STEEEP Huddle: S for Safe

This week’s STEEEP Huddle, Contributed by Jeff Bryers, System director, Enterprise Applications, will discuss the important procedures for Epic users, during the upgrade on October 13. Epic users are advised to review the PowerPoint presentations about the upgrade, by visiting the PIVOT site.

The STEEEP Huddle topics are posted every Monday on MLH To Go.

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LHI Live Cases Broadcast to San Francisco TCT meeting

By: William Gray, MD, System Chief of Cardiovascular Diseases for Main Line Health, and President of Lankenau Heart Institute

This past Saturday (Sept. 28), Lankenau Heart Institute/Main Line Health joined a very select group of 14 other institutions from around the world when we broadcast live  three cases to the 31st annual Transcatheter Therapeutics (TCT) meeting in San Francisco:

  • Apollo Health City (Hyderabad, India)
  • Ballad Health | Wellmont CVA Heart Institute (Kingsport, TN)
  • Cedars-Sinai Medical Center (Los Angeles, CA)
  • Cleveland Clinic (Cleveland, OH)
  • Instituto Dante Pazzanese de Cardiologia (São Paulo, Brazil)
  • Fuwai Hospital (Beijing, China)
  • Golden Jubilee National Hospital (Glasgow, Scotland)
  • Hadassah Medical Center (Jerusalem, Israel)
  • Lankenau Institute for Medical Research (Philadelphia, PA)
  • McGill University Health Center (Montreal, Canada)
  • Minneapolis Heart Institute (Minneapolis, MN)
  • New York-Presbyterian/Columbia University Medical Center (New York, NY)
  • Ohio Health Riverside Methodist Hospital (Columbus, OH)
  • Paul’s Hospital (Vancouver, Canada)
  • University of Washington Medical Center (Seattle, WA)

LHI was carefully chosen for this honor by virtue of both the excellent and state-of-the-art cardiac care as well as its participation among the most elite strata of US cardiovascular clinical research through the efforts of the LIMR team. We also have twice broadcast Live Cases (featuring Drs. Chandhok, Mangalmurti, Abramson, and Kahn) for the CRT meeting  in Washington DC over the past few years, and have been invited back again to broadcast a third time to that meeting in March 2020.

These TCT broadcasts were a tremendous success: featuring both Endovascular and Structural Heart cases, each showcased LHI’s physician and staff expertise and provided an exceptional educational opportunity for the more than 10,000 TCT attendees in the Moscone Convention Center in San Francisco.

It goes without saying that an accomplishment like this takes a significant effort by many people in order to execute it successfully.  At the risk of unintentionally omitting someone, it is important to acknowledge the cath lab preparation under the direction of Chris Dearing (who came in the late Friday night/early Saturday morning hours to help get the production team set up) and Beth Ragan, the participation by both LMC and BMH cath lab staff who came in on a Saturday to work from noon-9 PM, biomedical engineering, inventory, echo support, nurse coordinators, marketing, etc.  Given the chance to “show their stuff” everyone, to a person, stepped up and performed in spectacular fashion.

And this was truly an all-LHI effort: Drs. Pratsos and Mangalmurti did outstanding jobs in the performance of the two Endovascular cases, Drs. Hawthorne, Goldman and Rodriguez the same in the Structural case. Thank you to everyone on the team, including:

  • William Gray, MD
  • Antonis Pratsos, MD
  • Scott Goldman, MD
  • Sarang Mangalmurti, MD
  • Kate Hawthorne, MD
  • Shalin Patel, MD
  • Chris Dearing, RN
  • Beth Ragan, RN
  • Betsy Develin, RN
  • Jeremy Lane, RN
  • Rosemary McKee, RN
  • Sean O’Malley, RN
  • Arlene Collins, RN
  • Lauren Long, RN
  • Andrea Beers, RN
  • Lisa Igidbashian, RN
  • Kelly Henzler, RN
  • Janene McClelland, RCIS
  • Mitch Torh, RCIS
  • Kelly Davis, RCIS
  • Gary Akins, ORA
  • Mike Carboine, PA
  • Jessica Curran, RT

The feedback thus far from the TCT organizers has been glowing, and we hope that there will be a request for a repeat performance.

This is an accomplishment we can all be truly proud to share. Here is the link to the opening video (which needs to be played on Chrome, Firefox, or iOS):  https://vimeo.com/user11304750/review/360859132/cc8aadaffe

 

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2019-2020 MLH Medical Staff Meetings

Attendance at 50% (1) Hospital Staff meeting per Calendar Year is required for Active Staff members by the MLH Medical Staff Bylaws.

