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Medicine 2011 Annual Report

Section Highlights

Cardiology – directed by the Heart and Vascular Service Line

Christiana Care cardiologists are experts in the diagnosis, treatment and prevention of heart disease, stroke and other diseases that affect the heart and blood vessels. Read more about what makes us leaders in cardiovascular care and our entire roster of programs and services. Read our entire section report here.

FY11 Highlights include:

  • Cardiovascular clinical trials broaden access to newest treatments.
  • Cardiovascular Practice Network joins outpatient practices as one team.
  • Cardiology Clinic opens on Wilmington campus.
  • Heart Failure Program is Joint Commission certified/wins AHA Gold Quality Achievement Award.
  • Ventricular Assist Device Program launched for Bridge to Transplant and Destination Therapies.

Endocrinology and Metabolic Diseases

The Christiana Care Center for Diabetes & Metabolic Diseases, recognized for quality by the Diabetes Physician Recognition Program of the National Committee for Quality Assurance and the American Diabetes Association, offers comprehensive care for patients with diabetes, metabolic and other endocrine disorders.

Nurses become "diabetes resources"
Staff nurses are serving as diabetes resources to their nursing colleagues as part of a pilot training program launched at Christiana Hospital by the Diabetes Management Group (DMG).  Having knowledgeable  "go to" staff  available on the units enhances overall clinical expertise and fosters evidence-based practices. An Inpatient Diabetes Report Card records data for baseline comparisons such as readmission rates, outpatient diabetes education participation, and when possible, glycemic control measures. Currently training is planned for nurses on one unit at Wilmington Hospital, as well.

Collaborations improve diabetes care
The DMG, a multidisciplinary team charged with coordinating diabetes care delivery systemwide, collaborated with Maternal-Fetal Medicine and Nursing to develop and implement a new patient order set for treating pregnant women who may have diabetic ketoacidosis (DKA) a potentially life-threatening complication. A protocol for patients on an insulin pump with instructions for nurses is now available on the iNET. A template for blank prescriptions for diabetes medication and supplies needed at the time of discharge is in development for posting on the physician portal.

Employees choose Health for Life
Christiana Care employees who joined Health for Life, a program developed by Weight Management in collaboration with Human Resources, saw significant favorable changes in body weight, percent body fat, cholesterol profiles and overall quality life. The program ran from December 2010 to April 2011, enrolling 179 employees and graduated 98 who completed the pre-program assessment, group sessions and the post-program assessment. The next round of Health for Life will be open to the public as well as employees in Fall 2011.

Targeting diabetes and its complications
The Diabetes and Metabolic Research Center actively recruits patients for a variety of multicenter, multinational clinical trials. New this year are a number of pharmacology trials focused on treating both type 1 and type 2 diabetes that include evaluating cardiovascular outcomes, controlling hypertension and treating early or new onset type 1 disease.

Gastroenterology

Our experienced Gastroenterology team is known throughout the region for quality patient care.

Regional Center for GI Services
Christiana Care Gastroenterology provides a comprehensive array of diagnostic, therapeutic and consultative gastrointestinal services. The GI Lab at Christiana Hospital is a recognized regional endoscopy referral center, specializing in advanced techniques. Among these are therapeutic ERCP (endoscopic retrograde cholangiopancreatography), endoscopic ultrasound, impedance esophageal manometry, Barrett's ablation therapy and balloon enteroscopy. Work has already begun on an expanded Endoscopy Unit at Christiana Hospital that will meet the growing demand for invasive GI procedures with efficient delivery of care. A newly designed GI Lab is also part of the Wilmington Hospital expansion project.

More than 9,000 GI Lab procedures were performed at Christiana and Wilmington hospitals in the last year.

General Internal Medicine

Residents listening to attending physicians during rounds.The Department of Medicine is committed to providing excellent, coordinated, patient focused care in inpatient and outpatient settings. The Section of General Internal Medicine is the largest section with 157 members, and now includes two divisions: the Division of Addiction Medicine and the Division of Hospitalists. Physicians in the overlapping Medicine/Pediatrics Section are both general internists as well as pediatricians. 

