Bryn Mawr Hospital, Lankenau Heart Institute, participates in landmark study using sonic pressure waves to treat heart artery blockages 

 

Bryn Mawr Hospital is the first in the region to participate in a new clinical trial investigating a novel treatment option for those suffering from an advanced form of coronary artery disease (CAD) in which the plaque blockage also includes the presence of calcium. Intravascular Lithotripsy (IVL) is an innovative technology that generates sonic pressure waves – also known as shockwaves – designed to break up problematic calcium so that the artery can be opened and blood flow restored with the placement of a stent. The therapy leverages a similar minimally invasive approach that has been embraced by physicians for decades to treat kidney stones, which are also made up of calcium.

“We are thrilled to be the first in the state of Pennsylvania to offer this innovative technology,” says Sarang Mangalmurti, MD, Lankenau Heart Institute interventional cardiologist at Bryn Mawr Hospital, who performed the hospital’s first procedure. “Hardened calcium within the heart is becoming more common as people are living longer and is very challenging to treat. The sonic pressure waves produced when performing Intravascular Lithotripsy give us a novel treatment option to weaken the calcified plaque, with potentially less risk of trauma to the artery compared to other treatments.”

Calcium slowly develops and progresses to its hardened, bone-like state in the heart’s arteries over the course of several decades of cellular growth and death in diseased plaque within the heart arteries. While it is slow to develop, its impact is immediately encountered when performing procedures in calcified lesions. The calcium’s hardened structure restricts normal artery movement and makes the rigid arterial tissue resistant to traditional balloon therapies that have been designed to compress the plaque within the artery wall to restore normal blood flow. For these reasons, the presence of calcium increases the complexity of most cases and decreases the effectiveness of most treatments.

Bryn Mawr Hospital was also the first in the region to offer Shockwave Medical’s Lithoplasty System to treat calcified leg artery blockages with lithotripsy. This sonic pressure wave treatment has been derived from a similar therapy used to treat patients with kidney stones.

The DISRUPT CAD III study is designed to enroll 392 patients at 50 hospitals worldwide and follow the patients for up to two years. Shockwave C2 Coronary IVL catheters are commercially available for the treatment of de novo coronary artery disease in Europe and other select geographies; they are limited to investigational use in the United States.

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Temporary changes to pedestrian/vehicle traffic flow and parking at Main Line Health Center in Newtown Square

By Karen Fritz, assistant marketing manager

Starting Tuesday, April 23, and continuing into July 2019, the parking lot across from the Canopy main entrance at the Main Line Health Center in Newtown Square will be temporarily closed off for construction.  Parking and traffic flow for staff, patients, visitors, cancer center, and sleep study patients will be affected. Please refer to the PDF map to identify new traffic flow and parking areas for staff, patients and visitors. There will also be directional signage onsite.

As always, our first priority is ensuring a superior experience for our patients. As such, please be mindful that patient and visitor parking is temporarily moved to the employee parking area in order to allow them to enter and exit our building as easily as possibly. All staff are asked to offer assistance to patients and visitors who may need help navigating. We apologize for this temporary inconvenience and thank you for your patience and cooperation during this time.

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LabLink newsletter now available for viewing

 

Click here to view the Spring 2019 issue of LabLink, the newsletter of Main Line Health Laboratories.

 

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Best read of the week

 

 8 hospitals closed so far this year — here’s why

Becker’s Hospital Review: From reimbursement landscape challenges to dwindling patient volumes, many factors lead hospitals to close.

Additional news media reports on MLH physicians and the health care industry, excerpted from MLH’s daily Morning News Report:

Regional Health News…

Radnor’s Penn Medicine Facility Reaches Construction Milestone

Patch.com: A topping out ceremony was held at a multispecialty outpatient facility for the University of Pennsylvania Health System in Radnor recently.

 

Healthcare Business News…

Healthcare again tops industries for cybersecurity attacks, data breaches

Healthcare Dive: Healthcare again led all industries in cybersecurity breaches in 2018, claiming a quarter of the more than 750 incidents reported, BakerHostetler’s latest Data Security Incident Response Report shows.

