William Gray, MD, presents at ISET

William Gray, MD, System chief of the Division of Cardiovascular Disease at Main Line Health and president of the Lankenau Heart Institute, presented on to reduce stroke risk at the  carotis stenting technology International Symposium on Endovascular Therapy (ISET) in January in Hollywood, FL.

Gray’s presentation highlighted new carotid artery stenting technologies that have reduced risk for stroke during and after the procedure to much lower levels than historically seen. Some technologies have data that show improvement in clinical and surrogate marker results compared with historical CAS data, and other technologies in development have potential to make further advances. View this article on his presentation.

 

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Syphillis laboratory test : An update

 

By Pradeep K. Bhagat, MD, System chairman, Department of Pathology, MLH

Effective February 25, Main Line Health laboratories will perform syphilis test utilizing reverse algorithm. Currently, in U.S. two diagnostic algorithms are used for serological diagnosis of syphilis-the traditional algorithm and the reverse algorithm. The traditional algorithm involves an initial test using a non-treponemal assay followed by confirmation of a positive result with a more specific treponemal assay (used now at Main Line Health Labs). The reverse algorithm uses treponemal assay as an initial test followed by confirmation of a positive test with a non-treponemal assay (RPR). A discrepant result between an initial positive treponemal assay and a subsequent assay would be further tested with a second treponemal assay (FTA). Both algorithms are acknowledged and supported by the US Centers for Disease Control and Prevention (CDC). Nontreponemal assay (RPR) is known to have lower specificity and lower sensitivity than treponemal assay. The reverse screening algorithm for syphilis testing can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis. Treponemal assays (TP) are automated and we can easily perform on our existing laboratory instrument.

 

Syphilis treponemal assay that will be performed on Abbott instrument is a chemiluminescent microparticle immunoassay (CMIA) for the qualitative detection of antibodies (IgG and IgM).

 

If you have any questions please call Dr. Bhagat at 484,476.3521 or Derrick Smith, chemistry supervisor, at 484.476.8446.

Syphillis laboratory test :  An update

By Pradeep K. Bhagat, MD, System chairman, Department of Pathology, MLH

 

Effective February 25, Main Line Health laboratories will perform syphilis test utilizing reverse algorithm. Currently, in U.S. two diagnostic algorithms are used for serological diagnosis of syphilis-the traditional algorithm and the reverse algorithm. The traditional algorithm involves an initial test using a non-treponemal assay followed by confirmation of a positive result with a more specific treponemal assay (used now at Main Line Health Labs). The reverse algorithm uses treponemal assay as an initial test followed by confirmation of a positive test with a non-treponemal assay (RPR). A discrepant result between an initial positive treponemal assay and a subsequent assay would be further tested with a second treponemal assay (FTA). Both algorithms are acknowledged and supported by the US Centers for Disease Control and Prevention (CDC). Nontreponemal assay (RPR) is known to have lower specificity and lower sensitivity than treponemal assay. The reverse screening algorithm for syphilis testing can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis. Treponemal assays (TP) are automated and we can easily perform on our existing laboratory instrument.

 

Syphilis treponemal assay that will be performed on Abbott instrument is a chemiluminescent microparticle immunoassay (CMIA) for the qualitative detection of antibodies (IgG and IgM).

 

If you have any questions please call Dr. Bhagat at 484,476.3521 or Derrick Smith, chemistry supervisor, at 484.476.8446.

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MEC minutes available for viewing

By William Ayers, MD, MLH medical staff president.

In an effort to keep the MLH medical staff fully informed on issues concerning medical staff governance, this month we have begun publishing the past three months of MEC minutes on a rotating schedule. These minutes can be accessed on the MLH Intranet at  http://intranet/medicalstaff/page71.aspx

As always, if there are any topics or concerns that you would like to bring to the attention of the MEC, please contact your campus medical staff officers/MEC representatives, the Medical Staff Office or me directly.

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STEEEP Huddle: E for Efficient

This week’s STEEEP Huddle topic – submitted by Karl Ahlswede, MD, medical director of Palliative Care, MLH, focuses on advance care planning, which defines patients’ health care goals and wishes. It requires answering important questions about quality of life, their health care surrogate and more. The plan provides vital information to clinicians and loved ones if patients are unable to communicate and can enhance efficiency of patient care. Visit mainlinehealth.org/acp or call 484.580.1234 to receive a free Advance Care Planning Kit.

