July 2015 - Asante

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Published on July 20, 2015

July 2015

James Grebosky, MD, vice president medical affairs

A Surgical Complication That Shouldn’t Happen

James Grebosky, MD, vice-president, Medical Affairs

It’s no surprise that the Internet now offers an open forum for patients around the country to share their hospital horror stories. On one website, a woman in California describes suffering for months with painful open wounds caused by a surgical-site infection. Another says she was readmitted after shoulder surgery with an infection that destroyed her rotator cuff. And a patient in Alabama recounts how she lost her leg from MRSA following ankle surgery.


Some of the incidents in these self-reported stories may be no fault of the hospital; others may be exaggerated or misinformed. But many are very likely true, and they should be a caution for every physician and nurse dedicated to doing no harm.

Surgical-site infections are the second most common hospital-acquired condition – and more than half of them are preventable. Asante Ashland Community Hospital has always been committed to ensuring that these harmful and potentially fatal infections don’t happen to our patients. But it’s vital that surgical staff always follow rigorous safety measures, including:

  • Reinforcing the “Back to Basics” standards of practice from AORN for appropriate surgical attire and hair covering, hand hygiene, OR traffic control, noise reduction, patient hair removal practices, and OR humidity and temperature monitoring.
  • Implementing the use of a standard surgical checklist that is used for every patient. This requires the surgical team to verbally confirm that all important items have been done before the procedure starts.
  • Developing standardized antimicrobial prophylaxis orders with updated doses and redosing for longer procedures based on revised IDSA guidelines.
  • Educating patients on preoperative skin cleansing with CHG to reduce the amount of bacteria on the skin, and using CHG wipes upon admit.
  • Developed a standardized practice for applying perioperative skin prep.
  • Implementing active warming measures to prevent hypothermia
  • Implementing protocols for preventing SSIs in patients colonized with MRSA or MSSA to include pre-op screening, decolonization protocols, and ensuring the appropriate antibiotic.

Asante has also joined the American College of Surgeons National Surgery Quality Improvement Program, or NSQIP. Hospitals participating in the national program report fewer complications, better outcomes, and shorter hospital stays. (NSQIP has a helpful online calculator to help determine a patient’s risk for infection.)

We’ll report more on what NSQIP means for our hospital in future issues of Medical Staff News. In the meantime, it’s critical that every provider comply with infection-prevention efforts. Not only does strict adherence keep our hospital’s safety record in good standing, it helps keep our patients free from potentially disastrous surgical complications.

Resource: Spruce L. Back to basics: preventing surgical site infections. AORN J. 2014;99(5):600-8

Thanks as always,

Jamie Grebosky, MD

Patient Flu Vaccination Effort’s Surprising Results

At first the goal seemed challenging: Boost compliance for patient flu vaccinations by 50 percent for the 2015 flu season. Yet when the tallies came in, Asante hospitals had far surpassed the goal with a remarkable 87 percent overall increase in compliance and only 10 missed immunization opportunities for the entire season.


How did this happen? Asante hospitals took a multipronged approach, including:

  • Streamlining the immunization screen in Epic
  • Launching an education campaign championed by clinical leaders throughout the system
  • Implementing rounding to identify patients who hadn’t been screened
  • Educating nurses on the importance of flu screening and immunization before discharge

The Centers for Disease Control and Prevention estimates that influenza causes 3,000 to 49,000 deaths every year. Flu immunization for inpatients prevents the spread of flu in the hospital as well as in the larger community, since many of these patients otherwise may not have been immunized. Further, CMS now includes influenza immunization (IMM-2) as part of its Value Based Purchasing incentive quality measures.

Look for more on flu immunization in the early fall when Asante’s 2015-2016 flu vaccine campaign begins.

