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Physician Communication Packet March 2014


What’s Inside: 3

Stroke & Cerebrovascular Center at Baptist Medical Center Jacksonville

Physician Introduction - Ricardo A. Hanel, MD, PhD and Eric Sauvageau, MD

4 Baptist Health Transfer Center 6

Updated Bylaws and Rules & Regulations for All Facilitates


Emergency and Urgent Consultations


Large Volume Shortage Mitigation Plans


Physician Introduction

Baptist Endocrinology - Leslie “Brandi” Salomone, MD has moved


Pastoral Care Conference Save the Date


Premier Open MRI Oasis

Baptist CareConnect

Link - March 2014

Baptist Briefs Link - February 2014

Physician Introduction

Meet Doctors Hanel and Sauvageau Stroke & Cerebrovascular Center at Baptist Medical Center Jacksonville

Ricardo A. Hanel, MD, PhD and Eric Sauvageau, MD, have joined Baptist Health and Lyerly Neurosurgery to lead the new Stroke & Cerebrovascular Center at Baptist Medical Center Jacksonville. Highly trained cerebrovascular neurosurgeons, Dr. Hanel comes from Mayo Clinic Jacksonville and Dr. Sauvageau from Ohio State University Neurosurgery. They treat all neurovascular conditions, including strokes, cerebral aneurysms, brain tumors and brain arteriovenous malformations (AVMs). Doctors Hanel and Sauvageau have unique endovascular fellowship training from State University of New York at Buffalo and Neurovascular and Skull Base training at Barrow Neurological Institute. They specialize in ground-breaking minimally invasive procedures to treat aneurysms, including flow diverter technology, stenting and coiling, as well as more traditional methods, such as clipping and bypasses. Their philosophy of care focuses on the team approach to ensure easy access to care and optimal patient outcomes. Ricardo A. Hanel, MD, PhD n

Eric Sauvageau, MD

Medical degree from Universidade Federal


Do Parana in Brazil n

Sherbrooke in Quebec

PhD from combined program of


Universidade Federal Do Parana and State

n Endovascular n Skull


Clinical Fellowship from SUNY at Buffalo

Base and Cerebrovascular Clinical Fellowship from

the Barrow Neurological Institute

Office location: Lyerly Neurosurgery 800 Prudential Drive Weaver Tower, 11th Floor Jacksonville, FL 32207 Appointments: 904.448.3416 Emergencies: 904.202.brain (2724)

Endovascular Clinical Fellowship from State University of New York at Buffalo

in Neurosurgery from Hospital Nossa Senhora

das Gracas in Brazil

Residency in Neurosurgery from the University of Montreal

University of New York (SUNY) at Buffalo n Residency

Medical degree from the University of

n Skull

Base and Cerebrovascular Clinical Fellowship from the

Barrow Neurological Institute in Phoenix, AZ

Baptist Health Transfer Center Stroke & Cerebrovascular Transfers Effective March 17, Baptist Health’s new, system-wide Stroke & Cerebrovascular Transfer Center will serve as the single point of contact, providing a streamlined process for connecting physicians and coordinating the transfer of stroke and cerebrovascular patients to, from and between any of Baptist’s hospitals and Wolfson Children’s Hospital. It is available: n

24 hours a day


7 days a week


365 days a year.

This new Transfer Center is designed to enhance our timeliness and quality of care. Currently, the Transfer Center is set up for stroke and cerebrovascular transfers only. In the near future, this service will expand to include all service lines, with the exception of behavioral health. This will be rolled out in phases and communication will be sent in advance to all referring hospitals and physicians in the region. What will the Stroke & Cerebrovascular Transfer Center do for stroke patients? Now, emergent patients requiring stroke and cerebrovascular treatments can be transferred into Baptist Medical Center Jacksonville with just one phone call. Physicians call 904.202.BRAIN (2724) for 24/7 contact with an experienced transfer coordinator who will handle the complete transfer process including: n

consultation with the accepting physician specialists


arranging for a patient bed


communicating with nursing


arranging for patient transport (ground or air)


and all other transfer needs.

The goal is to ensure timeliness, quality and continuity of care for the patient. If for some reason there is a delay, the center keeps all parties informed every step of the way.

Stroke & Cerebrovascular Transfer Center FAQs Q.

When should 904.202.BRAIN (2724) be called?


Generally, if the patient has an NIH score greater than 8, the Stroke & Cerebrovascular Transfer Center should be called. Otherwise, consult Neurology who will evaluate the patient prior to calling the Transfer Center.


How will the Transfer Center process work?


