Barry Meisenberg, MD, chair for quality improvement and healthcare systems research, recently submitted a letter to the editor to the New York Times regarding “Treatment Cost Could Influence Doctors’ Advice” article (April 18, 2014). His letter was published in the April 27, 2014 New York Times–continuing the dialogue on Choosing Wisely. Read his letter here.
By Henry Sobel, MD, Chair, Women’s and Children’s Services
The FDA recently issued an advisory strongly discouraging the use of uterine power morcellators. Read the MedPage article with the advisory and ACOG comment here. The FDA’s specific recommendation to physicians is highlighted. Leading hospitals around the country are taking either of two approaches: banning use of the morcellator or having its use restricted to within bags in the abdomen to protect against the risk of spread of potentially malignant tissue. This controversy was the subject of our February Women and Children’s M&M Conference.
Since that discussion efforts have been made to assure that we have the necessary high quality surgical bags, and we do. The use of the power morcellator, the incidence of leiomyosarcoma, and the impact of surgical technique on survival are each of some small increment. Balanced against that risk is the benefit of the decreased morbidity of the minimally invasive techniques allowed by the use of morcellation. More informed high level conversation is coming from national medical thought leaders, including ACOG.
With that expectation, having seen different responses at other hospitals, and having gotten differing opinions within our service, at this time I see the prudent action to be the more conservative one of requiring the use of collection bags to isolate the tissue from spread within the abdomen at time of morcellation.
Further, the FDA’s discussion points (highlighted in yellow within the attachment) should be considered as imperatives in any pre-operative discussion where morcellation may be a possibility. And that should be documented.
Due to the small number of patients impacted by this controversy, the potential for stirring up fear and worry and the fact that we are simply responding to published recommendations, I do not view this as something justifying increased local publicity. It is a subject you should be familiar with, expect questions about and be able to discuss in an informed manner. If contacted by a reporter, the best response is to refer them to the AAMC PR department for comment.
Your comments are welcome. Thank you.
Seventy percent of acute coronary syndrome deaths occur outside of the hospital. As an accredited chest pain center, AAMC’s heart team needs your help in educating the public on the importance of calling 911 for suspected heart attack symptoms. Please do not let your patients or their family members drive to the Emergency Department. All local EMS have the ability to administer emergency medications and defibrillation if needed. EMS will transmit a 12-lead ECG directly to the hospital Emergency Department. Eighty-five percent of heart damage occurs within the first two hours of a heart attack. Early symptoms include chest pressure, squeezing or discomfort, anxiety, fatigue, shortness of breath, nausea, a feeling of fullness, and even back pain.
Our triennial Joint Commission survey occurred the week of November 18. The surveyors were overwhelmingly positive about what they saw and heard. They are taking several AAMC best practices back to the Joint Commission, and named AAMC a “role model” for other hospitals and health systems around the country – an incredible tribute to our employees and medical staff. Our survey results reflect the high-quality, safe care we provide to our patients daily. Thank you for your unending commitment to excellence in quality and safe patient care.
By now, I suspect that you’ve caught on from your national societies that the initiative called Choosing Wisely is here to stay. We have been highlighting the program as well. Recently we welcomed Daniel Wolfson, MHSA, a leader from the ABIM Foundation, to the AAMC Board Committee on Quality and Patient Safety. He walked us through the evolution of the movement and its primary goals related to physician leadership and professionalism. Wolfson is a masterful communicator and blogger. Click here to check out his past blogs, including a recent entry about Atul Gawande’s article in the New Yorker.
I invite you to comment here about your thoughts related to Choosing Wisely.
The James and Sylvia Earl Simulation to Advance Innovation and Learning Center (SAIL), is a world-class medical simulation and training facility in the Health Sciences Pavilion at AAMC. The Center serves not only the medical profession but also provides tours and educational opportunities for area school children, the community, patients, families, and organizations dedicated to healthcare improvement and patient safety. Here are a few upcoming events at the Earl SAIL Center:
- Orthopedics Cadaver Lab: September 24
- OB/GYN Simulation Training: September 26
- Patient Care Technician Education: September 27
- Women’s Conference and Tour: October 16
- GYN Pelvic Floor Reconstruction Cadaver Lab: November 1
- Breast Surgery Lab: November 1
- Biomedical and Allied Health Students from Anne Arundel County Public Schools and Glen Burnie High School Tours: November 15 and December 12
What kinds of simulation and learning opportunities can the Earl SAIL Center offer you and your team? Contact Ann Casamento, RN, simulation coordinator, at x4880 or acasamento@AAHS.org.
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). (Please note the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.)
AAMC’s Alec team is preparing Alec to receive the ICD-10 codeset. The database changes go into effect Wednesday, September 4, 2013.
Why is this change happening now? The Alec database structure must change to receive the ICD-10 codes while keeping the ICD-9 codes and cross reference the two. Our imported content will contain ICD-10 codes beginning with the October content release.
How will this affect the medical staff? There are several places within Alec where you document a diagnosis: Problem List, Medical History, Visit Diagnosis, Order Entry Diagnosis Association to name a few. Today you can search for a new code by numeric code or by terminology and are presented with a list of choices linked to the correct ICD9 code. Preferred search method moving forward is by terminology thereby guaranteeing you will find the coded diagnosis you are looking for.
Find a tip sheet here.
AAMC is working with our vendor partners to ensure Alec is fully compliant. If your practice does not use Alec, ask your EMR vendor what they are doing to support the ICD-10 transition.
Look for ongoing updates and education over the next several months leading up to the October 1, 2014 go-live. Questions? Contact David Mooradian, MD, chief medical content officer, at dmooradian@AAHS.org.