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Progress Notes May, 1993

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Progress Notes May, 1993 Medical Staff Volume 6, Number 6 Progress Notes May, 1993 President for Medical Staff Services, From the and members of TROIKA. A report President from this group would be sent to the Medical Executive Committee for At its April informational purposes and sent meeting, the Medical Executive directly to the Quality Committee voted on several important Assurance/Medical Allied Health Staff issues. The committee endorsed the Development Committee of the Board Board of Trustees' reports on which would then submit its Education and Chairpersons. These recommendations to the Board of two documents express the direction Trustees. and intent the Board envisions for our hospital. As previously noted, these A modification of the so called two documents have been available in the year rule was also passed. Medical Staff Office; however, as the Immediately upon receipt of contents of these documents are notification from a private practice important for our active :¥edical Staff, group that an individual has been copies will be provided at the next involuntarily terminated from the General Medical Staff meeting. group, or when an individual is no longer employed under a contract with The Medical Executive Committee also the hospital, that individual would lose voted to remove itself from the process medical staff privileges and In This Issue ... of reviewing and making membership. These individuals would, recommendations concerning requests however, be permitted to request a slot At-Large Members for Medical Staff Development slots. within 60 days of such notification, Needed forMed We struggled to this conclusion after requiring immediate consideration by Exec Committee considering the tangled deliberations of the new hospital group mentioned -Page 2 the Medical Executive Committee above, the Quality Assurance/Medical Physician Parking when reviewing slots/slot applications. Allied Staff Development Committee of Changes The department chairperson would the Board, and the Board of Trustees at -Page 3 solicit input from his division and their next scheduled meeting. UltlfiSound make his recommendations (as well as Voluntary termination from either Changes the division recommendations, if private practice groups or hospital -Page 5 contrary) to a group consisting of the contracts will be reviewed only during P & T Highlights 11 departmental chairpersons, the the normal Semiannual Needs Survey - Pages 17-19 hospital CEO, COO, Chief of Clinical cycle. Services, hospital counsel, Vice Continued on Page 2 Continued from Page 1 The Medical Staff Development Plan Managed care Committee for further has been a source of much discussion and revision. We have been consternation in its individual very active in formulating our plan at a application. The general principles of rapid pace. The issue of capitation/ the plan, however, remain an important gatekeeper concept also needs to be document which the Medical Staff, faced if we are to be perched through the Medical Executive competitively in the managed care Committee, must maintain input and arena. A group of primary care provide insight. In that regard, we practitioners and Tom Hansen, Senior will be reviewing those principles in a Vice President, are grappling with this upcoming meeting of the Medical issue. Executive Committee. Best wishes, Finally, a quick update on the Managed Care initiative. The first draft of the Business Plan has been completed, and TROIKA reviewed it with Dan Grauman of the Raleigh I..i:::Candio M.D. Group. It is being distributed to our President, Medical Staff At-Large Members Needed for Medical Executive Committee The Medical Staff Nominations If you have any questions regarding Committee is soliciting nominations for this issue, please contact Dr. Castaldo four at-large seats, each for a three- or Mr. Hart at 402-8968. year term beginning July 1, 1993, on the Medical Executive Committee. Nominations should be submitted in writing to John E. Castaldo, M.D., Chairman of the Nominating Committee, via the Medical Staff Services Office, Cedar Crest & 1-78, or verbally to Joseph A. Candio, M.D., Medical Staff President, John Jaffe, M.D., Past President, Medical Staff, or John W. Hart, Vice President. All nominations must be submitted prior to June 1, 1993. Page 2 Physician Parking Changes- Cedar Crest & 1-78 Effective Monday, May 17, 1993, After the trench work is completed, the physician parking was expanded and parking spaces formerly occupied by temporarily relocated to a new lot physicians will be dedicated to which provides physicians with over 30 accommodate the additional patient new spaces (please refer to the map on parking needed. It is anticipated that page 16). The new lot is gated and physician