 

Quality and Safety News…

How Can We Be Sure Artificial Intelligence Is Safe For Medical Use?

NPR: When Merdis Wells visited the diabetes clinic at the University Medical Center in New Orleans about a year ago, a nurse practitioner checked her eyes to look for signs of diabetic retinopathy, the most common cause of blindness. At her next visit, in February of this year, artificial intelligence software made the call.

 

Patient Care News…
Interns Spend Most Time With EMRs, Not Patients

Medscape: New results from the iCOMPARE trial show that first-year residents, or interns, spend almost five times more hours on indirect patient care than on face-to-face patient care.

 

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STEEEP Huddle:  P for Patient Centered

This week’s STEEEP Huddlecontributed by Pat Vassell, director of nursing, Riddle Hospital, focuses on renovations to The Birthplace at Riddle Hospital. MLH continues to invest in Systemwide facility renovations and upgrades to improve upon the environments in which we care for patients. Upgrades to The Birthplace at Riddle Hospital include both cosmetic and functional improvements. As MLH employees and staff, we ask that you remain committed to our patients and the community as we continue our organizational transformation.

The STEEEP Huddle topics are posted on the Performance Excellence 2020 site at landing.mainlinehealth.org/PE2020.

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Welcoming DVACO’s new Chief Medical Officer Dr. Mark Angelo

By Katherine Schneider, MD, DVACO president

Delaware Valley Accountable Care Organization (DVACO) is fortunate to have Mark Angelo, MD joining us as chief medical officer and his timing could not be better.

With the Centers for Medicare and Medicaid (“CMS”) announcing challenging new models for its Medicare Shared Savings Program (MSSP) and deeper engagement with commercial payers in our future, Mark is taking the clinical reins of the organization at a pivotal point.

Fortunately, he comes well prepared for the tasks ahead. He joins DVACO from Cooper University Health Care where he served in many roles, including medical director for Population Health and as chief executive officer of the AllCare Health Alliance ACO. He will manage all activities of the DVACO clinical team including quality, care coordination, population health pharmacy, post-acute strategy, clinical integration and practice transformation.

For more from Dr. Angelo, including a blog post about practice transformation and the Medicare Annual Wellness Visit (“AWV”), click here.

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Clinical Trial of the Week: Interventional study for patients diagnosed with moderate or severe peripheral artery disease

By Donna Loyle, communications specialist, LIMR

The Shockwave Disrupt PAD III trial is underway at Bryn Mawr Hospital, with Sarang Mangalmurti, MD, (right) serving as principal investigator and Lynn Sher, MBA, as clinical research coordinator. Main Line Health has enrolled more patients in the observational arm of this randomized trial than any other site in the country.

The Disrupt PAD III study is testing the safety and efficacy of the Shockwave Medical Peripheral Lithoplasty® System in combination with drug-coated balloon (DCB) vs. standard balloon angioplasty used in combination with DCB to treat moderate and severely calcified femoropopliteal arteries.

The Shockwave Lithoplasty System is a proprietary, lithotripsy-enhanced balloon catheter designed to be delivered through the peripheral arterial system of the lower extremities to the site of calcified stenosis. Activating the lithotripsy within the device will generate pulsatile mechanical energy within the target treatment site, disrupt calcium in the lesion and allow subsequent dilation of a peripheral artery stenosis using low balloon pressure.

Additionally, an observational study of participants who do not meet the inclusion/exclusion criteria for the randomized study will be conducted.

All subjects are followed through discharge, 30 days, and six, 12 and 24 months. Diagnostic ultrasound assessments are completed at 12 and 24 months.

For more, visit https://www.mainlinehealth.org/research/clinical-trials/disrupt-pad-iii

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SBAR: Therapeutic Duplication Hierarchy

By James R. Gengaro, DO, regional VP, Medical Affairs, Paoli Hospital and Riddle Hospital

 

SITUATION: To address the recent Requirement for Improvement (RFI) from the Joint Commission (TJC) at Paoli Hospital for therapeutic duplicate medications ordered for patients, and to prevent a similar finding at Riddle or Bryn Mawr Hospital, MLH Pharmacy will begin an automatic clarification process when duplicate PRN medications are ordered. This process is temporary with the goal of ultimately identifying all order sets that contain duplicate PRN medications in order to permanently eliminate them from Epic.

