Hospital of the University of Pennsylvania

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Jessica (Maciey) Minot, a nurse on Ravdin 9, never knew her older sister, who died of what was diagnosed as a “congenital heart defect” at eight months old. And she was only seven years old when she lost her mother to heart disease as well. Her mom was 29. “I don’t have a lot of memories of her but I do remember her being really sick,” she said. � ree years ago, heart disease suddenly claimed her older brother as well, when he was 24. “He had no symptoms that we knew of.”

� e terrible fates in her family tree can all be traced to dilated cardiomyopathy, a weakening or enlargement of the heart muscle. Its life-threatening presence can remain undetected for years and then suddenly strike. And it can be passed from parent to child as an inherited genetic abnormality.

In a sense, Minot was lucky. When she was in elementary school, her primary care physician, knowing her family history, referred both her brother and her to CHOP. At the time,

Volume 25 Number 3 February 7, 2014

INSIDE

New Advisory Council Board ..2

Our DAISY Winners .................2

ICN Revises Primary Nursing Model ..........................3

MS-150 Results Set Record .....4

her brother’s heart was � ne but Minot had mitral valve regurgitation; the valve wasn’t closing tightly, which caused blood to � ow backward into her heart. She received an echocardiogram each year to keep watch on the defect. Right before college, the annual echo showed that her heart had doubled in size. “I had no symptoms before I was diagnosed,” she said. “I never would have known without my yearly check-up.”

Her cardiologist referred Minot to another CHOP specialist but treatment didn’t seem to improve her heart function — in fact it was decreasing. In 2007, the 20-year old was referred to Mariell Jessup, MD, of Cardiovascular Medicine. As she described her symptoms and family history during the initial visit, Jessup suddenly realized she had treated Minot’s mother, 20 years earlier. “I was watching the cycle of familial cardiomyopathy repeat itself before my eyes,” she recounted.

Early Detection is Key� e sooner cardiomyopathy is detected, the more e� ectively it can be treated — or even prevented, such as in children or

young adults who have inherited the family genes. “When one person in a family has an unexpected death or cardiac condition, it’s wise to evaluate the whole family,” Jessup said. “We tell patients to make sure they talk to brothers and sisters, and recommend an evaluation for their children.”

� e Familial Cardiomyopathy program, a partnership between Penn Medicine and CHOP, speci� cally targets these patients. If an adult patient is diagnosed with cardiomyopathy, “we’ll send their children to CHOP to be evaluated and vice versa,” Jessup said, adding that “of people with poor heart function and no obvious cause (ie, coronary artery disease, longstanding hypertension), about 40 percent could have inherited their condition.”

Today, Minot is doing well. Her medication regimen has more than doubled her ejection fraction, a measure of how well heart pushes blood through her veins. “New medical therapies have been shown not only to make patients feel better and live longer, but also improve heart function,” Jessup said.

CHANGING THE COURSEo f He a r t D i s e a s e

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Jessica Minot (c.) with husband, Matt, and Mariell Jessup at a conference of the American Heart Association.

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Since 2011, HUP’s Patient and Family Advisory Council has worked with sta� members to transform the hospital culture to one truly centered on patients and their families. Comprising current patients and their family caregivers as well as sta� members, the group has made a positive impact by:

• Providing feedback to Food Services on the variety, taste and presentation of meals delivered to patient-care units.

• Improving processes to ensure that personal items follow patients as they’re moved through different areas of the hospital.

• Working with the Housestaff Quality and Leadership Council to develop a video to educate patients and families about the in-patient care team.

• Developing a brochure to inform patients of the expansion of preadmission testing sites.

• Working with staff on a post-discharge phone call initiative.

• Participating in the redesign of unit secretary role, focusing on patient- and family-centered care.

Now, with new members and a new co-chair — Anita McGinn,-Natali, a family caregiver — the Council will continue to tackle issues to help improve the patient experience. According to Karen Anderson, MSN, RN, clinical nurse specialist in Patient and Family Centered Care, one of the group’s major goals will focus on improving communication between nurses, doctors, and patients by strengthening therapeutic relationships. As Mary Walton, MSN, MBE, director of Patient and Family Centered Care, explained, “We need to understand what’s most important to patients and their families. When the patient’s unique perspective is incorporated into care, the patient experience and clinical outcomes will be improved.”

