Medical Executive Committee highlights

Highlights from the June meeting of the Medical Executive Committee (MEC) follow. The meeting was chaired by William Swartz, MD, president, MEC, UPMC Shadyside.

President’s report

Dr. Swartz announced that five high-speed computers and printers have been installed in the physician lounge near the West Wing Auditorim.

Radiology

Issues discussed by H. Scott Beasley, MD, chairman, Department of Radiology, were:

  • Practitioners ordering diagnostic tests must provide sufficient diagnostic information and appropriate clinical history so that the testing entity performing those tests can submit accurate bills. Sufficient diagnostic information and appropriate clinical history are required in order for payment to be made to the entity furnishing the service.

    Appropriate history includes signs/symptoms, as well as known diagnoses relevant to the imaging examination being ordered (for example, abdominal pain, chest pain, shortness of breath, pneumonia, or lung cancer).
    Orders to rule out suspected, probable, or possible diagnoses are inappropriate histories for imaging studies and are unacceptable indications, according to the Centers for Medicare and Medicaid Services.

  • Radiology is seeking ideas to improve communication of critical findings to all physicians who order diagnostic imaging studies at UPMC Shadyside. The department has encountered challenges in communicating unexpected or urgent findings to some physicians, especially those who practice at multiple sites. The MEC agreed to investigate this issue to help ensure that appropriate contact information (pager or cell telephone number or covering physician information) is available to communicate unexpected or urgent findings. An office number alone is not sufficient as a sole point of contact.

UPCI,UPMC Cancer Centers

Nancy Davidson, MD, director, University of Pittsburgh Cancer Institute (UPCI) and UPMC Cancer Centers, presented the following updates:

  • Hematology Oncology admissions to UPMC Shadyside continue to trend upward. Meanwhile, initiatives that emphasize efficient patient flow have decreased average length of stay.
  • An initiative was undertaken to administer chemotherapy in the most appropriate setting. Drugs that should be administered in the outpatient setting (for example, rituximab maintenance therapy for non-Hodgkin’s lymphoma) that were ordered during an inpatient stay were reviewed by a clinical pharmacist and then discussed with the prescribing physician. Through this process, drug expenses on the inpatient oncology units were reduced by more than $500,000. This initiative was led by Stanley Marks, MD, chief medical officer, UPMC Cancer Centers.
  • Under the leadership of Dwight Heron, MD, chairman, Radiation Oncology, UPMC Shadyside, case volume continues to increase for the use of stereotactic radiosurgery (SRS), a radiation therapy procedure pioneered at UPCI that precisely delivers a large dose of radiation to tumors. The SRS program at UPMC Shadyside, with more than 23,000 treatments, ranked No. 1 in the world last year and was the No. 2 intercranial SRS program in the United States.
  • A new Varian TrueBeam™ system for high-precision image-guided radiotherapy and radiosurgery will be installed this fall. A system uses a re-engineered control system and a multitude of technical innovations to synchronize imaging, patient positioning, motion management, and treatment delivery. It also can deliver treatments faster. This makes it possible to offer greater patient comfort by shortening treatments, and to improve precision by leaving less time for tumor motion during dose delivery.
  • Susan Frank, director, Clinical Operations, Hillman Cancer Center, has led a successful pilot project to help keep primary care physicians (PCPs) informed when their patients are admitted to Hematology Oncology. The entering of the “admit to” order generates the alert “do you want to consult the PCP?” The name of the PCP is displayed and the “add order” box for MD consult is prechecked. The box should remain prechecked to continue with the consult of the PCP. This project may be extended to surgical oncology patients in the near future.
  • Various patient satisfaction initiatives are moving forward. New patients receive courtesy calls before they arrive for treatment or appointments. Patients are welcomed in advance of their arrivals and have the opportunity to have questions answered. In addition, a successful program has been launched to ensure that most patients are welcomed by Security or a volunteer at the front door.
  • Data show that patient complaints and grievances have been reduced.
  • In September, Clayton Smith, MD, will join the UPMC Cancer Centers as director of the Hematological Malignancies Program. Dr. Smith is the director of the Leukemia/Bone Marrow Transplant Program of British Columbia. He also is the current chair of the Tumor Group Council at the BC Cancer Agency, a senior scientist at the Terry Fox Laboratory where he studies blood and marrow stem cells, and a Canadian Research Chair in Cellular Therapies.

