focus: october 8, 2009

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Clinical News NIH grants support research 4 Patient-Centered Medical Homes 5 Diabetes services expand at Springside Plaza 6 Centering Care program empowers pregnant women 7 General News Focus on Excellence Awards exhibit 12 Fall PTO cashout update 14 ED SuperTracking quickens the pace of care delivery for lower-acuity patients you would have said it couldn’t be done.” SuperTrack reduces length of stay In January 2008, a team of ED leaders and front-line staff began identifying bottlenecks and time wasters. The team implemented changes, then test- ed, modified, retested and con- tinued this process until the change met patient needs and the staff could sustain it. In addition to changes such as modifying order entry and establishing different methods of communicating among staff This is another in a series of articles about projects that are transforming care delivery at Christiana Care. T o patients, “emergency” means they expect to receive care fast. So spending more than an hour in a hos- pital emergency department can be frustrating. In August, Wilmington cam- pus joined Christiana Hospital in implementing SuperTrack, a process to quicken the pace at which less-acute patients—those identi- fied as emergency levels 4 and 5— move through treatment. Results are impressive. Average length of stay dropped from more than two hours to under an hour. Now testing SPEED Now, Christiana Hospital is testing a similar process for level 3 patients. Synchronous Provider Evaluation in the Emergency Department (SPEED) is scheduled to go live in December. “These programs are an example of the tremendous transformation that is taking place at Christiana Care,” says Janice Nevin, M.D., MPH, senior vice president/execu- tive director Christiana Care- Wilmington and associate chief medical officer. “Two years ago, SuperTrack quickens the pace of emergency care delivery for many Christiana Care Emergency Department patients.

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Focus is a publication for physicians and employees of Christiana Care Health System in Wilmington, DE.

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Page 1: Focus: October 8, 2009

Clinical News

NIH grants support research 4

Patient-Centered MedicalHomes 5

Diabetes services expandat Springside Plaza 6

Centering Care programempowers pregnant women 7

General News

Focus on ExcellenceAwards exhibit 12

Fall PTO cashout update 14

ED SuperTracking quickens the paceof care delivery for lower-acuity patients

you would have said it couldn’tbe done.”SuperTrack reduces length of stay

In January 2008, a team of EDleaders and front-line staffbegan identifying bottlenecksand time wasters. The teamimplemented changes, then test-ed, modified, retested and con-tinued this process until thechange met patient needs andthe staff could sustain it.In addition to changes such asmodifying order entry andestablishing different methodsof communicating among staff

This is another in a series ofarticles about projects that aretransforming care delivery atChristiana Care.

To patients, “emergency”means they expect to

receive care fast. So spendingmore than an hour in a hos-pital emergency departmentcan be frustrating.In August, Wilmington cam-pus joined ChristianaHospital in implementingSuperTrack, a process toquicken the pace at whichless-acute patients—those identi-fied as emergency levels 4 and 5—move through treatment. Results are impressive. Averagelength of stay dropped from morethan two hours to under an hour.

Now testing SPEED Now, Christiana Hospital is testinga similar process for level 3patients. Synchronous ProviderEvaluation in the EmergencyDepartment (SPEED) is scheduledto go live in December.“These programs are an exampleof the tremendous transformationthat is taking place at ChristianaCare,” says Janice Nevin, M.D.,MPH, senior vice president/execu-tive director Christiana Care-Wilmington and associate chiefmedical officer. “Two years ago,

SuperTrack quickens the pace ofemergency care delivery for manyChristiana Care EmergencyDepartment patients.

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“The times are phenomenal,” saysMichelle Reeder, LPN, ChristianaHospital ED. “Nearly 100 patientsa day go through SuperTrack.”‘SPEED’ shows great potentialLevel 3 patients—50 percent ofpatients seen at Christiana Care—have moderate to severe, but notlife-threatening, conditions. Onaverage, they wait 90 minutesbefore seeing a physician and stayan average of nearly 5.5 hours.Building on what has been learnedthrough SuperTrack, a team ofdirect health care workers andphysicians is developing a newprocess to standardize proce-dures, improve room use, decreaseancillary department delays andimprove patient communicationand flow through the ED for level3 patients.Even in its testing phase, SPEEDshows great potential. It helpedtrim the length of stay 1.8 hours to3.6 hours – a 33 percent improve-ment.Linda Laskowski Jones, RN, MS,ACNS-BC, CCRN, CEN, vice presi-dent of Emergency, Trauma &Aeromedical Services at ChristianaCare, attributes much of the earlysuccess to improved communica-tion among team members andtheir commitment to redefiningthe department. “We work together so closely andsupport each other,” says Reeder.“You just build tighterrelationships.”

