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Section Highlights

Cardiology 
Dermatology
Endocrinology and Metabolic Diseases
Gastroenterology
General Internal Medicine
Geriatric Medicine
Hematology
Infectious Disease
Medical Oncology
Neurology
Nuclear Medicine
Pain Management/Palliative Care
Physical Medicine and Rehabilitation Services
Pulmonary & Critical Care Medicine
Renal & Hypertensive Diseases


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. The Center for Heart & Vascular Health is one of the most technologically advanced cardiovascular care centers in the United States, earning the highest rating for heart surgery from the Society of Thoracic Surgeons and the Gold Quality Achievement Award from the American Heart Association.

Read more about what makes us leaders in cardiovascular care and our entire roster of programs and services.

FY12 Highlights:

One of first sites approved for TAVR

Christiana Care was one of the initial sites approved for implementation of Transcutaneous Aortic Valve Replacement (TAVR) in November 2011, following FDA approval. The first procedure was completed in February 2012, and by June, 48 patients had been evaluated for valve replacement and 9 patients had received the valve. The current average Length of Stay (LOS) for these patients is 4.3 days.

Value care for acute heart attack

The acute myocardial infarction (AMI) team, led by William Weintraub, M.D., Henry Weiner, M.D., and Brian Sarter, M.D is focused on achieving consistently high standards for heart attack outcomes. AMI is one of the key diagnoses charted for quality outcomes and value based purchasing by the Centers for Medicare and Medicaid Services (CMS). 

Christiana Care’s Focus on Excellence Report targets eight quality measures for AMI, including emergency angioplasty within 90 minutes of  arrival; prescribing recommended discharge medications (i.e., aspirin, beta blocker/ACEI, cholesterol); ED/Cardiology physician collaboration, and accurate coding. Our goal of being in the 90th percentile for these measures demands a focused and dedicated approach.

FY12 performance improvement initiatives included new on-call paging responsibilities for cardiologists; Heart Code team coverage for physician teams; dedicated coding oversight for AMI; supplemental staffing to support ECG within the ED; and physician education on documentation of diagnosis for AMI and education for physicians and nurses on guidelines for discharge medications.

Value Improvement Team raises Heart Failure standard of care

The Value Improvement Team is working to reduce variation and  improve the reliability of care for patients with heart failure. Value score cards that track performance showed an 8 percent improvement among core measures. Progress includes more timely identification by nurse navigators of patients requiring specialized heart failure care; increased bed assignments from ED to the dedicated heart failure unit; reduced length of stay; reduced 30-day readmissions (20%); greater patient satisfaction; and stricter compliance with evidence-based standards. Christiana Care’s heart failure program holds the Joint Commission Gold Seal of Approval ™.

Bridging the Divide – Heart patients benefit from CMS grant

Christiana Care is one of only 107 projects picked for CMS Innovation Grants from more than 3,000 applicants nationwide. “Bridging the Divide” is a three-year, system wide initiative to create a Patient Care Hub using existing hospital and office information systems to coordinate care of patients with ischemic heart disease both in the hospital and upon discharge home. The system will help a team of nurses and other health care professionals respond effectively to their patients, enabling them to recuperate in their homes and potentially avoid problems that can result in a costly readmission. Partners include Booz Allen Hamilton, the University of Delaware, the Delaware Health Information Network, The Society of Thoracic Surgeons and the American College of Cardiology.

More on ASCERT study

This landmark study, sponsored by the American College of Cardiology Foundation (ACCF) and The Society of Thoracic Surgeons (STS), compared the effectiveness of PCI and CABG for the treatment of stable coronary artery disease. ASCERT continues to attract both national and local media coverage. Cardiology Chief William Weintraub, M.D., is a co-author on two new papers in Circulation, arising from the study and one in the New England Journal of Medicine. Development of the ASCERT II grant is on-going.

Setting the standard for tomorrow’s heart medicine

Cardiovascular clinical trials test new drugs and new devices designed to improve and extend the lives of heart patients.  At any given moment, the program averages some 20 open, ongoing trials, with an additional 15 or more in follow-up, funded by NIH’s National Heart Lung and Blood Institute (NHLBI) and others. In FY12, some 350 patients participated in studies that included the following:

  • ATTRACT - Sponsored by the NIH National Heart Lung and Blood Institute to determine the best treatment for blood clots.
  • CTSN(Cardiothoracic Surgical Network) - Evaluates surgical ablation versus NO surgical ablation for patients with persistent or longstanding atrial fibrillation undergoing Mitral Valve Surgery, sponsored by the  National Heart Lung and Blood Institute.

Christiana Care participates in one of only nine elite National Institutes of Health, Heart Failure Clinical Research Centers in the nation, collaborating with Thomas Jefferson and Temple universities in Philadelphia. Heart Failure Network Trials sponsored by NIH include: 

  • EXACT HF -  Determines whether chronic inhibition of xanthine oxidase produces clinical benefits in heart failure patients with high serum uric acid levels who have left ventricular systolic dysfunction.
  • ROSE HF - Examines the benefits and safety of intravenous administration of low dose nesiritide or low dose dopamine in patients with congestive heart failure and kidney dysfunction.
  • Left Ventricular Structural Predictors of Sudden Cardiac Death (SCD) -  Information about the heart's structure obtained from cardiac magnetic resonance imaging combined with a number of other clinical risk factors is examined for characteristics that might better predict patients at risk for SCD.
  • PAPI 2 – Investigates whether patients with certain gene differences have fewer major cardiac events after stent placement if they are given anti-platelet therapy guided by their individual genetic type compared to standard anti-platelet therapy.

Dermatology

Safeguarding our community from skin cancer

Dermatologists Peter Panzer, M.D., Scott Panzer, M.D., Helen Mashek, M.D., Lori Spencer, M.D., Matt Hansen, M.D., Eric Oliet, M.D., and Jonathan Zieff, M.D., volunteered their services to screen 319 individuals for skin cancer at this year's annual community skin cancer screening event offered by Christiana Care in partnership with the Delaware chapter of the American Academy of Dermatology.

Endocrinology and Metabolic Diseases

The Christiana Care Endocrinology and Metabolic Diseases practice, 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 and other endocrinologic diseases.

Targeting diabetes and its complications

The Diabetes and Metabolic Diseases Research Center actively recruits patients for a variety of multicenter, multinational clinical trials. The center performs phlebotomy, EKG, glucose tolerance tests, mixed meal tolerance tests, autonomic function tests, and others based on study protocol requirements. Autonomic function tests are also performed at the Diabetes and Metabolic Diseases Center.

