Last week, urogynecologic surgeons from around the world came to AAMC for the 2014 American Urogynecologic Society/International Urogynecological Association (AUGS/IUGA) Scientific Meeting. Led by Briana Walton, MD, director of the Women’s Center for Pelvic Health, participants practiced their surgical skills in the SAIL Center and the 6th floor of the Belcher Pavilion on human specimens. Check out photos from the event here.
News and Updates
Last week was one filled with pride for Anne Arundel Medical Center. On July 21, 22 and 23, we had our Magnet® site visit—a critical step in our journey to Magnet recognition.
What is Magnet? The Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Developed by the American Nurses Credentialing Center (ANCC), Magnet designation is the ultimate credential for high-quality nursing. Over the last seven years, AAMC Nursing has used the Magnet framework to improve care, quality and outcomes for our patients, while also improving nurse satisfaction and the work environment. To even apply for Magnet recognition, we had to be above benchmark performance in our nursing quality indicators, patient satisfaction and nurse satisfaction. Only 6 percent of healthcare organizations nationally achieve this designation—most hospitals cannot even apply.
The site visit with three very experienced and accomplished Magnet appraisers was highly anticipated by all of AAMC. It gave us the opportunity to demonstrate the high quality of care we provide to the community.
The appraisers spent three days developing a deep sense of the knowledge and caring that defines AAMC nursing. Their visit included unit and department tours, interviews with leaders, staff on all shifts and community stakeholders, reviews of our patient, nurse and physician satisfaction data, as well as open forums. All employees, medical staff and community members were invited to come to open forums and tell their AAMC pride story about the care we provide.
The open forums were extremely well-attended. In fact, at the staff forum the lead appraiser’s first word was, “Wow,” as she observed the packed room of 150 colleagues. The stories about their partnerships with nursing were truly touching. Your colleagues spoke of feeling “honored” and “proud” to work at AAMC, how they have learned from nurses, and how they appreciate the high quality care we deliver. More than one staff member commented on the excellent collaboration we share and how they view the AAMC family.
In a later session, 150 community members representing schools of nursing, paramedics, city and county leaders, trustees, clinical partners like the Maryland Hospital Association, Hospice of the Chesapeake and Annapolis Wellness House, and mostly grateful patients and families shared heartfelt stories of gratitude and admiration for AAMC nursing. The appraisers commented they had never seen a Magnet community forum of that magnitude.
In summary, the Magnet appraisers cited five best practices they took from AAMC:
- Nursing leadership
- Nursing satisfaction results, especially nurse-physician collaboration
- Patient satisfaction results
- Implementation and dissemination of evidenced-based practice across the organization
- Patient- and family-centered care, especially our use of patient and family advisors
What’s next? We expect to hear about our Magnet designation status in the fall. In the meantime, we celebrate a successful visit that has left us feeling an overwhelming sense of pride. We will continue our never-ending journey of providing extraordinary care to our community.
Thank you for your care to patients, families, and to each other.\
With warmest regards,
Sherry Perkins, PhD, RN
Chief Operating Officer/Chief Nursing Officer
Anne Arundel Medical Center
Exciting news: The Clatanoff Pavilion, where much of Anne Arundel Medical Center’s Women’s and Children’s Center is located, is getting a refresh. We are creating a more welcoming, secure and contemporary environment for patients and families.
Construction began July 28 and will continue through the fall of 2015. We will be doing everything we can to minimize noise and any inconvenience to you and your patients. Please heed signs and let us know of any ways we can assist you. Should you have any concerns, please contact Henry Sobel, MD, chair of Women’s and Children’s Services, at 443-481-6968 or hsobel@AAHS.org. You can also contact Senior Nursing Director for Women’s and Children’s Services Betsey Snow, RN, at 443-481-6363 or bsnow@AAHS.org.
Adrian Park, MD, chair of the Department of Surgery, and Igor Belyansky, MD, director of the Abdominal Wall Reconstruction Program, led the surgical symposium “Advanced Hernia in General Surgery” on June 26 and 27. The event, which attracted general surgeons from all over the East Cost, was held in the Simulation to Advance Innovation and Learning (SAIL) Center. It provided surgeons the opportunity to learn or further refine their knowledge of hernia repair and soft tissue repair techniques.
The AAMC Laboratory Utilization Committee has identified an approximately 70% duplicate test order rate for CRP and ESR. This is clearly too high. While there are certain clinical indications for ordering both tests, in most instances the CRP is the test of choice. We will continue to monitor duplicate test ordering rates with a goal of reduction to under 20%. We plan to selectively interview physicians who continue the practice of duplicate ordering to get mutual feedback about the clinical utility of this practice. As a reference guide please refer to the table shown below that was published by the bpac nz better medicine organization from New Zealand. See the full article here, which has some excellent information about ESR and CRP. Thanks to Dr. Jack Lichtenstein for consulting on this problem.
What is the best test to use in different situations?
There are few studies that compare the use of ESR and CRP, hence there are only a few conditions for which there are clear recommendations. As a result, the best approach is to consider the various clinical questions that may be posed during the course of the consultation, refer to Table 1.
