System News - February 2017

SYSTEMNEWS FEBRUARY 2017

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CEO’s

Penn Medicine’s

CORNER

QUALITY SAFETY AWARDS

RALPH W. MULLER

CEO, University of Pennsylvania Health System

As the recent Super Bowl reminds us, success comes from paying attention to the basics. That’s as true at Penn Medicine as it is in the NFL.

Recognizing and fostering projects that raise the level of patient care When created in 2000, the UPHS Quality and Safety Awards had two goals: to recognize great work in patient care and to foster more.

Today the annual awards program is just one proof point of their success. The number of submissions shot up from an initial 35 to nearly 130 this year. Even accounting for the growth of Penn Medicine over the years, the increase “reflects the deep interest in this organization to improve performance,” said PJ Brennan, MD, SVP and chief medical officer for the Health System.

All projects, which align with the goals of Penn Medicine’s Blueprint for Quality (reducing and eliminating complications, readmissions, and preventable deaths), have led to tremendous gains in these key areas.

The advances are especially impressive considering the immense changes in health care over the past two decades. “Twenty years ago, we were not dealing with today’s patient care problems,” Brennan said.

“Our clinical interventions, many of which did not exist back then, have created a new set of challenges.” And yet, “we’re making constant progress.”

As challenges evolved, so did the submissions. For example, most now reflect multidisciplinary efforts, “a recognition that health care is now a team sport,” said Pat Sullivan, PhD, chief quality officer. Also, submissions must be more outcome-based.

“We have gone beyond just process and

anecdotal results,” she said. “It may be a great process but we want to see its impact.”

Penn Medicine’s Performance Improvement in Action, overseen by the Penn Medicine Academy, teaches clinical and nonclinical teams how to use scientific methods and quality/improvement tools to move the problem-solving process forward. “This introduced more rigor and discipline around the process of bringing an idea to fruition,” she said. Projects emerging from this program “took quality to a new level,” sometimes in targeting direct patient care and other times moving the needle in the behind-the-scenes operations that improve efficiency and safety.

While committed to quality at each individual hospital, Brennan and Sullivan are also trying to spread these efforts throughout UPHS. The Penn Value Team, led by Michael Posencheg, MD, associate medical director, will “drive the dissemination of interventions, developed by a panel of experts at Penn, for important clinical problems that impact value,” Sullivan said.

Although the annual award submissions vary tremendously in what they target, one area in particular has been the focus of many projects and has led to tremendous improvements — the fight to reduce catheter-associated urinary tract infections (CAUTIs).

Different Approaches Slash a Common Infection

in this issue A Push to Bring Healthy Food to a Low-income Neighborhood...........................2 Lancaster General First to Integrate Pain Control with EMR....................................2 Transfusion-free Medicine at Pennsylvania Hospital..........2 Penn Medicine@Work..............3 Newsmakers .............................3 Awards and Accolades.............4

A CAUTI is one of the most common hospital-acquired infections in the United States but, in many cases, it can be prevented.

Literature shows that the highest risk factor for CAUTIs is prolonged use of an indwelling urinary catheter (also known as a Foley catheter). The best way to prevent an infection is to remove the catheter when it’s no longer clinically necessary, but studies show that patients often have them longer, thus increasing the risk of infection.

In 2010, using an evidence-based, clinical practice guideline he coauthored with colleagues at the Centers for Disease Control, Craig Umscheid, MD, vice chair of Safety and Quality in the Department of Medicine, and his team created an alert in the UPHS electronic health records (EHR) that notified physicians in the-then three Penn Medicine hospitals (HUP, Penn Presbyterian, and Pennsylvania Hospital) when a patient’s Foley was in longer than recommended by guidelines. At the time, HUP had the highest CAUTI rate of all acute care hospitals in the state, according to a Pennsylvania Department of Health report. In the year following the launch of the initiative — which won the 2011 UPHS Quality and Safety Award — the UPHS rate for CAUTIs decreased by nearly 50 percent.

A second UPHS-wide initiative in 2014 took the efforts to a new level, creating a nurse-driven protocol within the electronic health record to allow nurses to safely remove a Foley catheter, without physician intervention. With implementation of this nurse-driven protocol, CAUTI rates (at the three urban UPHS hospitals) declined further, by 28 percent.

