Christiana Care Medicine

Medicine Brief
March 2014 Vol. VII Issue I

Table of Contents

Clinical Update

Christiana Care’s Pain and Palliative Care Program specializes in value-added, patient-centric, family focused health care

Christiana Care's interdisciplinary Pain and Palliative Care program helps patients and their families deal with complex illness through individual and comprehensive care designed to relieve pain, increase functional ability, give comfort and improve quality of life.

The team specializes in medical support for patients who have chronic, critical illnesses, acute or chronic pain, or failure of several organ systems. They provide consultation to medical teams who are treating patients with advanced stages of diseases such as cancer, renal disease, heart failure, COPD, and respiratory failure. Team expertise includes managing pain and symptoms, helping to define goals of care, leading family meetings, and strengthening patient support.

"Our entire team is focused on paying attention to the experience of the patient and family as they attempt to live with advanced and serious illness and to navigate our health care system," says John Goodill, M.D., chief of Christiana Care's Pain and Palliative Care Section. "It is about delivering patients from their anonymity and helping align care to their preferences and goals, empowering them to make decisions for their care and their lives.

Dr. Goodill, board-certified in pulmonology and palliative care, founded the Pain and Palliative Care program in 2004. Thomas Scott, M.D., a board-certified interventional anesthesiologist, serves as associate section chief. The team includes physicians, nurse practitioners, and specially trained nurses and chaplains.

As the Chaplain for the Pain and Palliative Care Service, the Rev. Pat Malcolm participates across transdisciplinary teams, sharing information and playing an integral part in the patient's plan of care. 'When patients and families are receiving end-of-life care, the chaplain is a resource to patients and families in seeing that social, spiritual/religious, and cultural variables that influence their perception of grief are assessed."

Christiana Care Health System Pain & Palliative Care Team

Members of the Pain and Palliative Care team.

John Goodill, M.D.
Roshni Guerry, M.D.
Linsey O'Donnell, D.O.
Tom Scott, M.D.

Nurse Practitioners
Shirley Brogley, ACHNP, ANP-BC
Helena Macdonald, ANP
Jennifer McElveen, ANP
Maripat Welz-Bosna, MSN, ANP-BC

RN- Program Operations
Lisa Keichline, RN

Patricia Malcolm, Staff Chaplain
Kefa Obara, Chaplain Resident

Anne Mueller, BSc, MBA, MBioethics

Administrative Support
Marcia Bukay
Medicine Supervisor

Pain and Palliative Care works collaboratively with a multidisciplinary group of specialists to offer the latest therapies and techniques for treating chronic and acute pain as well as to provide spiritual, psychosocial, and emotional and community support services. Team members are on-call for consultations, 24-hours, seven days a week, and recently have expanded service to Wilmington Hospital. Cancer patients may also access palliative care and symptom management services at the Helen F. Graham Cancer Center, under the direction of Theresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services.

"Ours is a comprehensive, multiple modal, interdisciplinary approach," says Maripat Welz-Bosna, a board-certified nurse practitioner on the team. "The earlier in the disease process we are involved, the more we can do to help patients and their families achieve their goals."

According to Director of Palliative Care Education Roshni Guerry, M.D., "We pride ourselves in our communication, not only to the patients and their families, but also to the other medical providers involved so as a team we can serve the patient in the best way possible." Dr. Guerry says team members feel strongly that people facing serious life-threatening illness should be treated with dignity, respect and compassion. "In training and mentoring other health care professionals, I strive to pass on what I have learned from my fellowship in palliative medicine, which is how to develop goals of care that are aligned with the patient's values and wishes."

There is strong evidence that pain and palliative care leads to greater patient satisfaction, shorter hospital stays, timelier access to hospice services, fewer inappropriate resuscitative efforts (codes), and fewer ethics consults. "Ours is a value-added service to the usual medical care provided," explains Dr. Goodill. "With a successful pain and palliative care program, we see improved quality of care, better outcomes and cost savings. That is what we call a win-win-win proposition."

For referrals, contact the Pain and Palliative Care team at 302.733.4186.

Save the date!  April 16th is National Health Decisions Day at Christiana Care
Pain and Palliative Care and the Ethics Committee are sponsoring the event to raise awareness for the importance of having both an advance directive and someone who knows your healthcare wishes to represent you when you are unable to do so yourself. Messages will also highlight the importance for clinicians and caregivers to ask for and respect an individual’s directive when setting goals of care.

