Main Line Health Physician Restructuring the MLH/Jefferson partnership

Surviving Sepsis: The future of Hepatology: SUMMER 2014 ED success moves at From Hep C to Inside: to inpatient Exton Square Mall transplant care Main Line Health Physician

Medical staff education initiative

BY ANGUS GILLIS, MD

The Main Line Health medical staff structure is an integrated model that encompasses private practice

MESSAGES | 2 physicians who are on staff, -employed physicians, and physicians/physician groups who are under contract for provision of services to the Hospital System. Medical staff functions have traditionally included initial credentialing, reappointment, and approval of privileges for new procedures. Tools used to fulfill these tasks include focused and ongoing professional practice evaluation (FPPE and OPPE). The staff is responsible for peer review, including case study and quality concerns. By-law and policy issues such as investigations, interventions, confidentiality, and physician rights are also areas in which the medical staff is involved. The staff has administrative functions related to patient safety, infection control, pharmacy and therapeutics, medical records, and behavioral issues like disruptive behavior and practitioner health. This is only a partial list of the responsibilities of the medical staff. Ultimate responsibility for approval and implementation of any recommendations by the staff’s Medical Executive Committee lies with the Board of Main Line Health. In addition to the above functions, the medical staff also takes an active role in continuing medical education. Your medical staff dues have always funded clinical educational efforts, such as Grand Rounds, at our various locations. A new additional effort is the Medical Executive Committee’s budgeting of dedicated monies for physician education, which will enable members to carry out these medical staff responsibilities. This effort will be funded yearly. The educational initiative will allow invested physician members to receive up-to-date information which can then be shared with all staff members. It will also enable staff physicians to be in contact with members of the medical staffs from other institutions and learn from best practices in other settings. It is the intention of the MEC to give physicians and physician leaders who are involved in these functions the tools and knowledge to lead in our complex and changing environment. Physicians who want to get involved can be assured that they will benefit not only from contact with experienced staff members but also from formal education. n Angus Gillis, MD, is president of the Main Line Health Medical Staff.

requirements to deliver comprehensive •  received the Accolades patient-centered level of care. Get With The Guidelines®–Stroke Gold Plus Quality Achievement Award from the • Lankenau Medical Center has again • For the first time, all four MLH acute American Heart Association for the fourth been named one of the nation’s 100 Top — Lankenau Medical Center, consecutive year. Bryn Mawr Hospital and Hospitals® by Truven Health AnalyticsTM and Bryn Mawr Hospital, and Riddle Hospital have also received recent is one of only five hospitals in Pennsylvania Riddle Hospital — were named among the recognition from the American Heart to receive this designation. Best Regional Hospitals for the Philadelphia Association/American Stroke Association. metro area for 2014-2015 by US News & • Riddle Hospital’s Cancer Center has been • Lankenau Medical Center has received a $40k World Report. Lankenau Medical Center has granted the 2013 Outstanding Achievement grant from the Department of Health for its also earned a national ranking as one of the Award by The Commission on Cancer of Medical Student Health Advocate Program. top 50 hospitals in the specialty of Diabetes the American College of Surgeons. The & Endocrinology. award is presented to a select group of 74 • Riddle Hospital’s ICU received a Gold accredited cancer programs throughout the Level Beacon Award from the American • Main Line Health has once again been US, representing approximately 14 percent Association of Critical-Care Nurses (AACN). named among the top 20% of health of programs surveyed by the CoC in 2013. systems in the nation by Truven Health • Philadelphia magazine’s May 2014 Analytics. Listed as one of 21 in the • Three MLH hospitals — Bryn Mawr, Paoli and “Top Doctors” issue recognized 77 Main “medium health systems” category, Main Lankenau Medical Center — have received Line Health physicians, after more than Line Health is the only in the American Heart Association’s Mission: 400 Main Line Health physicians were Pennsylvania recognized. Lifeline® Receiving Quality Achievement recognized by their peers in Main Line Today Award, acknowledging the implementation magazine’s 2013 “Top Doctors” list. • Main Line Health received the Hospital and of specific quality improvement measures Health System of Pennsylvania’s Donate Life • Lankenau Medical Center received the outlined by the AHA for the treatment of Challenge Award for building awareness LEED® Silver Certification from the US patients who suffer severe heart attacks. for tissue, eye and organ donation. Green Building Council for new, sustainable • Paoli Hospital has earned full Chest Pain design and construction of its Master Facility • All four Cancer Centers at MLH acute care Center re-accreditation with Percutaneous Project, including the Heart Pavilion. hospitals — Bryn Mawr Hospital, Lankenau Coronary Intervention (PCI) from the Medical Center, Paoli Hospital and Riddle • Bryn Mawr Hospital’s Bariatric Center Society of Cardiovascular Patient Care Hospital — earned a three-year National received a three-year accreditation as (SCPC). Offering cardiac care as part of the Accreditation from the Commission on an American Society for Metabolic and Lankenau Heart Institute, this is the second Cancer (CoC) of the American College of Bariatric Surgery (ASMBS) Bariatric Center time Paoli has received this accreditation. Surgeons. This award is presented to of Excellence, one of the field’s highest facilities that meet the 34 CoC standard levels of achievement. 3 | MEDICAL STAFF NEWS 3 | MEDICAL Technology and relationships Moving forward

