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Jun 14, 2015

14 Jun 2015

June 14, 2015
breakfastWhat's new with the Cardiovascular Clinically Integrated Network
Brandon Schmidgall, RN, BSN, Heart and Vascular Services Director 

Salem Hospital has been working with Salem Heart, Salem Cardiovascular Associates, and Cascade Cardiology in to create a new structure to address points of value, quality and efficiency within the Cardiovascular Service Line. This structure, currently referred to as a Clinically Integrated Network (CIN), would serve as the model for future subspecialty interests across the full continuum of practices here at Salem Health. The Cardiology CIN officially launched March 1, 2015, with co-management authority for defined areas within the service line, including Cath Lab, EP, Non-Invasive and Rehab.


With the formation of the Cardiology CIN, the Heart and Vascular Institute (HVI) structure will be retired June 30, 2015. Under our former model, EKG interpretations and echocardiography interpretation contracts were held by the HVI. This model was recently discussed at the Cardiology CIN Joint Operations Council (JOC) with the intent of streamlining current workflows and consolidating cardiology-based procedures within the CIN. The JOC is comprised of equal representation from all three cardiology groups as well as Salem Hospital administration.


Consolidating these interpretations will allow the CIN more control of the product we provide, decrease variability of practice among locations, and streamline workflows in Cardiovascular Non-Invasive (CVNIS) resulting in increased efficiency. The introduction of a robust quality and review process within CVNIS and the Cardiology CIN will also ensure that we are adhering to practice standards and appropriate use criteria to provide the best quality and value to our patients. 

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revisionsTrauma Services newsletter

Nicole VanDerHeyden MD, Trauma Program Director
Beginning this month, Trauma Services will begin publishing a communication for physicians involved in the care of trauma patients.  The intent is to both inform and to assist with the CME requirement. This month's edition also contains the Salem Health Massive Transfusion Blood Bank Policy and a JAMA article on Transfusion Ratios.


We value your input, so please send suggestions or comments to  Jenenne Aguilar, Trauma Program Manager.

Anyone interested may view the newsletter.

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fiveFive Star Awards program changes

David Barlow, Director of Service and Care Continuum

The product we have used to support our Five Star award program will no longer be offered by the vendor as of June 30, 2015. This recognition system is used by the Medical Staff Engagement Committee to award medical staff for being great role models, leaders, heroes and delivering excellence above and beyond what is expected.


We will develop a replacement system by Sept. 1, 2015.  


Thank you for your patience and understanding while we make the necessary changes to continue this important recognition program.

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icdICD-10 back on track for Oct. 1, 2015

Claire E. O'Brien, MD, Medical Director, Continuum of Care
As most of you probably remember, ICD-10 has had a tumultuous history of postponements. After several false starts, it appears that ICD-10 will finally go live (for real this time) on Oct. 1 of this year.  


For some of you this may seem to be coming out of the blue, but that is not the case. Please remember that CMS timing is beyond our control. We now need medical staff training completed before the Oct. 1 go-live date arrives. My sincere apologies for all the confusion the multiple postponements have caused.  


Training and proof of competency for the go-live will be required for all medical staff with active privileges and will be assigned through HealthStream beginning June 15.   There will be both general and specialty specific training modules through Precyse University ICD-10 Education Solution. This was our original plan a year ago, but the one year delay changed the timing.  


Please know that these modules were deemed necessary by our own Physician Coalition, who selected Precyse as the best education option. The deadline to complete the training modules is Aug. 31, 2015. This allows more than 11 weeks to complete the assigned modules.  Reminder emails will be sent. CME credit is available on completion of the training modules and exams.  


The Medical Executive Committee (MEC) agreed that the modules should be mandatory because of the potentially devastating impact ICD-10 will have on an uninformed medical staff.   That means that if they are not completed by the Aug. 31 deadline, a deficiency will occur, leading to the loss of privileges until the modules are completed.  


The assignment of mandatory education is taken very seriously and only implemented when deemed absolutely necessary. The minimum time it should take to complete the basic set of modules is about 2.25 hours. There is a nine or ten question competency test for each of the modules which must also be completed with 80 percent accuracy. Modules for sub-specialties will be in addition to the basic modules. I strongly suggest you pace your learning over the 11 weeks and not attempt to do all the modules at one time.  


Thanks for your time and understanding. Please contact Claire O'Brien, MD, if you have questions or concerns. 


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websiteNew Salem Health website 

As part of our digital strategy, Salem Health has overhauled and updated the public website.


The intent is to provide dynamic, interactive, intuitive content and design to meet patient/consumer expectations in both a desktop and mobile environment. The site will serve user needs with messages that are relevant to them at the appropriate time.


Highlights include: a new "look" that is compatible with modern design standards, mobile-friendly functionality, updated navigations, stronger search features, and the infrastructure to update the provider directory. The web development team is working very hard to align the organization's business objectives to the needs of consumers and communicate more extensively through digital channels.


