Page 1

Volume 2


Number 2

March 1, 2013

Pennsylvania Hospital

LASSO IT UP: How a Rodeo Roping Technique Can Help Treat an Age-old Heart Ailment / / /

At first pass, lariat seems like just a hifalutin’ word for the more down-to-earth, lasso — a long, noosed rope. For most, either word will bring to mind images of cowboys and rodeos, not human hearts. However, thanks to a new technology making its way onto the medical scene, lariat has a new meaning and is helping to treat the most common of cardiac arrhythmias, atrial fibrillation. Let’s take a few steps back though, before we make the leap from rodeo ring to hospital.

INSIDE Lasso It Up continued...............2 Helping a Beloved PAH Family Member.................2 Having Fun While Raising Funds at Pennsylvania Hospital’s First “Souper Bowl”..........................3 Development News...............4-5 Swift, Non-Surgical Help to Fix Newborn Ear Deformities...6 Tonya Johnson New Clinial Director..................7 New Faces in Quality Department...................7 What’s Happening.....................8

Atrial fibrillation (AFib) is an irregular heartbeat that feels like a fluttering or quivering of the heart that affects close to three million Americans. According to the National Heart, Lung and Blood Institute, when AFib occurs, rapid, disorganized electrical signals cause the heart’s two upper chambers to fibrillate, or contract very quickly and irregularly. AFib causes blood to pool in the upper chambers of the heart. This keeps the heart from pumping blood completely into the heart’s two lower chambers. While for some, the symptoms of AFib can feel very frightening, others have no signs at all. But symptomatic or not, make no mistake about it: AFib is not a simple “heart flutter” and certainly not something to ignore. The biggest threat from atrial fibrillation is the threat of blood clots and stroke. “Patients with atrial fibrillation are six times more at risk of having a stroke and 15 to 20 percent of all strokes a year are related to AFib,” said Daniel J. McCormick, DO, FACC, FSCAI, an interventional cardiologist at Pennsylvania Hospital. “This is not only significant from a direct health care standpoint, but a societal one as well since stroke is one of the biggest drivers of disability and health care costs in the U.S.”

The standard treatment for AFib is the use of anticoagulants, more commonly known as blood thinners, such as warfarin, and heparin. While there will always be a need for blood thinners in medicine, the truth is, their effectiveness is precisely what makes them so dangerous. Warfarin, the most commonly used for example, is also used to poison rats and mice. Its anticlotting properties produce death through internal hemorrhaging — a trait you want to control rodent populations, not your AFib. This is why warfarin is considered a “black box drug” by the U.S. Food and Drug Administration (FDA). The black box is the strictest warning the FDA can give a medicine while still permitting it to remain on the market. According to Dr. McCormick, patients on blood thinners must be monitored weekly to make sure their medication levels are safe, which limits one’s mobility and quality of life. Striking a balance between effective, therapeutic levels of blood thinners and hazardous ones is delicate and requires constant diligence on part of both the patient and physician — a level of diligence many patients aren’t capable of maintaining. “Even with careful monitoring only about 20 percent of all patients on warfarin are within the proper range at any one given time,”

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Penn Medicine Teams Up .......8


LASSO IT UP: How a Rodeo Roping Technique Can Help Treat an Age-old Heart Ailment / / /

/ / / Continued from page 1

explained Dr. McCormick. “These patients are living on a very short leash.” According to McCormick, herein lies a primary challenge of treating patients with AFib: there is a real need for other therapies to treat patients that:  ave a prior history of stroke and can’t take anti1) H coagulants because of bleeding complications. 2) Are extremely difficult to manage despite diligence and monitoring. More invasive treatments for AFib include implants (currently still in clinical trials) and surgery to place sutures, clips and staples to close off the affected trouble areas of the heart. A little less invasive in that it doesn’t leave anything in the heart, is radiofrequency ablation, where a small, flexible catheter is inserted through a vessel in the groin and up to the heart. Using fluoroscopy, a live x-ray image, an interventional cardiologist carefully guides the catheter up into the heart where small electrodes are placed. The electrodes, connected to monitors to help locate what exact areas of the heart are causing the