Asymptomatic bacteriuria associated with use of a Foley can lead to a urine culture that appears positive for infection even if the patient does not have symptoms. These “false positive” cultures can, in turn, lead to unnecessary antibiotic use. In FY16, a UPHS initiative focused on using a decision support tool “to help physicians understand the appropriate indications Continued on page 2.

What are the basics for us?

Warmly greeting patients when they arrive at our practices and hospitals, and checking them in with efficiency and friendliness.

Making it easy to schedule appointments and obtain test results and other information from care providers.

Providing follow-up care that eases concerns and minimizes the risk of readmissions.

At Penn Medicine we meet these basics of good patient care and more with a focus on access and value.

Sometimes access is about geography, and we’ve worked hard to spread Penn Medicine’s clinical sophistication and resources beyond Philadelphia, adding Lancaster General Health and Chester County Hospital, and opening full-service facilities in Radnor and Cherry Hill.

More often today, technology is crucial to improved access and expanding our ability to communicate. We want to interact with patients on their terms, in ways they prefer.

One example is the secure portal My Penn Medicine, which allows patients to, among other things, communicate with their care teams in a secure way, refill prescriptions, track test results, and, in some departments, schedule appointments.

Access also includes the ability of care teams to seamlessly tap into real time electronic medicals records across Penn Medicine — and sometimes even beyond.

We have invested heavily, and will continue to do so, to ensure that our physicians have the most up-to-date tests and data on their patients so they can make the right care decisions.

In addition, technology can help us get better at what we do. Our Clinical Capacity Calculator allows us to quantify opportunities to maximize available capacity for clinics across the system, thus ensuring optimal levels of access that patients need and deserve. In addition, information gleaned from our Press-Ganey surveys allow us to measure and analyze patient perceptions about access.

Continued on page 4.

It’s as Easy as 1-2-0...................4 Congressman Evans Discusses ACA with PM Faculty................4 Major Expansion to Start at CCH.........................................4

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Catrena Drake with and Pastor Willie Wilson, Sr, of the Fresh Fire World of Life Ministries

Penn Medicine’s

QUALITY

SAFETY AWARDS Continued from page 1.

for checking a urine culture in patients with Foleys. The goal was to reduce unnecessary and inappropriate urine culturing to ultimately decrease unnecessary antibiotic use,” Umscheid said. The initiative resulted in about 4,500 instances in a year across the three hospitals when urine cultures were avoided.

A Push to Bring Healthy Food to a Low-income Neighborhood

Studies have shown that low-income neighborhoods have fewer supermarkets (but more convenience stores) than in those with higher income, often leading to fewer healthy food options. As a result, the residents’ diets tend to comprise foods with higher fat, sugar and salt content, which, in turn, can lead to chronic health problems.

Catrena Drake, a clinical services coordinator in CCA, is trying to change that scenario. Since 2012, she has brought fresh produce to members of her church, Fresh Fire World of Life Ministries, who couldn’t otherwise afford it. And she’s using Penn Medicine CAREs grants — she has received two — to help her do it.

Twice a year, she and other volunteers travel to the Restaurant Depot, a warehouse that sells food and supplies, and Produce Junction to purchase cases of fruit and vegetables at a wholesale price. “We bring them back to the church and spread them out on tables,” she said. “Then we give the people who come [usually between 60 and 80 members] a paper bag to fill.” In addition to offering the free fruits and vegetables, they also educate people about the importance of getting more produce into their meals and other places they can get fresh produce, such as community gardens. “I’m starting to see more people getting involved in community gardens, using empty lots from houses that have been torn down.”

Staying healthy is more than just eating well. “Health care is not always visible in this neighborhood,” she said, so they also give out information about local health centers and practices where they could go for medical problems.

She hopes to reach out to elected officials “who could influence supermarkets in the neighborhood to address the costs,” she said.

Learn more about how to apply for a Penn Medicine CAREs grant for your community service at http://uphsxnet.uphs.upenn.edu/community/CARE/grant.html.

