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President of the Medical Staff: Meet and Greet

by Kenneth S Gummerson MD PhD on May 23, 2013

Almost as soon as it was signed into law in 2010, the Affordable Health Care Act began changing the way health services are provided. This year many new changes will begin to ease in including an increase in Medicare taxes and an increase in primary care reimbursements in Medicaid to match those of Medicare.  All leading up to January 1, 2014 when health insurance exchanges are implemented, and bundled payment demonstrations, accountable care organizations and consolidation will occur.

To keep our Medical Staff informed of the hospital’s strategies for meeting the challenges and risks of this massive transformation, Ken Gummerson, MD, and Mitch Schwartz, MD, will host a monthly information exchange. We invite you to be a part of the discussion as we address the issues and share the implications for infrastructure, technology, clinical integration, transition from fee-for-service  payment models, and, how all of the change will affect you, your practice and the medical system.

Join us for the first in the monthly series:

Friday, May 24 from Noon to 2pm
Medical Staff Lounge
1st Floor, Hsopital Pavilion South

For more information, call the Medical Staff Office at 443.481.4150.

AAMC Opens Patient-Centered Acute Care Geriatric Unit

by Medical Staff Office on May 9, 2013

On May 2, AAMC held a ribbon-cutting for its Acute Care of the Elderly (ACE) unit. The ACE unit offers a specialized model of care for older, hospitalized patients with acute illness. The 30-bed unit is one of 13 in Maryland.

“Many times, highly functioning older adults are admitted to a hospital for a few days and are so weakened by the experience that they become too frail to return to their independent lives,” says Prasad Savana, MD, medical director of the ACE unit. “Our team is specially trained to better understand the risk factors for developing adverse events and will take special attention to ensure patients are moving as soon as possible to avoid complications.”

AAMC was awarded the Nurses Improving Care for Healthsystem Elders (NICHE) facility designation in December 2012 as they prepared for the ACE unit opening. The national NICHE organization strives to improve the quality of care for hospitalized older adults, provides evidence-based geriatric protocols and geriatric education for hospital staff members so they are better equipped to care for older adults. NICHE is the largest geriatric nursing program available in the United States, with nearly 300 participating hospitals.

“Geriatric patients face a variety of health risks. This model of care has proven that focusing on the unique needs of the elderly enhances clinical outcomes during and following hospital admission,” says Sherry Perkins, PhD, RN, AAMC’s chief operating officer and chief nursing officer.

Patients admitted to the ACE unit will be seen by their attending physician and will receive consults from members of a special team that includes a geriatrician or geriatric nurse practitioner, dietitian, pharmacist, social worker, case manager, physical therapist, spiritual care, as well as auxiliary volunteers. Patient-and-family advisors will be active participants in the patients’ care plan, providing guidance to team members. Under the direction of this team, ACE patients will be gently pushed to maintain their strength and routine from the time they are admitted until their discharge.

Center for Healthcare Improvement

by Medical Staff Office on May 9, 2013

The AAMC Center for Healthcare Improvement (CHI) was created in September 2012. Barry Meisenberg, MD, medical director of the DeCesaris Cancer Institute, was named as CHI’s founding director and also serves as Chair of Quality Improvement and Healthcare Systems Research.

The overarching goal is to rapidly implement innovations that enhance patient safety and quality of care throughout AAMC’s growing system of care.

Targeting projects and initiatives addressing high-risk medications and procedures, the CHI acts a coordinator for patient safety initiatives. Working with the existing regulatory and quality committees, the CHI has responsibility for implementing  practices shown to improve safety and reduce waste. Additionally, CHI plays a key role in promoting initiatives aimed at reducing harm associated with care in a complex medical environment.

Related responsibilities include:

  • Enhancing the clinical measurement and program analysis (analytics) that allow clinical leaders to measure and refine care.
  • Managing the Research Institute and enhancing clinical research opportunities for patients through  participation  in the Johns Hopkins Clinical Research Network.
  • Evaluating Graduate Medical Education expansion to the AAMC campus.

List of CHI projects

  • Improving safety by optimization of computerized order sets.
  • Enhancing safe use of narcotics.
  • Improving safety profile of blood thinning medications.
  • Adopting best practices to reduce complications associated with antibiotics use.
  • Introducing ‘Choosing Wisely’ to consumers and the medical staff to reduce harms associated with over-utilization of tests, procedures and medications.
  • Analyzing medical complications of hospitalized patients.
  • Enhancing measurement tools to improve performance of clinical programs.
  • Evaluating Graduate Medical Education programs.
  • Expanding clinical research opportunities for patients.
  • Integrating regulatory and clinical patient safety initiatives.

AAMC’s Medical Surgical Unit receives patient safety award

by Medical Staff Office on May 9, 2013

The medical surgical unit at Anne Arundel Medical Center (AAMC) recently received a Circle of Honor Award from the Maryland Patient Safety Center. The Center recognizes hospitals and health systems for their progress in advancing a culture of safety for patients, families and staff.

AAMC’s medical surgical unit won the award for their work in preventing catheter-associated urinary tract infections (CAUTI). If left untreated, CAUTIs can lead to more serious kidney infection and contribute to health decline in patients with compromised immune systems.

“We are always looking for ways to eliminate preventable harm for every patient,” says Christine Frost, RN, AAMC’s director of the medical surgical unit. “The model we developed for prevention resulted in a full year with no infections and the positive trend continues.”

The medical surgical unit CAUTI team used evidence-based practices and rounded with nurses and staff each month conducting situational analysis regarding patients. The team worked closely with infection control to review trends and develop plans for catheter removal, a key factor in their success.

Heard About Choosing Wisely?

by Barry Meisenberg MD on April 26, 2013

In an unprecedented public health initiative during an era of diminishing resources, 35 medical professional organizations have joined forces with consumer groups to promote safe and responsible utilization practices, i.e. Choosing Wisely, for both patients and physicians.

Each partner organization has created or will create a list of five medical tests, procedures or medication indications that are of low value and associated with causing harm. Examples include early use of imaging for low back pain (in the absence of red flags), routine pre-operative chest x-rays, antibiotics for acute sinusitis, and screening DEXA scans in subjects at low risk for osteoporosis. There are 45 such recommendations at present with more to come in 2013 as additional organizations join the campaign.

Recognizing that demand for low-value tests often originates from the public, the Choosing Wisely campaign has gained broad credibility in the lay media by partnering with prominent entities that enjoy loyal consumer following, including Consumer Reports and AARP. Cogent, patient-friendly information resources from Choosing Wisely can be used in your practice to help patients understand why more tests or more medications aren’t always the best plan.

The unambiguous statements by professional societies recommending against certain tests in certain situations set a clear “standard of care” that should provide a comfort level to physicians when having discussions with patients and families about tests of questionable value and potential harm.

The website contains links to each of the current 45 Choosing Wisely recommendations, and the evidence used to develop them. It also lists the professional societies that are due to create their lists in 2013. Patient resources, such as well-written one-page discussions of the recommendations, may also be downloaded from the site.

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