AFib, are also used to send electrical energy to the problem areas, effectively destroying them and creating a tiny bit of scar tissue. It’s the scarring that halts the irregular heart rhythm. While ablation can often control AFib and many patients do well, it’s not full-proof. “There’s a high recurrence rate of AFib in ablation patients — about 30 percent,” said Dr. McCormick. Enter the lasso! Or more specifically, PLACE™ a LARIAT®. By using the PLACE procedure of Permanent Ligation Approximation Closure and Exclusion, a physician is able deploy the LARIAT, an FDA-approved Left Atrial Appendage Occlusion Device, to seal off the malfunctioning area of the heart where dangerous blood clots can form. Dr. McCormick performed the first two LARIAT cases on January 30, at Pennsylvania Hospital, the first in the region to use the new technology and second in the state. Performed in the hospital’s cardiac catheterization lab, the procedure takes approximately two hours with a patient under general anesthesia. Two small catheters are threaded through the groin up to

the heart allowing for two magnetic tipped wires to hold the affected area in place. Then a balloon is inflated to confirm the proper position of the area to be sutured off with a micro-mini lasso. The suture/lasso/lariat is then cinched up around the base of the appendage, sealing off the problem area. After a year, the whole affected area just naturally withers away to nothing. While still in the early stages of employment, previous use so far suggests there are low complications and a high success rate associated with the procedure. Patients are required to stay on bed rest for four hours once out of recovery and stay over the night in the hospital. “The LARIAT provides a permanent solution for stroke risk associated with atrial fibrillation without leaving any devices or other objects behind in the heart.” said McCormick. “But what’s really exciting is that the patient is off warfarin immediately after the procedure. It’s terrific to be able to add another tool to our arsenal of treatments for atrial fibrillation. WANT TO LEARN MORE about reducing your risk for heart disease this? Visit the Penn Heart and Vascular update on Penn Medicine’s website.

> > > HELPING A BELOVED PAH Family Member in Time of Crisis You may have seen it on the news: On January 23, Miki Takamori jumped from the second floor of her West Philadelphia apartment to escape a fire. The leap of bravery saved her life, but not before the fire and jump itself took their toll. Miki suffered significant burns over 30 percent of her body and a spinal cord injury. She is currently receiving care at the Temple University Hospital Burn Unit.

`` Miki Takamori is shown here with PAH Chair of OB/GYN, Dr. Jack Ludmir.


A beloved colleague, Miki has worked for the Department of Obstetrics and Gynecology since April 1997. She was the first employee of the CPUP OB/GYN practice when it was created here at PAH. Prior to working at PAH, Miki worked at HUP in the Family Planning clinic. She is also a graduate of the University of Pennsylvania.

Many employees and staff have inquired about Miki and asked how they can help.

Cards (no flowers, balloons or fruit permitted on the burn units) can be sent to:

Temple University Hospital Burn Unit Broad & Ontario Streets Rock Pavilion – 4th floor Room 405 – Miki Takamori Philadelphia, PA 19140

Donations can be sent to:

Miki Takamori’s Donation Fund Wells Fargo 50 E. Wynnewood Wynnewood, PA 19096

Hav ing Fun While Rai sing Fund s at Pennsylvania Hospital’s First “Souper Bowl” It was that time of year again. All across the U.S. folks gathered together on Sunday, February 3 not to worship, but to watch the 47th Super Bowl and — thanks to an increasing popularity due to “cute overload” — Animal Planet’s Puppy Bowl 9. Some even started the festivities early here in Philly at today’s Wing Bowl 21. While millions will scarf down junk food and alcohol in mass quantities this weekend, folks at the Joan Karnell Cancer Center (JKCC) at Pennsylvania Hospital celebrated earlier in the week with much healthier food choices at its first ever “Souper Bowl.”

`` Relay for Life Walk Chair, Michelle Rumbaugh and cancer survivor and JKCC volunteer Pam Barr are shown here setting up for the Center’s first Souper Bowl.

This year’s Relay for Life of South Philadelphia will be held Saturday, May 19, at Marconi Plaza, on Broad Street, between Oregon and Packer Avenues.