Lancaster General First to Integrate Pain Control with EMR

For many patients,

Lancaster General Health has integrated a patient-controlled analgesia (PCA) infusion pump with its electronic medical record (EMR), the first to do so in a clinical setting anywhere in the world. PCA pumps allow inpatients to self-administer pain medicine, such as important but high-risk narcotics, within a set amount determined by the physician. Patients at Lancaster General Hospital and Women & Babies Hospital will now benefit from this seamlessly integrative pain-management technology.

not an option because

The new technology allows the pump to be automatically programmed with the validated medication order direct from the Epic EMR and streamlines documentation of infusion data into the Epic system to improve the safety and efficiency of pain-management medication therapy.

“It’s double- and triple-checked by a pharmacist and a nurse, but there’s no longer a chance that someone is going to read something wrong or type in the wrong amount on the pump or make that kind of mistake,” said Michael Ripchinski, MD, LG Health Physician Executive for Quality, in an article in Lancaster Online.

blood transfusions are of religious, personal, medical or ethical reasons.

Transfusion-Free Medicine at Pennsylvania Hospital Twenty years ago, Patricia Ford, MD, recognized an unmet need in the Philadelphia area: a place for patients seeking medical care without the use of blood products.

Ford worked with local Jehovah’s Witness leadership groups to create what is now known as the Center for Transfusion-Free Medicine at Pennsylvania Hospital.

“For many patients, blood transfusions are not an option because of religious, personal, medical or ethical reasons,” Ford said. One such patient was Audrey Butler, who recently underwent knee-replacement surgery at Pennsylvania Hospital and sought out CTFM’s services to ensure that she was able to receive care while also upholding her beliefs as a Jehovah’s Witness.

“The Center for Transfusion-Free Medicine explained each element of their program so that I understood my options and I could make a choice about my surgery,” Butler recently told WHY Y’s The Pulse. “I made the right decision for me and my beliefs.”

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Many entities have recognized teams that have done impactful work in preventing CAUTIs. For example, Chester County Hospital gave its Quality and Patient Safety Award in 2015 for a project that decreased catheter utilization by nine percent and the CAUTI rate by a whopping 60 percent. And the LTACH (long-term acute care hospital) in Good Shepherd Penn Partners Specialty Hospital at Rittenhouse won this year for their program that reduced CAUTI infections to zero for several months after implementing multiple interventions.

High Tech Approaches In the last several years, technology has played a key role in improving patient care at Penn Medicine. Submissions have reflected this shift. For example, Penn Care at Home received the 2012 Operational Award for using Penn E-lert (a telehealth home monitoring program) to track their congestive heart failure patients, resulting in a decrease in hospital readmissions overall and in the 30-day readmission rate. Lancaster General Health won an award this year for reducing heart failure readmissions with the use of an ambulatory implantable hemodynamic sensor that provides frequent remote monitoring and can indicate a problem before symptoms appear.

While entity initiatives focus on one target population, this year’s system-wide Quality and Patient Safety Award winner uses technology to help care for patients in many different service lines throughout the Health System.

According to Katherine Choi, MD, Clinical Innovation manager at the Penn Medicine Center for Health Care Innovation, AGENT focuses on actions that need to be done now for a specific group of patients, delivering realtime clinical data to healthcare providers through alerts to their phones or through a dashboard which is easily accessible by all of a patient’s healthcare team.

The AGENT team has partnered with several clinical areas since launching in 2014. For example, the team worked with Anna Doubeni, MD, of Family Medicine and Community Health, to help reduce the number of superutilizers (patients who frequently come to the ED).

Identifying and tracking these patients on a dashboard in real-time “decreased the ED utilization by superutilizers by 36 percent,” Choi said.

Other partnerships have included work with Phlebotomy, sending alerts about the most urgent “STAT” labs that need to be drawn, and with GI to send evidence-based pathways to covering providers treating patients for an acute GI bleed.

So far 200-plus pathways have been sent to physicians at the time a patient is suspected to have a GI bleed.

“It’s all about getting the right information at the right time to the right person,” Choi said.

The importance of the Quality and Safety Awards throughout UPHS is apparent at the annual awards ceremony. Senior leaders from all entities often attend to support their teams. “These rituals help anchor us in a time of much change and turmoil in health care,” Sullivan said.

“They root us in what’s important.”

“The tremendous thing about all these awards is that these are self-starter projects. The ideas well up from individual practices or units,” Brennan said. “People are finding the time to improve their practice and work towards improving outcomes for patients…. It’s a hallmark of Penn Medicine.”