 

BACKGROUND: Nurses must have clear directions for medication administration as per TJC Medication Management (MM) standard 05.01.01.  Without clear directions, the nurse is put in the position of prescribing a medication and this is beyond their scope of practice. Each medication MUST contain explicit instructions regarding when to administer each medication.

Example: If a patient is ordered acetaminophen 500mg po PRN pain AND oxycodone 5 mg po PRN pain, this is a therapeutic duplicate since there is no instruction to tell the RN when to administer each medication.

 

ASSESSMENT: There is a long-term plan to review all order sets and remove therapeutic duplicates. This will take several months to complete and our action plan and window for compliance at Paoli Hospital started Monday, April 1st. The pharmacy department was asked to create a process to address the RFI in the interim period.

 

Last month, the P&T and Medical Executive Committees approved a new process for pharmacists to address the issue of therapeutic duplication.  Please see below for an outline of the process for automatic clarification of duplicate PRNs by pharmacists.

 

RECOMMENDATION:

  • Review the information and disseminate amongst colleagues as necessary. See the attached algorithms.
  • Remind staff that as needed “prn” medications must have appropriate indications for use including escalation from one medication to another.
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Best read of the week

 

Patients can get paid to shop for health care. But there are challenges

Boston Globe: When he goes to the doctor for his annual checkup, Andy Vachon can easily get his blood drawn and checked right there. But he opts to go elsewhere.

Additional news media reports on MLH physicians and the health care industry, excerpted from MLH’s daily Morning News Report:

Main Line Health News…

Philly ‘burbs show low DUI deaths rate, study shows

Daily Local News: Gaza noted that in March the Westtown East Goshen Regional Police Department, alongside the Goshen Fire Department and EMS, Bryn Mawr Rehabilitation Hospital and the county Coroner’s Office, had a “mock crash” demonstration and discussion to show the students at Bayard Rustin High School what a homicide by vehicle crash looks like, and the consequences of that crash.

 

Regional Health News…
Pennsylvania’s war on opioid addiction to highlight national event

Tribune-Review: Pennsylvania’s approach to the opioid epidemic will be front and center Monday at the National Governor’s Association’s Summit for New Administrations in Washington, D.C.

 

Healthcare Business News…
Medicare For All Could Reduce Hospital Revenues By 16%

HealthLeaders Media: Medicare for All could have consequential repercussions for hospital finances, according to a new JAMA report.

 

Quality and Safety News…
Medicaid expansion tied to fewer heart-related deaths, study finds

CNN: Between 2010 and 2016, counties in states where Medicaid expanded had 4 fewer deaths per 100,000 residents each year from cardiovascular causes after expansion, compared with counties in non-expansion states, according to the research.

 

Patient Care News…
Taking care of Charlie helped one California town nearly halve hospital use

STAT: In a single year, Charlie racked up more than 35 skirmishes with law enforcement, 25 hospital visits, and 16 emergency transports. By most accounts, he was a burden to the system.

 

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MLHC updates

 By Karen Fritz, assistant marketing manager, MLH

 Main Line HealthCare Welcomes: 

Cynthia LaCapra, MD

MLHC Primary Care in Delaware County – 484.573.5116

(Seeing patients in both Springfield & Drexel Hill offices)

 

Lauren Martin, CRNP

MLHC Family Medicine in Bryn Mawr – 610.649.6400

 

Mary (Katy) Macon, PA-C

MLH Jefferson Neurosurgery (BMH office) – 610.525.1061

 

Lankenau Heart Group (CT Surgery / LMC Heart Pavilion)

Jackie Redman, CRNP

Gabrielle Wasser, CRNP

 

Hospitalist Medicine Services

Daniel Lin, MD (Bryn Mawr)

Katarzyna Wasilczuk, CRNP (Paoli)

 

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