BY BARBARA WADSWORTH, MSN, RN, FAAN, FACHE, NEA-BC BY ANDY NORTON, MD

Moving forward is Physicians and record is unavailable. Paper… “What a recurring theme throughout this nurses have do you mean, paper?” As we continue issue of Main Line worked side by the technological journey, with easy Health Physician. side for many, access to order entry from any location The “Strategies many years. and the expectation of immediate for growth” article (page 4) outlines As a nurse for responses and communication, I would the future clinical almost 30 years, ask that you consider how and when and educational I can recall many you speak to — or seek — the nurses. relationships wonderful stories If you have a patient that requires a between Main Line Health and Jefferson following the restructuring of Jefferson where a physician and I partnered in “STAT” or “NOW” medication that you Health System. You may find comments conversation to deliver difficult news, enter in the computer, do you tell the by MLH CEO Jack Lynch and Jefferson or promising news, or sometimes little nurse as well, or do you assume our CEO Steve Klasko, MD, helpful in news, simply an update on the patient’s technology is that good and they will understanding collaboration plans for the future. condition. Today, there are more opportunities Part of that collaboration involves the Jefferson Transplant Institute, which will than ever to be partners enable MLH staff to better serve patients in the care of our needing liver, as well as kidney and patients and families. lung, transplants. Information on that The ability to coordinate is included in our hepatology article, along with a focus on the importance of care, to help patients to hepatitis C testing (page 8). understand their illness, Another look at the future is MLH’s new and to facilitate the health center in Exton Square Mall (page highest level of function 7). This is only the second such facility in for the patient to assure a retail environment in this region, but it the greatest quality of life provides a glimpse of where health care may be going. is readily available — and Further glimpses can be found in: immensely important. With all the • How Main Line Health is reducing early elective deliveries (page 9). advances in technology, I wonder about see it immediately? EEDs are associated with higher their impact on our conversations. We Our technology is indeed very rates of infant mortality as well as have migrated away from relationships, good. However, technology cannot additional problems for the baby and as exhibited by texts, tweets, email, replace our team relationships longer hospital stays for both mother and baby. and CPOE. The advances in technology and communications about our — creating safer practices for patients patients. Just as I worry about the • How Main Line Health is successfully addressing sepsis, which causes as with medical alerts, clarity of orders, younger generation missing out many as 325,000 deaths annually protocols that provide the best on truly meaningful conversations across the US (page 5). Initiatives evidence-based medicine to support and learning from others, I too am in the ED are now being applied to the patient — are all examples. These concerned that, as physicians and inpatient units across the System. advances improve the care setting for nurses, we are missing opportunities The value of “Systemness” across the patient, eliminating handwriting to communicate in a meaningful way. Main Line Health is reinforced in the standardization of our clinical system interpretations, order transcription, Please give some thoughtful reflection across all four acute hospitals, enhancing and guesses at the medication name. (I to your interactions with your entire patient care, reducing costs, and making remember there were certain “special” health care team. The power of your life considerably simpler for our staff. individuals who easily could read the communication, compassion, and You’ll see what I mean on page 6. physician’s writing, and I would seek empathy for our patients is best As always, my administrative office them out to help with the orders.) appreciated when we partner directly. door is always open, and my e-mail ([email protected]) is always on. Many nurses today will chuckle at Thank you for all you do to care for I’d welcome hearing your comments on that memory. Our newer nurses wonder our community across Main Line Health. n any of these topics. n what order transcription means exactly. Barbara Wadsworth is chief nursing officer Andy Norton, MD, is chief medical officer for They are lost if the electronic health for Main Line Health. Main Line Health.

SUMMER 2014 A CONVERSATION WITH STEPHEN KLASKO, MD

The president and CEO of Jefferson shares his thoughts on the future of health care, creative partnerships and Jefferson’s relationship with Main Line Health. When I came to Philadelphia, the very first person I met with was not a member of my board or faculty; it was Jack Lynch. I believe in the strength of our partnership,

