M e d i c a l S ta f fGrandRounds

January 11 “State of the Hospital”Michael Maron, President/CEO

January 18 “Food Allergies”Mathew Varghese, MD, JFK Medical Center Jersey City, NJ, Future HNMC Staff Member

January 25 “Prostate Cancer Update”Daniel Lowe, MD, HNMC, Urology Dept.

FEbruary 1 “Healthy Heart Initiatives”Judith Kutzleb, DnP, HNMC, Vice President, Education FEbruary 8 “An Update on MDR & XDR- Tuberculosis” James brust, MD

FEbruary 22 TBA umesh Gidwani, MD, FCCP, FCCM, Chief, Cardiac Critical Care, Cardiovascular Institute, Mount Sinai Hospital; Asst. Professor of Medicine, Mount Sinai School of Medicine

MarCh 1 “Treatment Advances in Non-Small Cell Lung Cancer” Gregory riely, MD, Memorial Sloan-Kettering Cancer Center, Thoracic

Location: Marian HallTime: 9 - 10 a.m.

(unless otherwise noted)

MD360ºIn

dici

aor

Post

age H

ere

US

Post

age

PAID

718

Tean

eck

Road

• Te

anec

k, N

J 076

66

Medical Staff OfficersPresident: Patricia Burke, M.D.Vice President: Thomas Birch, M.D.Secretary: Mihran Seferian, M.D.Treasurer: Ronald White, M.D.

Members-At-Large:Medical Chiefs Representative: Joel Goldfarb, M.D.Surgical Chiefs Representative: Harris Sterman, M.D. Member At Large: Giuseppe Condemi, M.D.Member At Large: Rosanna Modesto, M.D.

Medical Staff Department Directors and Division ChiefsDept. of Anesthesiology: Alan Gwertzman, M.D. Dept. of Emergency Medicine: Richard Schwab, M.D.Dept. of Family Practice: Joseph Cassotta, M.D.Dept. of Interventional Radiology: John Rundback, M.D.Dept. of Medicine: Joseph Schuster, M.D. Allergy: Patrick Perin, M.D. Cardiology: Stephen Angeli, M.D. Dermatology: Jeffrey Rapaport, M.D. Endocrinology: Mark Wiesen, M.D. Gastroenterology: Joel Goldfarb, M.D. Infectious Disease: Thomas Birch, M.D. Internal Medicine: Lewis Attas, M.D. Nephrology: David Levin, M.D. Neurology: David VanSlooten, M.D. Oncology: Beata Pieczara, M.D. Psychiatry: Sharad Wagle, M.D. Pulmonary Medicine: Stuart Silberstein, M.D. Radiation Oncology: Charles Vialotti, M.D. Rehabilitative Medicine: George Gombas, M.D. Rheumatology: Ralph Marcus, M.D.Dept. of Obstetrics & Gynecology: Christopher Englert, M.D.Dept. of Pathology: Drew Olsen, M.D. Dept. of Pediatrics: Harry Banschick, M.D. Dept. of Radiology: Jacqueline Brunetti, M.D.Dept. of Surgery: John Poole, M.D. Dentistry: Steven Haber, D.D.S. General Surgery: Joseph Manno, M.D. Neurosurgery: Patrick Roth, M.D. Ophthalmology: Christopher Brown, M.D. Orthopedics: Jeffrey Steuer, M.D. Otolaryngology: John Poole, M.D. Podiatry: Ritchard Rosen, D.P.M. Plastic Surgery: Harris Sterman, M.D. Thoracic Surgery: Ignatios Zairis, M.D. Urology: George Klafter, M.D. Vascular Surgery: Kenneth Fried, M.D.

News from and for Holy Name Medical Center’s

Medical Staff

Also available online at:www.holyname.org/md360

Sept/Oct/Nov 2010

ItisgreattobebackinJerseyandworkingwiththeexcellentteamofpeopleatHolyNameMedicalCenter.Iwanttothankallofyouwhohavereachedouttomeandmademefeeltrulywelcome.IntheshortamountoftimeIhavebeenhereitiseasytoseewhyHolyNameisroutinelyreviewedasoneofthebestplacestoworkinNewJerseyandoneofthebesthospitalstoworkatinthecountry.IlookforwardtomeetingthoseofyouwhoIhavenotyetmet,andworkingcloselywithallofyouoverthecomingyearstomakeHolyNameMedicalCenterthefirstchoiceinhealthcareforourcommunityofpatientsandproviders.Pleasestopbymyofficeifyouneedtodiscussanythingwithme,orjuststopbytosayhelloandintroduceyourselfifourpathshavenotyetcrossed.

Zen and The Art of Physician Autonomy Maintenance IrecentlyreadanarticlewrittenbyJamesL.Reinertsen,MD,thathithomeforme.IhaveheardDr.ReinertsenspeaktogroupsofphysiciansandhehasalwaysimpressedmeasadoctorwhounderstoodthestrugglethatI,asaninternist,havefeltontheissueofautonomy,asitrelatestodailypracticeanddecision-making.Inthearticleentitled,“ZenandtheArtofPhysicianAutonomyMaintenance,”hewrites,“Whilesomepartofmedicineisregulatablescience,muchofitisunregulatableart—anartwhichdependsonourabilitytobuildrelationshipswithpatientsandfamilies,tosetanswerstopatients’questionsintothecontextoftheirlives,andtoheal,evenwhenoursciencecannotcure.Physicians’fierceattachmenttoclinicalautonomyhasabasisinthistruth:notwopatients,andnotwodoctors,arethesame,andthattheartofmedicinehappenssomehowintherelationshipbetweenthoseindividuals.”

Today’sphysiciansstrugglewiththeapparentconflictbetweenappropriateindependenceandthe“restrictions”imposedbyourcurrenthealthcaresystem.Reinertsendoesanexcellentjobdetailingwhythereisaneedtoretainphysicianautonomy,buthealsoarguesthatuncheckedautonomyandaresistancetotheuseofsuchthingsasevidencebasedguidelineshasleadtoourcurrenterror-pronehealthcareenvironment.Heconcludeswiththefollowingstatement:“Themosteffectiveapproach,theprofessionalapproach,wouldbetojointogetherwithourcolleagues,invenueslargeandsmall,todecideonandapplythebestsciencetogether,asaprofession.TheZenparadoxofclinicalautonomyisthatbygivingitawaytoourcolleagues,wegainitasaprofession.” IntheshorttimeIhavebeenatHolyNameIsensethatthisMedicalCenterhasdoneanexcellentjobbalancingphysicianautonomywiththeapplicationofevidencebasedmedicinetobestmeettheneedsofourpatients.IhopethatasyourCMO,IcancontinuetohelpyouandHolyNameMedicalCenterbalancethisongoingstrugglebetweenautonomyandindependence,andthatwhenallissaidanddone,wewillbeaclinicallyandfinanciallystrongerinstitutionifwestrikethecorrectbalance.Ifwegetitright,HolyNameMedicalCenter,itsmedicalstaffandmostimportantly,ourpatients,willallbenefit.IhaveReinertsen’sfullarticleifanyoneisinterested;stopbymyofficeandIwillgiveyouacopy.

rePOrT frOM The Chief MeDiCAL OffiCer

Thanks to All

Adam Jarrett, MD, is Executive Vice President/Chief Medical Officer at Holy Name Medical Center. He can be reached at 201-833-7273.

Asamiddle-agedRollingStonedevotee,IwasexcitedtoseeMickJagger’sfaceonthecoverofThe New York TimesStylesectionfromthispastweekend.Greedily,Igrabbedthemagazine,flippingthroughthepagesofhigh-endfashion,expectantlylookingforthearticlewithpicturesofMick.Surprisingly,andinstead,IhappeneduponpicturesoftheBlessedVirgininanarticlebyHollyBrubachentitled,“TheImmaculatePerception.” ForthosenotoftheRomanCatholicfaith,today,December8th,isthedayoftheImmaculateConception,adayuponwhichMarywasconceivedwithoutsinsothatshecouldbetheMotherofGod,theMotherofJesus.HollyBrubach’sarticle,inessence,belittlesMary,placingdoubtonherroleintheCatholicChurchandevenonthenecessityforherexistence.ShecastigatesandpeevishlymockstheCatholicfaithfulfortheirbeliefs,whileignoringthedifferencesandmysteriesofotherreligions.PerhapsMs.BrubachconsidersitopenseasononCatholics,butpolitically

incorrecttoopineonthetheologicaldictatesofBuddhism,Hinduism,Islam,Judaism,orevenUnitarianism(afteralltheytheoreticallyprayto“towhomitmayconcern”). Althoughthisessaymaysoundsimilartoalettertotheeditor,itisnot.Itisratherapleatoacceptotherpeople’sbeliefsandfaithintheirreligion. So,inthisseasonofjoyandhappiness,letusallcontinuetorespectoneanother’sviewpointsandcontinuetoworktogetherforthebenefitofall. Peace,JoyandHappinessintheNewYear!

