Searching for greener energy,Christiana Care’s Facilities and

Engineering team found one goodanswer blowing in the wind.

Starting Jan. 1, 2010, a wind farmbeing developed of Schuykill andColumbia counties of easternPennsylvania will supply much of ourelectricity.

Christiana Care signed a nine-yearagreement with Iberdrola Renewablesof Radnor, Pa., to purchase 40 millionkilowatt hours of electricity annuallyfrom its Locust Ridge II wind farm.

That amount represents approximately15 percent of the output of the new102-megawatt, 51-turbine wind farm –enough electricity to power about3,700 homes.

Steady supply of green electricityAccording to Bob Mulrooney,Christiana Care vice president forFacilities and Services, the LocustRidge II wind farm will providebetween 30 percent and 40 percent ofChristiana Care’s annual electricityneeds.

The deal assures a steady supply ofpollution-free electricity. “You’re har-nessing the power of wind to produceelectricity,” says Mulrooney. “From anenvironmental standpoint, it’s a cleanand renewable source.

Clinical News

order entry 2

A look back atEducation Week 8

Paramedic trainingfor police officers 13

Teamwork tackles novovirus 15

Publishing, PresentationsAwards, Appointments 17

General News

Dr. Rizzo visits U.S.House of Representatives 20

F O C U SA publication for Christiana Care Health System physicians and employees

April 23, 2009VOLUME 20, NUMBER 7

Published every two weeks byChristiana Care Health System

External AffairsP.O. Box 1668

Wilmington, DE 19899-1668www.christianacare.org

Christiana Care’s next green initiative:Purchase wind-generated electricity

PLEASE RECYCLE FOCUS

I N T H I S I S S U E

Starting Jan. 1, 2010, Christiana Carewill begin purchasing 30 to 40 percentof its annual electricity needs fromLocust Ridge II wind farm inPennsylvania.

Because we are a health care provider,it’s a natural fit for us,” Mulrooneysays.

In addition to the environmental bene-fits, the deal provides cost benefits:Christiana Care’s electricity costs willremain unchanged during the nine-year contract.

Computerized doctors’ orders will transform patient care

In January 2010, a new, multimillion-dollar software system that workswith PowerChart, the electronic med-ical record system, will put ChristianaCare in the forefront of hospitals in theUnited States.

According to a survey by the NewEngland Journal of Medicine, only 17percent of U.S. hospitals today haveimplemented computerized physicianorder entry (CPOE), lifesaving infor-mation technology.

“CPOE is an extraordinarily powerfultool for patient safety and a great stepforward for Christiana Care,” saysJames Newman, M.D., chief medicalofficer.

Improving patient safety Submitting orders electronicallyreduces the risk of medical errors.With CPOE, pharmacists, laboratorytechnicians and others who need toread the orders no longer have toquestion illegible handwriting andinconsistent medical abbreviations.

“The legibility issue dramaticallyimproves with CPOE because we’renot dealing with handwriting from300 or 400 physicians,” says AlHelmeczi, vice president for PharmacyServices.

Saving time and costsThe new system will also eliminate theneed for transcribing orders and scan-ning doctors’ handwritten orders intothe system before sending them to thepharmacy or lab.

Removing these steps in the process

will improve overall order processingtime, making ordered medicationsmore readily available. And streamlin-ing the process might lead to cost sav-ings and give pharmacists more timeto support direct patient-care activity.Christiana Care’s Pharmacy Servicesfills about 1.5 million orders each year.

Increasing order efficiencyAt the heart of the new CPOE systemwill be 500 order sets, collections oforders physicians typically write forpatients with particular diagnoses. Togive patients with the same diagnosisthe safest and most effective treat-ment, order sets use best medical prac-tices to standardize patient care.

“When you deliver care that’s stan-dardized, it’s safer and of higher qual-ity,” says Senior Vice President forQuality and Patient Safety SharonAnderson.

But the order sets don’t dictate tophysicians how they should practicemedicine. Rather, they provide whatChief Medical Information OfficerTerri Steinberg, M.D., calls “ease ofordering.” The new system is “singleclick, fast and efficient,” she says.