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

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Bryn Mawr Hospital Pavilion opens

Levels four and five of the Pavilion have opened, receiving patients transferred from the existing hospital. The transfer of patients will continue over the next several weeks.

A Pavilion Move Command Center, located in the Board Room, 1st floor D wing, is now set up to provide support during the relocation period. You are encouraged to contact the command center with any move related issues or concerns that may arise during the relocation process. Some examples of issues that may arise during the move may be, but are not limited to: IT concerns, locating a specific piece of equipment, furniture questions and environmental services needs. If you have a non-emergency issue after the command center closes, you can email the command center and your issue will be addressed the following morning.  If there is a critical event that requires immediate attention, (i.e. a major clinical, facility or IT issue), please follow Bryn Mawr Hospital Protocols.

Learn more about the new Patient Pavilion at Bryn Mawr Hospital.

Photo:  BMH ICU staff ready to start rounds for the first time in the new Pavilion

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MLH supports heart month throughout February

 

Throughout the month of February, MLH is offering events in the community and on the MLH campuses to promote heart health. Click here to find more information about MLH’s calendar of events for February 2019. Don’t miss out on the health fairs, educational seminars and screenings hosted all throughout the MLH community! To register for an upcoming event below, call toll-free 1.888.876.8764 or visit mainlinehealth.org/heartmonth.

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Clinical Trial of the Week: Device trial for patients diagnosed with left heart failure

By Donna Loyle, communications specialist, LIMR

Patients diagnosed with significant heart failure and elevated left atrial pressure may qualify to participate in a prospective, early feasibility study that is examining the safety and efficacy of the Edwards transcatheter atrial shunt system.

Eligible patients in the ALT-FLOW trial must have chronic symptomatic heart failure documented by the following:

  • NYHA class II with a history NYHA class > II; NYHA class III; or ambulatory NYHA class IV; and
  • at least one hospital admission for heart failure in the past 12 months or elevated BNP
  • elevated left atrial or wedge pressure

Patients must have no significant valve disease, such as mitral valve regurgitation (>3+ MR), tricuspid valve regurgitation (>2+ TR), or aortic valve disease (>2+ AR or > moderate AS). Additionally, patients must be stable on guideline-directed medical therapy for heart failure and expected to be maintained on such therapy without change for six months.

Trial participants will have the Edwards transcatheter atrial shunt implanted in their heart and undergo close follow-up care for five years. Other inclusion/exclusion criteria apply.

The principal investigator is William A. Gray, MD. The study is available at Lankenau Medical Center. For more, visit https://www.mainlinehealth.org/research/clinical-trials/alt-flow

 

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MLH names Carolyn Gorman SVP for Strategy, Business Development, Communications and Marketing

By Jack Lynch, president and CEO, MLH

Dear Colleagues:

I am very excited to announce the appointment of Carolyn Gorman as Main Line Health’s new senior vice president for Strategy, Business Development, Communications and Marketing. Carolyn officially joined us in her new role on Monday, February 4, 2019.

As SVP, Carolyn will provide strategic direction for all disciplines of strategic planning, marketing including digital strategy, business development, brand management, referral development, communications, public and government relations, and customer relationship management.

Carolyn has over 25 years of experience in the healthcare industry as an operations administrator, service line director and strategic integration officer.  Most recently, Carolyn served as vice president, UPHS System Integration at the University of Pennsylvania Health System where she led system-wide integration efforts across their entities with the addition of new strategic alliances and consolidations.  This included establishing the first Primary Care Service Line for Penn Medicine; developing an organizing structure for the Trauma, Injury and Acute Care Rescue Network; reestablishing the Women’s Health Service Line; developing a Post-Acute Care Preferred Provider Network; and she provided oversight for the successful integration of Lancaster General Health into Penn Medicine.

Carolyn holds a BA in Organizational Management from Immaculata University and an MBA in Healthcare Administration from Penn State University.  She is a member and past president of AMGO-OBGYN professional society; member MGMA; member and certified with American College of Medical Practice Executives; and member American College of Healthcare Executives

Carolyn and her husband live in Downingtown, where they have resided for the past 25 years. Please join me in welcoming Carolyn to the Main Line Health family.

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Please support opposing changes to venue rules in medical liability actions

By Andy Norton, MD, CMO, MLH

Dear MLH Medical Staff,

I am writing to request your support in opposing the changes to the venue rules in medical liability actions being proposed by the Civil Procedural Rules Committee of the Pennsylvania Supreme Court.