Patricia A. Burke, MD, PhD, is President of the Medical Staff and an ophthalmologist on staff at Holy Name Medical Center.

frOM The PreSiDenT Of The MeDiCAL STAff

A Plea to Accept Others’ Beliefs

Communicate with Your Colleagues:

Write an article for MD360. Share an exciting new development in your specialty, give your opinion on a health-related issue or tell about a recent achievement.

Email your submission to: editorMD360@holyname.org. Contributions are accompanied by the author’s photograph, Holy Name title and practice contact information.

2

HolyNameMedicalCenterhascontractedwithJAThomasandAssociates(JATA)toimplementaClinicalDocumentationManagementProgram(CDMP)whichwillbegininJanuary2011. JATAspecializesinimplementingaCDMPforhospitalsandtheirphysicianswiththesolepurposeofcomprehensivelyimprovingclinicaldocumentationforinpatientcareatacutecarefacilities.With the help of JATA, hospitals around the country have improved their documentation, typically resulting in a 4-8% improvement in Case Mix Index (CMI).

Program Benefits HNMCwillbenefitfromacomprehensiveclinicaldocumentationprogrambyestablishingthefollowing:• Appropriateseverity,complexityandrisk ofmorbidityandmortalityprofiling• CaseMixIndexthatismorereflectiveof ourpatients’severityofillness• Completeandaccuratecoding• SupportfordocumentationofHospital AcquiredConditions(HAC)• Increasedreadinessfordealingwith complexrules,regulations,andinitiatives requiredbygovernmentandcommercial payors

role of the Clinical Documentation Specialist OurCDMPwillbesupportedbyClinicalDocumentationSpecialists(CDS)whoareregisterednurseswithastrongcriticalcareormedical/surgicalbackground.TheCDSwillbeassignedtospecificunitsandbecomeanintegralpartoftheinterdisciplinaryteamtofacilitateimprovementintheoverallquality,completenessandaccuracyofmedicalrecorddocumentation.Theywillberesponsibleforconcurrentlyanalyzingclinicalinformationforaccuraterepresentationoftheseverityofillness,whichinvolvesextensivemedicalrecordreview,interactionwithphysicians,codingspecialistsandnursingstaff.Thisnewprocesswillgenerateacomprehensivepictureofthepatient’sclinicalstatusandcareprovidedatHolyName.

it Starts with Physician education JATA’sCDMPpromotesaclinicalandholisticapproachtodocumentationthatstartswithphysicianeducation,whichwillbedeliveredpeer-to-peerthroughJATAphysicians.Educationonhowtoimprovedocumentationwillbeprovidedpriortoandduringthehospitalimplementationphasesforbothinpatientandoutpatientsettings.

Clinical Documentation improvement Duringthesechallengingtimesinhealthcare,accuratedocumentationofpatientencountersiskeytotheeconomichealthandgrowthofhospitals.HNMCiscommittedtoprovidingphysicianswiththetoolstorecognizeincompletedocumentationinrealtimeandprovidespecificityandcompliantterminology.Asregulationsevolvetoreflectadvancesinmedicalcareandtofulfillpay-for-performancerequirements,thedocumentationprocesswillcontinuetobecomeevenmorecomplex. JoinusaswestrivetoimproveourclinicaldocumentationeffortstomoreaccuratelyreflectourCMIandgetproperlyreimbursedfortheservicesweprovide.Ifweimprovetheaccuracyofourdocumentation,wewillalsoimprovecomparativeperformancereports,ensurecompliance,andenhancepatientcarequality.

Dying a Good DeathMyfriendandneighbordiedlastweek.Thisstoryisbasedonhisstory.Inhisearlyeighties,wiry,opinionated,wellread;henevertoleratedschooling.Hebuiltanexcavatingbusinesswithaperfectedaestheticforcontouringsoilandalsobuiltafewhomesintown,includingmine.Whenhesawthearchitect’slowerpitchedroofframedonthegarage,hehadittornoffbecause“itjustwasn’tright.Itlookslikeatinybowlerhatonafatman.”Hislong-standingpastimewascorrectingtheTownCouncil,totheirconsternation,becausehewasalmostalwaysright. Hehaddiedoncebefore,28yearsagowhenhewasrescuedfromanarrestonthebeachinFloridabyadoctorfromNewJersey.Thistimehewasinhisgardenonawarm,sunny,earlyautumnday.Hedidn’tdierightawaybecausehistoolswerelaiddownneatlyandhehadwrittensomethinginthedirt.Intheleftlateralposition,hewouldhave

Joseph M. Lemaire is Executive Vice President/Chief Financial Officer at Holy Name Medical Center.

OnNovember13,2010,I,alongwithDrs.TimothyFinleyandAlanGwertzman,receivedtheSpiritofHealingAwardsatHolyName’sAnnualFoundersBall.IwashonoredtostandalongsidemycolleaguesasMikeMaronpresenteduswiththisprofoundrecognitioninfrontofourfriends,family,coworkersandHolyNamedonors.Needlesstosay,itwasaspecialevening. Drs.Finley,GwertzmanandIwereacknowledgedforthetimeandeffortwegaveandcontinuetogivetoourfriendsattheHôpitalSacréCoeurinMilot,Haiti,especiallythisyearfollowingtheearthquakeinJanuary.Whilewewereselectedforthisaward,weshareitwiththeentireHolyNamecommunityforitwasyourgoodwillandgenerositythatallowedustorespondsoquicklytoourHaitianfriendsinneed. Duringthisholidayseason,IamremindedofjusthowblessedIamandhowthisspiritofgivingtouchesallofus.Whetherwearetherecipientofsomeone’sgenerosityorweourselvessacrificetogive,letusrememberthatgivingisitsownreward.IamproudtobepartoftheHolyNamefamilyandprouderstilltogivebacktoanorganizationthatprovidessomuchtosomany. SupportingtheHolyNameHealthCareFoundationisaninvestmentinourselvesandourworkonbehalfofHolyName.YourgifttoHolyNametodayisapromiseofoursustainabilityandacommitmenttothehealingmissionfoundedbytheSistersofSaintJosephofPeace.Happyholidaysandhere’stoahealthyandhappy2011!

David Butler, MD, is an obstetrician/gynecologist on staff at Holy Name Medical Center.

Spirit of healing, Spirit of Giving

MeSSAGe frOM The Chief finAnCiAL OffiCer

improving Clinical Documentation

beenabletoseethesoil…andthesky.Ican’timagineabetterdeathforhim. Wetakegreatcaretoensurethatbabiesenterthislifeinagoodwaywithbirthingcentersandhomedelivery.Thereissoftlightingandmusic,fatherpresent,trainedstaff,awarmblanketandmother’smilk.Ontheotherendoflife,thereistoooftenamiserablewastelandofpainful,denigratingtherapiesofferedupashopefulattemptstostaveofftheinevitable. Fortunately,thisdoesn’thavetohappen.Hospiceandpalliativecarearebringingdyingbacktolife.Studieshaveshownthatpatientsreceivingtheseservicesarenotonlymorecomfortable,calmerandmoreincontrol;buttheyalsolivelongerthanthosewhochoosesomeformsofheroicmedicaltechnology. Thenominalnormalhumanlifespanineveryerahasbeenabout1,000months.Ifyoureadhistoryandpayattentiontolife

Thomas Birch, MD, is Chief of Infectious Disease at Holy Name Medical Center.

spans,thisisaboutthebestthatisseenwithorwithoutmodernmedicalcare.Evennow,itisraretomeetsomeoneover90withagoodqualityoflife.Wecanprobablyincreasethatestimatebyafactorof1.5bylivingasimple,unpollutedlifestylewithlife-longmoderatecaloricrestriction(gettingbeyondingestionasgratification)andapsychedetachedfromanxietyoverthefruitsofouractions. Everyminuteoflifeissacred.OurSpiritshedsitsphysicalsheathwhenitisno

www.villamarieclaire.org201-833-3105

longeruseful.Neverworryaboutdeath.Giveforlife.Wearenotguaranteedasgoodadeathasmyfriendbutwewillknowhowtotrywhenthetimecomes. Pleasejoinmanyofyourcolleaguesand

meinsupportingVillaMarieClaireHospice.