Within General Medicine, hospitalists as well as general internists who also have office practices provide inpatient care at both Christiana and Wilmington hospitals. Outpatient clinical care sites include the HealthCare Center at Christiana, the Internal Medicine Faculty Practice at Wilmington Hospital and the Adult Medicine Office and the HIV Program at the Wilmington Hospital Health Center.

New Division of Addiction Medicine at work
To  improve care for people with alcohol and substance use disorders, the Department of Medicine Executive Committee recently created a Division of Addiction Medicine within the Section of General Medicine, appointing Terry Horton, M.D., FACP as chief. Critical to its mission is work toward an integrated state-wide treatment continuum for patient identification, early engagement and referrals to community providers for ongoing drug and alcohol treatment. Companion objectives include development of an addiction education curriculum for providers, an addiction-related research effort and philanthropic funding base to support the overall mission.

Poster wins IHI Permanente Journal Service Quality Award
With clinical oversight for the Alcohol Withdrawal Work Group, Addiction Medicine developed and launched a nursing educational component to help insure compliance to Clinical Institute Withdrawal Assessment (CIWA) triggered protocols. Results were highlighted at several national meetings including the 22nd Institute for Healthcare Improvement Annual National Forum, at which their poster was awarded the Permanente Journal Service Quality Award. 

Alcohol withdrawal research in progress
Addiction Medicine is collaborating with the University of Pennsylvania to study the validity of the AUDIT-PC screening tool which will yield important performance information on the tool's ability to predict alcohol withdrawal as well as performance in both senior and adult populations. 

Peer-to-peer addictions counseling helps save lives
Patients with substance abuse issues receive potentially life-saving treatment for addictions through Project Engage, an innovative peer-to-peer counseling program offered at Wilmington Hospital in partnership with Brandywine Counseling and Community Services. As many as 35 percent of patients who receive peer-to-peer counseling enter a licensed inpatient or outpatient treatment program.

Among the first 24 patients studied, hospital admissions declined by 58 percent within six months after intervention, and there were 12 percent fewer visits to the Emergency Department, representing a savings of almost $72,000. Visits to primary care providers increased to 88 percent for patients visited by a peer counselor. This is important because those who receive treatment for their addictions and routine medical care are less likely to develop more serious conditions. The program continues to produce dramatic results that could ultimately reduce serious illnesses associated with addition, as such as pancreatitis, heart disease, kidney failure, cirrhosis and pneumonia. A poster was presented at the Annual Meeting of the College on Problems of Drug Dependence, the premier international addiction medicine venue. Collaboration with the University of Pennsylvania to track patient results and cost savings eventually could take this model nationwide. Roll out of the program at Christiana Hospital is planned.

Geriatric Medicine

The Section of Geriatric Medicine is an interdepartmental section which includes internists and family medicine physicians with either fellowships or a special interest in geriatrics, advanced practice nurses, and pharmacists. All are focused on providing integrated, expert health care and services for senior patients who live independently or require hospitalization, assisted living or long-term care. Outpatient programs include adult day care, senior center offices, home doctor visits, geriatric assessments, and dementia care. 

Transforming Alzheimer's care – Swank Memory Care Center
The Swank Memory Care Center is the area's first comprehensive outpatient office for patients with memory disorders and their families. More than 14,000 people across Delaware are coping with Alzheimer's disease and other forms of memory loss. The Swank Memory Care Center offers these patients and their families essential support, education and guidance from diagnosis through treatment. For the first time, health care services, caregiver support and education to treat memory loss are provided in one outpatient clinical care location, supported by an interdisciplinary team of professionals including neurologists, psychiatrists, geriatricians, internists and family medicine physicians, a nurse and social worker with knowledge of community and regional resources. The Center, opened in May 2011, is a collaborative effort of the Departments of Medicine, Family and Community Medicine and Psychiatry.

ACE Units improve senior outcomes
ACE Units at Christiana and Wilmington hospitals improve clinical outcomes by addressing specific concerns of patients age 70 and older who may be more susceptible to problems including falls, skin breakdowns, immobility or cognitive impairment. ACE nurses receive special training in providing care to older patients. An interdisciplinary ACE team works to integrate care planning and improve continuity of care and communication with patients and families. The concept serves an increasing population of especially frail patients coming to the hospital from nursing homes and helps to decrease their hospital length of stay and potential loss of Medicaid-held nursing home beds. Complications associated with geriatric syndromes are also less frequent: patients over the last year experienced zero restraint use and decreased falls, less Foley catheter use and safer medication regimens.