Prior to 2002, before the current venue rules were instituted, Pennsylvania experienced a medical malpractice crisis in which liability insurers left the market, limited their insurance offerings, and experienced significant downgrades in their credit ratings. This both sharply reduced the availability of medical liability insurance to providers and left hospitals and physicians facing skyrocketing premiums. To continue to keep doors open, many hospitals were forced to reduce services. In addition, many physicians and medical residents left the Commonwealth.

Pennsylvania physicians and hospitals—and, most importantly, health care consumers—would be adversely affected by going back to the previously detrimental venue rule. By allowing venue in counties with little relation to the underlying cause of action, claimants could shop for verdict-friendly venues in which to file their suits. This would again lead to higher premiums for medical liability insurance, make Pennsylvania less attractive to physicians and other health professionals considering practicing in the state, increase medical costs, and adversely impact access to care for consumers.

Implications of the proposed change in venue rule are not in the best interest of our medical staff, and most importantly, the public. Among other adverse outcomes, this change will likely lead to:

  • Increased medical liability insurance rates, which will make Pennsylvania a less attractive place for physicians, nurse practitioners, and midwives to practice.
  • Access issues for patients, due to difficulties in recruiting and retaining physicians and other health care practitioners.
  • Increased health care costs for businesses, consumers, and government payors.

I urge you to join your colleagues at Main Line Health, other PA hospitals and health systems, The Hospital and Healthsystem Association of Pennsylvania, and the PA Medical Society, to help stop this threat from becoming a crisis. Please take action by clicking here to submit comments via an easy-to-use online form by the deadline of February 22.

 

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Help us Eliminate the Power Gradient at MLH

By Jack Lynch, president & CEO, MLH

Colleagues,

In September 2018, we implemented the Power Gradient Reporting and Resolution Policy in response to incidents at MLH and our AHRQ (Agency for Healthcare Research and Quality) Patient Safety Survey. The results of the survey identified that only 52% of our team felt empowered to question authority and speak up for safety.

Eliminating the power gradient is a critical component in ensuring a safe, respectful environment across Main Line Health for both patients and staff. I personally am committed to eliminating any power gradient in my interactions with the entire MLH team. I am also holding leaders at all levels as well as all employees, physicians, and volunteers, to the same standard. Please know that any reported violation of the Main Line Health Power Gradient Reporting and Resolution Policy will be taken seriously and handled in a timely and equitable manner.

The definition of the power gradient is: the extent to which power is distributed unequally or a difference in perceived power that makes expressing concerns, questioning, or clarifying instructions difficult for someone who feels they are in a position with less power. Power gradients can also exist as a result of intimidating and disrespectful behavior that ultimately disrupts the culture of safety and prevents collaboration, communication, and teamwork, which is required for safe and highly reliable patient care.

  • Disrespect and intimidation – a direct violation of the Main Line Health Power Gradient Policy –can manifest in many forms, including the following examples:
  • Inappropriate language (profane, insulting, intimidating, demeaning, or abusive);
  • Belittling or shaming others;
  • Refusal to comply with known and generally accepted practice standards, the refusal of which may prevent other providers from delivering quality care;
  • Not working collaboratively with other members of the interdisciplinary team;
  • Creating rigid or inflexible barriers to requests for assistance or cooperation;
  •   Hitting, pushing, shoving, throwing objects or other attempts at physical intimidation;

In addition to the AHRQ survey, several questions in our annual Employee Engagement Survey address our focus on the power gradient, including:

  •  Staff members are willing to report errors.
  • I can freely speak up to someone with more authority if I see something that may negatively affect patient care.
  • When an error is reported, my department/unit handles it in a fair and just manner.

We will continue to monitor outcomes for these questions as a baseline for departments in MLH that have opportunity to alleviate any power gradient issues. It is important to note that we are taking steps to eliminate these behaviors at MLH, not only as a result of our survey feedback, but also because there has been an increased level in the reporting of inappropriate behavior occurring in our environment.  I encourage you to use our Culture of Safety tools to speak up to the individual directly and immediately as a way to achieve a real time resolution. Once you report a concern, if you experience retaliation or perceive something to be retaliatory you must report it immediately. Retaliation for speaking up will not be tolerated at MLH.

I ask that everyone at Main Line Health treat one another with dignity and respect and take the responsibility to report behaviors that you experience or witness that are disruptive, intimidating or contribute to a power gradient.

For more information, the Power Gradient Reporting and Resolution Policy can be found on the Intranet under Policies and Procedures.

Jack

 

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