Leadership Spotlight

Focusing on excellence
Loretta Consiglio-Ward, MSNCarol Kerrigan Moore, MS, FNP-BC

In this issue we spotlight Carol Kerrigan Moore, MS, FNP-BC and Loretta Consiglio-Ward, MSN, education specialists with the Christiana Care Center for Quality & Patient Safety and the Value Institute Academy. Both are key facilitators/consultants in the Department of Medicine's drive forward to improve patient centered care and outcomes.

"The Department of Medicine is responsible for the care of a large proportion of patients who are served at Christiana Care," says Moore. " Leveraging expertise from various areas and individuals demonstrates the power of partnerships to help facilitate desired changes and outcomes."

As Quality & Safety education specialists, Moore and Consiglio-Ward collaborate across departments and service lines, to guide data-driven improvements designed to produce measureable results. They participate in curriculum development and educational programming (i.e., Achieving Competency Today and Value Institute Academy courses), facilitate team building and support both unit-based value improvement and clinical leadership initiatives. They also support and mentor Medicine Quality & Safety fellows.

Their collaboration with Medicine has earned both national and Christiana Care project excellence awards, including a 2013 Christiana Care Focus on Excellence "Safety First" Gold Award for the successful application of bundled evidence-based strategies to reduce the risk of ventilator associated pneumonia among critically ill patients.

According to Consiglio-Ward, "The Department of Medicine has identified pneumonia as an area of significant opportunity to improve the quality, safety and value of care we provide." As such, she says, 'With the Pneumonia – Data Warehouse/Business Intelligence (DW/BI) pilot project, we will be adopting clinical guidelines and standards for pneumonia care and creating DW/BI tools to measure adherence to those guidelines, while determining ways to reduce cost and improve patient outcomes across care venues."

Both Moore and Consiglio-Ward were members of the development team and faculty for the Advanced Quality and Safety Improvement Science Program, offered through the Christiana Care Value Institute Academy. "This new train-the-trainer initiative is designed to help faculty develop advanced knowledge and skills to teach and to lead the incorporation of continuous performance improvement and safety principles into all educational curricula as well as into clinical practice," Consiglio-Ward says.

The AQSISP program was piloted in Internal Medicine as part of the National Initiative III of the Alliance of Independent Academic Medical Centers. This was accomplished by leveraging the success of our inter-professional resident QI curriculum (ACT) and partnering with the Value Institute. The model is now spreading to other Christiana Care residency training programs.
Other collaborative projects include the TeamSTEPPS evidence-based curriculum and the Culture of Responsibility initiative. "We look forward to continuing our partnership with the Department of Medicine in the care transformation journey," Moore adds.

Selected presentations and credentials.

Moore CK. Jasani N, Integrating Quality Improvement, Patient Safety, and Interprofessional Teamwork into Resident Education. Panel discussion at the Association of American Medical Colleges (AAMC) Integrating Quality (IQ) Meeting: Increasing Value and Educating for Quality, Chicago IL, June 6 - 7, 2013.

Dressler R, Consiglio-Ward L. Integrating Quality Improvement and Patient Safety Curriculum into Graduate Medical Education. Workshop presented at the Alliance of Independent Academic Medical Centers (AIAMC) National Initiative III Meeting, Tucson AZ, March 31-April 1, 2012.

Riesenberg LA, Consiglio-Ward L. Stofferahn M. Integrating Quality Improvement and Patient Safety Curriculum into GME. Workshop presented at Association of American Medical Colleges (AAMC) Integrating Quality (IQ) Meeting, Chicago IL, June 11-12, 2011.

Moore CK, Consiglio-Ward L. Transformative Quality Improvement Education. Workshop presented at the American Society for Quality (ASQ) World Conference on Quality and Improvement, Pittsburgh PA, May 16–18, 2011.


Carol K. Moore, MS, FNP-BC, is a board-certified family nurse practitioner with over 25 years experience as both a practicing clinician and educator/facilitator in various academic and healthcare settings. She was a member of the clinical faculty in the Graduate School of Nursing at the University of Delaware (1994-2005). She is skilled in patient advocacy, patient centered care, inter-professional team facilitation, quality and safety improvement methods, change management, and educational design. She has published and presented nationally on a variety of health care topics and team training for quality/safety improvement.