Prevention, diagnosis and treatment of delirium
New delirium guidelines rolled out in September 2008 focus on prevention and appropriate treatment for delirium patients and foster better communications through a team-based approach. The Delirium Care Management Team is also working on an electronic-based approach to assessment, prevention and management of delirium. In addition, members of the section continue their work systemwide on management of constipation, reduction of Foley catheters systemwide, restraint reduction, fall prevention, promoting skin integrity, through team based care.

WISH Program models care for other hospitals
The We Improve Senior Health (WISH) Program is a collaboration among nurses, physicians, pharmacists, rehabilitative therapists, social workers, dietitians and staff from other disciplines to improve care to senior patients.  WISH has trained more than 1,450 health care providers to become Senior Health Resource Team (SHRT) members to promote best-practice geriatric care. WISH is derived from a national initiative called Nurses Improving Care for Healthsystem Elders (NICHE). CCHS has been a member since 2001 and was recognized in 2005 as a NICHE/AONE model of care.

Hematology

Collectively, the Hematology Section represents more than 120 years of clinical and laboratory hematology experience. Section members care for patients at Christiana and Wilmington Hospitals and in offices at the Helen F. Graham Cancer Center. They provide direction for several clinical programs and laboratories.

Hematology section members are active in clinical research and participate in carefully selected pharmaceutical industry clinical trials. Eligible patients have the opportunity to enroll in trials under the auspices of the National Cancer Institute Clinical Trials Cooperative Group program that includes studies from the Cancer and Acute Leukemia Group B (CALGB) and the Eastern Cooperative Oncology Group (ECOG), as well as in the  National Marrow Donor Program and the Blood and Marrow Transplant Clinical Trials Network.

Blood and Bone Marrow Transplant Program recognized
Delaware's only stem cell transplant program was recognized for superior care to volunteer marrow and apheresis stem cell donors by the National Marrow Donor Program with the "Be the Match" award, in April 2011. For more than a decade, the transplant program has been continuously accredited by the Foundation for Accreditation of Cellular Therapies (FACT) and is currently preparing for re-accreditation to continue both autologous and allogeneic transplants. The Blood and Marrow Transplant Laboratory also is accredited by FACT as well as the American Association of Blood Banks, the College of American Pathologists, and the FDA.

In calendar year 2010, the program performed 30 transplants (23 autologous, 5 donor transplants and 2 reduced intensity blood and marrow transplants) and through June 2011, another 18 transplants (17 autologous and 1 donor transplant).

Improving outcomes for hemophilia patients
Christiana Care's Hemophilia Treatment Center provides comprehensive care and preventive services to more than 200 patients with bleeding disorders. This means focusing not only on the disease itself but also on the emotional, social, educational, financial and workplace concern of patients. Close communication with primary care and other physicians providing outpatient treatment, such as colonoscopies, dental, dermatologic and gynecological procedures, has resulted in our patients having zero percent post-procedure bleeding.

Infectious Disease

The Infectious Diseases Section provides inpatient consultations to almost 10,000 patients each year and thousands more on an outpatient basis. Key initiatives include antibiotic stewardship and universal use of effective, infection prevention and control strategies in line with national guidelines.  

Infectious Disease research is pursuing new therapies to treat Clostridium Difficile infection (C-Difficile), yeast/fungal infections, pneumonia, and more. Because of the emergence of resistant bacteria and fungal isolates, the need for new drugs to treat these conditions is essential. Section members serve as mentors for student research projects as well as collaborators on national clinical trials. Several also significantly contribute to the care of HIV patients in our state, working through the Christiana Care HIV Program.

ID conference approved for CME credits
The popular infectious disease conference series that involves house staff and community physicians in the differential diagnosis of challenging cases now offers CME credits. Organized by Stephanie Lee, M.D., it is widely considered to be one of the best case management conferences offered. The program often features reports by interns and residents, reflecting ID's commitment to academic education. This is no surprise as the ID Section faculty are consistently recognized for their teaching efforts. This year, five of the 12 section members were nominated for teaching awards.

