospital and
Valley Home Care continue to have the essential resources in place to fund the maintenance
of its modern facilities, cutting edge technology, innovative programs,
and groundbreaking research.
To celebrate 35 years of success, the Valley Hospital Foundation is inviting individuals, businesses, and interest groups in the Ridgewood vicinity to attend its 35th Anniversary Gala. This black
tie affair promises an exquisite evening of fine dining, cocktails, and live entertainment, while
mingling among a unique, local, likeminded audience committed to clinical excellence for this region. All guests will be listed in the Gala journal, a special edition of the donor newsletter Inside
Valley, and on the Foundation website. Businesses interested in demonstrating their commitment
to this community are also lining up for corporate sponsorship which creates a unique
promotional opportunity for a captivated local audience.
To find out more about this event, purchase tickets, or
become a corporate sponsor,
please visit
www.valleyhospitalfoundation.org/35thGala