A number of pharmacology trials are 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, metabolic and other endocrine disorders. Three new grants, totaling in excess of $100,000, include support from Delaware INBRE (IDeA Networks of Biomedical Research Excellence), which will fund investigations of insulin resistance, cardiovascular complications associated with diabetes treatment and genetic dysfunction in FHHNC, a rare disorder leading to progressive kidney failure.

Ongoing trials include:

  • DUAL I -  Compares the efficacy and safety of three drugs: insulin degludec/liraglutide, insulin degludec and liraglutide in subjects with type 2 diabetes to help manage blood glucose levels.
  • DIA-AID2 -  This Phase III study looks at the treatment effect of DiaPep277 on preservation of beta-cell function in newly diagnosed type 1 diabetics. DiaPep277 is a peptide that blocks immune system attacks on insulin producing beta cells.
  • REWIND - Assesses whether the drug, dulaglutide, can reduce major cardiovascular events and other serious outcomes in persons with type 2 diabetes, when added to their anti-hyperglycemic regimen.

Recently completed:

  • LX4211-2-202 DM - This phase 2 trial tested the effect on Hemoglobin A1c of different dose regimens of LX4211 in combination with metformin in subjects with type 2 diabetes who had inadequate glycemic control on metformin monotherapy.

Weight Management Program gains patient satisfaction

Christiana Care's Weight Management Program offers a wide array of services, including a Bariatric Surgery/Life Skills program, diet and nutrition programs including OPTIFAST Meal Replacement, exercise services including Fit4Life, medical weight management, education and much more.

In FY12, patient visits rose by 3 percent, and patient satisfaction scores consistently averaged above the 95th percentile for program materials, staff and services. Staffed in part by members of the Endocrinology and Metabolic Diseases section, Weight Management has earned accreditation as a Bariatric Center of Excellence from the American College of Surgeons and the American Society for Bariatric and Metabolic Surgery and is designated with “Blue Distinction” from the BlueCross BlueShield Association; a Three-Star Quality Bariatric Center by Cigna and an Aetna Quality Bariatric Surgery Facility.

Gastroenterology

Christiana Care Gastroenterology provides a comprehensive array of diagnostic, therapeutic and consultative gastrointestinal services. These include therapeutic ERCP (endoscopic retrograde cholangiopancreatography), endoscopic ultrasound, impedance esophageal manometry, Barrett's ablation therapy and balloon enteroscopy. In FY12, GI Labs performed more than 8,000 procedures at Christiana and Wilmington hospitals.

Managing patients at high risk for GI bleeding

Gastroenterology collaborated with the Emergency Department, Critical Care, and Anesthesia to develop a hospital wide protocol for the management of patients with high risk GI bleeding requiring emergent intervention. The protocol is designed to improve care coordination and efficacy that will lead to improved patient outcomes. This collaboration has opened opportunities for future improvements in the delivery of care for patients requiring GI interventions after hours and on weekends.

Endoscopic Ultrasound service expands

Our endoscopic ultrasound (EUS) service continues to grow with more than 350 cases performed in the last year and an active referral practice from Maryland, downstate Delaware, and New Jersey. Close coordination with the Christiana Care Helen F. Graham Center has augmented clinical care and collaboration on multiple clinical trials.

GI Safety Event Committee supports performance improvement

The GI Section has formed a GI Safety Event Committee to critically review GI related events to enhance safety and quality of care. Three gastroenterologists, two GI Lab nurse managers, one staff nurse, and an anesthesiologist serve on the committee, which meets twice monthly to review referred cases and make recommendations for action or intervention. An Emergency Department physician is available as needed. In the future, the committee will also track endoscopic performance parameters.

Colorectal screening assistance study

Gastroenterologist Nathan A. Merriman, M.D., M.S.C.E. is collaborating with Med-Peds Section Chief Allen Friedland, M.D., FACP, FAAP, on a performance improvement project  to facilitate rapid colonoscopy referrals from primary care patients with positive fecal immunochemical test (FIT) results. The study is called the Colorectal Assistance Program for Screening (CRAPS).

New Endoscopy Lab under construction

The GI Section is actively engaged in the design and planning of the much anticipated Endoscopy Lab under construction at Christiana Hospital. The expansion will meet the growing demand in our region for invasive GI procedures. 

GI Lab enters Rapid Process Improvement

The GI Lab at Christiana Hospital is a recognized regional endoscopy referral center, specializing in advanced techniques. In FY12, the lab entered a 90-day Rapid Process Improvement (RPI) cycle to increase “on-time” starts for GI cases.

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General Internal Medicine

A robust group of 152 general internists are committed to providing excellent, coordinated, patient focused care on inpatient medicine services, in our offices at the hospital and in the community. Christiana Care has internal medicine practices in the Wilmington Hospital Health Center (Adult Medicine Office, Internal Medicine Faculty Practice, and Transitional Practice), at the Wilmington Hospital Annex (HIV practice), and at various sites in the county (Medical Group of Christiana).

Currently, there are two divisions within the Section of General Internal Medicine:

  • Division of Hospitalist Medicine
  • Division of Addiction Medicine

Our clinical faculty are focused on enhancing the value of the care provided throughout our health systems to all the communities we serve. Conduits to this effort are clinical care, performance improvement and original research. Here are some examples:

  • Education regarding “Lean” technology and how it applies to medical care.  Target: Enhancement of efficiency in the Adult Medicine Office and effective and efficient teaching rounds in the inpatient setting.
  • Application of principles of self-management and patient report cards to enhance control of blood sugar and other clinical markers in the care of diabetes mellitus.
  • Re-organization and restructuring of teaching practices in anticipation of application for Level 2 National Committee for Quality Assurance (NCQA) recognition as a patient centered medical home.
  • Ongoing monthly faculty development seminars.
  • Teamwork and use of electronic record systems to enhance the rate of mammography in the outpatient practices.
  • Restructuring and revising the approach to research and scholarly activity with the development of a research track in the Internal Medicine Residency and improved collaboration with the team of research nurses.
  • Updating the protocols for treatment of patients in alcohol withdrawal, resulting in reduced rates of delirium tremens and use of restraints.
  • Improving access to substance abuse treatment for inpatients by expansion of Project Engage to Christiana Hospital.
  • Collaborative work with the University of Delaware to use simulation exercises for resident and nursing education to enhance teamwork.

Smoothing care transitions

A highlight of the year was the wine reception Meet n’ Greet, held in May 2012, “Bridging the Gap From Hospital to Home.” This was an opportunity for community internists and hospitalists to share thoughts regarding barriers to safe care transitions. The group spent time brainstorming about solutions and paths forward.

