Save the date for this very special night honoring AAMC medical staff on January 17, 2015. Find details here. Formal invitation to follow. For more information, please contact the Medical Staff Office at 443-481-4150 or mso@AAHS.org.
Medical Staff Updates
Measuring our “culture of safety” (how we think of and implement patient safety measures) is important to figuring out where we can improve our safety processes and help reduce errors. Complete the confidential survey here.
October 8, Doordan Institute
5pm: Happy hour and networking
6pm: Chet Burrell, President and Chief Executive Officer of CareFirst BlueCross BlueShield presents “An Update on the CareFirst Patient-Centered Medical Home (PCMH) Program.”
7:30pm: Buffet dinner
The journal article “Improved Coordination of Care for Patients with Abnormal Chest Imaging: the Rapid Access Chest and Lung Assessment Program” was published in the October 2014 Journal of Clinical Outcomes Management by Stephen Cattaneo, MD; Maria Geronimo, RN; Teresa Putscher, RN; Catherine Brady-Copertino, BSN; and Barry Meisenberg, MD. Read the full article here.
This review article (NEJM, Aug 28) updates the pathogenesis, diagnosis, screening and surveillance, management, endoscopic eradication of dysplasia, management of low-grade dysplasia, and radiofrequency ablation of nondysplastic metaplasia. Click here to read full-text
This article (Mayo Clin Proc, Aug) concludes, “Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy. Click here to read full-text.
Is hospital admission for heart failure really necessary? The role of the ED and observation unit in preventing hospitalization and rehospitalizationby jmiller on August 20, 2014
“Evidence-based therapies have resulted in improvements in the outpatient mangement of HF. Despite an increasingly complex population of patients, the overall length of hospital stay has decreased. However, post-discharge event rates remain disturbingly high and it is not clear that hospitalization mitigates these event rates. Emergency physicians are key stake holders in this process, as the ED is the point of triage and disposition fo rthe majority of HF patients who are considered for hospital admission. Alternatives to hospitalization, such as the one posed in this article, are crucail to the overall goal of allocating resources to those high-risk patients in need of intense evalutation and therapy, while simultaneously faiclitating outpatient management of lower-risk patients.” (J Am Coll Cardiol, Jan 2013) Click here to read full text
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.