Collaborative Practice update

Shuja Hassan, MD, and Sandy Rader, chief nursing officer, and vice president, Patient Care Services, serve as co-chairs for Collaborative Practice at UPMC Shadyside. Collaborative Practice initiatives they discussed included:

  • A systemwide committee has been formed to launch a catheter-associated urinary tract infection (CAUTI) campaign. The goal of the effort is to decrease CAUTIs by 10 percent in Fiscal Year 2011. For many patients, a CAUTI is a preventable infection. Urinary catheters should be used only when patients meet Centers for Disease Control and Prevention and UPMC guidelines. Each patient with a urinary catheter should be assessed daily by a clinical rounder to ensure these criteria are met. Jody Feigel, coordinator, Infection Control, and Kathleen Finn, a clinician on 3 West (Medical Intensive Care Unit/Cardiac Care Unit), are UPMC Shadyside’s representatives to the systemwide committee.
  • An effort continues to help ensure that all clinical computers are functional or issues are reported in a timely manner to PC Support. As part of this effort, health unit coordinators (HUCs) complete daily assessments of clinical desktops. The HUC’s assessment includes opening PowerChart and MyApps, launching Print-on-demand, ensuring the mouse and keyboard are working properly, and determining that the keyboard skin is intact. Issues identified in the daily assessment are submitted electronically to PC Support. On June 21, the HUC computer/device assessment procedure went into effect on all remaining inpatient units.
  • The Clinical Decision Unit (CDU) opened June 1 and has been a success. The goal of the pilot project is to create more bed space at UPMC Shadyside and reduce average length of stay (ALOS) for patients, especially those with such diagnoses as chest pain that often result in admissions to observation status. CDU patients are cared for by a care team comprised of nurses, care managers, and house physicians, known as the crimson team, for consistency in coverage. Data show that average length of stay for chest pain patients in the CDU was 0.83 days while the average length of stay for patients with similar chest pain diagnoses who are not in the CDU was 1.7 days. Planning is under way to expand the CDU to include abdominal pain, dehydration, and other diagnoses that typically result in observation admissions.
  • The bedside central line placement project was reinstituted this spring. Bedside care providers may call 623-LINE to alert Steven Evans, MD, and Leonard Evans, MD. The IV team then will be notified and retrieve the dedicated line cart. Surgeon and IV nurse will meet at the bedside for line placement. Patients may need a central line for the following reasons: (1) delivery of medications and fluids, (2) they have limited peripheral access, (3) their management requires frequent serum sample collections, or (4) they are not candidates for PICC lines.

Administrative update

John Innocenti, president, noted that both the UPMC Presbyterian and UPMC Shadyside campuses had strong patient volumes in May. Mr. Innocenti also stated that the opening of the Clinical Decision Unit to lower ALOS has been a success and that plans to decompress UPMC Shadyside by moving practices and volume, when appropriate, to other UPMC facilities continue to move forward.

UPMC eRecord update

Debra Quinn, director, Information Technology Services, announced changes will be made to order sets for patient restraint use. One redesign requires practitioners to note specificity (which extremity) on restraint orders.

Tap and Go
The use of Tap and Go will be expanded. Tap and Go saves valuable time by eliminating the need for clinicians to log in and log out repeatedly of the computers they use to access patient data through eRecord. The technology uses identification badge authentication to enhance the eRecord login process on clinical computer workstations. The clinician uses his or her UPMC ID badge, which contains a radio-frequency identification (RFID) tag, on a reader at the workstation. When the clinician completes his or her first login for the shift, the username is entered automatically via information detected from the badge, and the password is entered manually by the clinician. For the rest of the shift, the clinician need only tap his or her badge on the workstation reader to log in and log out.

Upcoming Tap and Go deployment dates are:

  • Monday, June 28, Emergency Department
  • Monday, July 12, UPMC Shadyside Family Health Center

  • Monday, Sept. 13, remaining intensive care units

    The MEC also discussed processes to update badges to use Tap ands Go.

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