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and departments, the team alsoredesigned the space. Wilmington created an entirelynew space, which opened on Aug.6. Because everyone from IT to EDhealth care providers contributedto

the design, the space is more effec-tive and efficient, according toSusan Angeline, RN, MSN, CEN,Wilmington ED.“We’ve seen significant improve-ment in flow and patient

satisfaction,” says Angeline.“Patients are happy. Some are outin 30 minutes.” Will Paynter, PA-C, WilmingtonED, says one of the most success-ful parts of the overall redesign

was stationing ateam of a nurse,a physician’sassistant and apatient-care tech-nician close tothe patient-arrival area.

Now, rather than repeating infor-mation at various stops, the low-acuity patient goes through theintake and assessment processsimultaneously, significantlyincreasing patient satisfaction aswell as reducing length of stay.

S U P E R T R A C K , C O N T I N U E D

—Janice Nevin, M.D., MPH

Members of the SuperTrack Project Team are transforming care delivery inthe Emergency Department, speeding wait times for patients with less-acute conditions.

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Christiana Care’s Heart Transplant EvaluationProgram is celebrating another successful

case of partnering with a regional transplant cen-ter and community-based cardiologist to achievean optimal outcome for a patient awaiting a hearttransplant.Florence Gibson, 46, of Wilmington, needed extrahelp while waiting for a donor organ.Surgeons implanted a Jarvik 2000 ventricularassist device to help restore blood flow through-out her body. Mark Zweben,M.D., of DelawareCardiovascular,referred her toChristiana Care’sCenter for Heart &Vascular Health.The team coordi-nated Gibson’s carewith ThomasJeffersonUniversity Hospitalin Philadelphia,where shereceived a donorheart on Sept. 16.Gibson also willreceive follow-upand long-termcare at ChristianaCare. Spares stress of traveling out of state According to Medical Director Mitchell Saltzberg,M.D., the program enabled Gibson to keep closeto her family, sparing her the expense and stressof traveling while coping with serious illness.

“For Ms. Gibson, the coordinated approach provided by theHeart Failure Program, Dr. Zweben and the transplant physiciansat Jefferson serves everyone’s needs,” says Dr. Saltzberg. “The patient stays connected to her long-term care providerswhile simultaneously undergoing testing that previously couldonly be performed at the regional transplant centers. Everybodywins.” For information and referrals, call the Center for Heart & VascularHealth at 302-733-1663.

Mark Zweben, M.D., ofDelaware Cardiovascular,referred his patient Gibsonto the Heart TransplantEvaluation Program.

Mitchell Saltzberg, M.D., medical director ofChristiana Care’s Heart Transplant Evaluation Program,with patient Florence Gibson.

Christiana Care offers heart transplant candidatesessential tests, less stress and less expense

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The third and final phase of theChart Completion project rolls outOct. 12—bringing us a step closerto the ultimate goal of a paperlessmedical record.Phase 3 provides the paper portionof the medical record within 48hours of the patients discharge forviewing within accessANYware.Benefits of having the recordavailable in accessANYware short-ly after discharge include:n Immediate access to the recordwhen needed for patient care.n Physicians can dictate dis-charge summaries without comingto HIMS. n Multiple people can access therecord at the same time.Phase 1, rolled out in January2006, provided the ability to viewthe patient’s historical medicalrecord through accessANYware.Phase 2, implemented in June2007, provided physicians the abil-ity to sign and edit their dictationin PowerChart and gave the physi-cian a view through their portalpage of what documents needed tobe completed.

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Christiana Care has receivedtwo grants for heart and can-

cer research from the NationalInstitutes of Health, part of the $5billion government stimulus pack-age aimed at cutting-edge medical

research.ClaudineJurkovitz,M.D., MPH,director ofoperations atthe ChristianaCare Centerfor OutcomesResearch, isprincipalinvestigator of

a $211,925 grant to study elevatedlevels of the protein troponin oftenfound in patients with chronic kid-ney disease. High troponin levelsalso indicate a patient has suffereda heart attack. Dr. Jurkovitz’sresearch will take a retrospectivelook at patients who have beenadmitted to the emergency depart-ment with suspected acute coro-nary syndrome.“As a result, we’re going to beable to better understand heartdisease in kidney patients andoffer treatment that is better tai-lored to their condition,” saysWilliam Weintraub, M.D, John H.Ammon chair of Cardiology anddirector of CCOR.Dr. Weintraub says the NIH grantsrepresent a trend toward support-ing population-based research,which focuses on how particulardisorders affect groups of people,rather than individuals. Christiana

Care is ideally positioned for thistype of clinical research becauseDelaware represents a microcosmof the nation, yet is small enoughto readily manage.A $239,776 grant goes to theCommunity Cancer OncologyProgram (CCOP) to develop soft-ware to more accurately track andmanage patients in clinical trialsof new treatments. The data willbe shared with program affiliates,

Beebe MedicalCenter inLewes, CooperHospital inCamden, N.J.,and UnionHospital inElkton.