You may attend any ONE of the following meetings, at the hospital of your choice, whether that hospital is/is not your primary facility.

THERE ARE NO EXCUSED ABSENCES.

 Fall 2019 Meetings

Tuesday, October 15, 2019 5:00PM Lankenau Medical Center – Center Pew Auditorium
Tuesday, October 15, 2019 6:00PM Paoli Hospital – Potter Room
Thursday, October 17, 2019 6:00PM Riddle Hospital – Drexelbrook Catering & Special Event Center
Thursday, October 24, 2019 5:30PM Bryn Mawr Hospital – Pennypacker Auditorium

Spring 2020 Meetings

Tuesday, April 21, 2020 6:00PM Paoli Hospital – Potter Room
Tuesday, May 5, 2020 6:00PM Riddle Hospital – Springfield Country Club
Thursday, May 14, 2020 5:30PM Bryn Mawr Hospital – Pennypacker Auditorium
Tuesday, June 2, 2020 5:00PM Lankenau Medical Center – Center Pew

Auditorium

Questions? Contact the Medical Staff Affairs Office at 484-337-8031 

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Save the Date for the 2020 Women’s PGA Championship

Main Line Health has been asked to provide medical care during the 2020 Women’s PGA Golf Championship at Aronimink Country Club, and medical personnel are needed to volunteer. Volunteers would need to be present on the following dates:

  • June 23, 2020
  • June 24, 2020
  • June 25, 2020
  • June 26, 2020
  • June 27, 2020
  • June 28, 2020
  • Rain date June 29, 2020

More information will be shared in the future regarding times and how to volunteer for this event.

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IV acyclovir drug shortage – Adding ID consult to order approval

Situation:  Injectable Acyclovir is on national drug shortage due to unavailable raw supply causing manufacturing delays.  The shortage is anticipated to last until early 2020 and conservations measures are needed to preserve supply.

Background: At the present time, IV Acyclovir order holds no restrictions and is available for all prescribers to order. The IV formulation should be reserved for severe infections where treatment is concentration-dependent such as HSV or VSV encephalitis, neonatal herpes simplex infections, varicella pneumonia, disseminated herpes simplex viral infection or esophageal herpes simplex infections. Although there are alternative treatments, they are considered to be significantly more toxic and we typically try to avoid such medications if possible.

Assessment: Due to unknown duration of IV acyclovir drug shortage, conservation and proper dosing (especially for obese patients) is imperative to preserve the limited supply. IV acyclovir is the drug of choice for: neonates with proven herpes simplex virus (HSV) disease, pregnant women with HSV or varicella-zoster virus (VZV) infection, and individuals with herpes simplex encephalitis.

Recommendation: During this shortage, we are recommending that IV acyclovir be reserved for patients with severe infections only and Infectious Disease consult will be required, except for the treatment of neonatal/PEDS patients. ID pharmacists will review all orders for IV acyclovir on a daily basis to ensure appropriate dosing and therapy duration (including NICU and PEDS).  As supply information becomes available, Pharmacy will provide status updates on this drug shortage.

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Physicians respond promptly to atrial fibrillation detected by insertable monitors, study finds

Insertable cardiac monitoring to detect atrial fibrillation (AF) guides both immediate and long-term clinical management of patients at high risk for stroke, according to recently released results of the multicenter REVEAL AF clinical study in which Main Line Health participated in 2013.

The study found that physicians were more likely to change clinical management of patients who were newly diagnosed with AF detected by insertable cardiac monitors (ICM). Moreover, physicians were more likely to make those management changes in newly diagnosed patients at their first follow-up visits and for those who reported AF-associated symptoms.

“Previously it was believed that early identification of AF in ICM patients would lead to meaningful changes in management. The results of this study show that most physicians do indeed find ICM data actionable, and most react promptly,” said Peter Kowey, MD, a cardiologist at Lankenau Heart Institute, the William Wikoff Smith Chair in Cardiovascular Research at Lankenau Institute for Medical Research, and one of the study’s authors.

The REVEAL AF study enrolled 446 patients, of whom 387 underwent ICM insertion and met inclusion criteria. Of those, previously undetected AF was found in 115 patients. Within that cohort of 115 patients, 87 (76 percent) had a change in clinical management, 80 of which occurred at the first follow-up visit.