WearepleasedtoannouncethatHolyNameMedicalCenterhasenteredintoanagreementwithAprimaMedical

Software(Aprima)tobringanambulatoryelectronicmedicalrecordtophysicianoffices.AprimaisaseamlesssolutionforPracticeManagementandElectronicHealthRecords(EHR). WeselectedAprima,withinputfromHolyNamephysicians,becauseofitseaseofuse,speed,integratedplatform,andreputationforcustomerservice.PhysiciansnationwidehavechosenAprimaduetoitsuniqueapproachofIntelligentNavigationandAdaptiveLearning.Furthermore,AprimawillintegratecloselywiththeHolyNameWebHIS. Aprimaisafullycertified“CompleteEHR”andmeetsMeaningfulUsecriteria.ThismeansthatphysicianswhoutilizeAprimaintheirofficeareeligibletoreceive

thegovernmentincentive,upto$44,000,foruseofanambulatoryEMR.Inaddition,HolyNameMedicalCenterhasnegotiatedpreferredpricingonAprima,andisplanningtosubsidizefeesforlicensureandimplementationinphysicianoffices. WeareexcitedtobringAprimatoourphysicianfamily.FurtherdetailsontherolloutofAprimawillbeforthcomingintheNewYear.

Craig Hersh, MD, is Assistant Vice President of Medical Affairs at Holy Name Medical Center.

HNMC Chooses Aprima for Office Electronic Health Records

3

rePOrT frOM The Chief nurSinG OffiCer

Patient Satisfaction now a Government initiative

If you don’t yet know what HCAHPS stands for, you will soon… HCAHPS,orHospitalConsumerAssessmentofHealthProvidersandSystems,isaU.S.governmentsurveythatmeasurespatientsatisfactionathospitalsacrossthecountry.WhileitresemblesHolyName’sownpatientsatisfactionsurveysconductedbyourbenchmarkingorganizationofchoice,HealthStream,theHCAHPStoolmeasurespatientsatisfactiondifferentlyandprovidesanationalstandardforcollectingandpubliclyreportingthedata. Whyisthesurveyimportant?WhilepatientsatisfactionhasalwaysbeenatthecruxofHolyName’smission,HCAHPSsurveyresultscanhaveadirectimpactontheMedicalCenter’sbottomline.Starting in 2011, the Centers for Medicare and Medicaid Services (CMS) will use the HCAHPS patient experience data to determine the level of funding it will reimburse hospitals for services we provide to our Medicare patients. Hospitalswithbetterclinicalandpatientsatisfactionresultswillreceivehigherreimbursements.

The survey and how it works HCAHPSsurveycategoriesfocusoncommunicationwithdoctorsandnurses,responsivenessofhospitalstaff,painmanagement,cleanlinessandquietnessof

Sheryl Slonim, DNP, RN-BC, NEA-BC is Executive Vice President for Patient Care Services and Chief Nursing Officer at Holy Name Medical Center.

hospitals with better clinical and patient satisfaction results will receive greater reimbursement

from CMS.

SurVEy QuESTIOnSThe HCAHPS survey consists of questions related to 10 areas. Those that involve physicians directly are below:

CommunicationDuring this hospital stay…• How often did doctors treat you with courtesy and respect? (Q5)• How often did doctors listen carefully to you? (Q6)• How often did doctors explain things in a way you could understand? (Q7)

Pain controlDuring this hospital stay…• How often was your pain well controlled? (Q13)• How often did the hospital staff do everything they could to help you with your pain? (Q14)

MedicationsBefore giving you any new medicine…• How often did hospital staff tell you what the medicine was for? (Q16)• How often did hospital staff describe possible side effects in a way you could understand? (Q17)

Discharge instructionsDuring this hospital stay…• Did hospital staff talk with you about whether you would have the help you needed when you left the hospital? (Q19)• Did you get information in writing about what symptoms or health problems to look out for after you left the hospital? (Q20)

thehospitalenvironment,andinstructionsaboutmedicationsanddischarge.Thesurveyalsoasksforanoverall1to10ratingofthehospitalandwhetherornotthepatientwouldrecommendittofriendsandfamily. Unlikesurveysthatusearatingsystemof“poor”to“excellent”tomeasurethepatientexperience,theHCAHPStoolmeasuresthefrequencyofvariousaspectsofcare,usingascaleof“always,”“usually,”“sometimes”and“never.”Theresultsrepresentthepercentageofpatientswhoresponded“always.”Byusingaratingscalebasedonfrequency,

thesurveyhasthepotentialtoreflectthepatient’sexperiencemoreaccurately,helpinghospitalstobetterdecipheropportunitiesforimprovement.

Where does hnMC stand? WhileHolyName’sscoresarerespectable,theydon’taccuratelyreflectthehighqualityofcarewegive.Whythedisparity?Itappearsthatwhatwedoforpatientsisnotalwaysevidenttothem.It’snotenoughtobemoreattentivetopatientneeds;wemusteducatepatientsaboutwhatwedoforthem.

InNursing,we’veengagedstaffateveryleveltogenerateadialogueandtakeactionstepstowardthisgoal.Initiativessuchasscripting,hourlyrounding,call-belleducation,creatingWong-BakerPainScalecommunications,andleavingapadandpenatthebedsidewillenhancepatients’perceptionsofpersonalcontrol,engagethemindiscussionandensurethattheywillremembervariousaspectsoftheirexperiencewhenitcomestimetoanswerthosesatisfactionsurveyquestions.

how physicians can help Thequestionis:Howdowecontinuallydelightpatients?Notjustsatisfythem,butdelightthem?Explaintoyourpatientswhatyouaredoingandbesuretheyunderstand.Encouragethemtoaskquestions.Exploretheirpost-dischargeneeds.Don’thesitatetowriteremindernotesforthem.Theywillrememberyouandthissatisfyinginteraction,castingapositivelightontheirentireexperienceatHolyName.It’sateameffortandyoucanhelpimmensely. Asalways,thankyouforyouroutstandingcareofourpatientsandforyourcontinuedsupportofournursingstaff.

Medical Leadership Sought to Champion hnMC’s national Patient Safety Goal initiatives TheJointCommissionestablishedtheNationalPatientSafetyGoal(NPSG)programin2002,withthefirstsetofguidelineseffectiveJanuary1,2003.Asoutlinedinthewww.jointcommission.orgwebsite,“theGoals[seekto]highlightproblematicareasinhealthcareand[to]describeevidenceandexpert-basedsolutionstotheseproblems.Recognizingthatsoundsystemdesignisintrinsictothedeliveryofsafe,highqualityhealthcare,theGoalsfocusonsystem-widesolutions,whereverpossible.” ThedevelopmentandannualupdatingoftheNPSGsisoverseenbyanationalpanelofwidelyrecognizedpatientsafetyexpertsaswellasnurses,physicians,pharmacists,andriskmanagerswhoscrutinizeanaggregateofsentineleventsreportedtoTheJointCommission.Fromthisdatabaseandanexhaustivereviewofcurrentpatientsafetyliterature,thepanelrecommendsrevisionstocurrentgoalsorestablishmentofnewGoals.Revisionsmayinclude“clarifyingandstreamliningcertainelementsofperformance,”orretiringGoals–movingthemcompletely,orinpart,toaccreditationstandards. OrganizationalcompliancewithNPSGsandtheabilitytodemonstrateahistoryofcompliancearetransparentcomponentsofthetriennialsurveyprocesswithGoal-specificscoresavailableforeachaccreditedhospitalonthe“QualityCheck”linkatwww.jointcommission.org.Additionally,unlikeaccreditationstandards,whichareaffordedvaryinglevelsofsignificanceduring

thesurveyprocess,failuretodemonstratecompliancewithasingleNPSGwillresultdirectlyinaRequirementforImprovement–adeficiencywhichneedstobeadequatelyaddressedandcorrectedinorderfortheorganizationtoretainitsaccreditationstatus. The2010NationalPatientSafetyGoalsaredelineatedatright,alongwiththename(s)oftheHolyNameMedicalCenterTeamLeader(s)responsibleforcoordinatingcomplianceefforts.EachteamhasthoroughlyevaluatedclinicalandoperationalsystemdesignscontributingtosuccessfullymeetingtheexpectationsoftheirrespectiveGoal.Datademonstratingcompliancehasbeencompiledandperformanceimprovementinitiativeshavebeenimplementedwherewarranted. Criticaltonotonlyasuccessfultriennialaccreditationsurveybutinestablishingawarenessandongoingattentiontotheseevidence-basedparametersforpatientsafety,isenhancedmedicalstaffinvolvement.Medical staff members with an interest in promoting and maintaining patient safety initiatives are encouraged to participate in our NPSG Program. Make your interest known to the Medical Staff Office or contact a Team Leader directly.