Health Fair at Connections Homeless Café

Internal Medicine residents launched a project with Christiana Care social workers, EM/IM and Med-Peds residents, Pharmacy Services and other staff at the Connections Homeless Café in October 2012. More than 100 people attended the event, which featured “Ask the Doctor” tables, free flu shots, health screenings and information about healthcare access and resources. Connections Café in Wilmington is sponsored by American College of Physicians Delaware Chapter and Christiana Care Social Work and Community Health Outreach and Education.

Division of Addiction Medicine

Project Engage garners praise and funding support

White House Visits Christiana Care's Substance Abuse Intervention ProgramProject Engage, Medicine’s unique substance abuse intervention program, is gaining national recognition. In September 2012, White House Deputy Director of the Office of National Drug Control Policy, David K. Mineta, MSW, and colleague June Sivilli visited to take a closer look. Also in attendance were Delaware Secretary of Health and Social Services Rita Landgraf and Delaware State Representative Michael Barbieri, highlighting Delaware’s success in nurturing public and private innovation collaboratives.

Led by Terry Horton, M.D., chief of Addiction Medicine and faculty in General Internal Medicine, Project Engage operates in partnership with Brandywine Counseling, Inc. and Delaware Physicians Care. An on-site embedded outreach coordinator from Brandywine Counseling works one-to-one with patients identified as addicted to drugs or alcohol after they arrive at the hospital. Since the program began in 2008, 667 patients have consented to speak with an interventionist. More than 40 percent were successfully admitted to community-based substance use disorder treatment programs. Key to success is engaging patients during those “reachable moments” and identifying barriers to intervention efforts.

A $1.1 million anonymous gift expanded Project Engage in November 2011 from a Wilmington campus-based pilot to a fully funded three-year program now launched at Christiana Hospital. The gift also funds a robust program evaluation conducted in collaboration with the  University of Pennsylvania and Christiana Care’s Center for Outcomes Research (CCOR). There is already evidence that patients who received peer-to-peer counseling, are visiting their primary care physicians more and relying less on emergency care.

Alcohol treatment guidelines gain national recognition

On its Innovations Exchange website, the Agency for Healthcare Research and Quality (AHRQ) highlighted alcohol withdrawal risk evaluation and treatment guidelines for patients admitted to medical and surgical units, developed by Christiana Care’s Alcohol Withdrawal Workgroup. The integrated screening, treatment and monitoring algorithms have helped to identify more patients with alcohol withdrawal and to prevent development of delirium tremens (a dangerous, acute episode of delirium caused by alcohol withdrawal). The protocol also improved care for patients with delirium tremens, as evidenced by shorter average length of stay, less use of restraints, and fewer transfers to the intensive care unit. Approved for participation in Christiana Care’s Operational Excellence Rapid Process Improvement Program, the Workgroup is collaborating with unit based clinical leadership at Christiana Hospital to craft innovative monitoring and intervention methods. 

Alcohol withdrawal research presented nationally

Addiction Medicine is collaborating with the University of Pennsylvania to study the validity of the AUDIT-PC screening tool to predict alcohol withdrawal as well as performance in both senior and adult populations. Initial results were presented at the Society of General Internal Medicine annual meeting in May 2012.

Division of Hospital Medicine

Fifty-two physicians and eight non-physician providers from the Division of Hospital Medicine (DoHM) provide care for inpatients on the Medicine service. Hospitalists have a key role in Medicine’s clinical transformation initiatives, focused on improving care for medically critical patients and managing transitions of care into and out of inpatient settings.

In FY12 hospitalists discharged 21,561 patients, approximately 71 percent of all patients in the Internal Medicine service line. Adjusted LOS is 4.90 days. Seven-day readmission rates dropped to 5.0 percent and 30-day readmissions to 15.4 percent.

Currently a hospitalist serves as Associate Chief Medical Officer for Christiana Care and as physician-in-chief for Wilmington Hospital. Four hospitalists serve as Unit Based Clinical leaders, driving change in key areas including length of stay (LOS), transitions to post acute care, VTE prophylaxis, pain management and Clinical Institute Withdrawal Assessment (CIWA) updates. In the last year, 26 members of the Division of Hospital Medicine received “Diamond” recognition from their colleagues for their contributions and commitment to excellence.

Geriatric Medicine

The Section of Geriatric Medicine is an interdepartmental section, which includes geriatricians, internists and family medicine physicians with a special interest or additional training in geriatrics, advanced practice nurses, and pharmacists. Currently 63 members are board-certified or associates in Geriatric Medicine. 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.

Section members provide post acute senior services through a variety of avenues: the Senior Center Office Practices in New Castle and Wilmington; Home Visit and Geriatric Assessment programs;  affiliations with local nursing homes; Christiana Care Pain and Palliative Care and inpatient hospice services; and the Christiana Care Visiting Nurse Association (VNA). For several, a commitment to improving clinical excellence in geriatrics includes serving as faculty and mentors for our graduate medical education programs.

Acute Care for the Elderly (ACE) units

Christiana and Wilmington hospital ACE units continue to model care and improve outcomes for patients age 70 and older. In the last year multidisciplinary teams on these units decreased length of stay by at least one day and lowered the rate of  complications associated with geriatric syndromes. Patients over the last year experienced zero restraint use and decreased falls and Foley catheter use and safer medication regimens. 

WISH celebrates decade of accomplishments

The We Improve Senior Health (WISH) Program celebrated 10 years of exemplary care to senior patients in September 2011. Led by Program Coordinator Denise Lyons, MSN, GCNS-BC and Medical Advisor and Section Chief Patricia Curtin, M.D., FACP, CMD., WISH is a collaborative program that includes nurses, physicians, pharmacists, rehabilitative therapists, social workers, dietitians and staff from other disciplines. WISH teams have garnered national awards and recognition for their efforts to reduce complications associated with the hazards of hospitalization for older adults, such as adverse drug reactions, delirium, depression, falls prevention, use of Foley catheters and restraints, malnutrition and dehydration. A WISH Program Toolkit, updated annually, details nursing protocols, standardized order sets and other resources.

In the last decade, WISH has trained more than 1,500 health care providers to become Senior Health Resource Team (SHRT) members to promote best practice geriatric care.  

In May 2012, WISH offered their sixth Geriatric Review Course for nurses. There are now 130 Christiana Care nurses certified in geriatrics, an increase of 20 percent in the last year.