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pharmacyPharmacy IV to SQ insulin transition protocol

Best practices indicate that insulin infusions and long acting insulin preparations should be overlapped by two to six hours. Many providers find this difficult to convey in Epic.


A new "Pharmacy Protocol" order has been created to help smooth the transition from IV to subcutaneous insulin. This new pharmacy protocol is called "IV to SQ Insulin Transition Protocol." This new protocol allows pharmacists to transition diabetic patients from IV insulin infusions to a basal-bolus regimen and provide an appropriate overlap between the infusion and SQ dose according to best practice evidence.


A pop-up will help providers remember that this assistance is available. It will appear when a new long-acting insulin order is placed if an insulin infusion is still on the Medication Administration Record (MAR). Another Best Practice Advisory (BPA) will remind the RN who administers the first dose of levemir to stop the insulin infusion in two hours. An automatic MAR prompt was explored but is not currently possible.


For questions or comments related to this new protocol and best practice alert contact AJ Sowles.



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protocolPatient safety update to universal protocol

 Over the past year, many department leaders, staff and physicians have come together to develop a standardized patient safety universal protocol or "time out" process that would be recognized across the organization. The efforts have produced a product that is applicable to all procedural areas and proceduralists. The new process begins Monday, July 6, 2015.


All clinical staff will receive a HealthStream notification to complete a CBT. Physician education is under way and will be completed by Friday, June 26. You can read the Bedside Procedural Checklist as a sample of what all applicable areas will have posted for use prior to procedures.  


Specific procedural areas include labor and delivery, operating room, endo, cath lab, and bedside. Please note that these are guidelines and not all items listed may be applicable to each patient. Thank you for your time and attention to promoting patient safety.


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You asked to hear about medical staff who are voluntarily resigning from the medical staff. Look for this section in future editions of Common Ground. 

Loring H. Winthrop, MD - Family Medicine, effective May 31, 2015
Douglas H. King, MD - Pediatric Cardiology, effective June 4, 2015
Robert J. Hejl, MD - Internal Medicine, effective June 1, 2015
Mary J. Bedell, CNS - Clinical Nurse Specialist - Adult, effective May 13, 2015
Jennifer H. Kim, MD - Internal Medicine, effective Aug. 18, 2015


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PARTERNSHIPSOther hospitals and health systems on partnership journey
Silverton Health and Legacy Health continue to pursue a merger, signing their own letter of intent this month. Read:  Silverton Health, Legacy move closer to merging, from the Statesman Journal on June 2.
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kishanBen Miller, Role Model for Excellence

Anethesiologists have been recieving individual performance data from patient surveys for more than a year. Ben Miller, MD, has been a leader in the anesthesia group to advance this measure and speak with his fellow anesthesiologist about both its relevance to their practices and the means by which it is collected and reported. Along the way Dr. Miller has constantly reviewed his own performance and early on made a decision to change practice to see if he could improve his care as measured by his patients. He systematically applied three practices to each patient encounter. Some of these practices were new, and some were in use but not consistently applied. In the course of the year his scores showed a steady and substantial improvement to the point that his patients now rate his explanations of the anesthesia prior to surgery as top in the nation (99th percentile) for anesthesiologists. Dr. Miller is a great example of a leader owning his practice, owning patient centric care and making a concerted and thoughtful effort to improve.


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CMOInvitation to People Week activities
People Week is a chance for Salem Health to celebrate the hard work and dedication of all staff, and that includes you! There will be activities throughout the week of June 21 to 27, ending in a Fun Run on Saturday, June 27 in Bush Park. Bring the family for snacks, beverages, games, face-painting and Huggy Bear!

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checUpcoming classes at the CHEC  

Select class headlines to download a flier to print and share with your patients. For more information and to register visit the CHEC website or call 503-814-2432 (CHEC). 


Lower Sodium
This class series is taught by registered dieticians who will offer nutrition tips, snack suggestions, how to manage dining out and answer your questions about eating less salt.
Date: Wednesday, June 24
Time: 1 to 2 p.m.
Cost: Free


Infant CPR
Learn how to help a baby who is choking, respond to a breathing or cardiac emergency and how to childproof your home. For parents, grandparents, and anyone who will be with a newborn.
Date: Monday, June 22
Time: 4 to 5:30 p.m.
Cost: $10   


Freedom from Smoking
This program is specifically designed for adults who want to quit smoking.
Date: Thursdays, July 9 to Aug. 20
Time: 6:30 to 8:30 p.m.
Cost: $120. Scholarships available.   


NAMI Family Support Group
For family and friends who care about someone with a mental illness.
Date: 2nd and 4th Saturday of every month
Time: 1 to 2:30 p.m.
Cost: Free (see attached flyer) 


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Common Ground Newsletter Editorial Board 
For past issues of this newsletter, visit
Email us anytime with feedback, suggestions, or something for the next issue!  Dr. Ian Loewen-Thomas, Chair, Compact Implementation Committee