CCOPResearch

Director Kandie Dempsey, RN,MS, OCN, CCRP, researched thesoftware and put together thegrant proposal.The money also will fund Web-based technology that will helppatients to identify which clinicaltrials might be a match for them. “If a new trial becomes available,we can contact the patients and letthem know about it,” says StephenGrubbs, M.D., principal investiga-tor of the program. “It has thepotential to be very meaningful toour patients and their families.”The funding from NIH is part ofthe American Recovery andReinvestment Act of 2009.

National Institutes of Health stimulusgrants boost heart and cancer research

Chart Completionproject launches3rd and final phase

Dr. Jurkovitz

Dr. Grubbs

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cians leave their practice. Ironically, he said, a trend amongmedical residents toward morespecialists and fewer primary carephysicians leads to higher healthcare spending and a situationwhere costs are inversely relatedto quality. “The more you spend,the less you get,” he said.Nation’s quality of care has fallen Moreover, the quality of U.S.health care compared with otherindustrialized nations havingadvanced health care systems hasfallen dramatically. On a pointscale where 100 equals the besthealth care, our nation’s totalscore is only 66. And efficiency—with a dismal category score of

Guest speaker Richard J. Baron,M.D.’s message about

patient-centered and family-cen-tered health care drew more than150 physicians, surgeons and staffto the Departments of Surgery andMedicine combined Grand Roundsat the John H. Ammon MedicalEducation Center.Dr. Baron’s Sept. 30 lecture, “ThePatient-Centered Medical Home :What Is It, and Why Should anIntegrated Delivery System Care?”reflected input from the AmericanCollege of Physicians, AmericanAcademy of Family Physicians,American Academy of Pediatricsand American OsteopathicAssociation and others, in a revi-sion of NCQA’S Physician PracticeConnections® a tool for assessingwhether physician practices arefunctioning as medical homes.Hard-hitting factsHe began with a series of hard-hit-ting facts about general internalmedicine career trends, compar-isons of U.S. and other nations’health care systems, and chal-lenges and obstacles to changeand performance and qualityimprovement.For example, according to Dr.Baron, as the U.S. population ages,our nation can expect a severeshortage of primary care physi-cians. Reasons: only two percentof medical school graduates plancareers in general internal medi-cine (GIM). Ten years after start-ing out, 20 percent of GIM physi-

Guest speaker Richard Baron, M.D., lectureson ‘Patient-Centered Medical Homes’

51—is a major reason for low per-formance. Dr. Baron, a past chair of theAmerican Board of InternalMedicine, has served on theNational Committee for QualityAssurance (NCQA) StandardsCommittee since 2005. He is presi-dent of Greenhouse Internists, PC,a national leader in the use of elec-tronic health records.

Virginia U. Collier, M.D., Hugh R.Sharp, Jr. Chair of Medicine, briefsRichard J. Baron, M.D., before thecombined Surgery-Medicine GrandRounds Sept. 30 at the John H.Ammon Medical Education Center.

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At the center, patients are treatedin a collaborative, multi-discipli-nary approach that combines diet,medication and education onhealthy living. “We have made tremendousstrides in the past 20 years,” Dr.Lenhard says. “We’re workinghard to do even more to care forpeople with these disorders.”

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Twenty years ago, the Diabetes &Metabolic Diseases Center beganseeing patients in the old ICU atWilmington Hospital.“They would pull the curtains andthat would be the offices,” saysJim Lenhard, M.D., medical direc-tor, who joined the center in 1993.In 1989, the only physician was G.Stephen DeCherney, M.D., a nativeDelawarean who had come fromthe National Institutes of Health toopen the center with BernardineHenderson, RN, CDE, an LPN anda secretary.Today, there is a staff of more than

35 to care for Delaware’s growingpopulation of people with diabetesand metabolic diseases, includingfive doctors, four nurse practition-ers, seven patient educators andseveral support staff. U.S. News &World Report has named ChristianaCare one of the top 50 centers inendocrinology multiple times.Although the rate of diabetes inDelaware has risen dramatically—from an average of 3 percent in1989 to 8.2 percent today—deathsin New Castle County havedeclined, from a five year averageof 34 for every 100,000 residents to

24.5 per 100,000.That’s largely dueto improvements indrugs, devices andtesting, Dr. Lenhardsays. “There have beenmore diabetes med-ications developedin the past 20 yearsthan in all the pre-vious years in his-tory combined,” henotes.“Twenty years ago,an insulin pumpwas the size of aclock radio. Now,it’s the size of adeck of cards.”Still, diabetes is on

the upswing because more peopleare overweight, sedentary andgrowing older.