Annual survey results from November 2011 illustrate WISH impact:

  • 98% of staff reported they practice what they learned from WISH to provide best practice care to geriatric patients.
  • 91% make suggestions to physicians about patient concerns.
  • 97% make suggestions to other team members.
  • 91+% reported improvement in 15 senior patient care areas.

WISH is derived from a national initiative called Nurses Improving Care for Healthsystem Elders (NICHE). Christiana Care has been a member since 2001 and was recognized as a model of care by NICHE in 2005 and by the American Geriatrics Society in 2010.

Swank Memory Center Open House

The Swank Memory Care Center celebrated its first Open House and Donor Recognition in October 2011. The Center is the first of its kind in our area to offer essential support, education and guidance from diagnosis through treatment, all in one location to families and patients with Alzheimer’s disease and other forms of memory loss. Since opening in May 2011, the Center’s interdisciplinary team of geriatricians, neurologists, psychiatrists, medical assistant and social worker have provided health care services, caregiver education and support, and community referrals for more than 255 patients. The Center’s “mantra” is “to help manage the journey with the patient and their caregivers.” The Center is a collaborative effort of the Departments of Medicine, Family and Community Medicine and Psychiatry. Dr. Curtin served as interim medical director while Dr. David Simpson was the associate clinical director.

Denise Lyons, RN, MSN, GCNS-BC completes Practice Change Fellowship

Denise Lyons, RN, MSN, GCNS-BC clinical specialist in gerontological nursing, completed a two-year, highly competitive Practice Change Fellowship, sponsored by Atlantic Philanthropies and the John A. Hartford Foundation. As part of the program, Lyons worked with seven other fellows and a team of mentors, including geriatrics professionals and national policy experts, to develop a comprehensive model of care to promote physical function in hospitalized older adults. Her test field was Christiana Hospital’s ACE unit.

Results of this project included a 35 percent reduction in 30-day readmission rates, a 60 percent decrease in the falls rate, and a 0.5 day decrease in average length of stay, with an estimated $200,000 cost savings. She received a $90,000 award to complete the program and is now part of a collegial network of dedicated professionals who share a commitment to improving geriatric care delivery. For more information on the Practice Change Fellows Program, visit www.practicechangefellows.org.

Hematology

Hematologists care for patients at Christiana and Wilmington Hospitals and at the Helen F. Graham Cancer Center. They provide direction for several clinical programs and laboratories. An active clinical research program affords patients opportunities to participate in carefully selected pharmaceutical industry clinical trials as well as those supported by the National Cancer Institute. These include NCI’s Clinical Trials Cooperative Group Program (CCOP) that includes studies from the Cancer and Acute Leukemia Group B (CALGB) and the Eastern Cooperative Oncology Group (ECOG). Clinical trial opportunities also come from the National Marrow Donor Program and the Blood and Marrow Transplant Clinical Trials Network.

Bone Marrow/Stem Cell Transplant Program reaccredited

Christiana Care's Bone Marrow/Stem Cell Transplant Program has earned three year re-accreditation by the Foundation for the Accreditation of Cellular Therapy (FACT), an accreditation it has held since 1997. Accreditation demonstrates adherence to rigorous standards for adult allogeneic and autologous hematopoietic progenitor cell transplantation, marrow and peripheral blood cellular therapy product collection, and cellular therapy product processing. The program is also accredited by the American Association of Blood Banks and the College of American Pathologists.

In FY12 the program performed 32 transplants (23 autologous and 9 donor transplants). Program Director Frank Beardell, M.D., continues as Principle Investigator on numerous CALGB and ECOG community based protocols for bone marrow transplants and other treatments for hematological cancers.

Recognized for performance

The National Marrow Donor Program (NMDP) recognized Christiana Care as a national performance leader in the collection of bone marrow for 2011. Christiana Care is an NMDP designated Apheresis Collection Center, Bone Marrow Collection Center and Bone Marrow Transplant Center. The award recognizes excellence in meeting service and quality indicators for donor care, product integrity, data submission and overall service. We have had a total of 168 NMDP donors since the program’s inception in August 1996.

Infectious Disease

The Infectious Diseases Section provides inpatient consultations to some 10,000 patients each year and thousands more on an outpatient basis. Working through the Christiana Care HIV Program, section members provide much of the care for HIV patients in Delaware. Key activities include student and resident education and promotion of best practice standards, particularly through the Section’s acclaimed, bimonthly case management series. Antibiotic stewardship in collaboration with the Pharmacy Department, and infection prevention, facilitated by the work of the Infection Prevention Committee and Infection Response Team, continue to top the list of key initiatives.

Infectious Disease research is pursuing new therapies to treat Clostridium difficile (C. difficile) infection, yeast and fungal infections, influenza, pneumonia, and more. Other studies include analyzing the potential of Computerized Physician Order Entry (CPOE) to evaluate prescription patterns and restrict over-prescribing of proton pump inhibitors associated with increased risk of community acquired pneumonia and C. difficile infection. Section members serve as mentors for student research projects as well as collaborators on national clinical trials.

Targeting zero hospital acquired infections

Healthcare associated infections are a major contributor not only to patient morbidity and mortality but also to increased length of stay and increased healthcare costs. Christiana Care’s Infection Prevention team is focused on protecting patients and the community by promoting universal use of evidence based infection prevention and control practices and diligent monitoring and reporting of infection rates. The team’s efforts have spurred progress toward the hospital-wide target of zero healthcare associated infections. Here are some examples:

Hand hygiene compliance climbed in FY12, as teams sustained monthly handwashing goals of 90 percent. 

 

Hospital acquired C. difficile infection rates declined at both Wilmington and Christiana Hospitals.

A comprehensive flu vaccination campaign raised the employee vaccination rate to 92 percent. Additionally, a streamlined electronic health records system now ensures that all eligible patients receive seasonal influenza and pneumonia vaccinations.

Using the CUSP approach

Christiana Care is part of a national collaborative to address the risks of central line associated blood stream infections (CLABSI). Using a Comprehensive Unit-Based Safety Program (CUSP) approach, teams achieved a 44 percent decrease in CLABSI. Multidisciplinary and unit specific strategies to prevent ventilator associated pneumonia (VAP) resulted in a 72 percent drop in the last fiscal year. Other initiatives include successful reductions in surgical site infections and catheter associated urinary tract infections (CAUTI).

Methicillin resistant Staph aureus (MRSA) prevention strategies implemented in the intensive care unit at Wilmington Hospital (WICU) earned a Certificate of Excellence from the Centers for Medicare & Medicaid Services. The three-year, statewide collaborative project to reduce MRSA ended in July 2011 and included hand-hygiene education and monitoring, educational sessions with staff and new isolation signs. Successful strategies and barriers were shared with collaborating hospitals statewide.