M.S., Pace University, Lienhard School of Nursing, New York, 1982
B.A., Psychology, University of Virginia, Charlottesville, VA, 1979
Senior Fellow, Thomas Jefferson University School of Population Health, 2010

Selected Professional Affiliations/Honors
2006 American Academy of Nurse Practitioners State Award for Excellence
University of Delaware College of Health Sciences:
Excellence in Graduate Teaching Award, 2003
Delaware State Board of Nursing, Advanced Practice Issues Advisory
Committee, 1994-2005
American Society for Quality (ASQ)
Alliance of Independent Academic Medical Centers
American Nurses Association/Delaware Nurses Association

Loretta Consiglio-Ward, MSN
, is a master's prepared registered nurse with more than 20 years' experience facilitating organizational performance improvement, patient safety and patient care activities for community hospitals and healthcare systems. She has experience as a medical-surgical nurse, manager, care manager, clinical guideline developer, improvement advisor and coach, electronic/system development, and patient safety specialist. She teaches Improvement Science and Safety Science methodologies, Just Culture concepts and skills, and Team Facilitation techniques.

MSN, Newmann College, Aston, PA, 2001; BSN, 1987.

Selected Professional Affiliations/Honors
Editor, Partners in Safety Update, Christiana Care
Delaware Association for Healthcare Quality (President 2009-2010)
2010 NAHQ State Association Excellence in Education Award


A fresh look at graduate medical education: Integrating continuous improvement

With the inauguration of their “Next” Accreditation System (NAS), the Accreditation Council for Graduate Medical Education (ACGME) is shifting toward a more outcomes oriented assessment for institutions that train tomorrow’s physicians. A key component of NAS is the Clinical Learning Environment Review or CLER Program. 


CLER goes beyond a simple assessment of the GME learning environment in an effort to capture national data on the attributes that engender both quality and patient safety in the environments where residents learn and work. The CLER Program is also structured to recognize top performing institutions as learning examples for others.ACGME logo


“This approach is somewhat new for medical education,” says Brian Aboff, M.D., FACP, Medicine’s associate chair for Education and director of residency programs. “It is all about integrating our residency training programs with the hospital’s goals and initiatives so that residents are engaged in and contribute to continuous performance improvement during their training and in practice after graduation. ”The CLER site visit focuses on six key areas: patient safety, quality improvement, transitions in care, resident supervision, duty hours’ oversight, including fatigue management and mitigation, and professionalism.

“In this environment, the hospital and health system become accountable in partnership with the individual programs for the quality of our medical education and the competency of the physicians we train,” Dr. Aboff explains. Christiana Care’s first CLER site visit took place in January 2014.

“We think the site visit went well and we look forward to receiving the official report in a few months to target areas for further improvement,” Dr. Aboff says. “Moving forward, we want to be certain that our residents, faculty and attendings are aligned and working together through this process as we expand our focus beyond just the components of the residency rotation.”

Medicine Shots   News about people and events

Ed Ewen, M.D., FACP, clinical informaticist in the Department of Medicine, and Terri Steinberg, M.D., chief medical information officer for Christiana Care, are among the first physicians in the nation to earn certification by the American Medical Informatics Association. They join 453 first-ever diplomates in the subspecialty of clinical informatics to receive notice of their board certification in December. AMIA intends for the creation of the new subspecialty to help standardize clinical informatics training programs, increase the number of training opportunities available, and provide an immediately recognized credential for organizations hiring informaticians.

Project Engage. The Professional Nurse Council will honor Addiction Medicine's early intervention substance abuse program in May 2014. Each year during Nurses Week, the Council honors one program chosen for "contributing significantly to the care of our patients and that supports nursing."

John Goodill, M.D. will receive the Outstanding Alumni Award in Clinical Practice from the Alumni Association of Drexel University College of Medicine at the annual alumni awards luncheon on May 3, 2014.

Daniel Hess, M.D., EM/IM resident, received the 2013 Leadership Excellence Award in October from the Emergency Medicine Resident's Association.

Ehsanur Rahman, M.D., a member of Christiana Care's Department of Medicine, Cardiology Division, for 33 years, received the 14th Annual Christiana Care Medical-Dental Staff Commendation for Excellence, presented by his longtime friend and colleague, Anand Panwalker, M.D.