To contact the HUP Patient and Family Advisory Council, email mary.walton@uphs.upenn.edu or anita.mcginn-natali@uphs.upenn.edu.

ADVISORY COUNCIL BOARD

New

Minot still gets an annual echocardiogram and sees Jessup every six months. Although not allowed to drink alcohol, she has no other restrictions on her daily life.

In addition to following her medication regimen, “I exercise and try to eat a healthy, low-sodium diet,” Minot said, tools that will help her stay healthy. She and her husband, Matt, recently adopted a dog, Lexi, from the SPCA. “We love taking her for walks and hikes at Valley Forge National Park and other parks.”

While Minot has wanted to be a nurse since she was little, following in the footsteps of her grandmother, her medical history has de� nitely had an impact on her specialty. She will soon be working in the CICU, helping cardiac patients.

CHANGING THE COURSE of Heart Disease

Sura StottEmergencySosamma AbrahamRhoads 6Filarina AningalenSurgiCentreMonique LloydPerinatal Evaluation CenterAlexandra CosanRavdin 6Clarice MaggioOncology 2nd Floor Perelman

Socrates DeGuzmanED Observation UnitRavi KorotaneSilverstein 11Mary Jean KimkangPerioperative - ORMeghan McFarlandNICUEmily HarbaughRhoads 4Colleen Ott-WeisbordOncology

The DAISY (Diseases Attacking the Immune System) Award was created by the Barnes family, in memory of their son, Patrick, who received care at HUP. It recognizes the clinical skills, extraordinary compassion and care exhibited by nurses every day.

To nominate a nurse for the DAISY award or learn more, email victoria.dixon@uphs.upenn.edu.

Congratulations

2013 winners of the DAISY award:

T O O U R D A I S Y S

Dawn Nespor (l.) and Victoria Dixon (r), both members of the Professional Development Core Council, with some of this year’s DAISY Award winners (l. to r.): Dawn Nespor, Colleen Ott-Weisbord, Clairce Maggio, Ravi Korotane, Sosama Abraham, and Sura Stott.

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Both HUP and the Health System continue to be � nancially strong, HUP executive director Garry Scheib told participants at the most recent Meal with an Administrator. As of November, “both are running ahead of our budgeted targets.”

� is is especially good news in a market that has seen a decline in admissions resulting, in part, from two federal programs: observation status and the two-midnight rule. � e former applies to patients who usually come in through the ED and stay up to 24 hours in the hospital; the latter a� ects those who do not stay over two midnights. Medicare previously reimbursed hospitals at inpatient rates for these patients, but the new measures have changed them to outpatient status, lowering reimbursements by 80 percent or more.

Although HUP will feel the impact of this reduction in reimbursement, its patient case mix index is high, meaning cases are more complicated and require longer hospital stays. Other hospitals in the region with a greater number of one-day stays, especially community hospitals, are more vulnerable. With the steep cut in reimbursement, “some hospitals in the region might start closing programs, which is not good for anyone.”

He said patients are also feeling the impact from these programs. “� ey receive the same care but because Medicare considers them outpatients, copays can be very high,” he said. “Patients may think they’re inpatients because they stay longer than 24 hours, but, if they

don’t stay for two midnights, they discover that they owe a lot more.”

Other government measures could also lead to lower hospital reimbursements. � e federal budget includes another two years of the two-percent rollback that was part of last year’s sequestration to cut costs. On the state level, “we will know about the Medicaid program in the FY15 state budget,” which will be announced shortly.

Scheib said higher surgical admissions are helping to keep us � nancially strong, as is our outpatient activity which has “exceeded expectations.” At the Perelman Center for Advanced Medicine, “we’ve had double digit growth in many areas, including cancer, proton therapy and radiology.” He expects similar results at the recently opened Penn Medicine Washington Square ambulatory facility near Pennsylvania Hospital and Penn Medicine University City, the outpatient facility for Penn Presbyterian, which is scheduled to open later this year.

