Medical Staff e-Update

Mark Smith, MD

Mark Smith, MD

Clinical Service Chief and Medical Director of Emergency Services, Executive Medical Director of Adult Hospitalist Services & Chief of Staff

Ray King, MD

Senior Vice President, Medical Affairs & CMO

Issue 18 - February 25, 2015

Every spring, Allegiance Health honors and thanks our exceptional physicians with a Doctors’ Day celebration. One of the most meaningful ways we let physicians know they are appreciated is to share expressions of heartfelt gratitude from their patients.

This year, we received more than 600 letters from grateful patients and family members who wanted to say thank you to a special doctor in their lives.

Highlighting our 28th annual Doctors’ Day event was the presentation of the 2015 Physician Excellence Award to general surgeon Christopher Pfeifer, DO.

Allegiance Chief Medical Officer Ray King, MD, praised Dr. Pfeifer’s engagement with patients and his exceptional attention to detail. Dr. King also thanked Dr. Pfeifer for the great leadership he has shown by training our residents, even before we had a Graduate Medical Education program.

Allegiance Health is thankful to Dr. Pfeifer and the entire network of dedicated, skilled physicians who make a meaningful difference in the lives of our patients and in our community every day.

Allegiance Health is pleased to receive the 2015 Patient Safety Excellence Award™ from Healthgrades, a leading online resource for comprehensive information about physicians and hospitals.  Making it unique among all other hospitals in the state of Michigan, Allegiance has been honored with this distinction for the seventh consecutive year in recognition of its demonstrated dedication to patient safety.

“We congratulate all 2015 recipients for their considerable achievement and outstanding performance in the area of patient safety,” said Evan Marks, Healthgrades Chief Strategy Officer.

In 2015, there were 467 hospitals across the nation that achieved the Healthgrades Patient Safety Excellence Award™. The distinction places this elite group of hospitals within the top 10% of all hospitals evaluated for their excellent performance in safeguarding patients from serious, potentially preventable complications during their hospital stays.

“Receiving this distinction seven years in a row is very meaningful to us,” said Georgia Fojtasek, Allegiance President and CEO. “Our physicians and staff are dedicated to patient safety. We hardwire safety behaviors across our organization to create the safest care environment possible.”

Safe care starts with identifying our patients using two identifiers – name and date of birth or medical record number, and verifying that the two identifiers match the clinical documentation for care that is provided.  Performing patient identification ensures that the right patient receives the right treatment at the right time.  Patient identification is considered an Always Event – every patient, every time. 

Allegiance Health has had an increased focus on preventing patient identification errors.  For fiscal year 2015, there have been a total of 215 events in which patient identification was not accurately completed.  Errors attributed to medical staff accounted for 10% of the total patient identification errors.

The most frequent error involving physicians related to order entry on the incorrect patient. 

The most common patient identification error with CPOE is ordering on the correct patient but the wrong patient account.  This results in orders not being visible to nursing and all performing departments.  

The most common cause of this is the use of an improper workflow when selecting the patient visit [encounter] while the patient is in the ED.  Before the patient is switched to inpatient or observation status they do not appear on the provider’s work list in Physician Portal.  

The recommended practice is to:

  1. Search for the patient in the CM Patient Search module on the Patient Locator tab using the medical record number or first and last name.
  2. Open the list of ‘visits’ and select the current visit [encounter].  The patient can be added to the work list from this screen but will not appear there until their status is changed.
  3. Orders placed on this encounter will persist when the patient status is changed.
  4. If select the patient without opening visits and there is either an old inpatient encounter that has not been closed [seem to be more of these lately] or a pre-admit encounter for upcoming procedure visit one of these rather than the current encounter will be selected and any orders placed will be on the wrong visit [encounter].

Ordering on the wrong patient is less common.

The most common cause of this is selecting the CPOE tab directly while on the Census tab without first selecting a patient.  The result is the first patient on the work list is selected.

  1. Should always make sure patient is selected before moving to another tab in Physician Portal.  
  2. We have created quick links in the work list that select patient and move to the desired tab with one click.
  3. The links have been set up for all new users created but there are users without the links configured [and no way to know who does or does not have configured].  It can be done by the individual provider but most not inclined to customize their view.
  4. This is supposed to be part of the training for new users.