John Grangeia is Vice President of Professional Services at Holy Name Medical Center. He can be reached at 201-833-7251.

national Patient Safety GoalsEffective July 1, 2010

.01.01.01 Use at least two patient identifiers when providing care, treatment, and services. HNMC Team Leaders: Linda Masincup & Jan Terlizzi

.01.03.01 Eliminate transfusion errors related to patient misidentification. HNMC Team Leader: Ed Torres

.02.03.01 Report critical results of tests and diagnostic procedures on a timely basis. HNMC Team Leader: Mary Ellen Kilgallen

.03.04.01 Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. HNMC Team Leader: Donna Vaglio

.03.05.01 Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. HNMC Team Leader: Michelle Acito

.07.01.01 Comply with current CDC hand hygiene guidelines or the current World Health Organization hand hygiene guidelines. HNMC Team Leader: Rosemary Perry

.07.03.01 Implement evidence-based practices to prevent healthcare-associated infections due to multi- drug-resistant organisms in acute care hospitals. HNMC Team Leader: Rosemary Perry

.07.04.01 Implement evidence-based practices to prevent central line-associated bloodstream infections. HNMC Team Leader: Mary Jo Tracy

.07.05.01 Implement evidence-based practices for preventing surgical site infections. HNMC Team Leader: Rebecca Rigolosi

.15.01.01 Identify patients at risk for suicide. HNMC Team Leader: Robert Baker

UP .01.01.01 Conduct a pre-procedure verification process. HNMC Team Leader: Donna Vaglio

UP .01.02.01 Mark the procedure site. HNMC Team Leader: Donna Vaglio

UP .01.03.01 A time-out is performed before the procedure. HNMC Team Leader: Donna Vaglio

4

Erectiledysfunction(ED)affects140millionmenworldwide,withaprevalenceof52%inmenaged40to70years,and70%overage70.Historically,EDwasthoughttohavebeenpredominantlyaconditionofpsychogenicorigin,leadingtoshameandunderreportingbymalepatients.TheintroductionoforalmedicationstotreatEDhasleadtogreaterawarenessoftheproblemofED,andanincreaseinthenumberofmenseekingtreatment.WiththisincreasedawarenesshascomeagreaterunderstandingofthemechanismsresponsibleforED,specificallyitsphysiologiccauses(mostimportantly,endothelialdysfunction),resultinginalargenumberofdiagnosesoforganicED. ManystudieshaveidentifiedthemostsignificantriskfactorsforED,includinghypertension,diabetes,smoking,obesity,hyperlipidemia,andcoronaryarterydisease.Thesearealsocommonriskfactorsforcardiovasculardisease(CVD).IthasthereforebeenhypothesizedthaterectiledysfunctionmaybeasentinelsymptominpatientswithundiagnosedCVD.InastudypublishedinJAMAin2005,menwithEDhada45%increasedriskofdevelopingCVDduringthefive-yearstudy

periodwhencomparedtomenwithoutED.Thispercentagewassimilartotheriskassociatedwithsmokingorafamilyhistoryofmyocardialinfarction.EDhasalsobeenassociatedwithhigherratesofdeathfromcardiovasculardisease. TheleadingexplanationattributesthecorrelationbetweenEDandCVDtotheirmutualcauseofendothelialdysfunctionandtheformationofatheroscleroticplaques.Atherosclerosisisasystemicdiseaseaffectingallvascularbedswithinthebody.However,thevaryingsizesofarteriesthroughoutthevascularsystemresultinthepresentationofsymptomsatdifferenttimepoints,withsmallerarteriesoccludingbeforelargerones.Giventhesmalldiameterofthecavernosalarteriesinthepenis,theinabilitytoachieveanerectionmaybeasensitiveindicatorofsystemicvasculardisease. DespitethepotentialofEDtoserveasanearlywarningsignofCVD,asignificantnumberofpatientsevaluatedbyprimarycarephysiciansreportEDthatwasunaddressedbytheirdoctor,despitethepatient’sdesiretodiscusstreatmentoptionsandcausesofthecondition.EDshouldnolongerbethoughtofassimplyaquality-of-lifediagnosis,butasapotential

indicatorofoverallcardiovascularhealth.AddressingcardiovascularriskearlyafterthepresentationofED,andaggressiveinterventiontoreducerisk,mayhavelong-termsymptomaticandprognosticcardiacbenefits. AnyasymptomaticmanwhopresentswithEDthatdoesnothaveanobviouscause(e.g.,trauma)shouldbescreenedforvasculardisease,andundergomeasurementsofbloodglucose,lipids,andbloodpressure.Patientsatriskbutasymptomaticforcoronarydiseaseshouldconsiderelectivestresstesting.WhilewhethercardiacriskreductionwillpreventsubsequenteventsinpatientswithEDcontinuestoremainanareaforfurtherstudy,ourcurrentknowledgesuggeststhatearlyinterventioniskeytopreventingmorbidityfromcardiacdisease.

erectile Dysfunction and Cardiovascular Disease

Daniel R. Simon, MD, is a urologist on staff at Holy Name Medical Center. He practices with The Urology Center, 222 Cedar Lane, Suite 204, Teaneck, NJ, and can be reached at 201-457-1500 and at danielrsimon@gmail.com.

HNMC’sMedicalLibrarycantapthecollectionsandservicesofthe3,000+librariesintheUS(includingUSterritories),Canada,andMexico,andprovidesfreeexpertsearchingofmedicalliterature. Searchesareperformedbythemedicallibrarian,whohasamaster’sdegreeinlibraryscienceandisskilledinthedisseminationofmedicalinformation,literaturesearchinganddatabaseselection.Iknowhowtogetthe“goodstuff”quicklyandefficiently,savingyoutimeandeffort. Simplycalloremailthelibrarywithinformationaboutthesearchandthedeliverymethodyouprefer(mail,faxoremail).Withinonetotwobusinessdays,youwillreceiveyourresults.Urgentrequestswithaturnaroundtimeof30minutestoanhourareavailableforclinicalemergencies.

Keydi Boss O’Hagan is HNMC’s Medical Librarian. Mrs. O’Hagan’s office is located in the Marian Conference Center. She can be reached by phone at 201-833-3395, by fax at 201-530-7919 or by email at k-ohagan@holyname.org or hnhlibrary@gmail.com.

need an article search?

neWS frOM The MeDiCAL LiBrArY

understanding hospice and Palliative Care Palliativeservicesfocusonpainandsymptommanagementforindividualsfacingchronic,progressive,incurableillnessesthatmayormaynotbeeligibleforhospice.HolyNameMedicalCenter’sinterdisciplinarypalliativecareteamoffersabroadrangeofservicesdesignedtoinstillphysical,mental,emotionalandspiritualwell-beinginconjunctionwithclinicalpainandsymptommanagement. Hospiceisacarephilosophythatemphasizesqualityoflife,ratherthanlengthoflife,forindividualscopingwithadvancedillnesses.Hospiceisappropriatewhenanindividualcannolongerbenefitfromcurativetreatmentandlifeexpectancyissixmonthsorless,iftheillnessfollowsits“normal”progression.Hospicerecognizesdeathasanaturalpartoflife.Itislife-affirmingandadvocateslivingthejourneybyprovidingresources,tools,palliativeinterventions,hopeandcompassionatepresences.Itfostersanenvironmentthatensuresthatthispartofthejourneyisspentwithdignityandcomfort.Referraltohospiceshouldnotwaituntilthefinalweeksordaysoflife.Studiesshowthatwhenpatientsarereferredearlier,theycanaccesspalliativeinterventionsandexperienceimprovedqualityoflife.