Held January 29, the JKCC decided to host the Souper Bowl to help support their inaugural team participating in the annual American Cancer Society’s Relay for Life. Each year, over four million people from over 20 countries partake in the global community walk to raise much-needed funds and awareness to save lives from cancer. During a Relay event, participants and cancer survivors celebrate what they’ve overcome and run a victory “Survivors Lap.” This year’s Relay for Life of South Philadelphia will be held Saturday, May 19, at Marconi Plaza, on Broad Street, between Oregon and Packer Avenues. “The Souper Bowl was a pilot event,” said Marylou Osterman, JKCC coordinator. “We wanted to come up with a fun and creative new way to raise funds and support our team.” They succeeded. In only two hours, the Souper Bowl raised almost $500 — 50 percent of the JKCC team goal of $1,000. The Souper Bowl was a team effort across the board. Staff chipped in to cook up five different kinds of homemade soups, cornbread and desserts. Guests were also treated to a soup toppings bar and all the buttered rolls they could eat. Bowls and flatware were donated to the event by the Department of Food and Nutrition at Pennsylvania Hospital.

“It was nice to take time away from our busy schedules, spend some time with colleagues, friends and former patients and contribute to a great cause — all at the same time,” said Alan L. Schuricht, MD, FACS, clinical professor of Surgery. “The soups were great but the company was better.” To help supplement supplies (and make sure there was plenty to go around) the JKCC purchased ten additional quarts of soup from MANNA. Formally, the Metropolitan Area Neighborhood Nutrition Alliance, MANNA prepares and delivers nourishing meals to individuals in Philadelphia who are at acute nutritional risk and battling life-threatening illnesses such as cancer, renal disease and HIV/AIDS. Between MANNA and staff contributions, approximately 75 supporters, for only a five dollar donation each, were able to enjoy a creamy corn chowder, holiday bean soup with ham, chili con carne, Italian escarole soup with little meatballs, or a curried cauliflower soup. Proceeds to MANNA from the JKCC helped to provide a balanced, nutritious meal for 50 people. “It was great to break away from my desk and attend the Souper Bowl party. I had a great time hanging out with coworkers and meeting people from other departments. The food was fantastic, especially the Turkey Chili with all the toppings,” said Cynthia J. Briola, RN, OCN, CBCN, Cyberknife Program coordinator. Well, it looks as if all those books were right: chicken soup — or any soup for that matter — is indeed good for the soul.

Want to learn more about nutrition and the healing power of foods? Visit the JKCC’s Cancer Fighting Cupboard on Penn Medicine’s Focus on Cancer blog which provides nutrition news, information and tips and healthy recipes.


Development N E W S PA R K I N S ON ’ S DI SE A SE A N D M OV E M E N T DI S OR DE R S C E N T E R Awarded $200,000 The Parkinson Council recently announced its annual awards for 2013. This year’s awards include a $200,000 grant to the Parkinson’s Disease and Movement Disorders Center (PD&MDC) at Pennsylvania Hospital to go toward outreach, education, clinical care and research. The Parkinson Council is the Greater Philadelphia area chapter of the National Parkinson Foundation. The Council works diligently to raise funds to support Philadelphia area nonprofits and institutions dedicated to improving the life of patients, caregivers and their families, educating and promoting the search for the cause and cure for Parkinson’s. The PD&MDC is deeply grateful to the Parkinson Council for their continuing support.

`` Christ Healing the Sick painted by the renowned artist Benjamin West.

H I S TOR IC C OL L E C T ION S Receives Grant to Help Heal “Christ Healing the Sick” Pennsylvania Hospital’s Historic Collections recently received a $40,000 grant from the Stockman Family Foundation for the assessment and initial conservation efforts of “Christ Healing the Sick in the Temple,” the painting by renowned artist Benjamin West. Completed in London in 1815, the painting has been displayed at Pennsylvania Hospital for almost 200 years, and depicts Jesus Christ receiving the sick, lame and blind. The addition of the “lunatic boy” to the painting was an added homage to the Hospital’s care of the mentally ill. Positioned between the historical and modern parts of the hospital, “Christ Healing the Sick in the Temple” provides an eloquent bridge between the hospital’s past and future. The conservation of the painting will be directed by Conservators Steven Arisoty and Mark Bockrath, recommended by Mark Tucker, Philadelphia Museum of Art vice chair of Conservation and senior conservator of American Art. Under the supervision of Stacey Peeples, the Hospital’s curator-lead archivist, the initial phase will involve removing the painting from the wall to fully assess the bulge in the left hand corner of the painting and produce a detailed conservation treatment plan. Initial assessment will take place in spring 2013. Many of us pass the painting every day — perhaps even multiple times a day. However, how many realize what a treasure hangs here at PAH? In 1800, Benjamin West — a teacher of other American artists and historical painter to King George III — received a letter in London from the president of the Board of Managers of PAH requesting he contribute a painting to the nation’s first hospital.