The two most common changes in clinical management were prescriptions for oral anticoagulation (OAC) therapy, prescribed 63 percent of the time, and rate and rhythm control medications, prescribed 23 percent of the time.

“We also found that physicians whose patients self-reported AF symptoms — including fatigue, dizziness and shortness of breath — at the first visit after AF detection were more likely to change clinical management,” said Dr. Kowey, who also served on the steering committee for the REVEAL-AF study. “These patients tended to have higher maximal daily AF burden and longer AF episodes.”

Additionally, while study participants frequently reported AF symptoms during follow-up — even among patients who were not diagnosed with AF — physicians changed clinical management more frequently in those participants who were diagnosed with AF and who were symptomatic.

“That was unexpected, as OAC initiation was the most common change in management, and stroke risk is similar with patients with and without AF-related symptoms,” the authors noted. “However, it is less surprising for the initiation of treatment with rate and/or rhythm control, where the benefits are largely symptom-driven.”

Dr. Kowey and his colleagues noted that the REVEAL-AF study “provides insights into how physicians handle treatment decisions in the face of knowledge gaps and in the absence of clear guideline recommendations.”

Dr. Kowey also noted that definitive information regarding the absolute benefit of anticoagulation in patients with incidentally discovered AF will be available with the completion of clinical trials that currently are in progress.

The results to date of the REVEAL-AF study were published in “Changes in Management Following Detection of Previously Unknown Atrial Fibrillation by an Insertable Cardiac Monitor (from the REVEAL AF Study)” in The American Journal of Cardiology.

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Clinical Trial of the Week: Treatment trial for certain patients diagnosed with early-stage breast cancer

By Donna Loyle, communications specialist, LIMR

Researchers are comparing comprehensive radiotherapy (radiation to the breast, chest wall and lymph nodes) to standard breast radiation in treating patients with early-stage breast cancer.

Study #NSABP B-51/RTOG 1304 is a randomized phase III of patients diagnosed with T1-3, N1 cancer. Patients whose primary tumor has been deemed HER2-positive or HER-2 negative are also eligible. Patients must have already undergone at least eight weeks of standard chemotherapy.

All patients in the study receive systemic therapy as planned. They also are grouped into two study arms, each with two groups:

  • Arm1/Group 1A: Lumpectomy patients undergo whole breast RT once daily for five days for five weeks, followed by an RT boost to the lumpectomy cavity once daily five days for 1.5 weeks.
  • Arm1/Group 2A: Mastectomy patients do not undergo RT.
  • Arm 2/Group 2A: Lumpectomy patients undergo regional nodal RT with whole breast RT five days for five weeks, followed by an RT boost to the lumpectomy cavity five days for 1.5 weeks.
  • Arm 2/Group 2B: Mastectomy patients undergo regional nodal RT five days for five weeks.

This study is approved for Lankenau Medical Center and Bryn Mawr Hospital. The principal investigators are Albert DeNittis, MD, and Paul Gilman, MD. For more, email cancertrials@mlhs.org or visit www.mainlinehealth.org/research/clinical-trials/nsabp-b51-rtog-1304.

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Save the Date! Population Health Day 2019 Creating Connections: Conversations to Advance a Healthy Community for All

October 18, 2019

The focus of this one-day workshop is to define important areas for research and collaboration to address patient health care needs. The day will include presentations from population health researchers and others, as well as roundtables to promote questions and extensive interaction.

This community-wide conversation will offer perspectives on:

  • barriers to health care delivery;
  • strategies for research that lead to the best health outcomes for all; and
  • addressing disparities in health and wellness.

Where: Lankenau Medical Center

Target audience: all health care professionals, insurers, researchers and academics, legislators and policy makers, community health professionals, and the general public.

The day kicks off at 8 a.m. with Grand Rounds in the Lankenau auditorium. Executives from HealthShare Exchange and the Health Promotion Council will be speakers. Continuing medical education credits will be available for Main Line Health Grand Rounds attendees.

Following complimentary breakfast will be an interactive roundtable whose leaders will facilitate a lively discussion to identify key population health concerns in our community, determine the best way to prioritize strategic initiatives and create a plan of action.

Where: Annenberg 101 ABC

A complimentary lunch will be followed by a roundup of the morning’s discussion and insights.

At 2 p.m. Main Line Health residents are invited to discuss research training opportunities with an expert panel.

Hosts: Main Line Health Center for Population Health Research at the Lankenau Institute for Medical Research, and the Center for Population Health Research at Thomas Jefferson University.