The role and importance of the Attending Physician IntheCenterforMedicareandMedicaidServices’ConditionsofParticipation(COPs)forMedicare-certifiedhospiceproviders,involvementoftheattendingphysicianisindicated.TheConditionsofParticipationrequirethatthehospiceinterdisciplinaryteamcompletethepatient’sinitialcomprehensiveassessmentandinitiatetheplanofcareinconsultationwiththepatient’sattendingphysician,ifany.(“TheMedicareConditionsofParticipationforHospiceCare,”Dec.2008) HolyNameMedicalCenter’shospiceteam

Palliative and hospice Services: Assuring a Seamless Continuum of Care

encouragestheattendingphysiciantobeapartofthepatient’sjourneyattheendoflife.Whiletheroleoftheattendingphysicianmaychange,involvementshouldnotstopiftheattendingchoosestostayinvolved. InaMarch2009studypublishedinArchives of Internal Medicine,researchersfoundthat“patientsandfamiliescansufferfromfeelingsofabandonmentwhenaphysicianwhohadbeenactivelyinvolvedincareisnolongerinvolved.”Continuityofcareandongoingcommunicationbetweentheattendingphysicianandthehospiceteamisessentialtoinsurethatfamilies,aswellasphysiciansandtheirstaff,feelasenseofclosurefollowingapatient’sdeath.

Attending Physicians: What You need to Know Forpatientswithanattendingphysician,thephysician’sroleisintegraltotheoverallprovisionandmanagementofcare.Ifthereisnoattending,theHospiceMedicalDirectorcanassumeresponsibilityasbothAttendingandHospiceMedicalDirector. FollowingisabriefsummaryofMedicareregulationsandrulesconcerningtheroleofattendingphysicians:

Certification of the Terminal Illness: Uponapatient’sadmissiontoHospice,ornomorethantwocalendardaysafterapatient’sadmissiontoHospice,youmustcertifythat,baseduponyourclinicalexpertise,yourpatienthasalife-expectancy(prognosis)ofsixmonthsorlessiftheterminalillnessrunsitsnormalcourse.Ifyouprovideverbalcertification,werequirethatwrittencertificationbereceivednolaterthansevencalendardaysafterthepatient’sadmission.

Initial Plan of Care and Ongoing Plan of Care Astheattendingphysician,youwillshareresponsibilitywithHospice’sphysicianandinterdisciplinaryteamforestablishing,maintainingand,ifnecessary,updatingyour

patient’splanofcare.Wewillconsultwithyouonaregularbasis.Yourpatient’splanofcaremustbeagreeduponbythepatient,thepatient’sfamily,Hospice’sinterdisciplinaryteamandyou.Wewillprovideyouwithwrittenpatientsummariesonaregularbasis. Diagnosticstudiesandinvasiveprocedureswillonlybeconsideredastheyrelatetoyourpatient’sillnessandwhenitisbelievedthattheywillimproveyourpatient’ssymptomsorqualityoflife.

Day-to-Day Management of Your Patients ItiscriticalthatyouarereadilyavailabletoconsultwithmembersofHospice’steaminorderforustocareforyourpatient’sday-to-dayneeds,intheeventthatchangesinyourpatient’splanofcarearise. Ifyouwouldliketolessenyourdailyinvolvementwithapatient,pleaseinformtheteamandcontactHospicetodiscusschangestoyourrole.Themedicaldirectorandtheinterdisciplinaryteamwillmakeevery

attempttoaccommodateyoubytakingovertheprimaryday-to-daymanagementofthepatient,andcommunicatethepatient’sstatustoyouonaregularbasis.Pleasenotethatitremainsyourresponsibilitytobeinvolvedinmanagingyourpatient’splanofcareifyouchoosetoremainastheAttendingPhysician.

Payment for Physician Services TheattendingphysiciancontinuestobillMedicarePartBorthepatient’sinsuranceastheAttending.Inaddition,youmaybillMedicarePartBforcareplanoversight.IwillbepreparingasummaryofguidelinesthatcanbeutilizedbyAttendingPhysicians,aswellasthosewhoHospicemayseekasconsultants.Inaddition,IwillprepareguidelinesthatmayassisteachofyouwhenyourpatientsrequireapalliativeconsultfromourPalliativeTeam.

Iamconfidentthatwearemakingadifference.Ifyouhavequestions,pleasedonothesitatetocallandspeakdirectlytomeoramemberofourinterdisciplinaryteam.

Jean A. Leone, RN, BS, MS, is Executive Director and Clinical Administrator of Hospice and Palliative Services and Villa Marie Claire, Holy Name Medical Center. She can be reached at 201-833-3293, or via cell at 201-359-5154.

“referral to hospice should not wait until the final weeks or

days of life.”

In a study published in JaMa in 2005, men with ED had a 45% increased risk of developing CVD during the five-year study period when compared to men without ED.

Call 201-833-3188for a copy of

our informative brochure

Did You Know? • Only 30% of medical literature and less than one-quarter of medical and biomedical journals are freely available on the Web. • Only 60% of the article content published since 1992 is available electronically.

5

The article below is reprinted from a previous issue of MD360, based on a recommendation from the Antimicrobial Subcommittee after the issue of PCN allergies was discussed at length. Penicillin allergies continue to pose obstacles for physicians when prescribing antibiotics.

BacterialresistancecontinuestobeanongoingproblemnationwideandatHolyNameMedicalCenter.Wecontinuetofacedailychallengeswhenprescribingantibiotics.Ourbiggestchallengehasbecomepatientswithpenicillin(PCN)allergies!PatientswithPCNallergiescanhavedelaysintherapyand,manytimes,areadministeredsecondlineagentsfortheirinfection. Thetrueincidenceofallergicreactionstopenicillinisunknown,butsuchreactionsareestimatedtoinvolve0.7%to10%ofthepopulation.Nearly10%ofallergicreactionsarelife-threateningand1%arefatal. PCNisknowntocause types I, II, III, IVandidiopathicreactions.Inorderforthosereactionstooccur,thepatientmustbesensitizedtothedrug.Thereactionsaredefinedasfollows:

Type i – Anaphylactic and mediated by IgE.Generallyoccurringwithin30minutesofexposuretotheallergen.Somemanifestationsincludebronchialasthma,allergicrhinitis,urticaria,angioedemaandanaphylacticshock.

Type ii –Antibody mediated cytotoxic reaction. Thisoccurswithin5-12hours.IgMorIgGareinvolvedinthistypeofhypersensitivityreaction.Manifestationsincludehemolyticanemia,agranulocytosis,leucopeniaandthrombocytopenia.

Type iii – Mediated by an immune complex. ThecomplexisformedbetweentheallergenandIgGorIgM,causingdrug-inducedfeverandallergicvasculitis.Thisoccurswithin3-8hours.SerumsicknesssyndromeisalsocategorizedasTypeIIIandcantake7-14daystoappear.

Type iV –Delayed reaction mediated by T-lymphocytes, often with dermatologic

manifestations. Occurswithin24-48hoursofcontact.Idiopathicimmunologicalreactionsarebelievedtobeimmunemediatedbutthemechanismofactionisunknown.Exfoliativedermatitis,erythemamultiformeeruptionsandmaculopapularrashareindicatiorsofPCNhypersensitivity.