Top notch care for HIV patients
Christiana Care is a major provider of HIV medical services throughout Delaware, operating seven clinical sites (five in New Castle County, and one each in Kent and Sussex Counties) integrated into the communities with the highest rates of HIV infection. In addition to comprehensive medical care for HIV infection, the HIV program includes a number of nested programs to address medical and psychiatric co-morbidities and women's health. It is important to note that these nested programs currently account for 50 percent of the visits attended by our patients (compared to 30 percent in 2009). The HIV Program is also working in collaboration with the Delaware Department of Corrections (DOC) and on a University of Delaware study to improve linkage to community based medical care following release for prisoners who are identified as HIV positive.

In  FY2010, the program treated 1,612 HIV positive individuals (a 4 percent jump over the previous year). The total number of clinical visits at all sites jumped to 12,529, a 5 percent increase over the previous year.

Although the majority of patients live well below the federal poverty level, 85 percent of appropriate patients are on HAART (anti-retroviral therapy). Of those, 75 percent have undetectable HIV RNA levels. It is important to note that 66 percent of HIV Program patients are AIDS-defined, which is significantly higher than those patients accessing care in the private sector. As the chart below indicates, lost to follow up rate is 4 percent and the mortality rate is 2 percent.

Screening offered for HIV-associated cancers
HIV infected patients have a high prevalence of HPV-associated anal disease, and there is evidence that the incidence of anal cancer in HIV infected patients is twice that compared to an HIV-negative at-risk population. The HIV Program offers screening to high-risk men and women in an effort to prevent anal cancer by early interventional and monitoring of precancerous conditions.

Broadening access to substance abuse treatment
More than 30 percent of all AIDS cases in the United States are linked directly or indirectly to drug use. More than 60 percent of HIV positive people experience at least one mental illness after diagnosis and many struggle with co-occurring substance use. The HIV Program will pilot an office-based opioid treatment program at the Wilmington Hospital Annex under the direction of Dr. Susan Szabo, in collaboration with Larry Yurow, LCSW. The program offers a holistic approach that combines pharmacotherapy with counseling and behavioral health, offering an important option for patients who want to stop opioid use without making daily visits to a methadone clinic or going to a drug treatment program. Research shows that Medication Assisted Treatment (MAT) reduces illicit opiate use, increases engagement in HIV care and treatment, improves adherence to antiretroviral therapy, and enhances HIV treatment outcomes.

Transition clinic eases care pathway for young HIV patients
As HIV infected adolescents grow into adulthood, transition to an adult care setting presents a unique set of challenges. The HIV Program has established a unique model in collaboration with the Nemours/A.I. duPont Hospital for Children Infectious Disease Clinic to smooth the transition for young adults as they take responsibility for their own health and disease management. The program offered at the Adolescent Transition Clinic at the Wilmington Hospital Annex, allows patients to become familiar with the adult care setting and staff, while maintaining a relationship with their pediatric provider. Patients receive care in the Transition Clinic until they have demonstrated appropriate levels of adherence and self management.

Medical Oncology – directed by the Oncology Service Line

State-of-the-art cancer care driven by best practices and the latest research comes from multidisciplinary teams of professionals in private practice and at the Helen F. Graham Cancer Center, a select NCI Community Cancer Centers Program. Read more about what makes us a national model for community cancer centers and our entire roster of programs and services.

FY11 Highlights include:

  • Helen F. Graham Cancer Center performs first gene therapy in Delaware.
  • Breast Center is Delaware's first to earn American College of Radiology accreditation for MRI.
  • Avon grant helps fund breast cancer outreach.
  • Christiana care promotes breast health to Latinas.
  • Helen F. Graham Cancer Center leads national colorectal cancer trial.

Neurology

With 24-hour coverage, the section of Neurology provides more than 5,000 neurology consultations a year including stroke code/alert coverage. Members of the section provide services for and serve as medical directors of  the EEG, Sleep and EMG laboratories, and members provide services for both EEG and EMG laboratories.