Daniel Kahn, MD, PhD - Maternal Fetal MedicinePhysician Profile: Daniel Kahn, MD, PhD

Current practice: Obstetrics and gynecology/maternal-fetal medicine, APP

Distinctions: Postdoctoral work with Nobel Laureate biologist and immunologist David Baltimore, PhD; research published in multiple peer-reviewed journals, including Proceedings of the National Academy of Sciences, the Journal of Experimental Medicine and the Journal of Immunology; oral and poster presentations at more than 25 conferences


Quirky coincidence: Shares the same name and middle initial as ARRMC anesthesiologist Daniel A. Kahn, MD.

Research focus: Immune regulation during pregnancy

Awards: Oppenheimer Award, UCLA Scholars in Translational Medicine Program; Joint Center for Translational Medicine

Medical education: MD and PhD (biomedical sciences), University of California, San Diego; OB/GYN residency and maternal-fetal medicine fellowship, University of California, Los Angeles; postdoctoral fellowship, California Institute of Technology

What are we learning about the immune system and high-risk pregnancies?

One of the mysteries about pregnancy has been why the mother’s immune system fails to mount an attack on her fetus despite the fact that the fetus carries different antigens inherited from the father. We also understand that the fetus is capable of making robust immune responses of its own, so why doesn’t the fetus attack the mother?

In recent years we have finally begun to understand the molecular mechanisms at play during this important process. Further, we’re beginning to learn that when this process of immune tolerance fails during pregnancy, diseases such as preeclampsia and fetal growth restriction are the result. This understanding is allowing researchers to develop novel therapies for these perplexing conditions of pregnancy and may offer hope for millions of mothers and their unborn children.

What medical advances/techniques have emerged in the past few years?

One that has gotten a lot of attention is the new approach to detecting fetal genetic conditions through a maternal blood sample. This approach takes advantage of increasingly efficient whole genome sequencing. Maternal blood carries free-floating DNA, a fraction of which is coming from the fetus. By sequencing the entire free DNA in the blood sample and reassembling the codes using advanced computation, the fetal and maternal genomes are largely determined.

Since it’s possible to quantify the represented genes, we can get an accurate determination of the number of chromosomes. In pregnancy, we can use this tool to screen for several genetic syndromes, including Down syndrome, with detection rates approaching 99 percent with 0.1 percent false-positive results.

How are these advances affecting outcomes?

In many ways, the advent of cell free DNA testing has allowed us to screen more effectively for common fetal genetic disorders and to target our invasive testing (e.g., amniocentesis) to only those pregnancies at highest risk for fetal genetic disorders. By and large, the greatest benefit has been to put many couple’s minds at ease without the risk of an invasive test.

How is medical education changing for maternal-fetal medicine specialists?

There’s now a greater emphasis on care for the mother with medical complications. For a long time, there was an emphasis (bordering on obsession) with the fetus, but MFM training in the past five years has begun to rebalance the focus.

This is important because with an aging maternal population, medical conditions such as hypertension, history of cancer, autoimmunity, etc., are becoming a more common part of routine obstetrical care. Also, we’re beginning to recognize that pregnancy complications can have lifelong impacts on maternal cardiovascular health. So, appropriate care of the mother can be very important beyond the joy of birth.

Who taught you the most, and why?

I have been blessed with many really terrific teachers, but I’ve grown the most as a person through the education provided by my children.

You like to repair cars. What kind and, more important, why?

Like many in surgical fields, I really enjoy working with my hands. In fact, my favorite part of being a bench researcher was executing experiments. Working on our family’s cars provides me with the same tactile satisfaction. That, and it allows me to fulfill another deeply held passion: saving money.

Why did you decide to join Asante Physician Partners?

After trying to find a balance between medicine and research and family for nearly 20 years, I needed to make a change. My short list of priorities was to be involved in my family’s life and to provide excellent care to my patients. Of all the options I considered, APP provided the best combination of those “must haves.” Also, Asante’s dynamic growth and its mission to improve the health of the people of Southern Oregon is irresistible.