Addressing safety issues statewide

Christiana Care Infection Prevention provides leadership statewide to protect our communities from health care associated infections. Working in collaboration with other facilities, the team developed “Guidelines for Norovirus Prevention and Control in Long Term Care Facilities,” endorsed by the Delaware Division of Public Health (DPH) in November 2011. Team members hold leadership positions on DPH’s Healthcare Associated Infection Advisory Committee (HAIAC) responsible for regulations and public reporting of infections.

Multi-center national collaborations

Christiana Care is one of 200 hospitals collaborating as part of the  SHEA (Society for Healthcare Epidemiology of America) Research Network. A project, accepted for publication in Clinical Infectious Diseases, evaluated the implications of a 2008 Centers for Medicare and Medicaid Services policy of not reimbursing for hospital acquired CAUTI. Results showed no evidence of over testing to screen for and document a diagnosis of urinary tract infection on admission. 

Gowns and Gloves study

In partnership with Infection Prevention, Christiania Care’s Surgical Critical Complex is one of 20 ICUs nationwide participating in the multicenter, randomized Benefits of Universal Gown and Glove (BUGG) Study to determine whether using gowns/gloves for all patients (not just those in contact isolation for known resistant bacteria) decreases acquisition of the resistant bacteria and health care associated infections. The study is funded by Agency for Healthcare Research and Quality. Data collection began in September 2010 and the intervention in January 2012. The study concludes in October 2012.

Grant award for primary HIV medical care

In August 2012, the U.S. Health and Human Services announced the release of more than $68 million to ensure that women, infants, children, and youth living with HIV/AIDS receive comprehensive primary HIV medical care and support services. The grants, funded through the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program, help people who lack sufficient health care coverage or financial resources to manage HIV. Christiana Care, the only organization in Delaware to receive funding, will have $355,509 to spend on those who are most vulnerable such as the newly diagnosed, those who have never been in care and those returning to care after more than a 12-month absence. Christiana Care’s HIV Program provides care to an estimated 65 percent of people in Delaware who are HIV-positive and accessing medical services.

Top notch care for HIV/AIDS patients

In addition to comprehensive medical care for HIV infection, the HIV Program provides a “medical home” and is the sole source of medical care and treatment for 76 percent of our patients. Seven clinical sites (five in New Castle County, and one each in Kent and Sussex Counties) are integrated into the communities with the highest rates of HIV infection.  A number of nested programs 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 just three years ago.) The HIV Program also works closely 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 FY12, the program provided care to 1,640 HIV-positive individuals (a 4 percent jump over the previous year). The number of clinical visits at all sites exceeded 12,000.

Although the majority of patients live well below the federal poverty level, 90 percent of active patients are on HAART (anti-retroviral therapy). Of those, 78 percent have undetectable HIV RNA levels. Sixty-four 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, far below national benchmarks, and the mortality rate has dropped to 1.4 percent.

Rapid HIV testing available

New HIV infections arise mostly from people who are unaware of their HIV-positive status. To raise awareness of HIV status and link HIV-positive individuals to treatment, the HIV program in collaboration with Beautiful Gate Outreach Center now offers HIV rapid testing to Wilmington Hospital Emergency Department patients over age 18. An experienced HIV counselor/tester is available onsite, weekdays from 10 am to 2 pm.  The screening provides a preliminary indication of HIV infection within 20 minutes. Positive results must be confirmed by Western blot testing.

Broadening access to treatment

Leveraging technology affords patients better access to care at the HIV Program satellite offices in Georgetown, DE. Rural HIV patients seeking mental health services can have a clinical visit via video cam with a psychiatrist in Wilmington without having to travel from their home community. This telepsychiatry program is made possible through a Christiana Care Community Service and Education grant in collaboration with Christiana Care Behavioral Health.

The HIV Program now provides medial treatment to the residents of Kent County in two locations. In addition to services at the Smyrna Wellness Clinic, residents can now access treatment one morning a week at the Westside Health Center offices in Dover.

Promoting best practice standards

The  HIV Program Clinical Oversight Committee, established in December 2011, is working to enhance provider education and provide the latest, standardized, HIV care to patients throughout the state. The multidisciplinary group has statewide representation and meets monthly to discuss topics of interest and to develop evidence based treatment and management guidelines. The HIV Program is Delaware’s only Ryan White Part C and Part D grantee and works collaboratively with the Delaware Division of Public Health and the Delaware HIV Consortium to provide a comprehensive service delivery system.  

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Medical Oncology – directed by the Oncology Service Line

Our efforts to further reduce the cancer burden in Delaware are paying off with lower incidence and mortality rates reported for all types of cancer. Progress depends on continuing to provide state-of-the-art cancer care driven by best practices and the latest research that 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.

FY12 highlights:

Top enroller in cancer clinical trials

Medical oncology physician investigators collaborate with pharmaceutical companies, other research sites and the National Cancer Institute (NCI) Community Clinical Oncology Program (CCOP) to streamline clinical pathways to the most promising new anti-cancer therapies. Collectively, NCI cooperative groups enroll some 25,000 patients in clinical trials each year. At 27 percent, Christiana Care’s CCOP is a top enroller among the 3,100 participating institutions, and far above the national average of 4 percent enrollment. Our physicians  have leadership roles on multiple NCI cooperative group committees and with the newly formed Alliance of Clinical Trials in Oncology that merges three NCI funded research groups: Cancer and Leukemia Group B (CALGB), North Central Cancer Treatment Group (NCCTG), and the American College of Surgeons Oncology Group (ACOSOG).

Here are some examples of on-going cancer research:

  • T DM-1 – Tests a new drug for a particularly aggressive breast cancer that occurs in 25 percent of cases. The drug, trastuzumab developed by Genentech, is tagged with a cancer killing agent, DM-1, to go directly to the HER-2 positive breast cancer cell with minimal toxicity to the patient.
  • Oncotype DX - An NCI sponsored study uses this gene expression assay from Genomic Health to determine which patients with node positive breast cancer may not need adjuvant chemotherapy.
  • Yttrium-90 - A study with Immunomedics using this a tagged monoclonal antibody in hard to treat metastatic pancreatic cancer.
  • E1609 – An Eastern Cooperative Oncology Group (ECOG) study examines postoperative treatment with a ipilimumab Anti-CTLA4 therapy or treatment with interferon à-2b to improve disease-free and overall survival in patients with high-risk melanoma that has been surgically removed.