Diabetes & Metabolic Diseases Centercelebrates 20 years of service and progress

Diabetes and Metabolic Diseasesservices expanding at Springside Later this fall, patients withdiabetes and metabolic disor-ders will have greater access tocare when a 4,400-square-footsuite opens at Springside Plazaon Route 40 in Glasgow. Thefacility will offer expandedservices from physicians, nursepractitioners and educators.The move is in response tofeedback from patients in west-ern New Castle County andMaryland who asked for carethat is more geographicallyaccessible, says Dale Lowe,director, Eugene du PontPreventive Medicine &Rehabilitation Institute. “You have to make health careconvenient in order to make ithelpful,” Lowe says.

Christiana Care’s Diabetes andMetabolic Diseases Center celebratesits 20th anniversary this year.

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model of care,” says CarolineConard, NP. “We talk about issuesthat we never have time for in aregular checkup and are able tofocus on issues important to thegroup.” Informal support most importantBoth Conard and Sushereba saythat one of the most importantparts of the program is the infor-mal support that the women pro-vide each other. “They reallylearn from each other,” saysConard.Since its beginning in 2008, theCentering Care program contin-ues to expand. Wilmington Hospital is holdingits 14th class. ChristianaHospital’s first class began inSeptember and the SmyrnaWomen’s Health Group’s firstclass will begin October.

In the Centering Room at theWilmington Hospital Annex,

what looks like a game is inprogress. A group of pregnantwomen are talking and laugh-ing, dropping pompoms on topof cards on the floor. But it’s not a game. It’s a groupexercise, part of ChristianaCare’s Centering Care programfor pregnant women. They areranking common discomforts attheir stage of pregnancy for dis-cussion—the discomfort on thecard with most pompoms isfirst.Integrating key elements of effective health careAt first every four weeks, thenevery two, from the end of thefirst trimester through delivery,groups of eight to 10 womenmeet for two hours in prenatalcare sessions that integratehealth assessment, educationand support, three key elementsof effective health care. Each of the 10 sessions beginswith women taking their ownvital signs (with assistance fromthe program staff) and recordingthem in their “Mom’sNotebooks. The notebooks alsocontain topics for discussionand self-assessment worksheets. As they chart their vitals andcomplete their work sheets, thewomen take turns going to anarea set aside for their examwhere a midwife or nurse prac-titioner may also talk about any

concerns or schedule more timeafter class. Same physical careplus ‘so much more’ “The women receive exactly thesame physical care that theywould in a regular prenatal visit,”says midwife Elizabeth Sushereba,MSN, CNM, “but they receive somuch more. The classes are educa-tional and help the women devel-op a support network.”Class topics range from nutritionto birth control to domestic vio-lence issues to what is happeningto both mother and fetus duringthis phase of their pregnancy.Examining fetal models at 16 and30 weeks helps them conceptual-ize fetal development and whythey may feel pressure or whykicks are so hard—“It’s so big!”“Look at the size of that foot!”“I love to teach, so I love this

Centering Care program provides pregnant women skills in health assessment, education and mutual support

Centering Care programinstructorCarolineConard, NP, andStefanie Hahnuse a lifelikemodel to discusspointers oninfant care anddevelopment.

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For five years, the CrisisAssessment and Psychiatric

Emergency Services (CAPES) unitat Wilmington Hospital has pro-vided a safe, secure area thatmeets the special needs of psychi-atric patients while removingthem from a busy emergencydepartment.

Partnership revolutionized careA successful partnership betweenChristiana Care and the State ofDelaware, CAPES has revolution-ized the way patients with seriousmental health problems are treat-ed, reducing the number ofpatients who are committed whiledecreasing the cost of care.“In the past, there were timeswhen patients were handcuffedand taken away by police like acriminal rather than a patient,”says Sandeep Gupta, M.D., med-ical director, Intensive Outpatientand Partial Hospital Program andCAPES. “We provide compassion-ate care rather than pushingpatients into restrictive care.”

In recognition of its achievements,CAPES received a communityservice award from the StateHealth and Social ServicesDivision of Substance Abuse andMental Health.The CAPES team evaluatespatients in a locked unit, adjacentto Wilmington Hospital’s

Emergency Department. The staffis highly trained to work withpatients experiencing acute psy-chiatric emergencies. This mayinclude de-escalating an agitatedpatient while ensuring safety forall. After a comprehensive psychi-atric assessment, patients are dis-charged to the most appropriatelevel of treatment, in either aninpatient or outpatient setting.Proud of ‘cutting-edge’ approach“They can see a psychiatrist in theED. We can get them medication,”Dr. Gupta says. “We take a lot ofpride in being on the cutting-edgeof psychiatry, keeping patientsfocused and coordinating theircare.”