`` The PD&MDC receives a donation from the Parkinson Council

In the letter, the Board of Managers pled their case: “The works of an artist which ornament the palace of his King cannot fail to honor him in his native land.” West couldn’t say no: “The subject I have chosen is analogous to the situation. It is the Redeemer of mankind extending his aid to the afflicted of all ranks and condition.”


“Christ Healing the Sick in the Temple” was completed and exhibited in 1811. It caused such a stir in England, however, that officers of the British Institution pressured West to sell it as the first work to be hung in a proposed National Gallery. It was purchased for 3,000 guineas, the largest sum ever paid for a modern work. Determined to not let down PAH Board of Managers, West wrote them and promised “a more improved plan of composition.” He decided to include “a demoniac with his attendant relations” to reference the hospital’s treatment of the mentally ill. The second painting was eventually completed and arrived in Philadelphia on the ship “Electra” in 1817. Accompanying the picture was a touching letter from West, who was nearing the end of his long life. It read: “Benjamin West, Historical Painter to His Majesty George III, and the President of the Royal Academy of Arts in London, feels the highest satisfaction in informing the Managers of the Pennsylvania Hospital by having finished the picture of our Savior receiving the Lame and Blind in the Temple to heal them. And Mr. West bequeaths the said picture to the Hospital in the joint names of himself and his wife, the late Elizabeth West, as their gratuitous offering and as a humble record of their patriotic affection for the State of Pennsylvania, in which they first inhaled the vital air — thus to perpetuate in her native city of Philadelphia the sacred memory of that amiable lady who was his companion in life for fifty years and three months.” The painting was first hung in its own specially constructed “Picture House” on Spruce Street where the Cathcart Building now stands. It attracted over 30,000 visitors during its first year on display. The admission fees over a 25-year-period were enough to pay for the building with $15,000 left over for general hospital funds. The painting has also been exhibited at the Pennsylvania Academy of Fine Arts, the hospital’s former West Philadelphia Department for Mental and Nervous Diseases (the Institute), and in a former clinical amphitheatre at the hospital’s 8th Street site.

M OR E SU P P ORT for PAH Working with constituencies across Pennsylvania Hospital, the PAH Development Office assisted in securing a number of very generous grants in calendar year 2012. Grants awarded to hospital programs and the Department of Historic Collections include: •  $750,000 from the Otto Haas Charitable

Trust for palliative care at the Joan Karnell Cancer Center

•  Over $400,000 in pledges and grants

from the First Hospital Foundation for various hospital programs and historic preservation efforts

•  $210,000 from the Hall Mercer

Foundation for services at Hall Mercer Hospital

•  A total of $117,760 in payments from

the Catharine D. Sharpe Charitable Trust in support of the Sharpe Spinal Research Laboratory

•  $80,000 representing a second payment

on a $240,000 grant received from the Hanger Orthopedic Group in support of the Hanger Orthopedic Fellowship at Pennsylvania Hospital

•  $30,000 for language services in Latinas

Community Health Services in the Department of Child and Family Services from the Connelly Foundation

•  $10,000 from the Garfield Duncan

Diabetes Research Foundation for the Diabetes Education Center

•  $5,000 towards Pine Building renovations

from the Vanguard Group Foundation

•  $5,000 from the Scholler Foundation for

the purchase of a new EKG machine for the Emergency Department

•  $2,500 for the Department of Family

Education from the Barra Foundation.