To see this year’s winners and all of the submissions, go to http://bit.ly/2lrSBJK.

@

pennmedicine With Honors:

WORK

Paula Card

Dan Guzman

Mariel Harden

Sonja Owens

2016 PSA Academy Graduates Celebrate The Academy showers you with a wealth of information, so it’s important to listen and absorb as much as you can.

It had the makings of a family reunion, with plenty of food, good vibes and laughter. Last month, the recruits for the Patient Service Associate (PSA) Academy reunited to celebrate their success — completion of the five-week program designating them as a critical touch point for the patient experience.

After more than 800 applications and 50 interviews, only 21 candidates were accepted.

They learned everything from PennChart to a specific practice’s protocol to the delivery of a transformative patient experience.

“Through the collaboration of the Penn Medicine Academy, Human Resources and the Access Academy leadership, we designed a program to develop well-supported and trained employees who can hit the ground running the first day after they graduate,” said Cindy Morgan, VP of Learning and Development and an executive sponsor of the PSA Academy.

In speaking with a few of this year’s graduates, their commitment to the program — and our patients — is clear.

Pursuing Your Passion Dan Guzman had his heart set on working at Penn Medicine. He heard good things about working here and equally positive things about being a patient from family

and friends. An opportunity for growth was important to Dan too. He saw a listing for the PSA Academy and watched the video that talked about the benefits of the program.

The PSA Academy not only confirmed his initial impressions of the Health System, but it also cemented the fact he was in the right place. “I feel extremely prepared to move into my new role at Penn Medicine. They set realistic expectations and goals for us. Every week we were learning something different.

And I couldn’t have asked for better people to go through the training with — they’re really amazing,” Dan explained. “I graduate today knowing it is my responsibility to give patients the best experience I can. I am setting the standard for their care at Penn Medicine.”

PSA Proves Perfect Sonja Owens comes from a clinical background and has experience in customer service roles at Amerihealth and GlaxoSmithKline. She came across the PSA Academy and felt the job description was a perfect fit for her skills and expertise.

Sonja now works in the neurology department of the Access Center. “The people I have come in contact with from the Penn Medicine community, including senior leadership, are directly impacting my success.

I know they care about my future,” Sonja

raved. Overall, she feels Penn Medicine encourages her to achieve her personal and professional goals.

Customer Service: Her Calling Card A Midwest native, Paula Card had to find her next career opportunity in an entirely new city. Penn Medicine proved an enticing place to pursue a career in healthcare.

With her background in customer service, community relations and health and wellness, Paula had a good feeling about the PSA Academy.

“The Academy showers you with a wealth of information, so it’s important to listen and absorb as much as you can,” Paula said.

A few weeks in and it’s even clearer how important her role is in providing patient care. “I’m very aware that what I do affects other parts of the organization.” Enjoying her newly adopted city, Paula is gratified with her decision to join Penn Medicine and making a difference in people’s lives.

PSA Academy Alumni Update: From Customer Service to Patient Service This is the Penn Medicine Access Center’s third PSA Academy graduation. The hard work over the years of some of our Access Center employees has paid off and they have since moved into other positions at Penn

Medicine. Mariel Harden is a good example of this success.

Mariel started her customer service career at Abecrombie & Fitch, a global giant in the contemporary retail space. After graduating from Penn State with a bachelor of science in Human Development, Mariel wanted to follow in her mom’s footsteps with a career at Penn Medicine. It turned out to be a great way to marry her customer service experience and formal education.

After going through the first PSA Academy, Mariel had the opportunity to work on a pilot program at Pennsylvania Hospital.

While on the project, Mariel partnered with her supervisor and management to develop a live scheduling program in the Emergency Department. Mariel’s hard work led to a promotion as a Patient Service Coordinator.

“I’m really happy I chose Penn Medicine to live my life’s work,” Mariel said, smiling.

With the caliber and potential of these graduates, there is no doubt the graduation was indeed a family reunion. A family bound by the same guiding principles that ensures patients get the care they deserve beginning with the very first phone call.