KEY MESSAGE | 4 and now with the restructuring, instead of concentrating on corporate or organizational issues related to JHS, we can identify our shared goals and look at unique ways to work together to improve our community and advance medicine. The next big thing that will transform health care is going to be creative partnerships. MLH and Thomas Jefferson are the perfect example of how innovative collaboration can result in successful Left to right: Dr. Stephen Klasko and Jack Lynch. programs and clinical affiliations. For example, the Trauma Center at Paoli Hospital is a creative partnership that reflects well on both organizations, while Strategies for growth: Restructuring filling a crucial community need. We recently held an event to unveil the the MLH/Jefferson partnership vision for “Jefferson 3.0” to over 800 attendees. Only one health system CEO BY JACK LYNCH was invited to speak that day, and it was Jack. Ours is an important partnership that will take us into the future. ealth care reform has are now each responsible for our own Stephen K. Klasko, MD, MBA, is president drastically changed managed care contracting and debt, as and CEO of Jefferson, which includes the landscape of our well as managing our own financial and Thomas Jefferson University and the Thomas Jefferson University Hospitals. industry, sharpening quality standards. This affords each the distinction between organization greater freedom to pursue Hthe challenges faced by MLH as a opportunities, execute its strategy, and suburban, teaching community health respond rapidly to new challenges. A strong foundation of collaboration system and those confronting Thomas MLH and Jefferson are committed to Jefferson University Hospitals, as We are evaluating several continuing their partnerships in the an urban academic medical center. opportunities to combine areas of clinical medicine, education Successfully addressing these and research, including these existing individual challenges requires that each our strengths for the initiatives: organization remain nimble and poised benefit of our patients. • Paoli Hospital’s Regional Trauma to swiftly and creatively respond to Center in affiliation with Jefferson — change and opportunity. Jefferson CEO Stephen Klasko, MD, Since its inception in 2010, the skills Consequently, this spring, the Board and I are mutually committed to of Jefferson-trained trauma clinicians of Trustees of Jefferson Health System continuing the thriving, synergistic have saved the lives of hundreds of voted to implement a restructuring partnerships that MLH and Jefferson Chester County residents who had plan that provides each System with have built over the last five years, as life-threatening injuries. the autonomy and agility to respond well as exploring new ways to leverage • Jefferson Neuroscience Network — to today’s rapidly changing health care our combined strength. We will also MLH’s Neurosurgery program environment, while maintaining and continue to partner in the ACO-PA and affiliation with the Jefferson enhancing our joint clinical, academic in creating a common medical plan Neuroscience Network, including and research affiliations. option for our employees, based on the Neurovascular Center at Bryn Under this new arrangement, the principles of an ACO. This medical Mawr Hospital, continues to enable MLH and Jefferson — which includes plan will integrate nicely with the joint patients to receive advanced care Thomas Jefferson University and the Health & Productivity Program we have for stroke and other time-sensitive Thomas Jefferson University Hospitals — shared for almost two years. neurovascular diseases. (continued on page 11) MAIN LINE HEALTH PHYSICIAN 5 | SAFETY/QUALITY n

A Clarke Piatt, MD, is the sepsis clinical champion for MLH and medical director of Critical Care for Bryn Mawr Hospital. sepsis mortality rates are, it is equally s impressive as theimportant falling recognize to the cultural shift that has taken place across Main Line Health. bottom top From to and across all four acute hospital campuses, have members staff and physicians this supported enthusiastically initiative. None the of progress we madehave would been have possible without their full participation. based, but an early warning electronic system is planned that would be incorporated into the SmartChart clinical application. This system will screen for subtle changes that may indicate the onset sepsis of — giving providers the benefitcomputer of analysis. 55% DECREASE OVER 8 QUARTERS Quarters (with count of mortalities at MLHS) SEPSIS MORTALITY, MAIN LINE HEALTH (ACUTE) F S Source: Premier via MLHS Dashboard database Dashboard MLHS via Premier Source: N I P within 30 minutes the of call or a Rapid Response (RRT) Team alert will be been have called. date, no RRTs To called thanks full to compliance on the part the of physicians. for nine sepsis indicators. These includemay increased heart rate or respiratory rate, elevated or below- increased and temperature, average white blood count, among others. or more indicators, the nurse contacts the attending physician. urses screen patients every 12 hours f the patient screens positive for two hysicians are asked respond to used on the inpatient unitsis paper- theor screening now, tool being inpatient unit at each hospital began one February, past this tarting screening all patients (excluding hospice patients) for signs sepsis. of • • • — between members a patient’s of medicalteam. as early as to identify to possible n initiative launched nearly three years ago in all four Main Line Emergency Health and — Departments

B A A

severe sepsis patients, based on symptoms such low as high fever, blood pressure, rapid heart rate and a history infection. of Nursing staff use a sepsis screening tool at triage for all patients and SEPSIS ALERT mobilizes the team. possible and always within the first hour recognizing of severe sepsis and septic shock. B I E that includes blood tests (lactate), an immediate blood chest X-Ray, cultures and IV infusion. supported the by ICUs — is showing impressive results in reducing sepsis mortality rates at MLH. EDs, attention has now turned to ased on our success in the the inpatient population under the direction a new of Inpatient Sepsis Performance The Team. goal is twofold: 1) improve awareness changing of conditions that indicate may sepsis, and improve 2) communication — communication “hand-off” particularly • eginning IV antibiotics • mplementing aresuscitation bundle • ducating staff achievements: mong the actions behind these Sepsis Campaign, sepsis-related decreased have 2011 since deaths approximately 50 percent. In addition, shortened have we the time needed to identify and begin treating sepsis in the EDs (the primary portals for patients just to with sepsis) one hour. s aresult MLH’s of Surviving A