After several mental healthinstitutions in Delaware closed,the CAPES unit was created tohelp address an influx of patientswith psychiatric emergencies atthe Emergency Department.CAPES is staffed around the clockby state-employed mobile crisisworkers, registered nurses whospecialize in mental health nurs-ing and mental health associates.In addition to Dr. Gupta, a psychi-atric resident from DelawarePsychiatric Center rotates toCAPES.Increasing volume, but fewer committalsAfter only a year of operation,involuntary commitments weredown 43 percent as more patientswere successfully referred to andtreated in intensive outpatientprograms. Although the volume ofpatients being served in CAPEScontinues to increase, committalrates remain low. In addition topsychiatric evaluations, CAPESstaff provides support to familymembers of patients in crisis.“It is a wonderful example of theway the state and a private organi-zation can cooperate to providebetter care,” Dr. Gupta says.

At fifth anniversary, CAPES looks back at its impacton emergency mental health care in Delaware

“We provide compassionate care rather thanpushing patients into restrictive care.”

—Sandeep Gupta, M.D.CAPES medical director

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supplies and equipment for local domesticviolence centers.Helped develop crisis centerBecause Delaware had no crisis center forpsychiatric patients, Janney helped developa Crisis Assessment Psychiatric EmergencyServices (CAPES) unit at WilmingtonHospital and later one at ChristianaHospital.When praised for her commitment toChristiana Care and the community, Janneyrefuses to take credit. “I just reflect thegoals of Christiana Care. It is a great placeto work,” she says. And she adds, “If youdon’t have a relationship with your com-munity, there’s no sense in being here.”

In October at the annual AmericanPsychiatric Nurses Association (APNA)

conference, Regina Janney, RN II, BC, MS,will receive the APNA Award forExcellence in Practice—RN-PsychiatricMental Health Registered Nurse.This award recognizes exemplary psychi-atric mental health nursing practicethrough collaboration, patient and publicadvocacy, mentoring/supervision and con-tinuing education.Janney insists that she is receiving theaward for many nurses at Christiana Care.“Every day lots of nurses do the samethings I do,” she says. Credits colleagues, health systemJanney credits Christiana Care with sup-porting their work. “Christiana Care is allabout excellence. It encourages staff togrow and advance. And it supports staff indelivering care to the community.”Within Christiana Care, she worked with amultidisciplinary team to develop a sup-port program for families of critically illand trauma patients in the EmergencyDepartment. She mentors student nursesand nurse interns, teaching them to pro-vide the care they would want their ownfamilies to receive. In the community, she teaches constablesand county police intervention techniques.She works with New Directions Delaware,which offers support groups to people withdepression and bipolar disorder and totheir families. She talks with church youthgroups about suicide and organizes

Regina Janney, RN, recognized forexemplary psychiatric mental health nursing

Regina Janney, RN II, BC, MS

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Therapeutic Notes

P romethazine (Phenergan®) has been on the market since 1956. It has been used by oral, intramuscularand intravenous routes as a sedative, hypnotic, antiemetic, antiallergic and anti-motion sickness agent.

Concern

The FDA recently requires the manufacturer of promethazine to add a “black box” warning at the top ofthe package insert explaining that when the drug is administered incorrectly, it can damage skin severelyincluding causing gangrene. Severe tissue injury can occur from perivascular extravasation, unintentionalintra-arterial injection, and intraneuronal or perineuronal infiltration.Mechanism of harm

Promethazine contains phenol and has an alkalinic pH of approximately 4.0-5.5, making it damaging toveins and tissues. Accidental intra-arterial injection or perivascular extravasation during administrationof promethazine can lead to vascular and tissue damage. Another possible mechanism of harm involvescrystallization and precipitation, due to the high alkalinity of promethazine, causing arterial blockage thatcould result in severe spasm and eventual tissue necrosis.Signs/symptoms

Adverse events associated with tissue injury include: pain, burning, erythema, swelling, arteriospasm,thrombophlebitis, venous thrombosis, phlebitis, paralysis, abscess, nerve damage, tissue necrosis andgangrene.Recommendations