For more information on the PSA Academy, or Workforce Development, contact Kerry Standeven at Kerry.Standeven@ uphs.upenn.edu.

newsmakers Bleak State of Kids’ Nutrition: 1 in 3 Eat Junk Food Daily

Just 15 Percent of Primary Care Doctors Want ACA Repealed, Survey Finds

Report States ‘Fat Shaming’ May Lead To Greater Risks than Obesity

The Daily Mail and the PhillyVoice reported on new research from Penn Medicine showing that kids’ menus in fast food restaurants are laden with as many calories, as much saturated fat and as much sodium as they were five years ago. Christina Roberto, PhD, an assistant professor of Medical Ethics & Health Policy, was senior author on the study.

According to a new study published in The New England Journal of Medicine and covered by media across the nation, only 15 percent of physicians support a full repeal of the Affordable Care Act. “This is no longer hypothetical,” said David Grande, MD, MPH, an assistant professor of Medicine and co-author of the study. “The idea of repeal is something that makes primary care physicians nervous.”

A new study by Rebecca Pearl, PhD, an assistant professor of psychology in Psychiatry, found that the very act of feeling bad about one’s weight can have negative health impacts.

The research was covered by several outlets, including CBS3 and Maire Claire.

Penn Medicine Launches a New Center for Digital Health Fierce Healthcare and other outlets reported on Penn Medicine’s newly launched Center for Digital Health. Under the direction of Raina Merchant, MD, MSHP, an assistant professor of Emergency Medicine and an associate vice president for UPHS, the new Center will have early focus on leveraging social media to improve health.

Visit the new Penn Medicine Communications website at PennMedicine.org/news.

Genital Herpes Vaccine Clinical Trial to Begin after Promising Results New research from Harvey Friedman, MD, a professor of Infectious Diseases, and his team showed that a new type of vaccine could offer powerful protection against genital herpes, which currently infects more than 500 million people worldwide. The news was reported in the International Business Times, The Sun, and other outlets.

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AWARDS AND ACCOLADES Master Clinicians Welcome Newest Members The Academy of Master Clinicians, launched in 2013, recognizes Penn Medicine clinicians who exemplify the highest standards of clinical excellence, humanism and professionalism. Congratulations to the newest members of The Academy of Master Clinicians: Aba Barden-Maja, MD, MS. . . . . . . . . . . . . . . . . Medicine

Mindi M. Roeser, MD. . . . . . . . . . . . . . . . . . . . . . . Medicine

Jean B. Belasco, MD . . . . . . . . . . . . . . . . . . . . . . Pediatrics

Stephen J. Schuster, MD . . . . . . . . . . . . . . . . . . . Medicine

John H. Keogh, MD. . . . . Anesthesiology and Critical Care

Steven Sondheimer, MD. . . . . Obstetrics and Gynecology

Stephen J. Kovach, III, MD. . . . . . . . . . . . . . . . . . . Surgery

Christine Stabler, MD, MBA. . . . . . . . . Family Medicine &

Christopher J. Miller, MD . . . . . . . . . . . . . . . . Dermatology

David A. Piccoli, MD. . . . . . . . . . . . . . . . . . . . . . . Pediatrics

Eric T. Stoopler, DMD. . . . . . . . . . . . . . . . . . . Oral Medicine

Raymond Price, MD. . . . . . . . . . . . . . . . . . . . . . . Neurology

Neha Vapiwala, MD. . . . . . . . . . . . . . . Radiation Oncology

Community Health

Voight Receives Presidential Early Career Award Benjamin F. Voight, PhD, of Systems Pharmacology and Translational Therapeutics and of Genetics in the Perelman School of Medicine, received the Presidential Early Career Award for Scientists and Engineers.

This award is the highest honor given by the United States government to scientists and engineers during the early stages of their independent research careers.

IT’S AS EASY AS 1-2-0 Stroke is the number one cause of death in China. Millions die each year. “And it’s happening to a younger and younger population,” said RenYu Liu, MD, PhD, of Anesthesiology and Critical Care. But the potential for reducing these cases is great, if only people could easily and quickly recognize the signs.

The acronym FAST (Face, Arm, Speech, Time) is an easily remembered way for English-speaking people to recognize the signs but it clearly wouldn’t work in a population that predominanty speaks Chinese. So Liu, who grew up and practiced medicine in China before coming to this country, collaborated with Zing Zhao, MD, PhD, a neurologist at Minhang Hospital in China, to create a new system without a language barrier.