Ehsanur Rahman, M.D., a member of Christiana Care's Department of Medicine, Cardiology Division, for 33 years, received the 14th Annual Christiana Care Medical-Dental Staff Commendation for Excellence, presented by his longtime friend and colleague, Anand Panwalker, M.D. The award recognizes Dr. Rahman for "exceptional contributions to the community through clinical, scholarly, and educational" activities."

Christiana Care Respiratory Therapy featured prominently at American Association for Respiratory Care (AARC) Congress 2013. Tom Gillin, RRT, was named AARC Adult Acute Care Practitioner of the Year. He and Bob Donnelly, RRT, represented the state of Delaware as delegates through the Delaware Society of Respiratory Care. The team presented five abstracts, including one project led by Heather Thomas, RRT, who joined the team less than a year ago. John Emberger, RRT, FAARC, also presented five lectures during the four-day event and served as Open Forum moderator. Joel Brown, RRT, FAARC, served as lecture moderator.

Edmondo Robinson, M.D., MBA, FACP, physician-in-chief for Christiania Care Wilmington Hospital was selected by the Society of Hospital Medicine to join their Leadership Committee. The committee is charged with developing a strategic plan and curriculum for leadership development training and to provide educational resources to support hospitalists as both institutional and organizational leaders.

Congratulations to Our ACP Poster Winners
Medicine's 2013-2014 winners of the American College of Physicians (ACP) Delaware Chapter Poster Competition are listed below. Category winners will present their posters at both the Delaware and national ACP meetings.

Adrian Hurst, D.O., (Medicine, PGY-3) is this year's grand prize winner with mentor David Cohen, M.D., section chief, Infectious Diseases. Dr. Hurst gave a podium presentation of his abstract, "A Horse of a Different Color: Rhodococcus equi Infectious Endocarditis in an immunocompetent Host," at the ACP Delaware meeting in February and a poster presentation at the ACP national meeting in April.

Kelly Lyons, a 4th year medical student from LECOM, gave an excellent podium presentation on a rare case of fusobacterium necrophorum bacteremia caused by endocarditis, entitled, "The bottom line – IVDA is bad for you?"

Winners for Best Resident Posters
1st Place Jennifer Guantt, M.D.
2nd Place Khurram Baig, D.O., Vishal Patel, M.D. and Adam Lammly, D.O.
3rd Place Peter Burke, D.O.

Winners for Best Clinical Vignettes
1st Place Akash Sethi, D.O.
2nd Place Joseph Santora, D.O. and J.J. Hernandez, D.O.
3rd Place Seema Niphadkar, D.O. and Shaun Hanson, M.D.

Medicine's 2013-2014 ACP- Delaware Chapter Posters

Resident Clinical Vignette Poster Competition

Baig MK, Butrt W, Slease RB.Rituximab – A friend or foe in ulcerative colitis?

Deitchman A, Fistler C, Bartoshesky L. Persistent lactic acidosis after treatment of Diabetic Ketoacidosis – A common metabolic derangement or something more insidious?

Facciolo K, Piper J. Group A Streptococcus: An Infrequent, but Deadly Killer.

Gaukler E, Upchurch C. A Confusing Case of Confusion: Hyperammonemia without Hepatic Failure.

Guantt J, Chasanov W, Hundal RS, Bennett J. Giant bilateral adrenal masses in a man with untreated 21-hydroxylase deficient congenital adrenal hyperplasia.

Niphadkar S, Hanson S, Varadarajan R. Will you Kiss and Tell? EBV-associated Hemophagocytic Lymphohistiocytosis.

Palli V, Melnick P. Not Your Usual Case of Ambulatory Dysfunction.

Persad K, Guarino M. Ipilimumab-induced Hypophysitis Precipitating Chronic Hormone Replacement.

Santora J, Hernandez J, Saltzberg MT. Atrioventricular Block in a Young Man with a History of Ulcerative Colitis.

Sethi A, Lenhard MJ. What Goes Around, Comes Around – A Case of Cyclical Cushing's Syndrome.