Oncology practices certified for quality

The American Society of Clinical Oncology (ASCO) under the Quality Oncology Practice Initiative (QOPI) certified each of the private practices in the Oncology Section this year. QOPI certification is a rigorous assessment of 97 quality measures with the goal to promote excellence in cancer care by helping practices create a culture of self-examination and improvement.

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.

Gold Plus Quality Award for stroke

Once again, Christiana Care received an American Heart Association/American Stroke Association Get With the Guidelines Award for treatment of stroke. In 2011, the Gold Plus Quality Award recognized Christiana Care’s commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines.

Sleep Disorders Center

The Sleep Disorders Center 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, the center instituted a new program to facilitate clinical follow-up for sleep disorder patients tested in the laboratory by a Sleep Medicine specialist. Center staff performed 1,497 polysomnograms (sleep studies) and 31 multiple sleep latency tests.

Delaware’s only accredited EEG lab

Christiana Care’s Electroencephalography (EEG) lab is accredited by the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET), the national credentialing  board for EEG technologists. ABRET’s lab accreditation process evaluates technical standards, the quality of the laboratory’s output and lab management issues. Successful accreditation means the EEG lab has met strict standards and is recognized as a place where patients and physicians can have confidence they are receiving quality diagnostics.

In FY12, the lab saw a 4 percent increase in the number of EEGs (2,208) performed. These included routine, neonatal, 24-hour video and under 4-hour video EEGs. Outpatient 24-hour ambulatory EEGs increased by 27 percent over the previous fiscal year totals.

Neuromuscular EMG Lab

The EMG Lab conducts a full range of conventional and quantitative electromyography services, motor and sensory nerve conduction studies, and repetitive nerve stimulation testing. Medical Director Enrica L. Arnaudo, M.D., Ph.D., is the Delaware State Liaison for the American Academy of Neuromuscular and Electrodiagnostic Medicine (AANEM), which is the accrediting body for the performance of EMG testing.

Performance improvement activities in FY12 included modifications to optimize EMG scheduling. Improvements were also made to ensure accuracy of EMG transcriptions and complete data reporting. Patient satisfaction scores continued to average between 4.5 and 5, the highest possible score. 

Nuclear Medicine

Nuclear Medicine provides a comprehensive range of services at several Christiana Care locations and is active in researching new diagnostic and therapeutic applications.

New and innovative services on board

Newly-introduced procedures include salivary gland imaging, glomerular filtration rate measurement, and 123I-Ioflupane (DaTscan) imaging (to differentiate essential tremor from Parkinsonian syndrome). Anticipated introduction in the coming months of PET myocardial perfusion imaging with 82Rubidium chloride will increase diagnostic accuracy, improve throughput, allow quantitative measurement of myocardial perfusion reserve, and decrease patient radiation exposure.

In FY12 the Section also implemented a structured reporting system for nuclear cardiology in collaboration with Cardiology and Noninvasive Services. This new system, called Pinestar, produces a combined EKG stress test and myocardial perfusion imaging report as required by accreditation guidelines and improves standardization and report turnaround.

Leading research in cancer and heart disease

Nuclear Medicine collaborated with Christiana Care’s Helen F. Graham Cancer Center, the leading enroller nationally, in a multicenter trial to treat inoperable pancreatic cancer using the radioimmunotherapy (RIT) agent 90Yttrium hPAM4. Christiana Care was the first center in the country to open a new phase of the hPAM4 study (for third-line therapy) and has just treated the first patient on this trial who travelled across the country from California. Additional cancer-related studies include research using radioimmunotherapy for lymphoma and PET imaging with 18F-FDG and 18F-sodium fluoride through the National Oncologic PET Registry. The Section has applied for Nuclear Regulatory Commission licensure to administer 223Radium chloride, the world’s first alpha-emitting radiopharmaceutical which has shown great promise in prostate cancer treatment trials.

In collaboration with Cardiology Research, section members are participating in an important multicenter investigation of the promising PET myocardial perfusion imaging agent, 18F-flurpiridaz, comparing it to standard SPECT myocardial perfusion imaging using cardiac catheterization as the reference standard.  

Leading bone health initiative

Nuclear Medicine has taken the lead to improve bone health and reduce fragility fractures. Section Chief Timothy Manzone, M.D., JD,  chairs the Bone Health Advisory Committee whose membership spans nine sections/departments. The group is on the threshold of creating a system-wide fracture liaison service supported by a dedicated regional bone health registry and quality DXA services. This multidisciplinary initiative is unprecedented at Christiana Care and elsewhere, and is considered by national leaders in bone health likely to become a model program in the  field of system-based disease management. The committee plans to initiate a pilot project of the service in the Emergency Department.

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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.

Treating pain, providing comfort

The Pain and Palliative Care team had 2,000 consults in FY12, providing care to patients at Christiana and Wilmington hospitals. A multidisciplinary team offers 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. The award winning, “No One Dies Alone” program manages volunteers who provide company to hospital patients who are dying but have no family or other visitors. In FY12, the finishing touches were added to the much anticipated inpatient hospice unit slated to open in August at Christiana Care in partnership with Season’s Hospice & Palliative Care of Delaware.

Insightful cancer rehabilitation and pain management

Oncology Rehabilitation 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. These services are also provided to outpatients at the Helen F. Graham Cancer Center. Theresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services at the Helen F. Graham Cancer Center, was recognized in FY12 as a Computerworld Honors Program Laureate award winner for her role in developing a unique self-evaluation tool called Insight to help patients discuss symptoms and quality of life with their physicians.

Promoting community health

Section Chief John Goodill, M.D., along with Theresa Gillis, M.D.,  and Philip Kim, M.D., are working together with public and private organizations allied with the State of Delaware, the Division of Public Health, and Delaware Medical Society to mount a coordinated response to the significant increase in prescription drug abuse in our state. As members of the Prescription Drug Action Committee, they are collaborating to identify best and promising practices to curtail misuse  and abuse, to influence policy strategies and recommend measures to assure continued availability of state-of-the-art resources for pain management.

Physical Medicine and Rehabilitation Services

The Center for Rehabilitation at Wilmington Hospital (CRWH) has achieved a maximum three-year re-accreditation from the Commission for Accreditation of Rehabilitation Facilities (CARF) for its Brain Injury, Amputation and Stroke programs and for Comprehensive Adult Inpatient care. This is the first time the Brain Injury program has earned CARF certification, the second consecutive time for Amputation and Stroke, and the sixth consecutive time for Comprehensive Adult Inpatient care. This achievement representing the highest level of accreditation confirms the Center for Rehabilitation offers programs and services that are measurable, accountable and of the highest quality.