BY CLARKEBY MD PIATT, Surviving Sepsis: ED success moves to inpatient to moves success ED Sepsis: Surviving Caused by patients’ overwhelming immune response to infection, sepsis occurs in as as in occurs sepsis infection, to response immune overwhelming patients’ Caused by people 750,000 least at US, affecting the in hospitalizations all of 2 percent as many 325,000 annually. 210,000 to estimated an killing and year each TECHNOLOGY | 6 were previously seen and/or treated treated and/or seen previously were who patients on information to see MLH physicians and other clinicians for easier much is it system, (EMR) records medical electronic same Health Line ow, Main all with the on standardized hospitals acute and treatment. diagnosis away from time valuable took history medical other and conflicts medication Researching yourself. for see could you what to or you tell remembered they what was them about knew you All strangers. virtually were hospital to the admitted or patients most to be t used brought to an Emergency Department B DO BULGARELLI, BY ROBERT One clinical system for the System treatment at Riddle Hospital. atRiddle treatment recent his from but Mills, Glen in family his from not bleeding, gastrointestinal with bout his about out found clinicians Paoli the TPA, intravenous given to be was he before But history. medical his about anyone tell couldn’t he so unresponsive, was patient N I Department, the stroke Hospital’s Emergency to Paoli Mall of Prussia King from him brought ambulance the time y the cross campuses. campuses. cross who patients for of care continuity enhanced as well as treatment, and diagnosis faster is result The system. health the across elsewhere advance transition of years of data. of data. of years transition advance and sessions, of training hundreds piloting, testing, included This process. conversion the planned had departments, clinical other from staff as as well staff, SystemIS and Riddle administration, pharmacy, operations, ateam years, two past the or nursing, physicians, comprised that Health’s Line Main acute hospitals. four all across patients for repository data medical asingle is result The with other system enhancements. along converted, was data patient the as unit ateach activated was platform EMR SmartChart the morning, Saturday SmartChart. to Soarian connection the make and inpatients current on data to load downtime system a planned starting off, turned was years nine for used had Hospital Riddle that system clinical Cerner the 29, March in link last Saturday, on the am At 12:01 connected spring. LH this standardization system clinical M F coaching for Julia Elcock-Vengen, MD. Elcock-Vengen, Julia for coaching Felton and Dr. Bulgarelli provide SmartChart Fiona Manager Nurse Hospital Riddle left: From • • between MLH hospitals. hospitals. MLH between transition who physicians for simpler considerably life makes it addition, In aSystem. as designation for application Magnet® MLH’s as well as 2 attestation Stage Use Meaningful ARRA successful to crucial is MLH, within costs software practices, and significantly reduced standardized clinical which processes and standardization, he workflow, to simplified lead will well. as patients Riddle to available etc.) now is instructions discharge reports, radiology results, (lab own data their access Health’s Line Main n addition, can patients where portal, patient • access: can hospitals acute system of clinical ow, aresult as MLH atall physicians standardization, Lankenau Group. Heart the of amember is DO, Bulgarelli, Robert otes, discharge summaries, ED visit visit ED summaries, discharge otes, results, other and radiology lab, ll and visits from records medical ll from all Main Line Health sites Health Line Main all from notes progress and consults reports, late 1990s to the back dating some Health Line to Main admissions n a a T I N n 7 | PATIENT CARE

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recision) r testing patients and la to clinical tria X-Ray) , s king apies) r MRI (for increased r added ease king spaces for re, and acces registration* ES I T I atology and Oncology roenterology umatology t N tic counseling, social work ser urodiagnostic and vascu rmatology ysical rehabilitation gent care op-off lane fo E as r em he adiology (CT Scan, DEXA Scan, ulmonology/Sleep Medicine amily Medicine aboratory services ne EDICAL SERVICES Ph Ur Complimentary valet par Dedicated par D One-step F Pediatrics Cardiology De H OB/GYN Orthopaedics and Spine Care Podiatry P R Cancer center (chemotherapy and in Ne Open-architecture R Extended hours (evenings and G L Additional specialties are available available are specialties Additional across the hall inside the mall. For more mainlinehealth.org/exton. see information, *Not applicable to all practices. PRIMARY AND SPECIALTY CARE SPECIALTY AND PRIMARY ge and complementary the • • AM • • visitors • • • • • • • • • • • • • survivorship ca • • patient comfort and enhanced p • Mammography, Ultrasound • weekends)* • M • n SUMMER 2014 I had the privilege serving of Fundamentally, this model is about The feedback from our patients as a member the of executive steering committee that guided the development the of Main Line Health Center at Exton Square. believe We this facility truly represents the future medicine,of and are we proud offer to our medicine personalized quality, the patients expect from Main Line Health in such an innovative setting. Carol Glessner, MD is a family physician with the practice of Main Line HealthCare Family Medicine at Exton Square. improving access health to care. The more available and convenient can we testing, and services physician make the more inclined patients will be to access these services, and ultimately, the better their outcomes. In addition, the design the of new center fosters physicians between interaction greater and specialists, allowing clinicians to coordinate care seamlessly. has been very positive. The extended hours mean patients no longer need to miss work or visit the hospital for lab work, or X-Rays, screenings. Women can get even a mammogram in the evening. It’s a very patient-friendly model, with a dedicated outside parking, valet complimentary entrance, one-step registration, and lab visits that don’t require any appointment at all. ame s esting, he ore. d m t cular n t nder as v a are nd are.” u ervices c rgent c utpatient aedics, laboratory services,