Resident "OTHER" Poster Competition

Baig MK, Catts Z A-K, Petrelli N, Guarino M. Statewide retrospective review of familial pancreatic cancer in Delaware and frequency of genetic mutations in pancreatic cancer kindreds. Winner: Cost-conscious category

Burke P, Vest M, Kher H, Deutsch J. Better Team Dynamics Result in Improved Medical Decision Making in Simulated Rapid Response Team Calls Led by Medical Residents. Winner: Quality Improvement/Patient Safety category

Gauntt J. ColoRectal Assistance Program for Screening (CRAPS). Winner: High Value/Cost-Conscious Care category

Patel V, Lammly A, Merritt N. The Color Purple: Maintaining Patients' Wishes. Winner: Quality Improvement and Patient Safety category

Patel V, Sprott C, Friedland A. Implementing Business of Medicine into Residency Education. Winner: Cost-Conscious category.

Student Poster Competition

A Complication of Chronic Salmonella Carriage: Aortitis. Dyer R, University of New England College of Osteopathic Medicine; Ruether J.

Not Your Typical Chest Pain. Kogut J, Philadelphia College of Osteopathic Medicine.
Upper extremity deep vein thrombosis in a 41 year old treated for rheumatoid arthritis and military tuberculosis. Lee BA, Jefferson Medical College; Magargle J, Moosavy F.

Unusual Presentation and Source of Atypical Pneumonia. Margiotta M, Jefferson Medical College; Meyer E, McCarter M.

A case of Acyclovir-Resistant, severe Herpes Simplex Virus Type 2. Penn E, Jefferson Medical College; Cohen D.

Read about our Focus On Excellence Awards

These awards represent the work of Medicine in its broadest sense, recognizing the accomplishments of the Medicine Service Line, the Department of Medicine, Residency Programs and Medicine colleagues. Medicine had the lion's share of entries in this year's competition, 55 of 144 submissions.

President’s Award
Improving Glycemic Control in the Adult Medicine Office
Team:  Medicine faculty, AMO Staff, Ammon Diabetes Care & Prevention Program

Value Award - Gold
Applying Evidence-Based CPOE to Telemetry
Team: Broad-based multi-disciplinary team including Medicine, Cardiology, Nursing, Information Technology and Data Acquisition & Measurement

Value Award - Silver
Improving the Health of Our Most Vulnerable Neighbors
Team:  Medical Home Without Walls

Value Award – Bronze
Strategies to 30 day Heart Failure Readmissions
Team:  Heart & Vascular, Heart Failure Steer Committee, Data Acquisition & Measurement

Value Award – Honorable Mention
“Respiratory Redesign – An Evaluation of Post Implementation Impact
Team:  Respiratory Care

Clinical Excellence - Gold
Improving early Mobilization of Critically Ill Patients in the MICU
Team:  Broad-based multi- disciplinary team including  MICU staff, MICU physician assistants, Physical Therapy, Respiratory care, and Nursing

Clinical Excellence – Silver
Urgent Treatment for Inpatients’ Ischemic Strokes
Team:  Broad-based multidisciplinary team including Inpatient Stroke Alert Committee, RRT teams, Neurology, Neuroradiology, Pharmacy, Vascular Access Nursing and residents.

Clinical Excellence – Bronze
SAD in the MICU
Team:  MICU, eCare, and Respiratory Care

Safety First – Gold
Ending VAP with Real-Time Feedback
Team:  VAP Collaborative Team, VAP Access Database Team, and PowerChart VAP Prevention PI Tool Team

Safety First – Silver
Interdisciplinary Approach to Fall Reduction
Team:  Center for Rehabilitation

Think of Yourself as a Patient – Gold
Improving Patient Satisfaction Using Multimodal Communication Tools
Team:  5D and Christiana Care Hospitalist Partners

Think of Yourself as a Patient – Silver
Life History: The Patient Story
Team: ACE units, Center for Rehabilitation, Volunteer Services and Patient Relations

Nursing Excellence – Empirical Outcomes – Gold
Cleaner Catches
Team:  Wilmington Hospital ACE unit

Nursing Excellence – New Knowledge – Gold
Patient Care Unit Dashboards Drive Excellence
Team:  Data Acquisition & Measurement Team, Medicine, Information Technology, and Nursing

Learning Excellence – Silver
Collaborative Model for Excellence in Stroke Care
Team: Broad-based multidisciplinary team including Center for Rehabilitation, 6C STAR unit, Physical Therapy, Speech Therapy and Occupational Therapy,