Withregardtocephalosporins,earlyworkoncross-sensitivitycitedratesof7%and8.1%,whichwereoftenroundedupto10%inmedicaljournals.Itwaslaterdiscoveredthatfirst-generationcephalosporinswereproducedbythecephalosporiummoldandoftencontainedtraceamountsofpenicillin.Also,analysesofearlierstudieswerefoundtocontainasignificantproportionofreportedreactionsthatwerenottrueallergicresponses.Cephalothin(Keflin)and

Penicillin Allergies

cephaloridine(Keflodin)(firstgenerationcephalosporins)andcefamandole(Mandole)(second-generationcephalosporin)didhaveanincreasedfrequencyofallergicresponsesinpatientswithpreviousallergicreactionstopenicillin.However,increasedreactionswerenotobservedwithothersecond-generationcephalosporinsoranythird-generationcephalosporin. Apteretalevaluatedallergicreactionsfromcephalosporinsamongpenicillin-allergicpatients.Theyfounda1.1%increasedriskofreactionsbutalsofoundtherewasa1.6%increasedriskofreactionswhenthesepatientswerechallengedwithsulfonamideantibiotics.Thesefindingsargueagainstcross-reactivityasthemechanismofreportedincreasesinallergicresponsesinthesepatients,asitappearsthatpenicillin-allergicpatientstendtobeallergictomultipleantibiotics,inadditiontoafewcephalosporins. Cross-reactivityofcephalosporinsandpenicillinsduetosimilarityofsidechains:Cephalosporinsandpenicillinsbothpossessabeta-lactamring.Severalcephalosporinshavesidechainsofthebeta-lactamringatthe7-positionsimilartothesidechainofpenicillin(seeTable1).Therefore,theseantibioticswouldbeexpectedtobeassociatedwithincreasedcross-reactivity.Severalcephalosporinshave7-positionsidechainssimilartoampicillinandamoxicillin(seeTable1).Theseantibioticswouldhaveagreaterprobabilityofallergicreactionsinpatientsallergictoampicillin.Ontheotherhand,cefdinir(endorsedbytheAAPforpenicillin-allergicpatients)doesnothavea

similar7-positionsidechaincomparedwithpenicillinorampicillinandwouldbeunlikelytoproduceanallergicreaction. Sastreevaluatedtheclinicalcross-reactivityofamoxicillinandcefadroxil,bothhavingasimilarsidechain.Two(12%)of16amoxicillin-allergicpatientswithgoodtolerancetopenicillindevelopedanallergicreactiontocefadroxil(Duricef).Inanotherstudy,8of21patients(38%)allergictoamoxicillinwerealsoallergictocefadroxil,butnonewereallergictocefamandolewhichhaddissimilarsidechains.Therefore,inpatientsallergictopenicillin,cross-reactivityisunlikelywithselectivecephalosporins.

When a PCn or cephalosporin type antibiotic is prescribed for a patient with a PCn allergy, the Pharmacy will continue to call Prescribers; however, we are encouraging all Pharmacists to discuss the PCn allergy and, when appropriate, educate Prescribers on the risks of cross sensitivities among the cephalosporins.

To reduce the phone calls, if you are aware that a patient is able to tolerate a PCn or cephalosporin, please indicate on the Physician Order Form that you are aware of the allergy. If you would like the allergy removed from the database, please indicate that on the Physician Order Form and the Pharmacy will do so.

It is imperative to identify the reaction and assess if the patient can take a penicillin-based antibiotic. As of January 2010, skin testing is now an option, as Pre-Pen, a skin determinant, has been brought back to the market. It is important to remember that test results do not apply to other classes of antibiotics. The test assesses only allergic reactions caused by IgE antibodies. Such adverse effects as serum sickness (most commonly, hives, pain and swelling) and drug fever (a high temperature due to a drug reaction) may still occur, even if a penicillin skin test is negative. An alternative is the prescription of a cephalosporin, as evidence now suggests cross-reactivity was over-estimated.

Table 1. Seven Position Side Chains of Penicillins and CephalosporinsSimilar Side Chain Cross Rx Possible

Penicillin G CephalothinCephaloridine

Similar Side ChainCross Rx Possible

Ceftriaxone (Rocephin)Cefotaxime (Claforan)Cefpodoxime (Vantin)Ceftizoxime (Cefizox)Cefpirome (Cedixin)Cefepime (Maxipime)

Dissimilar Side ChainUnlikely Cross Rx

Cefoxitin (Mefoxin)Cefprozil (Cefzil)CefmetazoleCefixime (Suprax)Ceftibuten (Cedax)Ceftazidime (Fortaz)

Similar Side ChainCross Rx Possible

AmpicillinAmoxicillinCephalexin (Keflex)Cephradine (Velosef)Cefadroxil (Duricef)Cefaclor (Ceclor)

Dissimilar Side ChainUnlikely Cross Rx

Cefazolin (Ancef)Cefotetan (Cefotan)Cefuroxime(Zinacef, Ceftin)Cefdinir (Omnicef)CefoperazoneCefditoren (Spectracef)

Published by Holy Name Medical Center’s Pharmacy Department. If you have any questions or concerns regarding the content of the Pharmacy & Therapeutics Newsletter, call the Pharmacy at 201-833-3055 or ext. 3773. References are available upon request

Pharmacy & Therapeutics newsletter now appears in MD360

2011 firSt Quarter MEETING SCHEDULE for departments & divisions

anesthesiology DepartmentMeets semi-monthly (2nd and 4th Friday)Executive Board Room, 7-8:30 a.m. Jan. 14 Jan. 28 Feb. 25 Feb. 11 March 11 March 25

Dentistry DivisionMeets bimonthly (3rd Wednesday)Medical Affairs Conference Room, 8-9 a.m. Jan. 19 March 16

Emergency Medicine DepartmentMeets monthly (1st Wednesday)Marian Hall Conference Room. #1, 7:30-9:30 a.m. Jan. 5 Feb. 2 March 2

General/Thoracic/Vascular Surgery DivisionMeets quarterly (4th Thursday)5 West Board Room, 7:30 – 8:30 a.m. March 24

Obstetrics/Gynecology DepartmentMeets monthly (1st Wednesday)Medical Affairs Conference Room, 8-9 a.m. Jan. 5 Feb. 2 March 2 Ophthalmology DivisionMeets quarterly (2nd Wednesday)3 West Conference Room, 7:30 – 8 a.m. March 9

Orthopedic DivisionMeets monthly (1st Monday) 5 West Conference Room, 8-9 a.m. Jan 3, (moved to Jan 11) Feb. 7 March 7

Pediatrics DepartmentMeets monthly (2nd Friday)Medical Affairs Conference Room, 8:30 – 9:30 a.m. Jan. 14 Feb. 11 March 11

Plastic Surgery DivisionMeets quarterly (2nd Wednesday)Medical Affairs Conference Room, 7-8 a.m. March 9

Podiatry DivisionMeets quarterly (2nd Thursday)3 West Conference Room, 8-9 a.m. March 10Confirm with Medical Staff Office, 201-833-3352

urology DivisionMeets quarterly (1st Wednesday)3 West Conference Room, 8-9 a.m. March 2

COMMITTEESICCr CommitteeMeets monthly (1st Monday)Executive Board Room, Convent, 2nd fl.2:30 – 1:30 p.m. Jan. 3 Feb. 7 March 7

Infection Control CommitteeMeets bi-monthly (2nd Thursday)Medical Affairs Conference Room., 12-1 p.m. Jan. 13 March 10

Medical Executive CommitteeMeets monthly (1st Tuesday)Medical Affairs Conference Room, 6 – 8:30 p.m. Jan. 4 Feb. 1 March 1 Operating room CommitteeMeets monthly (3rd Wednesday)5 West Board Room, 8-9 a.m. Jan. 19 Feb. 16 March 16

Patient Care Committee Meets monthly (3rd Tuesday) Executive Board Room, 8 - 9 a.m. Jan. 18 Feb. 15 March 15 Pharmacy and Therapeutics CommitteeMeets monthly (3rd Wednesday)5 West Board Room, 12 – 1 p.m. Jan. 19 Feb. 16 (Marian Conf. Rm. #1) March 16

6

Welcome to the Medical Staff

Joel Abramowitz, MDSurgery/Urology

Medical School: Autonomos University of Guadalajara, MDInternship: Queens General Hospital, Fifth Pathway ProgramResidency: Long Island Jewish Medical Center, SurgeryResidency: Montefiore Medical Center, SurgeryFellowship: University of Illinois Medical Center, UrologyPractice: 142 Palisades Ave., Suite 101, Jersey City, NJ 07306Phone: 201-656-4104

Maureen Beck, NPSurgery/Neurosurgery

Education: Fairleigh Dickinson UniversityPractice: 309 Engle Street, Suite 6, Englewood, NJ 07631Phone: 201-569-7737

Joseph Daoko, MDMedicine/Cardiology

Medical School: Aleppo Faculty of MedicineInternship: St. Michaels Medical Center, MedicineResidency: St. Michaels Medical Center, MedicineFellowship: St. Michaels Medical Center, CardiologyPractice: 230 East Ridgewood Ave., Suite 6-2, Paramus, NJ 07652Phone: 973-928-2566

Wojciech Franzl, MDAnesthesia

Medical School: SUNY Health Science Center, BrooklynInternship: North Shore University Hospital, MedicineResidency: SUNY Downstate Medical Center, AnesthesiaPractice: 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7149

Nancy Fremed, NPFamily Practice

Education: University of Medicine and Dentistry Practice: HNMC Clinic, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7183