s ncillary Perhaps the best example is the As Maria Flannery, Main Line

d a To continue thrive, to must we To meet In this new era, patients are looking The health care delivery model in the and exceed these expectations. for convenient hours, same-day access easy and appointments, servicesto outside the of hospital environment. US is in the midsttremendous a of evolution, rapidly moving a toward system that delivers more patient- centered and efficient care with the goal providing of a superior patient experience. a neurodiagnostic roof as 100 over retail stores. The Health Center offers cardiology, family medicine, hematology and oncology, orthop new Main Line Health Center at Exton Square — a 32,000-square-foot, state- of-the-art outpatient facility located on the lower level Exton of Square Mall with both physician practices an pediatrics, physical rehabilitation, u radiology, Health director physician of practices and ambulatory care, said, “We believe the hospital as know we it is going to change. are evolving more to We and o more Here are the facts: • BY CAROLBY GLESSNER, MD The future of health care at Exton Square Mall Square Exton at care health of future The MLH President and CEO Jack at the Lynch Center’s opening. • • CLINICAL ISSUES | 8 little to no side effects. side to no little with better, all or percent of 85 rates cure with less or weeks 12 in work that way toagents new giving quickly are effects side potential and percent) (under 40 rates low cure courses, treatment long —with ribavirin and interferon as —such therapies Scott Fink, MD, a gastroenterologist, is chief of hepatology at Lankenau Medical Center and Main Line Health. Line Main and Center Medical Lankenau at hepatology of chief is agastroenterologist, MD, Fink, Scott —including services hepatology Health Line Main across atients of spectrum to afull have access States. United the in transplantation of liver cause frequent most the is Cvirus hepatitis occur. Chronic cancer or cirrhosis as such complications Cpatients, hepatitis many or until appear don’t symptoms and appropriately treated. identified be might cases new 800,000 than more tested, got boomers baby all If C. hepatitis for tested be 1965 that recommends now CDC he and 1945 between born Americans all population.) of the percent 27 only up make they although US, the in Ccases hepatitis of the percent 75 for to account estimated are (Boomers symptoms. experienced never but ago decades virus to the exposed were who boomers baby are infected those of Many it. know don’t of them to Americans half million three t least up and virus, HCV the with infected are Cvirus. hepatitis new produce —that health to good important are of which —some systems target that drugs to older contrast in is This infection. and replication of viral disruption in resulting cycle, life HCV the within steps specific target they called are medications hese “direct-acting antiviral drugs” because T MD FINK, BY SCOTT Hepatology: From to C Hep transplant care P F T A T years. Traditional Traditional years. recent Cin hepatitis of treatment the in revolution a been has here

stage liver disease. patients with cirrhosis and end- of care the in of expertise Center has a particular area Medical Lankenau — but interventional radiology vascular procedures and surgery, medications, testing, hen, the Institute’s surgical teams teams surgical Institute’s the hen, closely collaborate will at Jefferson list. waiting organ the on placement of faster possibility the for evaluation, pre-transplant efficient to offer able be center, will transplant heart its as well Institute’s liver transplant center, as the atLankenau, centralized highly are services clinical because Further, patient. the with familiar is that team clinical experienced by an met be pre- and post-transplant needs can complex a patient’s where base a local liver advanced with atients of convenience have now the disease to home. pre- and post-transplant care close significant for opportunity the disease) heart end-stage (and with those disease liver end-stage with patients offers Center Medical at Lankenau of establishment recent he Institute Transplant Jefferson the MAIN LINE HEALTH PHYSICIAN T P T

effective transitions of care. of transitions effective and smooth to ensure teams surgical and clinical Institute’s the with together to work encouraged are physicians referring recovery. Naturally, through patients to monitor and procedures transplantation organ for successfully Lankenau to help patients prepare at teams clinical Institute’s the with 610.896.7360. call please Center, Medical Lankenau transplantation consultation at hepatic cirrhosis. (right) with liver diseased unhealthy to compared (left) liver healthy Normal To refer a patient for liver liver for To apatient refer n

9 | CLINICAL ISSUES

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INOLOGY — Labor and delivery — EED data is included TERM

M nurses the have authority question to physicians about scheduled EEDs and goto up the chain command of nurse to chief. department the or managers in the department’s monthly part of as Additionally, dashboard. the Pennsylvania OB collaborative, MLH submits monthly data on a standardized set measures. of T E   39 weeks 0 days – 40 weeks 6 days   E F L P 41 weeks41 0 days weeks – 41 6 days 37 weeks 0 days – 38 weeks 6 days 42 weeks days 0 and beyond Helen Kuroki, MD, is vice president, Medical Affairs, Riddle Hospital; Nancy Roberts, MD, is system chair, Department of OB/GYN, Main Line Health; Nancy Shields, MSN, RNC, is a clinical nurse educator, Obstetrics, Bryn Mawr Hospital. • • ransparency Adverse Events Collaborative, launched LHin is May 2012 amember the by Pennsylvania the of Obstetric Hospital Engagement Network (PA- HEN), an initiative the of Centers for Medicare and Medicaid Services. • mpowerment The collaborative is led The by Health Care Improvement Foundation (HCIF) through the PA-HEN. One goal key has been reduce to the non- rate of medically indicated EEDs less to than 5 percent. July From 2012 December to 2013, the 30 participating hospitals succeededhave in reducing their EEDs 78 percentby 1 percent. a rate of to The 2013 national average was 4.6 percent. CHANGING In 2013,the American College of and Gynecologists and Obstetricians the Society for Maternal-Fetal Medicine jointly proposed the following new definitions of term deliveries: • arly Term: • ull Term: • ate Term: • ost Term:

— Non- — Adherence — Physicians and — MLH’s electronic M begins in the physician’s office with patient education. If an expectant mother asks about early induction, her physician explains the importance lettingof the baby reach full term for outcomes. best the C Do A c P nurses discuss case management management case nurses discuss twice daily during board rounds, presenting the opportunity address to any early scheduled deliveries. medical record for labor and delivery, Centricity Perinatal Nursing (CPN) includes prompts for physicians enterto a reason for early elective deliveries, enabling accurate data collection andeasier identification of outliers. medically indicated EEDs before 39 weeks induction (by or scheduled cesarean section) are not permitted at MLH’s four acute care hospitals. • ommunication • • cumentation strategies: following LH• attributes its success the to learly defined policy • hysician-driven effort

Quarters (with count of cases at MLHS) esearch published in the past two three to years has confirmed that induced labor or cesarean births before

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39 weeks are associated with higher rates infant of mortality, admissions to the Neonatal Intensive Care Unit, respiratory and developmental problems, problems, developmental and respiratory and longer hospital stays for both providers some While baby. and mother and patients prefer may non-medically indicated early elective deliveries for such weeks) non-medical(37–39 reasons as convenience, relief of symptoms in the final stagesof liability perceived and pregnancy Department Health’s Line Main concerns, OB/GYNof has always recognized the importance women of reaching full term achieve to optimal outcomes. enacted stringent guidelines in an effortto decrease the numberof these early elective deliveries As a (EEDs). result, Main Line Health’s EED rates droppedhave from 4.4 percent 1.3 to percent, with some our of hospitals percent. 0 achieving ver the last two years, MLH has R

BY HELENBY KUROKI, MD; NANCY ROBERTS, MD;AND NANCY SHIELDS, MSN, RNC Reducing early elective deliveries elective early Reducing NON-INDICATED DELIVERIES WEEKS, 37–39 MAIN LINE HEALTH (ACUTE) Source: Centricity via MLHS Dashboard database MEDICAL STAFF NEWS | 10 PATIENTS LEARNING ABOUT MLH’S PATIENT PORTAL MLH’S ABOUT PATIENTS LEARNING or [email protected]. 484.596.2342 at Services, Information MLH Troy Brailo, contact please Use, Meaningful about questions For online. form request a out tofill mainlinehealth.org/connect visit can patients CONNECT, Health Line Main for toregister or information more For prevention.” in role active an take and provider, care health their with follow-up questions, ask to likely more are information health their to access easy have who “Patients officer. information chief and president vice senior MLH Thomas, Karen said outcomes,” health toimproving vital is care health their in part totake patients engaging that know “We record. health their view and log-on inpatients discharged of 6percent and CONNECT Health Line Main for register inpatients discharged its of percent 51 to have required is hospital care acute MLH each access, record health electronic for guidelines Use” “Meaningful Services’ Medicaid and Medicare for Centers tothe To adhere appointments and access their inpatient summary of care and discharge toschedule instructions. ability the as well as results, radiology and lab including records, medical their in included information health toimportant access users gives CONNECT Health Line Main patient portal. online 24/7, secure, MLH’s CONNECT, Health Line Main of benefits the understand patients helping are materials other and posters brochures, hospital, MLH At each During Interventional Procedures” to Real-TimeFeedback Using Reduction Dose Radiation “Physician study the of investigator principal also is He UK. Glasgow, in meeting scientific (CIRSE) of Europe Society Radiological the Cardiovascular and Interventional at presented being Technique,” 2D Conventional Versus Guidance MRA Uterine Fibroid Embolization 3D Using During Reduction Contrast and Dose “Radiation study of the investigator MD Gupta, Atul Medicine Emergency Medicine Club. of Osteopathic College Philadelphia by the arranged lab ultrasound apoint-of-care for instructor lead MD Fischer, Jonathan 2014. June in retired and 1998, since role this in served PhD MD, Keshgegian, Albert succeeding Health, Line at Main of Pathology System Chair, Department MD Daum, Gary of 2006-2014. period cumulative the for States United the in program ranked #1 the additionally is and 2009 since record this held has DO Lazowick, of leadership the under program, The trainees. 1,607 with programs 107 among from US the in scores exam in-training highest the scored residents, track osteopathic three (PGY-1) DO Sobuto, (PGY-2) DO Huntington, (PGY-3) DO Calder, Melissa Staff notes Bill Surkis, MD Surkis, Bill , and , is principal principal , is , has been named named been , has , Main Line Health’s Health’s Line , Main , was the the , was , and Amber , and , William , who , who