Avoid the use of intravenous promethazine. The preferred method is to use an agent from the ChristianaCare Formulary alternatives to intravenous promethazine.If patient failed therapy using an agent(s) from the Christiana Care Formulary alternatives to intravenouspromethazine and if intravenous promethazine must be used, please consider the following recommenda-tions:n Deep intramuscular injection is the preferred injection route of administration of promethazinen Intra-arterial and subcutaneous administration of promethazine are contraindicated. n The Pharmacy and Therapeutics (P&T) Committee recommends a maximum single dose of 6.25 mg IVpromethazine.n The maximum recommended rate of administration is 25 mg per minute.n For IV administration, dilute to 10 mL with NaCl 0.9% and give via Y port through which IV fluid isrunning. n Be alert for signs and symptoms of potential tissue injury including burning or pain at the site of injec-tion, phlebitis, swelling and blistering. n Injections should be stopped immediately if a patient complains of pain during injection. n Inform patients that side effects may occur immediately while receiving the injection or may develophours to days after an injection. n Promethazine should not be used in patients less than 2 years of age due to the risk of fatal respiratorydepression.

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This means we still have work todo! Our challenge is to remain focusedand reach performance goals. Wecan accomplish this by:n Maintaining open lines ofcommunication.n Being fully productive in ourroles.n Saving time, resources and/ormoney without compromisingquality.n Delivering the very bestpatient experience. Remember, it takes all of us work-ing as a team to transform careand meet our goals!

Christiana Care continues totransform the way we deliver

care. The new TransformationRewards program (TRP), intro-duced in August, was created toreward our collective success.Initial feedback about the programhas been overwhelmingly positive.Departments have begun to meet,brainstorm and implementchanges to improve the way wedeliver care and achieve our Focuson Excellence goals.To date, our progress in meetingour goals—operating gain thatexceeds budget and the HCAPHSscore for the question, “Likelihoodto recommend the hospital” are

Continuing through Oct.30,Christiana Care’s United Way ofDelaware campaign is off to astrong start.This year, the goal at ChristianaCare is to increase employeeUnited Way participation to 40percent.

Here are some FAQS for anyonewho needs to know more beforeparticipating.Q. Where can I find the link torespond?A. On the green bar on all por-tals, click “United Way.”Q. Where do I get my USER IDand password?A. An e-mail was distributedto all employees. If you deletedthe information click theUnited Way tab then click on

mixed, but encouraging. Remember, it’s the cumulativeresult at the end of the fiscal yearthat will trigger a payout to allemployees. As of the end of August, our oper-ating gain exceeded budget by$4.6 million. This amount isenough to trigger a payout if wecan maintain it throughout theremainder of the fiscal year endingJune 30, 2010. However, for the month of July,the score for the question,“Likelihood to recommend thehospital” has a 75 percent positiveresponse rate which is below theminimum threshold of 76 percent.

Transformation Rewards Program rewards collective success

“forgot password,” enter yourbadge ID number and e-mailaddress. The information will beresent to your inbox. Q. Where do I get the paperpledge forms?A. Both administration officesat Christiana and Wilmingtonhospitals have a supply of them.All paper pledge forms shouldbe sent to the Christiana CareDevelopment Office, 13 Reads

Way, Suite 203, New Castle, DE19720.Q. I want to make my gift to aspecific agency. How can I findthe agency code before goinginto the E-Pledge System?A. Go to the United Way ofDelaware Web site atwww.uwde.org. Click on theCommunity Impact link andselect “Search agency data-base”. Once you identify the

agency, click to display andidentify the agency code.Q. I am still having prob-lems with the E-PledgeSystem. What can I do?A. Call the United Way ofDelaware help-line at 302-573-3791.

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A. Youhave achoice. Ifyou chooseto staywithin aChristiana Care facility, thecopayment will be waived. Ifyou use a non-Christiana Carefacility, you will be charged the$500 copayment (Examples:cataract surgery performed atthe Cataract & Laser Center ormaternity/newborn care per-formed at St. Francis Hospital).

Q. If my doctor recommends aprocedure that Christiana Carecannot perform, what should Ido?A. If Christiana Care cannotperform the service, contact theHR Service Center at 302-327-5555 prior to the scheduledprocedure.

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Using Christiana Care services assures quality,saves money, and supports our mission

A s an employee of ChristianaCare, we encourage you to

seek medical treatment at one ofChristiana Care facilities whenpossible.By using a Christiana Care facility,you:n Receive high quality medicalcare.n Save money.n Help reduce the rate of rise ofChristiana Care benefit costs andyour contribution for your medicalinsurance coverage.n Support Christiana Care’s mis-sion to take care of our neighborsin our community.Remember, if you are a participantin the health benefit plan and livein New Castle County, you aresubject to a $500 copayment if youdo not seek medical treatmentwithin Christiana Care. Medical treatments include, butare not limited to, inpatient hospi-talization, outpatient surgery,imaging and machine testing

services, such as colonoscopy orsigmoidoscopy, and maternitycare, such as having a baby.If your medical treatment requiresa visit to a non-Christiana Carefacility, contact the HR ServiceCenter at 302-327-5555 prior to thescheduled procedure and/or treat-ment. There are some exceptionalcircumstances where ChristianaCare will not apply the copay-ment.Frequently Asked Questions

Q. If my doctor has a schedulingconflict within Christiana Care,what should I do?A. If Christiana Care cannot makereasonable accommodations inscheduling the procedure, contactthe HR Service Center at 302-327-5555 prior to the scheduled proce-dure.Q. If my doctor does not haveprivileges to perform the servicesat Christiana Care, what should Ido?