The Center for Rehabilitation at Wilmington Hospital is a 40-bed unit that offers a full range of acute rehabilitation services and features the latest in barrier-free and advanced rehabilitation technologies. At 61,000 square feet, the therapy space is one of the largest in the mid-Atlantic region and includes multiple areas that simulate real world environments, including a residential training apartment that allows patients to practice everyday living skills.

First to “Go Live”

Rehabilitation Services is leading the way with conversion to electronic documentation for all acute care and outpatient therapy services. “Go live” for the Center for Rehabilitation at Wilmington Hospital was August 2012, for therapies, nursing, and physicians (including progress notes). Physicians can check on the rehabilitative progress of their patients from any location where they can log into Powerchart. 

Outpatient physical therapy services added

Christiana Care Physical Therapy (PT ) Plus outpatient therapy services, previously under Health Initiatives, joined Rehabilitation Services in FY12. The move brings the number to 11 outpatient therapy facilities under the Rehabilitation Services umbrella, providing seamless care for patients throughout the continuum.

Pulmonary & Critical Care Medicine

Patient safety and reliable quality care drive section initiatives.

Respiratory care team to the rescue

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. In the last year, medical and cardiac teams joined Emergency Department and surgical teams which had initially been activated during the pilot phase. Respiratory Care also developed an electronic dashboard which displays clinical metrics and patient outcomes for each dedicated team. The team-based model has facilitated positive outcomes including reduced ventilator length of stay and ventilator associated pneumonia; increased extubations and transfers out of ICU; reduced ED readmission rates for asthmatics and COPD patients; improved continuity of care through communication and collaboration among physicians, nurses and therapists; timely medication delivery; and increased patient satisfaction. Teams for Women and Children’s health services will be brought on board in the coming year.

Recognized for quality respiratory care

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. Last year the department hosted a fellow from the Czech Republic as part of the American Association for Respiratory Care’s 2011 International Fellowship Program. Respiratory Care provides services to all inpatient and outpatient areas within both Christiana and Wilmington Hospitals.

The Respiratory Care staff carry out all treatment orders providing modalities which include oxygen therapy, aerosolized medication therapy, bronchial hygiene therapy, management of both invasive and non-invasive ventilators in the acute care setting, arterial blood gas draws and non-invasive monitoring of patients respiratory status/oxygenation with various equipment. In FY12, Respiratory Care services performed a total of 793,000 procedures.

Saving more lives with newer technology

In FY12, Respiratory Care took the lead to implement capnography to assess oxygen absorption during code blue responses, bringing Christiana Care into compliance with American Heart Association national guidelines. The team also introduced new technology to support patient care, including the Drager V500 ventilator, LTV 1200 advanced ventilatory support in the MIR suite, and a humidifier platform on all respiratory care equipment. On-going performance improvement efforts include participation in a system-wide project to evaluate the impact of subglottic suction oral endotracheal tubes on ventilator associated pneumonia rates among surgical patients and evaluation of the impact of a breath actuated nebulizer in the Christiana ED patient population.

Pulmonary Function Lab helps patients breathe easier

The Christiana Care Pulmonary Function Lab offers a full range of  tests to assist doctors in evaluating all aspects of pulmonary disease. The lab performs a combined average of nearly 1,400 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; measuring respiratory muscle strength; supplemental oxygen evaluation and high altitude simulation testing (HAST); asthma diagnosis and evaluation, and cardio pulmonary exercise stress testing.

In FY12, The Pulmonary Function lab performed 16,752 procedures:

Pulmonary Function Testing        

10,460

Bronchoscopy  

559

Exercise Testing                            

743

Interventional procedures              

271

Other Tests: Laryngoscopy, HAST, Nitric Oxcide Admin, Nebulizer Tx, Pentam, Sputum Induction, Metabolic Cart.

4,719

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.

Interventional Pulmonology offers leading–edge treatments

Interventional Pulmonary encompasses a broad range of diagnostic and therapeutic pulmonary procedures to mange of diseases of the lung and the lining of the lungs or pleura. These procedures include bronchoscopy, pleuroscopy, thoracentesis, tracheostomy and placement of pleural catheters and drains.

Pulmonary and Critical Care Physicians from the departments of Medicine and Surgery routinely employ both basic and advanced bronchoscopic skills as part of routine care. All bronchoscopies performed outside of the operating room fall under the purview of the Interventional Pulmonary service and Department of Respiratory Care.

In FY12, the service performed 1046 bronchoscopic procedures, a 12 percent increase over FY11. Of these, 45 percent were performed in the ICU, including broncho-alveolar lavage to collect secretions for microbiologic analysis, to clear blocked airways and to support percutaneous tracheostomy, a minimally invasive alternative to traditional tracheostomy. Diagnostic bronchoscopic procedures totaled 764 in FY12.  The most common procedure was broncho-alveolar lavage (39%). An endobronchial lesion was found in 47 patients during endobronchial biopsy, and 49 patients had fuoroscopic guided transbronchial biopsies.

The Surgery and Procedure Unit (SPU) at Christiana Hospital handles bronchoscopies that require conscious sedation.  Half of these are outpatient procedures. Bronchocoscopies at the Surgi-Center are performed under the care of an anesthesiologist and with total intravenous anesthesia (TIVA). 

Bronchoscopy by location

 

ICU

208

SPU

212

Surgicenter

208

CHR Main OR

32

Wilm GI Lab

15

Wilmington OR

1

Interventional bronchoscopy uses advanced diagnostic and therapeutic modalities including:

  • 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.

Interventional Bronschoscopy

 

EBUS

166

Electro-magnetic NB

76

Rigid Bronchoscopy

18

Fiducial Placement

35

Stent Placement

2

IBV insertion

2

IBV removal

1

Balloon Bronchoplasty

6

MICU wins prestigious Beacon Award – Again!

Congratulations to the Medical Intensive Care Unit at Christiana Hospital, recipients of the Silver Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses. Christiana Care is one of only 40 hospitals nationwide and the only hospital in Delaware to receive this honor for the 2012-2015 period. The Beacon Award recognizes the Medical Intensive Care Unit at Christiana Hospital for the highest standards in patient outcomes, nurse recruitment and retention, staff training and a healthy work environment. Christiana Care also received the award for 2009-2010.

AHRQ recognizes innovations from Sepsis Alert Campaign

Christiana Care’s award-winning Sepsis Alert Program again earned recognition for “high reliability,” featured on the Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange Website in August 2012. This care management program incorporates a number of initiatives, including use of screening criteria, an antibiotic recommendation sheet, a treatment order set and protocol, and a medication kit, to support the prompt identification and treatment of patients who have sepsis.