Scheib also touched on plans for a new hospital wing which, if approved, will be built on the spot where Penn Tower and its garage now stand. It would house between 200 and 300 beds. About 100 of these beds will replace beds lost when HUP converts its semi-private rooms to singles. Based on our current growth rate, “it would take about � ve to six years to � ll the additional beds in the hospital wing.” � is � rst phase is part of a very long-term goal to move all patient services out of HUP and over to the other side of the street.

SPEAKING WITH HUP’S LEADERS

ICN Revises Primary Nursing ModelHUP’s Intensive Care Nursery recently celebrated the start of a new Integrated Primary Nursing Model. Using a team approach, the nurses will coordinate care with patients, families, physicians and other health-care providers using � ve core patient-care tenants: patient- and family-focused, evidence-based, accountable and autonomous, coordinated, and continuous.

� e changes include more consistency in nursing assignments so patients receive more care from a smaller team and will not be transferred to other bays as frequently.

� e ICN is also participating in the AACN Clinical Scene Investigator Academy to build skills in sta� nurses and use their expertise to improve patient care outcomes and satisfaction.

Introducing Penn Primary Care ConnectionYOUR FAST PASS TO PRIMARY CAREA new concierge service, the Penn Primary Care Connection, provides easy access to new patient appointment scheduling for Penn Medicine employees and their families seeking a primary care provider (PCP). Find a PCP close to work or home, with an appointment time that meets your needs.

Learn more about Penn Primary Care at www.pennmedicine.org/primary-care/. To make a new patient appointment, call 267-414-2208.

Participating in the ribbon cutting were (l. to r.)Alyson Heleniak, Diana Strong, Melinda Valorie, and Kathleen Moyer.

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Team UPHS/PENN set a new single-year fundraising record of $174,170 in 2013, squeezing past the $171,887 record set in 2007. “We again had the largest team with 289 riders participating,” said team leader Dan Wilson, VP, Allied Health and Ambulatory Services at Pennsylvania Hospital. “An amazing day, great weather, lots of fun and memories to last a lifetime.”

In addition to setting records, the team won national recognition, winning the coveted Circle of Distinction Award, which recognizes any team that has surpassed the $1 million

mark in fundraising since its inception. Since 2002, only 94 teams out of a total of 2,740 nationally have reached this level. Team UPHS/PENN just completed its 17th year having raised an amazing $1,582,549.

� e team also received the following regional accolades:

• Largest Team Award

• Top Fundraising Team Award

• Millennium Award (for teams surpassing $100,000)

HUPdateEDITORIAL STAFF Sally SapegaEditor and Photographer

Lisa PaxsonDesigner

ADMINISTRATIONSusan E. PhillipsSenior Vice President, Public Affairs

Holly AuerDirector of Communications

CONTACT HUPDATE AT: 3535 Market Street, MezzaninePhiladelphia, PA 19104

phone: 215.662.4488fax: 215.349.8312email: sally.sapega@uphs.upenn.edu

HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.

M S - 1 5 0 R E S U L T S

SET RECORDCongratulations to all of the Team UPHS/PENN

MS City to Shore Bike Ride participants and their

supporters!

Each quarter, Penn Medicine CAREs grants are awarded to Penn Medicine faculty, sta� and students who donate their time and expertise to improve the health and well-being of the communities we serve.

To learn more about the grant and how to submit an applications, go to http://uphsxnet.uphs.upenn.edu/community and click on “CAREs grant.” � e deadline for the next round of grant winners is Saturday, March 1.

To view a list of last quarter’s winners, go to http://news.pennmedicine.org/inside/hupdate.

ANNUAL PAH NURSING RESEARCH C O N F E R E N C EPlease join us for PAH’s annual nursing research conference in � ursday, March 27, from 7:45 am to 4:30 pm, in the hospital’s Zubrow Auditorium. Registration for this event is required in Knowledge Link.

� ere is also a call for research and evidence-based practice posters for the Conference. Please contact Diane Angelos, RN, MSN, clinical nurse education specialist, at diane.angelos@uphs.upenn.edu or 215-829-8716, or Margaret Pearce, RN, PhD-C, director of Magnet and Patient Outcomes, at margaret.pearce@uphs.upenn.edu or 215-829-7639, to discuss how to showcase your work. Deadline for submissions is Friday, February 28.