Don’t miss the annual Focus on Excellence Awardsexhibit. It’s an opportunity to learn with and fromour colleagues about some of the most excitingthings that have happened at Christiana Care overthe past year. Here are the times and places to go:Wilmington Hospital Conference Center: Sunday,Oct. 11, 2 p.m. thru Wednesday, Oct. 14, noon.Christiana Hospital Room 1100: Sunday, Oct. 18,2 p.m. thru Friday, Oct. 23, noon.

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The minute your doctor orderslab tests, do you, like many

otherwise intelligent and sensibleadults, begin looking for creativereasons to delay having the testsdone? “I work when the lab is open—transportation is too complicat-ed—I don’t have time.”With 12 sites throughout the area,Christiana Care’s LaboratoryOutreach program makes comingup with those excuses more diffi-cult. Seven of the sites are open toany outpatient with orders fortests, and five are located inChristiana Care practices.Weekday hours range from 6 a.m.to 8 p.m.; Saturday hours, from 7a.m. to noon.Even though the impetus for theprogram was outreach to the com-munity, to make being tested easi-er and more convenient for outpa-tients, the program has alsoimproved the quality and safety ofpatient care. Serving the community“The program is another exampleof Christiana Care’s willingness toserve the community,” says CherylKatz, MS, MT(ASCP), vice presi-dent, Department of Pathologyand Laboratory Medicine. “But italso ensures continuity of care.”Because a courier picks up anddelivers specimens throughout theday, allowing tests to be complet-ed within 24 hours, specimenintegrity is better preserved, andquestions about physician orderscan be resolved immediately. And

because results are posted inPowerChart, physicians anywherein the system have access to theresults, enhancing timeliness andconsistency of care.Sue Saltar, practice manager,Christiana Medical Group, says,“The patients love being able towalk down the hall for a test. Andthe physicians are happy becausepatient compliance has greatlyimproved.”According to Joanne Downey,MBA, BHS, MT, outreach businessmanager, the number of patientsusing the services is growing rap-idly, particularly at new sites, suchas Foulkstone Plaza. Opened in2009, the program served morethan 50,000 patients this fiscalyear.Continual quality improvementTo accommodate the increased vol-umes in the Pathology lab,Kathleen Gorczyca, MT(ASCP)DLM, manager of laboratory oper-ations, says that rather than justhire more staff, the team continu-ally evaluates ways to make thelab more efficient.In 2007, the team added an auto-mated line that not only increasedlab capacity but also improvedtesting consistency.“The Outreach program is excel-lent for both Christiana Care andour patients. It provides theopportunity to have all care donewithin the system, ensuring highquality and seamless patient care,”says Department of Pathology andLaboratory Medicine Chair GaryWitkin, M.D.

Christiana Care Laboratory Outreachoffers many convenient locations

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1 4 F O C U S O c t . 8 , 2 0 0 9

CORRECTION The photo at left in aSept. 24 storyabout a pharmaceuti-cal/oncology clinicaltrial at Helen F.Graham CancerCenter should haveidentifed the nursepictured at left asKatie Alexander, RN.

The Magnet Video, produced atChristiana Care and featuringChristiana Care employees, pre-mieres at Wilmington HospitalConference Center on Monday,Oct. 12. Screenings of the three-minute program are slated from 7-8a.m., and from1-3 p.m. Anotherscreening is scheduled atWilmington Hospital ConferenceCenter on Saturday, Oct.24, from11 a.m.-1 p.m. Christiana Hospitalscreenings are scheduled onMonday, Oct. 19 and Saturday,Oct. 24. Oct. 19 showings are inthe main auditorium at the John H.Ammon Medical EducationBuilding from 6-7:30 a.m.,11 a.m.-1 p.m., 2:30-4 p.m. There also willbe a 6-7 p.m. screening in Room14. All screenings at ChristianaHospital on Saturday, Oct. 24 arescheduled in Room 1100: 7-8:30

a.m., 11 a.m.-1 p.m., 2:30-4 p.m.and 6-7:30 p.m. Come enjoy thevideo celebrating our quest forMagnet Nursing status and havesome popcorn!Christiana Care Breast Center andThe Helen F. Graham Cancer aresponsors of the American CancerSociety 2009 Making Stridesagainst Breast Cancer Walk/Run onSunday, Oct. 18. Registrationbegins at 7 a.m., the run begins at8:30 a.m. and the walk at 9 a.m.The location is Rodney Square indowntown Wilmington. Sign up atwww.strideswilmington.org. To bea team captain, walker, runner or avolunteer please contact KimStrickler at 623- 4206.