Once a physician places a call to 904.202.BRAIN (2724), an experienced transfer coordinator will immediately work to conference in the on-call endovascular neurosurgeon at BMCJ. The transfer coordinator will remain on the line while the physicians speak.

Once an agreement has been reached about accepting the patient, the Transfer Center will begin coordinating transportation, activate a “code stroke” at BMCJ, notify the OR desk to call in the appropriate team, connect the referring physician to an Emergency physician, and place a bed request with the house supervisor. Once a bed has been assigned, the Transfer Center will then connect the nurse at the referring facility to the nurse at BMCJ to give report. Finally, once the patient has arrived, the Transfer Center will notify the referring physician that the patient has arrived.

Q.      Why does Baptist Health need a Transfer Center for stroke? A.      Patients experiencing a stroke are time-critical. No time should be lost trying to contact a physician through an answering service. Having an easy-to-remember phone number and streamlined, single process helps to ensure the patient can be provided the necessary care as soon as possible.

A physician can call 904.202.BRAIN (2724) anytime and from anywhere, even from non-Baptist Health facilities, so having a centralized number helps to get patients to the care they need sooner.


When will non-stroke transfers be handled through the new Transfer Center?


There is not yet a specified go-live date for expansion of the Transfer Center service beyond stroke; protocols must be established and those will take time to develop and test. When the overall Baptist Health Transfer Center is rolled out, it will have a single, easy-to-remember toll-free number that will be used for all adult transfers. Wolfson Children’s Hospital will keep their current transfer number, but just have it routed to our new centralized Transfer Center.



March 5, 2014


All Medical Staff


Keith L. Stein, MD, FCCM, FCCP Chief Medical Officer


Updated Bylaws and Rules & Regulations for All Facilities

For your reference, the updated Professional Staff Bylaws and Rules & Regulations for the above campuses have been placed on the Physician Portal found at and on the home page of the Baptist Health intranet. The following sections of the Bylaws and Rules & Regulations below have been updated. Should you have any questions, please contact my office at (904) 202-2938.

BMCJ/BMCS/WCH Section Reference 07.2 Orders R&R Responsible physician must authenticate admission Orders;Drugs;Treatment

orders (whether to inpatient or observation status) within 24 hours of admission Clinical Students Physician supervising students must follow the hospital policy for student guidelines. Pediatric Behavioral Health Patient management in the pediatric behavioral health unit. Requirements Patient management in the adult behavioral health unit. Medical Staff Governance Removal of officers by the Active Staff Department Chairman Resignation and removal of Chair Department Vice Chairman Resignation and removal of Vice Chair Section Chief Resignation and removal of Chief Independent Service Chief Resignation and removal of Chief

Clinical Students


Patient Management


Department of Psychiatry Bylaws











Section Reference

R&R General Conduct of Care


NASSAU R&R General Conduct of Care


Orders Responsible physician must authenticate admission orders (whether to inpatient or observation status) within 24 hours of admission Section Reference


Orders Responsible physician must authenticate admission orders (whether to inpatient or observation status) within 24 hours of admission


Physician Members  of  the  Medical  Staffs  

From:   Keith  L.  Stein  MD,  FCCM,  FCCP    

Chief Medical  Officer,  Baptist  Health  


Emergency and  Urgent  Consultations  

Please be  reminded  that,  in  the  interest  of  patient  safety  (which  is  often  driven  by  effective   communication)  and  consistent  with  our  Rules  and  Regulations,  emergency  (stat)  and  urgent  consult   requests  require  the  ordering  physician  to  directly  contact  the  receiving  physician.  Note  that,  to   facilitate  this  direct  communication,  physician  cell  phone  numbers  are  available  on  the  password   protected  side  of  the  Baptist  Health  physician  portal.   The  language  from  the  Rules  and  Regulations  is:   “CONSULTATION”     Routine   The  attending  physician  may  request  a  consultation  with  a  qualified  staff  physician  by   placing  an  appropriate  order  in  the  patient’s  chart  and  indicating  the  purpose  for  the   consultation.  It  is  preferable,  but  not  required,  that  the  attending  physician  personally   contacts  the  consultant.  If  the  attending  does  not  specify  a  consultant  by  name,  the   physician  on-­‐call  for  that  specialty  for  the  Emergency  Room  shall  be  called  and  is   expected  to  respond.  Routine  consultations  shall  be  performed  within  twenty-­‐four  (24)   hours.     Emergency   Should  the  attending  physician  determine  that  a  consultation  must  be  obtained  without   delay,  it  shall  be  his  responsibility  to  speak  with  the  consultant  personally  and  shall  place   an  appropriate  order  in  the  patient’s  medical  record.     Urgent   Should  the  attending  physician  determine  that  a  consultation  must  be  obtained  urgently;  it   shall  be  his  responsibility  to  speak  with  the  consultant  personally  and  place  an   appropriate  order  in  the  patient’s  medical  record.  Urgent  consultations  shall  be  performed   within  six  (6)  hours  unless  the  physicians  mutually  agree  that  the  consult  can  be   performed  as  a  routine  one.”     Please  do  not  hesitate  to  contact  the  Medical  Staff  Office  at  202-­‐1117  with  any  questions.  