Swift, Non-Surgical Help TO FIX NEWBORN EAR DEFORMITIES Enlisting newborn hearing screeners to help identify common ear deformities allows doctors to easily correct the condition without surgery before a baby leaves the hospital, according to a new study by researchers at the Perelman School of Medicine at the University of Pennsylvania. The new study is published online ahead of print in the International Journal of Pediatric Otorhinolaryngology. “We’ve known for some time that by simply splinting the ears of newborns with congenital auricular deformities, we’re able to effectively reshape the impaired cartilage to prevent the need for future surgery,” said the study’s senior author, Oren Friedman, MD, director of Facial Plastic Surgery associate professor of Otorhinolaryngology: Head and Neck. “But we need to get to these newborns within the first three days after birth. It made perfect sense to enlist the help of hearing screeners in this endeavor, as they typically perform an in-hospital exam on babies within 24 to 48 hours.

It is an ideal opportunity to identify these deformities and allow doctors to take action quickly.” Congenital auricular deformities are birth defects affecting the shape and position of the ear. The soft cartilage around the ear and other structures that affect both the function and appearance of the ear may be involved. The incidence of these deformities varies based on the type and between racial and ethnic groups, however studies have found that up to 30 percent of children have some type of ear deformity at birth. If left untreated, some of these deformities can cause significant functional and social impairment, requiring major surgical intervention at a future date. In the new study, newborn hearing screeners received education on evaluation of congenital auricular deformities by a team of otolaryngologists and were provided an easy to use sheet to keep with them at all times of photos and illustrations of the most common ear deformities. When the newborn hearing screeners identified infants with congenital auricular deformities during a standard hearing exam, the infant’s primary care medical team was alerted. The primary care team then notified the family that

`` A patient with cup ear identified during the study. The infant underwent 1.5 weeks of splinting to correct the deformity without surgery. (A) Before splinting, (B) 2 weeks after splinting initiated, and (C) 3 months after splinting initiated.


an otolaryngologist would evaluate the infant’s ears. During the study timeframe, ten infants with 19 affected ears amenable to treatment were treated with a simple splint. All ears were assessed by physical examination and photographic documentation prior to splinting and at follow-up visits. Splinting was initiated prior to the infant’s discharge from the hospital. All of the patients exhibited improvement from the original deformity after one to four weeks of splinting and there were no instances of skin irritation or breakdown. “In addition to the results from this study, this technique has been used with great success for many newborns at Pennsylvania Hospital in the last year,” said Friedman.

“We have employed excellent screening methods utilizing a multi-disciplinary team of experts at the busiest birthing hospital in Philadelphia to ensure our patients get the best possible care.” Friedman and his co-authors note that over time, this approach may prove to be a cost-effective, minimalist method to manage the vast majority of congenital auricular deformities. It may also prove to enhance the psychosocial functioning of children during the formative years, which can improve their life-long well-being.




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Presby Bulletin System News What’s New

Tonya Johnson

New Clinical Director Tonya Johnson, MSN, RN, CCRN, has been appointed Clinical Director for the Emergency Department and 5 and 6 Cathcart. As a clinical director over the past two years, Tonya has achieved many successes leading and supporting the Critical Care, Dialysis, 7CC and 6S teams. Also during this time Tonya has led many initiatives such as the development of the new Shared Governance Model, ICCU Admission/Discharge Criteria, implementation of CRRT, and the establishment of many new nursing practices in support of patient care. “Over the past five months Tonya has supported the Emergency Department during an interim period and very quickly earned the respect and support of both the ED Nursing and physician teams,” said Mary Del Guidice, MSN, BS, RN, CENP, chief nursing officer at PAH. “In a short period of time Tonya and her team have achieved many impressive accomplishments in quality, safety, satisfaction and financial outcomes.”



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To help us better understand the interests and needs of our readers, we are conducting a What’s New readership survey. The survey takes only a few minutes to complete, and can be submitted online or by mail. Your responses will help us better tailor our publication and provide more of the content you want to read. A hard copy of the survey is available in this issue and the link to the online version is available at http://pennmedicine.pubsurvey. Please complete and mail the hard copy or submit the online survey by March 29.

Improvement: Quality and Patient Safety Coordinator. Danielle started at PAH in September of 2012. Prior to that, she worked for seven years at PPMC as a Perioperative RN Clinical Nurse IV.

Quality Coordinator. Jennifer started at PAH in September of 2012 after spending 16 years at Capital Health in New Jersey.