Raimonda Goldman, DOMedicine/Oncology

Medical School: New York College of Osteopathic MedicineInternship: Lenox Hill Hospital, MedicineResidency: Lenox Hill Hospital, MedicineFellowship: Hematology/OncologyPractice: HNMC Regional Cancer Center, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-227-6008

Yijun Guo, MDPathology

Medical School: Peking University Medical SchoolResidency: Drexel University, School of Medicine; Anatomic & Clinical PathologyFellowship: Albert Einstein College of Medicine, Surgical PathologyFellowship: Armed Forces Institute of Pathology, NephropathologyPractice: HNMC Pathology Dept., 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-3246

Vijay Gupta, MDAnesthesia

Medical School: All India Institute of Medical SciencesInternship: Long Island Jewish Medical Center, SurgeryResidency: Jackson Memorial Hospital, AnesthesiaPractice: Bergen Anesthesia

Associates, 718 Teaneck Rd., Teaneck NJ 07666Phone: 201-833-7149

Andrew Hirsch, MDSurgery/Urology

Medical School: SUNY, Stony Brook, Medical SchoolInternship: NewYork-Presbyterian Hospital-Columbia Campus, SurgeryResidency: NewYork-Presbyterian Hospital-Columbia Campus, UrologyFellowship: NewYork-Presbyterian Hospital-Columbia Campus, UrologyPractice: 15-01 Broadway, Suites 1 & 3, Fair Lawn, NJ 07410Phone: 201-791-4544

Dianna James, MDObstetrics/Gynecology

Medical School: Drexel University, College of MedicineInternship: Saint Joseph’s Mercy Hospital, Ob/GynResidency: Saint Joseph’s Mercy Hospital, Ob/GynPractice: 870 Palisades Ave., Teaneck, NJ 07666Phone: 201-907-0900

Gary Kline, MDSurgery/Thoracic Surgery

Medical School: Wayne State University, School of MedicineResidency: Wayne State University, SurgeryInternship: Wayne State University, SurgeryFellowship: University of Pennsylvania, Cardiothoracic SurgeryPractice: 332 Summit Ave., Hackensack, NJ 07601Phone: 201-488-6445

Inna Lee, MDEmergency Medicine

Medical School: Novosibirsky State Medical InstituteResidency: Newark Beth Israel Medical Center, PediatricsPractice: HNMC Emergency Dept., 718 Teaneck Rd., Teaneck , NJ 07666Phone: 201-833-3210

John Lincoln, MDMedicine/Neurology

Medical School: Texas Tech UniversityInternship: Texas Tech University, School of Medicine; MedicineResidency: Herman Hospital, NeurologyFellowship: University of Medicine and Dentistry of NJPractice: HNMC MS Center, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-3770

Rekha Miryala, MDMedicine/Internal Medicine

Medical School: Gandhi Medical CollegeResidency: Mountainside Hospital, MedicinePractice: 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-530-7931

Marjan Rahmanian, MDMedicine/Internal

MedicineMedical School: Shahid Beheshti University of MedicineResidency: Mountainside Hospital, MedicinePractice: 718 Teaneck, Rd., Teaneck NJ 07666Phone: 201-530-7931

Christine Salazar, PAEmergency Medicine

Education: Touro College

Practice: 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-3210

Maria Seo, NPMedicine/Internal Medicine

Education: University of Medicine & DentistryPractice: 22 Maple Street, Englewood Cliffs, NJ 07632Phone: 551-587-3252

Daniel Simon, MDSurgery/Urology

Medical School: University of Medicine and DentistryInternship: Mount Sinai Medical Center, SurgeryResidency: Mount Sinai Medical Center, UrologyPractice: 75 South Dean Street, Englewood, NJ 07631Phone: 201-816-1900

Daniel H. Smith, MDOb/Gyn – Gynecologic Oncology

Medical School: Harvard Medical SchoolInternship: Massachusetts General Hospital, SurgeryResidency: Massachusetts General Hospital, SurgeryFellowship: University of Southern California-LA County, Ob/GynResidency: Massachusetts General Hospital, SurgeryFellowship: Memorial Sloan- Kettering Cancer Center, Gyn OncologyPractice: HNMC Regional Cancer Center, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-227-6065

Avani Trivedi, DOAnesthesia

Medical School: UMDNJ School of Osteopathic MedicineInternship: St. Vincent’s Midtown Hospital, RotatingResidency: Nassau County Medical Center, AnesthesiaPractice: 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7149

Shawn Trokhan, MDSurgery/Orthopedics

Medical School: Case Western Reserve UniversityInternship: Mount Sinai Medical Center, OrthopedicsResidency: Mount Sinai Medical Center, OrthopedicsPractice: 235 Closter Dock Road, Closter, NJ 07624Phone: 201-767-1908

Wei Wang, MDMedicine/Psychiatry

Medical School: Tongji Medical UniversityInternship: Pennsylvania Hospital, MedicineResidency: Albert Einstein College of Medicine, PsychiatryFellowship: Cornell Medical Center, Child & Adolescent PsychiatryPractice: 163 Engle St., Bldg. 4A, Englewood, NJ 07631Phone: 201-408-4487

Ronald Weiss, MDMedicine/Internal Medicine

Medical School: University of Medicine and DentistryInternship: George Washington University Hospital, MedicineResidency: George Washington University Hospital, MedicinePractice: 6701 Bergenline Ave., West New York, NJ 07093Phone: 201-738-9100

45 YearsGeorge Azzariti, MD, Pediatrics

35 YearsRoberto Singer, MD, Internal Medicine

30 YearsGeorge Ajjan, DO, Obstetrics/GynecologyMark Pascal, MD, Internal Medicine

25 Years Stephen Angeli, MD, Internal MedicineJoseph Cassotta, MD, Family PracticeSusan Goldfarb, DMD, General DentistryMark Gurland, MD, OrthopedicsJoseph N. Lauricella, MD, Internal MedicineArnold Rabinowitz, MD, PediatricsMelba Vittal, MD, Anesthesia

20 Years Ronald Strobel, MD, Internal Medicine

15 YearsNalini Bethala, MD, Physical Medicine & RehabDavid N. Feldman, MD, OrthopedicsJerald S. Friedman, DDS, Oral & Maxillofacial SurgeryPeter G. Illowite, DO, DermatologyHeidi Nativo, PA, Emergency MedicineRafael C. Ramos, MD, Internal MedicineThomas L. Salazar, MD, Internal MedicineRichard L. Salzer, MD, OrthopedicsSteven M. Sherman, MD, Internal MedicineLeonidas Zapiach, MD, Internal Medicine

10 YearsThomas Y. Chun, MD, UrologySamyadev Datta, MD, AnesthesiaLarry W. Gingold, PsyD, PsychiatryRosy E. Joseph, MD, Internal MedicineDavid E. Konigsberg, MD, OrthopedicsGeeta L. Kumar, DO, PediatricsLorraine Lira, MD, Internal MedicineRoberto V. Nachajon, MD, PediatricsViswanathan Rajaraman, MD, NeurosurgeryEphraim E. Resnik, MD, Obstetrics/GynecologyLuba Stein, MD, PediatricsMichael A. Stein, PA, Emergency MedicineNatasha M. Steinman, MD, DermatologyPaul X. Wang, MD, Internal MedicineMelissa A. Weinstein, DO, Obstetrics/Gynecology

5 YearsBaback Adibi, MD, Internal MedicineCharles Asta, MD, NeurologyCataldo Cacace, MD, UrologySantiago A. Centurion, MD, DermatologyRakesh K. Chaubey, MD, AnesthesiaMonica Cisneros, RNFA, General SurgeryRaida Dovlatyan, MD, Physical Medicine & RehabSyeda S. Farooqui, MD, Internal MedicineOlgica Laban, MD, NeurologySean L. Lager, MD, OrthopedicsMarcelo E. Lancman, MD, NeurologyJoel Lupatkin, MD, AnesthesiaDonna McNamara, MD, Internal MedicineJohn H. Rundback, MD, Interventional RadiologyKamalesh R. Shah, MD, Internal MedicineDavid E. Solowiejczyk, MD, PediatricsLabrini D. Stathopoulos, MD, PediatricsCatherine Torres, MD, Internal MedicineSherry Zapata, PA, Emergency Medicine

FarewellTo My Patients and Colleagues:

Over the past 15 years, I have had the privilege to care for you and work with you in a profession that I love. Life is dynamic and change is the norm rather than the exception. While I could easily envision a lifetime in practice here in New Jersey, I have been offered an opportunity that my family and I feel we cannot refuse. Therefore, I am relocating out of state. In anticipation of my leaving, our group welcomed a new physician, Dr. Dianna Jones, into the practice. She is vibrant, caring and well-trained, and I know she will perform up to the standards of our group. My professional relationship with The Women’s Health Care Group has been productive and satisfying, and I have the utmost respect and appreciation for my partners. We all have built a practice that enjoys an excellent reputation in the medical community, so I heartily recommend to all my patients that they continue to receive their obstetric and gynecologic care with the Women’s Health Care Group.