March 19, 2014


Baptist Health Physicians & Providers


Kristin Certain, PharmD, Pharmacy Operations Manager, BMCJ/WCH


Large Volume Shortage Mitigation Plan: NS, LR, D5W

There is an industry-wide shortage of large volume fluids. The fluids most affected are NS, LR and D5W. All large volume fluid manufacturers, Baxter, BBraun and Hospira, are affected. Recovery is ongoing but large volume fluid shortages are expected to continue for the next several months. These recommendations do NOT apply to compounded bags prepared by Pharmacy. Recommendation 1: Use oral hydration whenever possible. Recommendation 2: Use smaller bag sizes for low rate infusions in outpatient settings if possible. ! OR/Procedural areas/ Emergency Department: For shorter procedures or those with low infusion rates (42 mL/hr or less) hang 500 mL bags rather than 1000 mL bags. Recommendation 3: Consider using alternative fluids. ! At this time, ½ NS and D5 ½ NS and D5NS are available in the supply chain. ½ NS is the most readily available of these fluid options. Recommendation 4: Infuse bags until empty. ! There is no nationally accepted length of hang time for most IV fluids. The Center for Disease Control and Prevention (CDC) Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 provides some information concerning replacement of IV administration sets, but has no recommendations on the hang time for the majority of IV fluids. ! Per Baptist policy 7.01.04 tubing should be changed every 96 hours (except for those drugs which require every 24 hour tubing changes—ex. lipids & TPN—see policy No. 7.01.04 Section: Patient Care Subject: CENTRAL VENOUS ACCESS DEVICES (CVAD) for exceptions list). ! To preserve current supply, NS, LR and D5W fluid bags (without additives) should be infused until empty. Tubing is to be changed every 96 hours as per Baptist policy. Recommendation 5: Discontinue IV fluids as soon as possible. SAFETY Compounding sodium chloride solutions from sterile water for injection and concentrated sodium chloride injection is a last resort. Per ISMP this practice could lead to medication errors and inadvertent administration of plain sterile water. In addition this could contribute to current shortages of concentrated sodium chloride (23.4% or 14.6%).


Dr. Salomone is moving to Baptist South Endocrinologist, Baptist Endocrinology Dr. Leslie “Brandi” Salomone is excited to join Dr. Alan Cleland, Dr. Rosalyn Crawford, Dr. Wasim Deeb and Dr. Brijmohan Sarabu at Baptist Endocrinology located on campus at Baptist Medical Center South. Dr. Salomone completed her fellowship in Endocrinology and Metabolism at the University of Virginia. She earned her medical degree at the University of Louisville and completed her residency in Internal Medicine at Wake Forest University. Dr. Salomone also co-writes “The Thyroid” chapter of the Sabiston Textbook of Surgery. Dr. Salomone has 7 years of experience in Endocrinology practice, with special interest in: • Type 1 and type 2 diabetes • Thyroid dysfunction and cancer • Menopause and hypogonadism • P  olycystic ovarian disease, osteoporosis, adrenal and pituitary disorders Baptist Endocrinology (located on the campus of Baptist South)

14540 Old St. Augustine Rd. Suite 2471 Jacksonville, FL 32258

904.880.9696 For patients preferring to see a physician in the Mandarin area, Melissa Morgan, MD, and Stacey Kelly, ARNP-BC, will continue to provide endocrinology services at the Baptist Endocrinology Mandarin Office located at: 11945 San Jose Blvd, Suite 301, Jacksonville, FL 32223 904.260.9699




May 2, 2014 University of North Florida, Adam W. Herbert University Center

The Way to Wellness: Coping with Mental Illness and Trauma through Pastoral and Psychological Counseling Baptist Health invites you to hear from experts in the fields of pastoral care and behavioral health on topics from domestic violence to faith struggles. The conference will feature speakers who will challenge caregivers to fully hear and respond to the voices of human struggle and suffering on the journey toward health and healing. Keynote Speaker Pamela Cooper-White, PhD, Professor of Pastoral Theology, Care and Counseling at Columbia Theological Seminary Register here:


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Baptist Health Physician Communication Packet March 2014