Sleep Disorders Center
The Sleep Disorders Center, accredited by the American Academy of Sleep Medicine, provides expert, multidisciplinary diagnosis and care for every kind of sleep problem. Latest technologies such as autoSV therapy are used to manage complicated sleep-disordered breathing patients. This year, staff performed 1,445 polysomnograms (sleep studies) and 34 multiple sleep latency tests.

Silver Plus Quality Award for stroke
Christiana Care received the Silver Plus Quality Achievement Award for Stroke from the American Stroke Association. The 'Get With The Guidelines" award recognizes that Christiana Care patients receive a higher standard of stroke care according to nationally accepted standards and recommendations. To receive the award, Christiana Care achieved at least 12 consecutive months of 85 percent or higher adherence to all Get With The Guidelines-Stroke Quality Achievement indicators and at least 75 percent or higher compliance with 6 of 10 Get With The Guidelines-Stroke Quality Measures during that same period.

Nuclear Medicine

Nuclear Medicine offers comprehensive services and nearly all approved diagnostic and therapeutic nuclear medicine procedures. New to the repertoire of clinical procedures offered is quantitative renal function evaluation measuring glomerular filtration rate, requested by the Renal Transplant service. Services are provided at Christiana Hospital (diagnostic & therapy); the Helen F. Graham Cancer Center (PET/CT); Wilmington Hospital (diagnostic) MAP-2 (diagnostic, therapy & DXA); Smyrna Health & Wellness Center (diagnostic & DXA); and our Foulk Road office (DXA).

Medication management wins gold
Nuclear Medicine collaborated with Pharmacy and Nursing to achieve compliance with Joint Commission standards to place radioactive pharmaceuticals under pharmacy control. Their efforts earned the 2010 Gold Award for Clinical Excellence in Christiana Care's Focus on Excellence performance improvement program. The team presented at the American Society of Hospital Pharmacists annual meeting, and submitted a solicited paper to the Journal of Nuclear Medicine Technology.

New space centralizes full range of services
New clinical space at Christiana Hospital transforms nuclear medicine in a "chartless" environment that improves patient convenience,  privacy and safety and brings full compliance with regulatory standards including regulations for radiopharmaceutical compounding. The new, easily accessible main floor space adds a 9,300 square feet, upgrades technology and centralizes a full range of nuclear medicine services, including integrating PET imaging and expanding cardiac PET imaging and adding two new large-field-of view, dual-head gamma cameras, one a hybrid imaging system incorporating CT technology, and a portable large-field-of-view gamma camera.

Additional service upgrades include a nuclear cardiology stress lab, ambulatory injection/staging area, PET reading room, blood-volume analysis suite, a redesigned patient reception area, video surveillance and nurse call bell system.  A complete renovation of the former 2,500-square-foot Nuclear Medicine suite will accommodate administrative offices, on-call rooms and a larger classroom for training future nuclear-medicine technologists in partnership with Delaware Technical & Community College.

Improving bone health
Nuclear Medicine has taken the lead to improve bone health and reduce fragility fractures. An upgrade to the DXA bone densitometry reporting system incorporates expanded patient history and includes absolute fracture risk assessment when appropriate.  Nuclear Medicine partners with OB/GYN and Imaging Services to provide DXA services at Christiana Care sites and at community outreach settings. Section Chief Timothy Manzone, M.D., chairs the multidisciplinary Bone Health Advisory Committee, which is working to develop a multifaceted, fracture reduction program.

Leading-edge clinical research underway
Nuclear Medicine is credentialed to participate in several notable clinical research trials. New among them is the Lantheus 18F flurpiridaz PET MPI study, a multicenter clinical trial of a PET myocardial perfusion imaging agent. Christiana Care PI is Timothy Manzone, M.D., with co-investigators Erik Marshall, M.D. and Robin Horn, M.D.

Pain Management/Palliative Care

Effective pain management can improve quality of life and shorten hospital length of stay. Evidence suggests that pain and palliative care programs lead to additional and more timely hospice referrals, fewer inappropriate resuscitative efforts (codes) and fewer ethics consults; thus improving overall quality of care.