Dan Dan , FDA, in White Oak, MD. The session The MD. Oak, White in FDA, the and (CSRC) Consortium Research Safety Cardiac by the sponsored (NOACS) Anticoagulants Oral Novel MD Seltzer, Jonathan with coordinated, also He DC. in Washington, Consortium Research Safety Cardiac the during Meeting” Tank Think ACSRC/FDA/ACC Safety: Drug to Define Studies Outcome CV for Roles and at “Thresholds Cardiovascular Diseases, presented Kowey,Peter MD afour-year for term. trustee at-large specialty an as Society Medical Pennsylvania of the of Trustees Board MD Klein, Walter luncheon. Women for Red AHA’s atthe Go Heart of the Woman 2013 the as honored recently also was She Community. Latino Stroke the in and Disease of Cardiovascular free lives healthier build to fight the in AHA to the dedication and commitment of extraordinary recognition in Award TuPor Ambassador Corazón (AHA) Philadelphia Chapter’s 2014 Association Heart American the MD Hernández, Maribel (PCMH). Home Medical Care Patient on expert recognized anationally is the second female president. Henwood is She FamilyPhysicians. Osteopathic of College American of the president DO Henwood, Carol CA. Diego, San in meeting (ARRS) Ray Society Roengten American annual 114th at the exhibit electronic an as presented be , was elected to the to the elected , was , system division chief, chief, division , system , became the 61st 61st the , became , a think tank on tank , athink , received , received Award presented Hospitalist Community Lee P s this retirement planned his announced has Hospital, Mawr Bryn at Affairs, Medical Mayer, MD Henry America. North in surgeons knee 22 top of the listed inOrthopaedicsThisWee leaders inthefieldoforthopaedicsand MD Lonner, H. Jess Healing. Wound in of Physicians Academy of the meeting International atthe casting contact of total ademonstration led and talk DPM Lehrman, Jeffrey “All entitled atOnce.” was b presentation the and Hospital/Staff/Referrals,” from Buy-In aProgram to Develop DO Sutter, Francis Ablation,” for of Patients Selection the and Drugs “Antiarrhythmic on Dr. Kowey DC, presented Washington, in of Cardiology College American the of Sessions Scientific annual 63rd At the US. the across from clinicians and researchers leading 100 attracted services, citizen engagement, information citizen engagement, services, government of delivery the efficiency, accomplishments remarkable and innovation vision, whose leaders IT Health celebrates program Healthcare Pr & Alliance aHealthTech is Research Health, of Association American the MD Rossenwasser, H. Robert York New in City. Hospital Hill at Lenox Center Wellness Aortic the and Surgery of Aortic Director as served recently most He Health. Line Main Institute, Vascula and of Cardiothoracic System Chief MD Plestis, A. Konstadinos Philadelphia—Tri-State C by of Practice Current to the Testing Applied His of Prussia. Fair King in Health and Lectureship of Christ Churches Atlantic DO Targan, David sh Harm Francisco. San in April in meeting scientific annual atits Neurosurgery in Innovation and Excellence Technical Award for Cushing (AANS) Surgeons in Excellence for nominee Council aring a Medicine, of Hospital Society the M t edicine.” “ opic: ummer. M eng, Scherpbier, MD, CMIO MD, Scherpbier, r Surger na nd Pr D G actical M oject , tional se received the Top the received Rizwan Sardar, MD Sardar, y Rizwan y atth , Vice President, President, , Vice h , spoke at the Mid- atthe , spoke , presented on “How “How on , presented ave , was selected by selected , was T anagement. enomics-Gene curity. Lankenau Heart Heart e Lankenau , presented a , presented i mproved hapter. , is the new new the , is Neurological , Main Main , r eceived k asone he Line ,

11 | MEDICAL STAFF NEWS -

and — This — major and participation and — Membership Main Line Health and Jefferson idney Transplant Program with Program Transplant idney ankenau Medical Center Medical ankenau xpansion aligns Lankenau’s 20-year Lankenau’s aligns xpansion efferson’s Transplant Program, estab Program, Transplant efferson’s in the National Cancer Institute- designated Kimmel Cancer Center Lankenau enables Jefferson at Institute for Medical Research to engage in a number collaborative of studies, including work in the area of immunogenetics. and immunotherapy lishing standardized clinical protocols, clinical standardized lishing Jefferson-based of team shared a surgeons and the opportunity for also Lankenau collaboration. research provides patients with advanced liver or heart failure on-site pre- and post- to access seamless and care transplant teams. transplantation Jefferson’s L e K J Academic appointments at Jefferson Jefferson’s Radiation Oncology Main Line Health’s HomeCare & JeffersonTransplant Institute at Cancer Research for MLH physicians MLHby as a training for site Jefferson and residents students, medical other health care professionals allows for the sharing expertise of and advancement clinical of knowledge between our two organizations. Service at Riddle Hospital Riddle’s membershipin the Kimmel Cancer Center delivers quality care to cancer patients in Delaware County. Hospice Services (formerly The Home Care Network) in affiliation with Jefferson Home Infusion Therapy home comprehensive offers Services Philadelphia throughout services care and the western suburbs. Strategies for growthStrategies (continued from page 4) Jack is Lynch president and CEO of Main Health. Line • • • are evaluating several opportunities to combine our strengths for the benefit theof patients serve. we When you look at health careyears five from now, I am confident that therelationship between our organizations will be among the strongest partnerships in the Philadelphia area. n • •