Excellence in Community Health – Silver
Million Hearts® Delaware: A First State Coalition to Prevent Heart Attack and Stroke
Team:  Center for Heart & Vascular Health

Resident’s Award – Gold
Never TMI
Team:  Internal Medicine, Medicine-Pediatrics and Transitional Year residents, Laboratory, Anesthesia and Wilmington Hospital ACE unit

Resident’s Award – Silver
ColoRectal Assistance Program for Screening (CRAPS)
Team:  Medicine-Pediatrics Residency Program

People’s Choice
Peripherally Inserted Central Catheter Tip Placement by Vascular Access Nursing
Team:  Broad-based multidisciplinary team including Radiology, and Vascular Access Nursing, Radiology

Research – Gold
Empowering Patients: A Safer Interdisciplinary Approach
Team:  Center for Rehabilitation

Research – Silver
Transfusions, it’s Bloody Easy
Team:  Medicine Lean Six Sigma green belt project including  MICU physician assistants, Hematology and Blood Bank

Medicine On Record   Sharing what we've learned...

Publications: Christiana Care authors in bold.

Pecoraro A, Ewen E, Horton T, Mooney R, Kolm K, McGraw P, Woody G. Using the AUDIT-PC to Predict Alcohol Withdrawal in Hospitalized Patients.. Journal of General Internal Medicine, Vol. 29, issue 1, January 2014, pp.34-40.

Friedman, NC, Hassan, A, Grady, E; Matsuoka, DT, Jacobson, AF. Efficacy of thyroid blockade on thyroid radioiodine uptake in 123I-mIBG imaging. J Nucl Med 2014; 55:211–215.

Michalee B, Reinhold N, Dressler R, Laskowski-Jones L, Adarve L, Elliott D. Barriers and Facilitators to Interprofessional-Interdepartmental Interventions: Unearthing Departmental Culture. American Journal of Medical Quality. Accepted for publication.

Deer TR, …Kim P, et al. Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel. Neuromodulation 2012: 15:436-366.


Marylou Dryer, M.D., CMQ, Medicine's 2012-2013 administrative fellow, presented her award winning process improvement project poster abstract, "Good Catch! Enhancing Quality and Safety Education in the Internal Medicine Residency Program by Optimizing Proactive Safety Event Reporting" at the Alliance for Academic Internal Medicine Week 2013, in October in New Orleans, LA. Her poster was selected from 113 submissions.

Edward Ewen, M.D., Sara Schenk, M.D., and John Donnelly, M.D. "Embracing the Huddle in a Resident Teaching Clinic." Society of General Internal Medicine regional meeting in New York, March 2014 and national meeting in San Diego, April 2014.

Erin Grady, M.D., Timothy Manzone, M.D., and Hung Dam, M.D., won "Best Poster" for "Comparison of quantitative cholescintigraphy techniques raises more questions than answers, " at the American College of Nuclear Medicine annual meeting/Society of Nuclear Medicine & Molecular Imaging Midwinter meeting in February 2014.

Janine Jordan, M.D., and the Patient Centered Synchronized Admission Team were selected from among 172 submissions for Oral presentation of their poster in the INNOVATIONS category at the Society of Hospital Medicine's Annual Meeting, March 24-27, 2014 in Las Vegas.

Adam Lammly, D.O. Nicholas Merritt, BS, MLS, and Vishal Patel, M.D. "Color Purple: Maintaining Patients' Wishes." Society of General Internal Medicine regional meeting in New York, March 2014 and national meeting in San Diego, April 2014.

Vishal Patel, M.D., William Weintraub, M.D., Edmondo Robinson, M.D., Roger Kerzner, M.D., Tabassum Salam, M.D., and Daniel Elliott, M.D. "Factors contributing to readmissions for patients with ischemic heart disease." Society of General Internal Medicine regional meeting in New York, March 2014 and national meeting in San Diego, April 2014.

Respiratory Care Presentations at AARC Congress, Nov. 16-19, 2013, Anaheim, CA.

John S. Emberger, BS, RRT-ACCS, FAARC, Joel M Brown II, BS, RRT, FAARC, Francis Gott III, MBA, RRT, Kathleen Bonis BS, RRT, Melanie Murphy MBA, RRT, Vinay Maheshwari, M.D. and Gerard Fulda, M.D. "Rapid process improvement to increase surveillance for patients ready for extubation around the clock."