The next most common cause of wrong patient is when a provider leaves Physician Portal open on the desktop and another provider comes along and begins using as if they had logged in.

Always log out of clinical applications when you walk away from a computer.

With regard to ensuring the correct patient and encounter it is displayed on all screens within the orders workflow but frequently not checked [I admit I don’t always either].

Jonathan Sykes, MD, Chief Medical Informatics Officer said, “When I talk to providers about this, I use the old ‘pimping’ question that used to be asked of medical students.  Hang a chest x-ray and ask, what is the first thing you should look at? The usual reply is something about the heart or lung fields.  The rebuke is—no, you look at the patient name to make sure you are looking at the right film.  Of course we don’t have much paper or film anymore which makes it all the more important.”

  1. At the top of all tabs in Physician Portal there is a selection box for both the currently selected patient and encounter [visit].
  2. On the CPOE tab there are number of demographic indicators including name, age, medical record number, room number, admit date, etc.
  3. Once CPOE is launched the name, age, medical record number, room number are displayed in the upper left banner.
  4. Unfortunately none of these include the patient’s date of birth and we are unable to change the display to show this.

We want to know about barriers you may have to completing patient identification.  Please contact Patient Safety and Advocacy Services at (517) 841-7925, if you have concerns or suggestions.

National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are set forth by Medicare and define indications and limitations of payment for certain tests, treatments and procedures. 

Within the NCDs/LCDs are descriptions of the documentation that should be present in the medical record for Medicare to pay for the service. Does your medical record contain enough detailed information to support performing the test or procedure? It is important to include a complete description of the patient’s historical and clinical findings, and avoid conclusive statements only.

NCDs and LCDs have been around for some time, but here’s a new Medicare rule that just came out in the Fall of 2014 called “Transmittal 541.” Essentially, if an inpatient surgical procedure is determined to be unnecessary by Medicare (per the NCD or LCD), then the claim will not be paid, and, the surgeon’s fee will be at risk. The surgeon’s professional payment may be taken back by Medicare.

It pays to know your NCDs and LCDs. View the Medicare website for the indexes of NCDs and LCDs.

Allegiance Health has partnered with the nationally recognized educational company TrustHCS to offer specialty specific ICD-10 education for our medical staff and their office staffs.  These 1 to 2 hour sessions will be held in late July to discuss the changes that ICD-10 will bring, new documentation requirements, as well as specific coding examples of changes related to the most commonly used diagnoses by specialty. 

Watch for more information in future newsletters and fax blasts for dates and times. We hope you’ll take advantage of these educational sessions.

Randy Bell, MDRandy Bell, MD, Internal Medicine

We are pleased to announce that Randy Bell, MD, internal medicine, has joined the practice of Allegiance Family Medicine – North Street. After graduating from Wayne State University School of Medicine, he completed both an internship and residency in internal medicine at the Medical College of Wisconsin. Dr. Bell is board certified, and his areas of special interest include primary care, preventive care and chronic disease management. He is currently accepting new patients.

Amritraj Loganathan, MD, Neurosurgery

Allegiance Neurosurgery welcomes Amritraj Loganathan, MD, to the practice of Harish Rawal, MD. A graduate of Ohio State University College of Medicine, Dr. Loganathan completed both a residency and an internship in neurological surgery at Wake Forest University Baptist Medical Center. His areas of expertise include brain and spine tumors, lumbar stenosis, and minimally invasive spinal surgery.

Lung cancer is the leading cause of cancer-related death in the United States and about 85% of lung cancers are attributed to cigarette smoking. In fact lung cancer causes more deaths than cancers of breast, colon and prostate combined. Five-year survival rates for lung cancer are only 16.8% partly because most patients have advanced lung cancer at the time of initial diagnosis. Until recently, no method of screening has shown to reduce lung cancer mortality. 

National Lung Screening Trial demonstrated that screening with low-dose CT chest in comparison with screening with chest x-ray can statistically significantly reduce the mortality from lung cancer by 16% to 20% in high risk population aged 55 to 77 years.