Multidisciplinary team offers broad range of services
 In FY11, the inpatient consult service provided care to nearly 1,740 patients at Christiana and Wilmington hospitals. Of these, 990 were pain management consults and 750 were palliative care. More than 500 nurses are now trained in PPC Nurse Liaison Course. Services provided by a multidisciplinary team include: evaluation and pain/symptom management, advance care planning, end of life care and referral to hospice, general inpatient hospice care, terminal weans, accelerated bereavement and psychosocial, emotional, and spiritual support for patients and families. A separate Oncology Rehabilitation program provides palliative care and symptom management, through bedside and unit based therapies for cancer patients, including physical therapy, medications, self-directed exercise, counseling and support groups.

"No One Dies Alone"
Pain and Palliative Care collaborated with Volunteer Administration, Pastoral Services, Nursing and Infection Prevention to institute  a program to provide a companion at the end of life to patients who have no family or friends present. The team earned top honors with the 2010 President's Award in the annual Focus on Excellence Awards performance improvement program. As of January 2011, 32 volunteers had been trained and 78 volunteer hours logged in support of 21 patient referrals.

Physical Medicine and Rehabilitation Services

Wilmington Rehab redesigned
Sweeping design changes are captivating patients at the CARP-accredited Center for Rehabilitation at Wilmington Hospital. Physical therapy, occupational therapy and speech therapy, previously in separate locations, are now in one space, expanding the area for outpatient therapy. The open floor plan also facilitates the flow of ideas and collaboration among health professionals on the floor. For example, nurses can observe and deliver medications to patients in the gym and communicate with therapists to ensure carryover of learned skills after patients return to their room. The improvements also let in more light and more equipment, such as a machine that helps patients build strength in their lower extremities. Wilmington Hospital's outpatient rehab currently records about 11,000 patient visits a year, but the new, more efficient operation will enable the center to care for more people. The Wilmington Center for Rehabilitation also has a 40-bed inpatient unit.

Physiatrist shares expertise a world away
The Center for Rehabilitation's Tony Cucuzzella, M.D., a leading expert in non-surgical approaches to treating back and neck pain travelled to China in September to lecture and demonstrate fluoroscopic spinal procedures. His visit was hosted by the Institute for Western Surgery, in Guangdong Province, to bring the benefits of western medicine to Chinese patients.

Pulmonary & Critical Care Medicine

"High reliability" concepts drive section initiatives in patient safety and improvements in quality of care. Read more about our recent accomplishments.

Transforming respiratory care
A Respiratory Redesign Project initiated in partnership with Nursing is transforming delivery of respiratory care services. Christiana Care ranks among a select 15 percent of hospitals recognized by the American Association of Respiratory Care as a Quality Respiratory Care institution. One reason is relying on specially trained respiratory therapists to assist physicians with pulmonary function testing and delivery of respiratory services.

In the last five years, respiratory procedure volume has increased by 44 percent, correspondingly increasing workload by 23 percent.  In 2010, respiratory-related events accounted for 47 percent of all Rapid Response Team (RRT) calls,  the single largest reason for RRT initiation.

To ensure adequate resources and continued patient safety, a multidisciplinary team of respiratory therapists and nurses benchmarked targets and developed a new, team-based model for respiratory care. The model is service-focused and integrates RTs as stable members of the care team in each area. Central to this concept is nursing collaboration and partnership.  Results just five months into the team pilot show potential for impact in many areas, including reducing ventilator length of stay and ventilator associated pneumonia, increasing extubations and transfers out of ICU, reducing ED readmission rates for asthmatics and COPD patients, better continuity of care through communication and collaboration among physicians, nurses and therapists, timely medication delivery, and increased patient satisfaction.

Helping patients breathe easier
The Christiana Care Pulmonary Function Lab offers a full range of  tests to assist doctors in diagnosing and evaluating all aspects of pulmonary disease. The lab performs a combined average of 2,600 procedures a month at Wilmington and Christiana hospitals. These include spirometry to evaluate air flow when exhaling; lung volumes and airway resistance; bronchoscopy and thoroscopy to inspect inside the lungs and airways; arterial blood gas analysis to measure oxygen and carbon dioxide levels; supplemental oxygen evaluation and high altitude simulation testing; asthma diagnosis and evaluation, and cardio pulmonary exercise stress testing.