XILLOFACIAL D D RY T ENTISTRY DIA /DIAGNOSTIC M tnam, D ND SUMMER 2014 Y S/NEONATOLOGY M akarcan, C /PO . Pu MA Y/ORAL Y/OPHTHALMOLOGY RY OLOGY A RGERY RGE S dullah URGERY/UROLOGY Brian D. Crispell, DPM S SURGER Jing Jin, MD Sharon S. Lehman, MD SURGER SU Gary Fishbein, T. DMD Charles A. Picchioni, DMD SURGERY/ORTHOPAEDIC SURGERY James C. Krieg, MD Angela D. Smith, MD SURGERY/PLASTIC SURGERY Christian R. Subbio, MD SU Darlene M. Gaynor-Krupnick, DO Francis J. Schanne, MD PATH Cheryl L. Davis, MD Kamel M. Ghaben, MD Kelly J. Zook, MD RADIOLOG RADIOLOGY Samuel G Pradeep K. Bhagat, MD PEDIATRICS Kristine A. Herrell, MD Offit,Bonnie MD F. Jessica A. Rosen-Pries, MD Ab Daniel DO Walmsley, PEDIATRI

appointments

REPRODUCTIVE ENDOCRINOLOGY Albert El-Roeiy, MD ANESTHESIOLOGY ANESTHESIOLOGY Benjamin J. Duckles, MD MEDICINE EMERGENCY Gambhir, MDVibha P. Jerahme S. Posner, MD FAMILY PRACTICE Beth Ann Bingaman, DO Catania,Charles P. MD DO L. Henwood-Dahdah, Carol Meng-Chao DO Lee, McClure,Charles MD P. Jeanne M. Sandella, DO Natalie MD B. Tussey, MEDICINE/DERMATOLOGY Gopal Patel, MD MEDICINE/ENDOCRINOLOGY Neema Chokshi, MD Eugena L. Wright, MD MEDICINE/INTERNAL MEDICINE MD Diamandi, V. Mihai Sonia L.Siu, MD MEDICINE MEDICINE/PHYSICAL REHABILITATION AND Ronald B. DO Lincow, Lance S. Roberts, DO MEDICINE/PULMONARY DISEASES/ CARE CRITICAL Leonard B. Berkowitz, MD Bin,Wei MD MD Frederique, Pierre Asad U. Khan, MD Hussein A. Kiliddar, MD Catherine A. MD Riley, Gary Wendell, D. MD OBSTETRICS/GYNECOLOGY/ New DECEMBER 2013–MAY 2014 240 North Radnor Chester Road Suite 300 Radnor, PA 19087

Philanthropy | Introducing the 1860 Society

n April 2, 1860, the part of an excellent medical staff and staff who have German Hospital of the institution,” said 1860 Society member shepherded City of Philadelphia was Jerome Santoro, MD. “Joining 1860 the care and incorporated through is about recognizing your colleagues culture at the tireless efforts and the hospital family and in a small Lankenau ofO a handful of physicians who were way hopefully perpetuating graduate for so many determined to meet the health care medical education, research, and first years.” needs of their community. Philanthropy rate patient care for generations to come.” Across was essential to founding what is now The vision of a Lankenau physician, the Main Lankenau Medical Center, and it has the 1860 Society consists of current Line Health Jerome Santoro, MD since been a transformational force in and emeritus physicians and scientists System, its evolution as a world-class academic who have pledged $25,000 or more physicians support a wide variety of medical center. The hard work and to support Lankenau Medical Center programs and services, from education unceasing commitment of physicians programs and services. In just a matter and research to technology and has allowed the institution to evolve of months, the 1860 Society grew facilities, with charitable giving, and from a 50-bed facility at 20th and Norris from an initial core group of nine to 38 participation in the annual Physician Streets to the world class, nationally Charter Members whose commitments Giving campaigns has always been acclaimed center of patient care, total more than $1.1 million. notable. In addition to the incredible education and research that Lankenau So far, the 1860 Society contribu- and direct impact that these resources is today. tions have supported areas including have, the physician-led 1860 Society In 2013, the 1860 Society was fellowships, surgical education, cardio- philanthropy is also a tremendous show established to recognize and honor the vascular services, breast care, cancer of support and vote of confidence philanthropic leadership of our physicians research and the Master Facility Project in the present and future, and a and scientists, who demonstrate their just to name a few. demonstration of the impact of the confidence in and commitment to the “These gifts are a real testament to culture of philanthropy within MLH. ideals that make Lankenau such an the leadership and commitment of our To honor the 38 Charter Members extraordinary institution. physicians at Lankenau,” said Lankenau of the 1860 Society, a permanent plaque “I have been very fortunate to be President Phil Robinson. “It is such a listing their names is displayed at able to practice at Lankenau and be meaningful response from the medical Lankenau Medical Center. n

Main Line Health Physician magazine is published for MLH-affiliated physicians. For comments and contributions, contact Michael Martin, MLH Internal Communications manager, at [email protected]. Editorial Board: Gary Daum, MD; Robert Day, MD; Steven Gamburg, MD; Scott Goldman, MD; Kay Kerr, MD; Lawrence Livornese, MD; Jack Lynch; Stephen Mechanick, MD; Andy Norton, MD; Nancy Roberts, MD; Emma Simpson, MD; Robert Stavis, MD; Barbara Wadsworth, RN. Cover photograph: JeffSTAT helicopter lands at Paoli Hospital, whose regional Trauma Center benefits from the skills of Jefferson-trained clinicians.