Table 1: Choosing CRP or ESR
AAMC practice guideline for universal screening of new colorectal cancer patients with molecular testing for Lynch Syndrome (LS)by Medical Staff Office on July 29, 2014
The AAMC Laboratory Utilization Committee, after consultation with representatives from gastroenterology, hematology/oncology, colorectal surgery, and our genetic counselor, endorses a policy of universal molecular tumor testing for Lynch Syndrome in newly diagnosed colorectal cancer patients under 70 years of age. After reviewing literature on this topic, the most reasonable and cost-effective strategy seems to be screening for mismatch repair genes using immunohistochemistry with reflex testing for BRAF V600E mutation if MLH1 is absent. Loss of expression in any of the MMR genes (in the absence of a BRAF mutation) should prompt consultation with a genetic counselor for consideration of additional testing. This screening strategy should detect approximately 97% of cases. Furthermore, it is recommended that testing be obtained at the time of diagnostic biopsy so the information is available prior to surgery, as a diagnosis of LS may change surgical options (hysterectomy in females and extended colectomy in males). We recommend gastroenterologists adopt these guidelines when they have a new colorectal cancer diagnosis in their endoscopy center. Any new diagnoses of colonic adenocarcinoma made at AAMC in patients less than 70 years of age will automatically be sent for MMR profile with reflex to BRAF if MLH-1 is borderline or lost. This policy is meant to serve as a practice guideline. Other testing approaches at the time of initial diagnosis may be equally reasonable at the discretion of the gastroenterologist or surgeon. Thanks to Drs. Steve Proshan, Barry Cukor, and John Neuman along with Ashley Allenby, genetic counselor for their review and input.
As we increasingly focus on ways to provide safer, higher-quality care to patients, we are finding ways to reduce waste in healthcare resources. A Laboratory Utilization Committee has been gathering since February 2014 and is tasked with providing our clinicians with evidence-based recommendations for optimal clinical laboratory utilization. This work is being done in collaboration with Choosing Wisely®, a national initiative of the ABIM Foundation and with the American Society for Clinical Pathology.
Below you will find the first in a series of recommendations and guidelines from the committee regarding the RBC folate test. Expect periodic updates regarding changes to our lab test menu as we work toward our goal of developing an evidence-based formulary approach to lab test ordering. For more information or to recommend tests as good candidates for utilization review or elimination, please contact Sanford Robbins, MD, chief of pathology, at 443-481-4252 or srobbins@AAHS.org.
RBC Folate Test No Longer Indicated
The Lab Utilization Committee has identified RBC folate as a test that is no longer indicated. Based on studies carried out at Mayo Medical Laboratories, we believe there is sufficient equivalence between RBC and serum folate testing to support this decision. Effective immediately, all requests for RBC folate will be converted to an order for serum folate.
A 10-year retrospective study of RBC and serum folate testing, performed by Mayo Medical laboratories, concludes that there is no evidence to support routine ordering of RBC or serum folate, and that serum folate concentrations provide equivalent clinical information to RBC folate in the assessment and diagnosis of folate deficiency. The following is a quote from a Mayo Medical Laboratories’ “Hot topics in laboratory medicine”:
“True folate deficiency in the current era of FDA-mandated folic acid supplementation is exceedingly rare. There is no evidence to support routine ordering of RBC or serum folate, but serum folate concentrations provide equivalent clinical information to RBC folate in the assessment and diagnosis of folate deficiency. Based on these statistics, and because serum folate provides equivalent results to RBC folate in almost all clinical scenarios, routine ordering of RBC folate is no longer warranted. Furthermore, investigation of megaloblastic anemia should preferentially be initiated with vitamin B12 testing instead of folate due to the low incidence of modern folate deficiency. In the absence of B12 deficiency, it is more cost effective to simply supplement with folic acid rather than routinely test and monitor a patient’s folate status, similar to other nutritional deficiencies such as vitamin D.”
Please use the link shown below for additional information from the Mayo Hot Topics presentation given November, 2010.
The entire article can be found here.
This policy change was approved by a multidisciplinary committee of AAMC physicians that included representatives from hematology/oncology. Please direct any questions or comments to Suzanne Leshinskie, laboratory director, or Sanford Robbins, MD, Chief of Pathology.
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MDICS is Maryland’s largest, private hospitalist group of physicians, nurse practitioners and physician assistants dedicated to providing comprehensive, cost-effective, high-quality medical care to patients in hospitals, skilled nursing and rehabilitation centers, assisted living communities and continuing care retirement communities.
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“We are extremely proud that we’ve been selected as one of The Washington Post Top Workplaces,” said Dr. Douglas Mitchell, CEO and Co-Founder of MDICS. “We value our employees and strive to attain our Core Values, which includes achieving quality metrics for healthcare systems, teamwork with our providers and clients, a willingness to accomplish what our clients request (‘Yes’ culture), and maintaining connections with our employees, providers, and valued customers.”