Medical Grand Rounds onThursday, Oct. 29, from 8-9 a.m.features Peter Green, M.D., noted

expert from Columbia speakingon celiac disease, which hedescribes as a silent epidemic.

The Heart Failure Program atChristiana Care’s Center forHeart & Vascular Health presentsa Heart Failure Summit onFriday, Oct. 30, 7:30 a.m.-2:30p.m., at the John H. AmmonMedical Education Center. A $20registration fee is due by Oct. 19by check payable to ChristianaCare Health System, mailed toChris Friday, Heart FailureProgram, Christiana Hospital,Suite 2E99, 4255 Ogletown-Stanton Road, Newark, DE19718. For more information,contact Chris Friday at [email protected].

2009 Wilmington Walk for Life &Breath is Saturday, Nov. 14 at 10a.m. at the Chase Center on theRiverfront, Wilmington, with reg-istration open at 8:30 a.m. Forinformation, call 302-655-7258.

The Respiratory Care COPDLecture Series continues inRoom 1100, Christiana Hospital,with lectures scheduled Nov. 1710 a.m.-noon, Feb. 16, 10 a.m.-noon, and April 20, 1:30-3:30p.m. Call Debbie Wood, 733-2562 to register.

Upcoming events

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Christiana Care’s paid-time-off (PTO) cashoutprogram allows full-time employees in

Christiana Care Health Services and HealthInitiatives who have a minimum paid-leave bal-ance of 200 hours and part-time employees witha minimum paid-leave balance of 150 hours toparticipate. New this year, employees have a choice ofselecting 40 or 60 hours of paid leave to cashoutat their base rate. The default cashout amountwill remain at 40 hours.This option, offered twice a year, in the springand fall, gives employees additional flexibility inbalancing personal needs. Because the cashoutprogram is considered supplemental pay, shiftdifferentials do not apply.Cashout letters mail out Oct. 23Cashout letters will be mailed Oct. 23 and arebased on paid leave account balances as of thepay period ending Oct. 17, after the time usedand accruals are applied. If you do wish to participate in the cashout andyou want to receive the default amount of 40hours, you do not need to reply. Your PTOcashout will be provided to you in a separatecheck or direct deposit on Nov. 20, 2009.If you choose to increase your cashout amountto 60 hours or to decline the PTO cashoutoption, please go to HR Online, available fromany portal, select My Personal Information, thenclick on Myself, PTO Cash Out, or return yourletter to Payroll by Nov. 6.Accrued paid leave account time that exceedsthe maximum allowable balance in a pay periodwill automatically roll over to the employee’sdisability leave account.Disability leave time may be accessed for med-ical leaves of absence, thus serving as a short-term disability bank. Disability leave is not avail-able for cashout.

Virginia U. Collier, M.D., Hugh R. Sharp Chair ofMedicine (left), and Susan Szabo, M.D., medicaldirector of the HIV Community Program, unveil thememorial plaque.

Fall PTO cashout includesnew 60-hour option

HIV/AIDS facility namedfor Wm. Holloway, M.D.

F riends, colleagues, proteges and admirersjoined in a ceremonial ribbon-cutting and

plaque unveiling at the HIV/AIDSCommunity Outreach facility in WilmingtonHospital Annex to dedicate the facility to thelate William Holloway, M.D. Dr. Holloway, an infectious disease specialist,was principal investigator for ChristianaCare’s HIV Community Program. He came toDelaware in 1950. He died in May 2006.

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Junior Board members (center with certifi-cates) Sandra Parkins and Anne McCarren

received certificates of appreciation for makingthree quilts to enhance the WilmingtonHospital Surgical Waiting Room.

The Junior Board gave the quilts and decora-tive plants to make the room a warm and invit-ing location for families. Diane Thomas (farright), Second Vice President, SurgicalServices, received a certificate of appreciationon behalf of all the Junior Board members whovolunteer in the Surgical Procedure Unit.

Barbara Burd (far left) Junior Board Presidentand volunteers attended the presentation andtea in their honor.

Junior Board quilters help beautify Wilmington campus surgical waiting room

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