This is a free event, and registration is not required of Main Line Health employees to attend Grand Rounds. To register for the rest of the day’s events, please RSVP to Meg Jones, JonesMe@mlhs.org, by Oct. 4.

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Physician Burnout Survey

From Walter Klein MD, on behalf of The Physician Wellness Committee

The incidence of physician burnout has worrisomely increased over the last decade and is now a hot topic of conversation. However, the rates reported vary greatly and likely are dependent on multiple factors including one’s own practice setting. To further investigate this issue at Main Line Health, an ad hoc committee on Physician Wellness has been established by the Medical Executive Committee. In an attempt to obtain more information about physician burnout among physicians on the medical staff at Main Line Health we have put together this brief survey. Please take the time to respond to the survey and encourage your colleagues to do the same. The results are important for us to establish a baseline and move forward with our next steps in addressing this critically important issue.

We thank you in advance for participating in this important effort as we move forward.

https://surveys.nationalresearch.com/survey/selfserve/1fd5/190801

Please respond by: October 25, 2019

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2019-2020 mandatory flu vaccine program begins next week

Colleagues,

The Main Line Health 2019-2020 mandatory flu vaccination program begins next week for employees, physicians, specified health care professionals and volunteers. Since 2010, MLH policy has required all physicians, specified health professionals, employees, contracted clinical personnel and volunteers to be vaccinated against influenza as a condition of employment or use of MLH facilities.

Employees hired during the non-vaccination period of March 31 and September 30th, 2019, are required to receive a flu vaccination during this current vaccination period.

Vaccinations are free and will take place across MLH until December 2, 2019, which is the deadline for compliance with our flu vaccination policy. You can see the complete vaccination schedule on the intranet.

  • The standard immunization is latex-free and will provide protection against four strains of flu, helping to reduce the risk of infection among your family as well as your patients and colleagues.
  • Egg-free (and latex-free) vaccinations for staff with previously noted egg allergies will be available at no charge. All individuals who were previously granted a medical exemption on the basis of an egg allergy are now required to participate in the mandatory flu vaccination program. Individuals 18 and over who are egg-allergic should call Occupational Health (484.565.1293) to schedule an appointment to receive the egg-free product, which is also latex-free.
  • Individuals who are 65 years or older and requesting the trivalent vaccine should call Occupational Health (484.565.1293) to schedule an appointment to receive this product.  Please note, this vaccine contains egg, but is latex-free.

The safety of our patients, employees, medical staff and community is best served by high rates of immunity.

To speed the immunization and data entry process and ensure more detailed reporting, employees should fill out “My MLH Flu Consent Form” online through MLH Self Service before being vaccinated and bring their ID badge to the vaccination site. Remember to dress appropriately so that your upper arm can be easily accessed.

  • Employees who are vaccinated at a non-MLH facility may send documentation (Informed Consent Form provided by your vaccination site or receipt indicating vaccination) to the MLH Occupational Health Office by fax to 610.903.1082 or by interoffice or regular mail to: Occupational Health Exton Square Health Center, 154 Exton Square Parkway, Exton, PA 19341
  • Physicians vaccinated at non-MLH locations will need to send proof of vaccination to the Medical Staff Office by fax (484.337.3731 or 484.337.8036) or email (elliotta@mlhs.org), including the Lot Number of the vaccine. Retain original documentation for at least four months.

MLH strongly urges all staff to receive the vaccination for the upcoming influenza season. Vaccinating health care professionals against influenza has been shown to result in lower flu rates in the community.

Those who wish to apply for a medical exemption for 2019-2020 should use the 2019-2020 Flu Medical Exemption available on the intranet. Staff who had temporary exemptions previously will need to reapply in order to receive a medical exemption for this flu season. Anyone who has received a permanent exemption does not need to reapply unless notified otherwise.

Medical exemptions will be reviewed by our Occupational Health Physicians. Religious exemptions will continue to be recognized, but we strongly urge all staff to receive the vaccination for the upcoming influenza season to safeguard themselves and our patients. Instructions for submitting new religious exemption requests are included in the Flu FAQs on the intranet. All exemption requests need to be submitted no later than October 31, 2019.

Complete information — including the vaccination schedule, Flu FAQs, medical exemption form, and flu reference material — is available through the 2019-2020 Flu Schedule link on the MLH intranet homepage.

As always, thank you for your continued support and participation and for all that you do to help keep our patients safe.

Sincerely,

Paul

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