The Pulmonary Function Laboratory is accredited by the College of American Pathologists (CAP) and the Clinical Lab Improvement Amendments (CLIA) and follows American Thoracic Society Laboratory Guidelines.

Interventional Pulmonology offers latest technologies
Interventional Pulmonary encompasses a broad range of diagnostic and therapeutic pulmonary procedures to manage lung and pleural diseases. Members of the section of Pulmonary as well as Critical Care Physicians from both the Department of Medicine and Surgery employ both basic and advanced bronchoscopic skills as part of routine care. All bronchoscopies done outside of the operating room fall under the preview of Interventional Pulmonary service and  the Department Respiratory Care.

In FY2011, 923 patients had bronchoscopic procedures performed at Christiana Care. A total of  76 percent of these patients had the procedure done for diagnostic purposes; 24 percent were for therapeutic reasons, such as for laser treatment, to clear the airway, or to place a stent or markers for radiotherapy. Just over a third (36%) of all bronchoscopies were performed as an outpatient procedure.

Approximately 40 percent of bronchoscopies performed were ICU related. These included broncho-alveolar lavage (BAL) to collect secretions for microbiologic analysis, to clear blocked airways and to support percutaneous tracheostomy, a minimally invasive alternative to traditional tracheostomy.

The latest interventional bronchoscopy procedures were used in 364 cases and include:

  • Endobronchial Ultrasound (EBUS) for guided lymph node biopsy.
  • Electro-magnetic Navigational Bronchoscopy for lymph node biopsy and placement of markers for stereotactic radiation surgery (Cyberknife).
  • Rigid bronchoscopy (RB) to treat endobronchial tumors, place stents or remove a foreign body from the airway.
  • Indwelling Bronchial Valve (IBV) placement to treat bronchopleural fistula, an abnormal passage that can develop in the lungs.

Promoting lung health for all Americans
Delaware pulmonologist Albert A. Rizzo, M.D., was named the national volunteer chair of the American Lung Association board of directors. He just completed serving a two-year term as the Association's highly visible nationwide assembly speaker. In his new role, Dr. Rizzo will work closely with top leaders to advance the organization's mission of saving lives by improving lung health and preventing lung disease.

Transitioning care for adults with cystic fibrosis
In cooperation with Nemours/A.I. duPont Hospital for Children, the Adult Cystic Fibrosis (CF) Program facilitates the transition to adult care for children with the disease.  In FY2011, there were 96 clinic visits, offering patients spirometry in collaboration with the Pulmonary Function Lab. The program contributes patient data to the Cystic Fibrosis Foundation data base and, through the CF Treatment Development Network, offers patients the opportunity to participate in the latest clinical trials of new drugs and new treatments. The program also offers treatment of cystic fibrosis related diabetes (CFRD).

Adding continuous pulse oximetry to flex monitoring
The latest enhancement to Christiana Care's flex monitoring system is the addition of continuous-pulse oximetry, a non-invasive method of monitoring the oxygenation of a patient's blood, along with the ECG monitoring with telemetry. This enhancement could help clinicians identify patients sooner who may be at risk for cardiac arrest. For the last decade, flex monitoring at Christiana Care has allowed for continuous ECG monitoring for any non-ICU patient in any bed in either hospital, improving patient satisfaction and reducing costs by decreasing room transfers when a patient requires monitoring.

Renal & Hypertensive Diseases

Nationally recognized Kidney Transplant Program
Christiana Care's nationally recognized adult kidney transplant program, a joint program with the Department of Surgery, is the only one of its kind in Delaware. The program is certified by the United Network for Organ Sharing to perform both living donor and deceased donor kidney transplants and led by an experienced team of transplant surgeons and professionals who provide optimum care for these complex patients. The program also offers medication management post transplant and living donor education, through the  Department of Surgery.

For FY2011, the kidney transplant team performed 29 kidney transplants and 699 pre-transplant evaluations. There were 107 new patients added and 229 referrals.

Magnet recognition for excellence in nursing CarePages Delaware Health Sciences Alliance
Christiana Care Health System PO Box 1668, Wilmington, DE 19899 Contact Us www.christianacare.org
Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit christianacare.org/donors.