According to a retrospective analysis that compared a control group of severe sepsis/septic shock patients with those treated after program implementation, results through November 2011 showed the following:

  • 53 percent reduction in overall sepsis related mortality.
  • 63 percent reduction in the incidence of sepsis-related organ dysfunction for acute respiratory distress syndrome.
  • 65.7 percent drop for acute renal insufficiency/failure.
  • Average LOS for sepsis patients (excluding 70-day outliers) decreased from 18.2 to 9.3 days.
  • Number of patients discharged from ICU to home increased by 199 percent, suggesting that fewer patients experienced a decline in health status from a prolonged ICU stay.
  • Compliance with Institute for Health Improvement’s acute sepsis resuscitation bundle increased from 28.6 percent to 45 percent of patients.

Results also showed quicker fluid resuscitation and initial improvement in administration of antibiotics.

Overall the initiative supports continuous improvement with positive clinical outcomes for sepsis patients with associated health care cost savings through early, goal directed therapy.

MICU fosters multidisciplinary research collaborations

Christiana Care’s Medical Intensive Care Unit is focused on bringing innovative, best practice care to critically ill patients. By measuring the vast amounts of data generated through new initiatives as well as routine care, MICU research is improving patient management and adding to the body knowledge in this specialty. A number of studies are underway, including sedation and delirium management as part of a national multidisciplinary effort; early mobilization of ICU patients, and a planned project for ICU nutrition support. The entire patient care team, including nursing, pharmacy, respiratory therapy and nutrition shares important roles in advancing these projects.

In the pipeline: Data collection is nearing completion on 200 patients undergoing a hypothermia protocol to study factors influencing survival rates and neurologic outcomes. A collaboration with Delaware’s INBRE program, supported by the Christiana Care Value Institute, will identify patients with pre-morbid conditions associated with low benefit to MICU admissions; and a prospective study in collaboration with the University of Delaware will assess outcomes for obese ICU patients.

Transitioning care for adults with cystic fibrosis

The Adult Cystic Fibrosis (CF) Program facilitates the transition of care for young adults with cystic fibrosis in affiliation with Nemours/A.I. duPont Hospital for Children. The team also works closely with Christiana Care’s Primary Care (PC) Transitions Care Practice to ensure CF patients have a PC provider.

In FY12 two clinics averaged 8 patient visits a month, 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. Currently one patient is on the newly approved medication, Kalydeco, to treat  a rare form of CF in patients age 6 and older who have a specific G551D mutation in what is called the Cystic Fibrosis Transmembrane Regulator (CFTR) gene.

Renal & Hypertensive Diseases

Christiana Care nephrologists provide hemodialysis for patients with chronic and acute kidney disease at two Joint Commission accredited labs. Located at both Christiana and Wilmington hospitals, the labs provide inpatient and outpatient kidney dialysis and continuous ambulatory peritoneal dialysis (CAPD). In FY12 these labs performed a total of 10,370 procedures. The capability to offer sustained low efficiency daily dialysis (SLEDD) enables acute renal failure patients who once had to be connected 24/7 to reduce their time on dialysis to as little as 10 hours a day.

Fighting catheter associated infections

Using the Comprehensive Unit-Based Safety Program (CUSP) approach to identifying and learning from defects, hemodialysis successfully reduced occurrence of blood stream infections associated with insertion of femoral catheters to 1 percent. The team developed a new bedside dialysis catheter insertion kit and catheter insertion protocol check list. On-going monitoring showed a sharp rise in the use of the check list from 30 percent to 90 percent compliance. Other continuous performance improvement projects include participation in an outpatient antibiotic administration continuity program, the Christiana Care Five-Diamond patient safety program, and institution of an anemia management protocol to ensure appropriate use of an expensive medication called Epogen.

Nephrology research in progress

  • Retrospective review of combined tunneled hemodialysis catheters and central venous catheters; procedure technique, outcomes, complications.
  • Study of stent-grafts or bare-metal stents vs. angioplasty for treatment of venous outflow stenosis in upper-arm basilic and cephalic arteriovenous fistulae; outcomes, complications, patency, and rates of intervention.
  • Study of chronic hemodialysis patients with pacemakers or implantable defibrillators; prevalence of cardiovascular implantable electronic devices and impact on arteriovenous hemodialysis access. Submitted for publication by Theodore Saad, M.D. and Waqas Ahmed, M.D. 

Renal and Hypertension Symposium held

On April 28, 2012, Nephrology Associates, P.A. sponsored the fifth annual Renal and Hypertension Symposium on the Christiana Hospital campus in Newark, DE.  A diverse audience of physicians, nurses and advanced practitioners from Delaware and surrounding areas learned about some of the latest topics in nephrology and hypertension tailored for the primary care community with the opportunity to earn continuing educational credits.  

Kidney transplant program turns five

Christiana Care's nationally recognized kidney transplant program, marked its fifth anniversary performing adult kidney transplants in Delaware. Initiated in January 2006, the program is certified by the United Network for Organ Sharing to perform both living donor and deceased donor kidney transplants. An experienced, multidisciplinary team provides optimal care for these complex patients and offers medication management post transplant and living donor education.

A second transplant clinic in Lewes allows patients from the central and southern counties in Delaware to be seen more easily by members of the team.

In response to new Centers for Medicare and Medicaid guidelines for Quality Assessment and Performance Improvement (QAPI), the kidney transplant team upgraded their performance dashboard with embedded QAPI indicators based on their overall strategic plan to maximize patient outcomes and achieve high reliability.  The dashboard facilitates timely transplantation, safety monitoring, adherence to regulatory requirements, and identifying ways of assisting patients to transition through the various phases of care.

Leaders in organ donation

Of the 130 hospitals in the tri-state region served by the Gift of Life Donor Program, Christiana Care ranks first in the number of families that have chosen to donate organs. In 2011, 45 donors and their families gave 141 patients the lifesaving gift of a heart, lung, liver, pancreas or kidney. Another 94 donated bone, skin, cornea and heart-valve tissue, potentially saving the lives of or assisting more than 6,000 patients. This represents record participation from the communities Christiana Care serves facilitated by strong collaborative support from both transplant and critical care teams and Gift of Life staff.

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Next: Honors, Awards & Kudos

Delaware Health Sciences Alliance CarePages Magnet recognition for excellence in nursing

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.

Christiana Care Health System PO Box 1668, Wilmington, DE 19899 800-693-CARE