The symptoms of lung cancer, unfortunately, do not usually appear until the disease has advanced to an incurable stage. The American Cancer Society provides screening guidelines for those who are at high risk for lung cancer due to cigarette smoking.

The majority of Allegiance Health patients diagnosed with lung cancer are in their 50s or older, and are most often already in Stage 4, when the chances of survival are lower. Our new Lung Screening program allows us to find and treat cancers earlier and improve quality of life and survival rates.  

Allegiance Health now offers CT lung screening for those who are at high risk for lung cancer. When lung cancer is detected at an early stage, there is a better chance for a cure, and we believe patients can gain peace of mind by knowing about their lung health.

CT lung screening is endorsed by reputable organizations, such as the U.S. Preventive Services Task Force, the National Comprehensive Cancer Network, American Cancer Society, Society of Thoracic Surgeons, American College of Chest Physicians, and the American College of Radiology. Since this test is only minimally covered by health insurance at this time, Allegiance Health makes it available at an affordable cost.

Calculating the lung cancer risk

Allegiance Health follows the National Comprehensive Cancer Network Guidelines for Lung Cancer Screening. These guidelines (below) are based on “pack years,” which equals the number of packs of cigarettes an individual smoked per day times the number of years smoked. For example, someone who smoked two packs a day for 10 years would have 20 pack years—the same as if they had smoked one pack per day for 20 years.

Low risk patients*Moderate risk patients*High risk patients
  • Are 50 or younger AND
  • Have smoked less than 20 pack years
  • Are 50 or older AND
  • Have smoked or been exposed to second-hand
  • Smoke for more than 20 pack years
  • Have no additional risk factors 
  • Are 55 to 77 years old AND
  • Smoked more than 30 pack years
  • Smoke now or quit smoking within the past 15 years

OR

  • Are 50 or older AND
  • Have smoked 20 pack years AND
  • Have one of the following additional risk factors:
    • Radon or asbestos exposure
    • Occupational exposure
    • History of cancer, or family history of lung cancer
    • History of COPD or pulmonary fibrosis

* For individuals at low or moderate risk, the American Cancer Society guidelines do not recommend CT Lung Cancer Screenings

The Lung Screen Team

Allegiance Health offers an oncology trained team including a patient navigator to provide support and guidance for patients with lung cancer and their families from diagnosis through treatment. No referral is required. The patient navigator helps by:

  • Determining if your patient qualifies for the Lung Screen program
  • Explaining to patients how and why tests are done and answering questions about complicated test results
  • Defining medical terms in a way that makes sense
  • Reducing confusion about plans of care and providing informationregarding conditions and treatments
  • Connecting patients to the resources they need to cope
  • Scheduling your patient and navigating their care according to results
  • Listening and caring in a time of need

Dr. Mohan Kulkarni leads the Lung Screen team and the Lung Disease Site Team. He is an esteemed surgeon whose areas of expertise are the treatment of lung and esophageal cancers and gastroesophageal reflux disease (GERD).  He joined the Allegiance Medical Staff in 1996 and serves as our Medical Director for Quality and Safety. He is also a member of the Allegiance Physician Advisory Council.

Dr. Kulkarni is on the faculty of Allegiance Health’s Graduate Medical Education program and is a member of the teaching staff at the University of Michigan Medical School.  Patients who qualify for the program will meet with Dr. Kulkarni to review results and make a personalized care plan. 

Licensed Radiologic Technologists with additional certification in CT Scanning and expertise in Lung Screening will perform the low dose CT Scan.   Immediately following the CT Scan, your patient may have an opportunity to personally sit with Dr. Parikh or another highly qualified physician, to discuss the images and ask questions. 

Dr. Samir Parikh is the Vice Chief Radiologist with Jackson Radiology and has been at Allegiance Health for 12 years. He is Fellowship trained in Cardiothoracic Radiology with emphasis in lung diseases, and is specially trained to read the low dose CT lung  screening images.

Call the Lung Patient Navigator, Lil McGaffigan RN, at (517) 780-7388, for screening, assistance or questions.

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