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»» Danielle C. Reynolds RN, MSN, CPHQ, CNOR, Performance

»» Jennifer Yocum, RNC, MSN, Performance Improvement: Senior

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Team: Infusion Support RN. Maureen worked at HUP for two years on an intermediate Neuro floor. She earned her degree from Holy Family University in 2009 and has been working at PAH on the Infusion Support Team since October 2012.

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Currently, Tonya co-leads the Cardiac Service Line Patient Experience team and the Penn Medicine CARP redesign Team — and is enrolled in a doctoral program.

»» Maureen O’Neill, RN, BSN, Clinical Nurse II, Infusion Support

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»» Jessica Stevens, RN, BSN, Performance Improvement: Clinical

Data Analyst and ACS NSQIP Surgical Clinical Reviewer. Jessica worked in the SICU at Johns Hopkins before coming to PAH Labor & Delivery in 2010.

»» Laura Schnarr, RN, BSN, Clinical Nurse III, Infusion Support

Team: Lead Infusion Support. Linda has worked at PAH since May of 2003. She was a Critical Care float pool nurse and began as a lead infusion nurse in June 2012.


WHAT’S H a p p ening


For complete events listing, please visit What’s New on the Inside Penn Medicine web site at:


March 13

March 7

March 14

12th Annual Patient Safety Fair HERE, THERE, AND ELSEWHERE: Medication Distraction at the Bedside — PAH Patient Safety Lecture

Brown Bag Medicine Review PAH’s Schwartz Center Rounds

March 20

PAH Town Meeting

March 19-22

American Cancer Society’s Daffodil Days at the JKCC

March 19 & 20

JKCC Colon and Uterine Cancer Awareness Program

April 21, 2013

18th Annual Dash for Organ & Tissue Donor Awareness

April 24

Penn Medicine Teams Up and Gives Back in the Fight Against AD `` Pictured from L to R: Gary Dorshimer, MD, section chief, General Internal Medicine, PAH, and Team Internist for the Philadelphia Eagles and Head Team Physician for the Philadelphia Flyers: Andreas Lilja, defenseman for the Flyers: Joe McKeown president of the McKeown Foundation: Suzanne Sawyer, chief Marketing Officer, Penn Medicine; Jim McCrossin, ATC, CSCC, head athletic trainer for the Philadelphia Flyers.

Penn Medicine teamed up with The McKeown Foundation and local athletes to raise funds for the fight against Alzheimer’s disease. At a “Score Against Alzheimer’s” event held at the Kitchen Bar Restaurant Café in Abington, they raised $7,000 to benefit the McKeown Foundation. The funds will support their work to promote the care, research and education of Alzheimer’s disease.

Since the “Score” event, The McKeown Foundation has presented a donation of $11,000 to the Penn Memory Center (PMC) to aid in their work to provide evaluation and care of people with Alzheimer’s disease and other dementia illnesses. The PMC combines the expertise of neurologists, geriatric psychiatrists, geriatricians and social workers devoted to the evaluation and treatment of dementia illnesses. The Penn Memory Center is a multidisciplinary part of the Cognitive Neurology program. It’s also the clinical component of the University of Pennsylvania’s Alzheimer’s Disease Center, one of 27 nationwide funded by the National Institute on Aging. The McKeown Foundation, which hosts an annual golf tournament, was founded by the family of William J. McKeown Jr., after losing their father to Alzheimer’s in 1991. “Through the generous donations of our sponsors and supporters, we have been able to work toward a cure for Alzheimer’s” said Joe McKeown, president of The McKeown Foundation and senior account manager for Penn Medicine. “The proceeds from this event helped the Foundation and Penn Memory Center continue working to achieve their goals.”


Thomas Story Kirkbride and the Pennsylvania Hospital for the Insane Lecture

April 29

32nd Annual Molly and Sidney N. Zubrow Lecture and Award Program


Sally Sapega Director of Internal Communications Olivia Fermano Editor and Photographer Pamela Furches Design Graphic Design Barry Ogburn Photography


Susan E. Phillips Senior Vice President, Public Affairs CONTACT WHAT’Snew at: Department of Communications Pennsylvania Hospital Philadelphia, PA 19106 phone: 215.829.6799 email: WHAT’Snew is published biweekly for PAH employees. Access WHAT’Snew online at

What's New  

News from Pennsylvania Hospital

What's New  

News from Pennsylvania Hospital