Kathleen Bonis, BS RRT, John Emberger BS, RRT-ACCS, FAARC, and Joel M Brown II, BS, RRT FAARC. "Comparison of two volume targeted neonatal algorithms when switching between triggered and non-triggered breaths."

John Emberger,BS, RRT-ACCS FAARC, Joel M Brown II, BS, RRT, FAARC, and Kathleen Bonis, BS, RRT. 'Initial experience with an airway management catheter to clear partial endotracheal tube obstructions."

John Emberger, BS, RRT-ACCS, FAARC, Joel M Brown II, BS, RRT, FAARC, Francis Gott III, MBA, RRT, Kathleen Bonis, BS, RRT, Melani Murphy, MBA, RRT, and Vinay Maheshwari, M.D. "Extubation outcomes for patients receiving more than one spontaneous breathing trial (SBT) per day."

Heather Thomas, RRT, Tom Heaney, CRT, Tom Blackson, RRT, Joe Ciarlo, RRT, and Susan Coffey Zern, M.D. "The role of acoustic reflectometry in evaluation of endotracheal tube patency: an in-vitro comparison of assessment techniques used to evaluate airway resistance caused by endotracheal tube biofilm formation."

Patient Experience

Physician committee targets rapid improvements in patient experience

An aggressive effort is under way to improve all aspects of patient experience at Christiana Care. For physicians, that effort is being led by the Physician Experience Oversight Committee, co-chaired by Neil Jasani, M.D., MBA, FACEP, vice president, Academic Affairs/Emergency Medicine, and Shawn R. Smith, MBA, vice president, Patient Experience.

If you have any questions or would like to get involved in our efforts to improve the patient experience, please contact Shawn Smith at 703-733-3312 or Neil Jasani at 302-733-2704.

Are patients satisfied with their physician?

After each admission to the hospital, our patients receive a patient satisfaction survey (HCAHPS). Part of that survey is specifically directed toward satisfaction with their physicians.

"These patient experience scores are publicly reported and searchable on Medicare's Hospital Compare website," says Dr. Janine Jordan, M.D., medical director of care transitions and utilization management. "As consumerism grows in health care, patients are looking at these scores when they make their decisions about where to seek care."

HCAHPS Question – Department of Medicine
Communication with Doctors Domain
How often did doctors treat you with courtesy and respect?
How often did doctors listen carefully to you?
How often did doctors explain things to you in a way you could understand?

The Department of Medicine's scores are currently under the 50th percentile nationally.

"Our Medical-Dental Staff has a longstanding culture of excellence," Dr. Jasani said. "What we're learning is that often our physicians aren't aware of the ways in which communication habits and how they interact with patients, families and colleagues impact the overall experience of our patients. There's more to it than just what we think of as 'bedside manner.' In the Physician Experience Oversight Committee, we're bringing together data and proven best practices to empower our colleagues to achieve excellence in this domain."

Follow AIDET
The committee is urging all physicians to begin a renewed focus on patient experience by using AIDET, an established tool for communicating to patients, family members and colleagues. AIDET is an evidenced-based, national best practice and is The Christiana Care Way. It especially reduces anxiety in patients and family members. In brief, the five fundamentals of AIDET are:

1. Acknowledge others. Smile, make eye contact, and offer a warm greeting. Try to follow the "10 & 5 Rule" – within 10 feet, acknowledge the patient/family members; within 5 feet, speak.

2. Introduce yourself and the care team (for those providing direct patient care). Share your name and role. Introduce colleagues in handoffs using the patient's preferred name.

3. Duration: Say how long it will take to finish your task and keep everyone informed of delays. Educate your patient. Explain why you are doing what you are doing.

4. Explanation: Explain what you are doing, why you are doing it and how you are going to do it in ways everyone can understand.

5. Thank others. Say, "Thank you" at every opportunity for the privilege to care for them.

Dr. Jasani also recommends that physicians familiarize themselves with the resources available to them in the intranet, including the reports on the Quality & Safety site and the videos, articles and tip sheets on The Christiana Care Way portal site.

Feedback? Send us an e-mail or call 302-733-5584.

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