parking will return to the card accessible as it has been in the original lot upon completion of the past. Dorothy and John Morgan Cancer Center. Additionally, the relocation and expansion of physician parking Thank you for your continued provides an increased number of cooperation since the early stages of patient parking spaces in response to the construction for the John and the growing demand from patients of Dorothy Morgan Cancer Center. In the 1210 Medical Office Building. particular, a special thank you to the tenants of 1210, 1220 and 1230 S. The relocation of physician parking is Cedar Crest Blvd., for their patience timely because of an upcoming with regards to parking and other construction project that will displace issues that have affected them during many spaces in the current physician this time. lot. In June, temporary trenching will ) occur so that pipework can be laid to If you have any questions regarding connect the hospital boiler system to this issue, please contact either John the John and Dorothy Morgan Cancer W. Hart, Vice President, or Joseph A. Center. The trenching will pass Candio, M.D., Medical Staff through the former physician lot President, at 402-8968. (please refer to the map). Physician Hotline for Patient Census Effective May 8, Information Services is pleased to the date of support this request, and will be PHAMIS automating the process as soon as "Go-Uve," the possible, offering fax service and telephone number computer notification directly off the 402-4508 will be computer mainframe. Unfortunately, manned and accepting calls from availability of these services is not physicians who wish to inquire as to anticipated for at least 60 to 90 days, the daily census of their patients at but it is hoped that this telephone both sites of Lehigh Valley Hospital. number and staffing will be helpful. Pagel Laboratory News from the Update infections. According to the NCCLS Microbiology Division guidelines, enterococcal endocarditis requires combined therapy with high a Sporadically, the Microbiology dose penicillin or high dose ampicillin, Division of Health Network or vancomycin, or teicoplanin plus Laboratories receives urine specimens gentamicin or streptomycin for obtained by "suprapubic" collection. bactericidal action. Detection of When these are received, the ampicillin or penicillin resistance for laboratorian must call the nursing unit enterococci due to B-lactamase in order to establish whether the production is not possible by the specimen was collected by suprapubic routine disk diffusion or dilution MIC "aspiration" or "catheterization" since methods. Therefore, blood and CSF they are processed differently. In isolates will be tested using a method contrast to catheterized specimens, that will detect B-lactamase. We will aspirates are cultured as closed body continue to screen for aminoglycoside site fluids and all organisms isolated susceptibility as a means of identifying are identified. It has been found, isolates that will respond however, that most, if not all, synergistically to ampicillin or specimens received are, in fact, penicillin and an aminoglycoside. collected by "suprapubic catheterization. " a The Microbiology Division of Health Network Laboratories has In order to assure that urines collected implemented the following policy basa. by aspiration are processed correctly, on recent reports in the literature please mark the chart under physician related to inappropriate testing for orders "suprapubic aspirate for C&S" diarrheal disease. and submit the specimen in a sterile Port-A-Cui transport vial. All other o The laboratory performs a specimens marked as "suprapubic" on screen for direct Giardia the Microbiology Request Form will be antigen testing. Since the processed as a catheter collected greater percentage of specimens specimen. are positive for this parasite, the lab recommends ordering a a Based on new National Committee Giardia antigen screen rather of Clinical Laboratory Standards than a comprehensive Ova & (NCCLS M110-S4) recommendations, Parasite examination. Orders the "moderately susceptible" category must specify Giardia antigen for ampicillin and penicillin screen or Comprehensive Ova susceptibility testing of Enterococcus & Parasite exam. Specimens spp. has been deleted. There are now will be stored in the laboratory two categories that may be reported, for five days following the final i.e., "susceptible" and "resistant." The Giardia screen report, before "susceptible" category for penicillin or discarding them. ampicillin implies the need for high dose therapy for serious enterococcal Continued on Page 5 Page 4 Continued from Page 4 o Stool specimens for Culture The lab may be contacted and Ova and Parasites will not within this five-day period at routinely be processed when 402-8190 if
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