They used numbers instead, transforming the phone number for a medical emergency in China (1-2-0) into three stroke-recognition actions.

“First, look for an uneven face. Second, examine for arm weakness. And zero, absence of clear speech,” he explained.

In China, the pronunciation for zero is “ling,” similar to “ting,” which means hearing (ie, cannot hear a clear speech).

Once the word got out about this new and simple way to educate China’s population about stroke — which started with a published paper in Lancet Neurology — it caught on like wild fire.

In fact, the day after it was published, the China Stroke Association officially adopted the easy-to-remember series of numbers and incorporated it in its stroke care guidelines.

Read more about how this initiative will change stroke care in China at https:// www.pennmedicine.org/news/internalnewsletters/system-news.

Major Expansion to Start at CCH While Chester County Hospital is reflecting on its 125 years of service, it is also gearing up to break ground on the largest expansion effort in its history. Starting this spring, a 276,000 square foot expansion project will begin. Once construction is complete, the hospital will gain a beautiful new front entrance, plus the following much-needed spaces: »» 14 modern Operating Room suites. »» 4 high-tech labs for Catheterization and

Electrophysiology.

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»» New areas for non-invasive cardiology

and pre-admission testing. »» Potentially 96 inpatient beds

(pending approvals).

Congressman Evans Discusses ACA with PM Faculty

»» 1 0 additional Emergency Department rooms.

US Congressman Dwight Evans, who serves Philadelphia’s 2nd Congressional District, visited and spoke with several Penn Medicine faculty about the potential implications of repealing the Affordable Care Act. Joining in the discussion were Zeke Emanuel, MD; Shreya Kangovi , MD; Chyke Douben, MD and David Grande, MD. Representative Evans said he was working to ensure that those who were able to receive coverage under ACA would not lose it if the program is repealed and replaced.

Because of its placement, the hospital will use its historic entrance as a temporary front door for patients and visitors. For more information, go to ChesterCountyHospital.org.

“The community we serve relies on our mission-based approach to care, our reputation for quality, and our history of providing advanced clinical services, treatments and programs,” said Mike Duncan, president and CEO of Chester County Hospital.

CEO’s CORNER Continued from page 1.

We take suggestions for improvement to heart, and one of our success stories in recent years has been the Penn Medicine Access Center, which specializes in scheduling, securing, and preprocessing all patient appointments. You can schedule appointments with multiple providers, and personnel will also help schedule any needed tests or follow up visits. The Access Center frees departments from having to manage their own front desks or call centers and allows them to focus on what they do best: providing compassionate, service-oriented care.

Of course access to the highest quality advanced medicine in the region is just part of the story. Once here, we need to ensure value — quality care that is delivered efficiently with an eye on lowering costs.

That’s why we’ve invested heavily in service lines and disease teams that offer medicinebased pathways for a continuum of care, from the moment patients walk through the door to post-discharge needs. These pathways ensure consistent quality care that reduces variations and thus cuts costs.

But don’t confuse consistent with static.

These are “living pathways” that our care teams update as conditions warrant. Consider the heart and vascular service line, which initially was organized around the best possible hospital care. Today it’s evolved to include post-care and home-care services, including electronic monitoring. These pathways show our understanding that care is a long-term commitment, and they help set expectations for patients, both about their treatment and their providers.

Meeting expectations is part of a new consumerism approach to medicine. In a world where a restaurant reservation is a phone tap away, shouldn’t we be as accommodating? That’s why we’re offering same-day appointments, welcoming walk-ins at clinics, extending hours beyond 5 p.m., and expanding our telemedicine offerings.

It’s also why the Penn Medicine Academy Simulation Center works so hard to ensure that everything our Patient Service Reps experience in training one day can be put to good use with patients the next.

We’re here to increase each patient’s ability to get the right level of care at the right time for the right outcome. It’s as basic, and as important, as that.

SYSTEMNEWS EDITORIAL STAFF: Sally Sapega, M.A. Editor Lisa Paxson Graphic Designer

ADMINISTRATION: Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Corporate Director of Communications

LET US HEAR FROM YOU: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 Please feel free to share your thoughts and ideas for improving System News! E-mail the editor at sally.sapega@uphs.upenn.edu.