Finish this sentence: A perfect day would be …

A bagel breakfast with my wife (a pathologist), our two daughters, and two sons. That would be followed by involvement with a beautiful birth and concluding with a hike in these wonderful hills around the Rogue Valley.

ICD-10 Training Reaching into Asante’s Ranks

ICD-10 isn’t just for coders anymore. Asante employees whose job codes relate to billing, finance, home health and “General Equivalence Mappings” may be required to complete online education courses that became active July 1.


None of the bundles of courses total more than seven hours of coursework, but some employees who have been assigned courses from multiple bundles – billing and finance, for instance – may have as many as 12 to 13 hours of course time to complete. But their time commitment still won’t compare to that of Asante coders and documenters, who have been at the forefront of the conversion from ICD-9 to ICD-10 for several months and have racked up dozens of hours of training.

All Asante employees will get a taste of the training before ICD-10 goes into effect as scheduled on Oct. 1. A basic ICD-10 module is being integrated into this year’s Elements online training requirement.

But for now, employees who deal with billing, finance, home health and General Equivalence Mappings should check their ALEC accounts to find out if they are required to complete any of the current round of ICD-10 course bundles. General Equivalence Mappings, developed by the National Center for Health Statistics and other agencies, provide a temporary mechanism to link ICD-9 and ICD-10. While there are no exact code matches between ICD-9 and ICD-10, GEMs can serve as a basic code-to-code translation dictionary.

ICD-10 – the 10th revision of the International Classification of Diseases – is a federally-mandated upgrade already being used by about 25 countries worldwide. It uses a system of about 70,000 diagnosis codes, compared to about 15,000 under its predecessor, ICD-9.

The new ICD-10 standards will change how physicians and providers document patient care provided in hospitals, and the way it is coded for reimbursement. A much more specific degree of coding will improve the quality of documentation and the resulting patient care.

Asante’s ICD-10 steering committee has been meeting periodically for the past few years, and has ramped up for this year’s implementation date. The committee is coordinating training in how to use the new classification system, communication with those who are most affected by the change and implementation of the new code set across all Asante entities.

Asante’s ICD-10 website will include additional information as it becomes available during the implementation period and beyond.

For information or questions, email Asante’s ICD-10 steering committee at ICD-10@asante.org.

Asante Moments: ED Doc, Neurologist Help Return Stroke Patient to Full Function

Eric Loeliger, emergency physician and VP of medical affairs at Asante Three Rivers Medical Center, is featured in the latest Asante TV commercial, which airs this month.

Asante Represents on Fourth of July

Even the triple-digit temperatures didn’t melt the spirit of Asante volunteers who participated in Saturday’s 4 th of July parade in Ashland. Asante Physician Partners sponsored this year’s event and led the floats with an Asante Moment-themed entry.


Staff from the Ashland and Talent APP clinics, along with patients and families, walked alongside the float, carrying signs with their own Asante moments. Kids wearing “What is Your Asante Moment?” T-shirts gave goody bags to those in the crowds lining Siskiyou Boulevard and East Main Street.

Afterward, parade-goers who dropped by Asante’s booth in Lithia Park were grateful to find free bottles of sunscreen and information about Asante Physician Partners and Asante Ashland Community Hospital’s services and providers. Did we mention it was blazing hot?

For those who missed the celebration, check out a photo gallery of the event or view a video of the APP parade entry. And don’t forget to visit the Asante Ashland Community Hospital Facebook page.

This year’s Fourth of July Celebration emphasized Ashland’s commitment to healthy lifestyles, with the theme “Be Active, Live Healthy.”

Ashland’s celebration, now over 100 years old, included a run organized by the Ashland Parks & Recreation Department; the parade that draws an estimated 20,000 spectators; the Lithia Park food, crafts and information booths; and a daylong lineup of bands in the Lithia Park Bandshell. A
fireworks display that began at dusk was visible throughout town.