Dr. Costa Sousou

Dr. Dianna Jones

Drs. George Ajjan, Costa Sousou, Jacinto Fernandez, John Frattarola and Payal Shah.

CongratulationsNicholas J. Bevilacqua, DPM, was recently involved in an historic dual publication in which he was co-author of the manuscript titled, “Surgical Offloading of the Diabetic Foot.” Dr. Bevilacqua writes to MD360: “As you are well aware, diabetes (and its associated complications) is common, disabling, and deadly. The CDC estimates that 23.6 million people in the United States (7.8% of the total population) have diabetes. Diabetes is the leading cause of non-traumatic lower-extremity amputations among adults—it’s estimated that there are 80,000 lower-limb amputations performed annually on people with diabetes. “In response to these frightening statistics, the Society for Vascular Surgeons (SVS) and the American Podiatric Medical Association (APMA) partnered on a major publication focusing on amputation prevention. This unprecedented joint effort assembled a select group of thought leaders on the subject of amputation prevention and the dual issue was recently published in both the September 2010 issue of Journal of Vascular Surgery (JVS) and the September/ October 2010 issue of Journal of Podiatric Medical Association (JAPMA).” Nicholas J. Bevilacqua, DPM, FACFAS is on staff at Holy Name Medical Center and a member of the North Jersey Orthopaedic Specialists, PA, at 730 Palisade Ave., Teaneck, NJ. He can be reached at 201-353-9000 and nicholas.bevilacqua@gmail.com.

Nicholas J. Bevilacqua

Service AnniversariesThe Holy Name family extends its congratulations and gratitude to the following members of the medical staff for their association with our Medical Center. This list recognizes anniversaries during September, October, November and December, 2010. WhenitcomestotheElectronicMedical

Record,it’saveryexcitingtimeatHolyName.WehavetrainedhundredsofHolyNamephysiciansonWebNOTESandareseeingmoreandmorenotescompletedelectronicallyeveryday.OurInformationTechnologyteamgetsgreatfeedbackfromHolyNamephysiciansandcontinuestoimplementchangesasaresultofyoursuggestions.Nearlyeveryonecanagree:TheuseofWebNOTESiseasyandhelpsgeneratelegible,comprehensivenotes. In2011,useofWebNOTESbecomespartoftheeligibilitycriteriafortheGainsharingprogram.That means, effective January 1, 2011, it will be necessary for all physicians in the Gainsharing program to use WebNOTES in order to receive distributions. IfaGainsharingparticipantphysiciandoesnotuseWebNOTESin2011,s/hewillnotreceiveanycompensationfromtheprogram. For all physicians (regardless of involvement in Gainsharing), the use of WebNOTES will become mandatory by March 1, 2011. AnyphysiciansnotusingWebNOTESatthattimewillhavetheirnon-compliantstatusrecordedintheirphysicianprofileandmayalsobesubjecttosuspension—similartohavingincompletemedicalrecords. Forthoseofyouwhohaven’tyetmadethetransitiontoWebNOTES,westronglyencourageyoutodosoatthistime.Wewillbeannouncinganotherseriesoftrainingsessionssoon.IfyouhaveanyquestionsintheinterimpleasecontactDr.CraigHersh,201-541-5947,Dr.AdamJarrett,201-833-7273orDebRoss,IT,201-833-7114.

WebNOTES: Get on Board by 2011

Appointments to the Medical Staff during September, October and November 2010

7

Annual founders Ball raises record $668,000 HolyNameMedicalCenter’sAnnualFoundersBall,presentedbytheHolyNameHealthCareFoundation,tookplaceonSaturday,November13atCiprianiWallStreetinNewYorkCity.Withcloseto700guests,theeventdrewunprecedentedparticipationandraisedarecord$668,000. Theeleganteveninghonoredthreephysicians—DavidButler,MD,TimothyFinley,DOandAlanGwertzman,MDwithSpirit of Healing AwardsfortheirmedicalreliefeffortsfollowingtheHaitiearthquake. Duringtheprogram,guestsviewedamovingvideoaboutthedesperateconditionsinHaitiandthedoctors’humanitarianworkthere.Drs.Butler,FinleyandGwertzman’stimeinHaitiandtheirdrivetosavemorelivesledtoafundraisingcampaignwiththegoalofpurchasingalifesavingoxygenprocessorfortheHôpitalSacreCoeurinMilot. SpecialguestsfromtheHôpitalSacreCoeurincludedDr.HaroldPrevil,ChiefMedicalOfficer;Dr.BernesChalumeau,CEO;andTimothyTraynor,HeadofOperations.ThethreerepresentativesattendedtheBalltocongratulatethethree

physiciansandtothankHolyNameforitscontinuedpartnership. “Thisyear’sFoundersBallwastrulyanexceptionaleveninglikenoother,”saidMichaelMaron,President/CEO,HolyNameMedicalCenter.“InhonoringDrs.Butler,FinleyandGwertzman,wealsorecognizedthecountlessliveslostorinjuredintheHaitiearthquake,andrenewedourcommitmenttoprovidinghealthcareexcellencetoourcommunityandbeyondthewallsofHolyName.ItisinthesamespiritthattheSistersofSaintJosephofPeacefoundedHolyName85yearsagoandweareextraordinarilyproudtosustaintheirhealingmissiontoday.” “IthasbeenaremarkableyearforHolyNameMedicalCenter,”saidJosephParisi,Jr.,ChairmanoftheHolyNameHealthCareFoundation.“Drs.Butler,FinleyandGwertzmanembodycompassion,sacrificeandcommitmenttoservingthoseinneed.Throughthefinancialsupportofsomanyinourcommunity,weareabletocontinueeffortslikethisandwillbetterserveallthoseinneedofstellarhealthcare.”

Photos by Mark Cap

Sept./Oct./Nov. 2010 Adam Jarrett, MD, ExecutiveVicePresident/ChiefMedicalOfficer Patricia A. Burke, MD, PhD,PresidentoftheMedicalStaff Jane F. Ellis,VicePresident,MarketingandPublicRelationseditor: Barbara Franzese Cron,Manager,MarketingCommunications

Please e-mail all comments and contributions to: editor MD360@holyname.org or call Jane Ellis, 201-833-3129 or Barbara Cron, 201-530-7904.

MD360º ispublishedbimonthlybyHolyNameMedicalCenter’sDepartmentofMarketing/PublicRelationsandisintendedforusebythemedicalstaffofHolyNameMedicalCenter.

Magnet Recognition From the American Nurses

Credentialing Center. Places us among the top 5% of hospitals

nationwide for excellence in patient care.

Beacon Award From the American Association

of Critical Care Nurses for exceptional acute and critical

care nursing.

J.D. Power and Associates Distinguished Hospital

Awards For Emergency, Inpatient,

Outpatient and Maternity Service Excellence.

Accredited Chest Pain Center

From the Society of Chest Pain Centers for our ability to

diagnose chest pain and acute coronary symptoms.

Primary Stroke Care Center Certification

From The Joint Commission, the nation’s leading health care

evaluation and accreditation organization.

HealthGrades® Specialty Excellence Award for

Stroke Care™

Ranked in the top 10% of hospitals nationally for stroke

services.

HealthGrades®

Distinguished Hospital Awards for Clinical

Excellence™ Among the top 5% of hospitals in the nation for

clinical excellence.

Modern Healthcare magazine

Ranked fourth in the nation on the “100 Best Places to Work in

Healthcare” list.

NJBIZ magazine Cited Holy Name among the

“Best Places to Work in New Jersey.”

Data Advantage, LLC Awarded for quality, affordability,

efficiency, patient safety and overall experience.

8

Annual Physicians’ Cocktail PartyHonoring Physician Leadership at

Holy Name Medical CenterSaturday, October 2, 2010

Photos by Mark Cap