For the past year, about 100 ChristianaCare physicians have been reviewingthe 100 existing paper order sets anddeveloping new ones. When CPOElaunches in January, physicians willhave access to about five times moreorder sets than most hospitals have.

Implementing the systemWatching health systems that havealready implemented CPOE has beena real advantage for the designers of

Christiana Care’s new system, accord-ing to Dr. Steinberg.

“We’ve been able to look at what’sworked and what hasn’t worked atother hospitals,” she says.

Engaging physiciansAccording to Dr. Newman, physicianswho are using technology more andmore in their practice resist this typeof new technology less than theywould have five years ago. He attrib-utes physicians’ growing acceptancein part to the fact that they have beenengaged in the planning process atChristiana Care.

Mary Jones Gant, MSN, RN, RRT, CS,a clinical specialist in PerformanceImprovement and part of the teamimplementing CPOE, says she hasfound physicians to be receptive.

“They are embracing the idea that thisis going to improve patient care,” shesays.

But no one believes that switchingcompletely to CPOE is something thatwill happen without hard work.

Learning the system“There’s definitely a learning curve,”says Edmondo Robinson, M.D., MBA.“It probably took me a couple ofweeks before I became fluent in usingthis system.” And he had substantialexperience. Before joining ChristianaCare, Dr. Robinson, a hospitalist,worked at three hospitals that usedCPOE.

But Dr. Robinson says he soon beganto enjoy the new technology and con-

C L I N I C A L N E W S

New software will speed pace of filling prescriptions, improve patient safety

2 ● F O C U S A p r i l 2 3 , 2 0 0 9

siders transformation to CPOEinevitable.

“The idea of doctors writing thingson paper that involve the care ofpatients is a little bit ridiculous inthis day and age,” he said. “I can’timagine years from now doctors aregoing to be handwriting anything.”

Using a computer to write medical orders is part of morning rounds led byattending physician Edmondo Robinson, M.D., MBA (left). Residents with him,from left, are Linsey O’Donnell, D.O., Amanda Kijac, D.O, ChandrakalaKathiravan, MBBS, and Keala R. TeKolste, D.O.

Research at the Helen F. GrahamCancer Center will provide an inti-mate look into the relationships ofwomen with breast cancer and theirpartners, providing important insightson how couples can cope with stressand support one another.

“Cancer affects not only the individualbut her loved ones, as well,” says ScottSiegel, Ph.D., health psychologist. “Byunderstanding these processes, we canbe in a better position to offer mean-ingful help and counseling.”

A two-year, $160,000 grant from theNational Cancer Institute will fund acollaborative effort with the

University of Delaware and willinvolve 50 couples.

In the study, each partner will registerhis or her feelings for 10 days using aPersonal Digital Assistant (PDA),about the size of a cell phone. Thepartners will rate such factors as howmuch stress they have experiencedthat day, positive and negative emo-tions, level of connection and emotion-al intimacy, and how much supportthey have received or given their part-ners.

Dr. Siegel says a cancer diagnosis canbe so overwhelming that partners getcaught up in their own stress and do

not support one another. Learning tomanage those emotions can signifi-cantly improve the patient’s well-being, emotionally, socially and med-ically.

“Decades of research indicate thatpeople who report more social sup-port, including women with breastcancer, have better outcomes, in partbecause they are more compliant withtheir doctors,” he says. “They aremore likely to complete all their treat-ments.”

That’s vital because advances in careare enabling patients to live longerand with a better quality of life.

Study examines emotional effects of breast cancer on relationships

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provided his risk stratification testingclose to home.

New heart, new lifeWichess, 55, went on the transplant listin December 2008. On Jan. 7, hereceived a donor heart at the Hospitalof the University of Pennsylvania, oneof several regional transplant centerswith which Christiana Care works toprovide seamless coordination of care.

“From the moment I woke up from theoperation, I could feel the difference. Icould feel that my new heart wasworking,” Wichess recalls. “Before, Icouldn’t walk three feet without hav-ing to sit down.”

On a recent morning, the formerMarine strode briskly into the waiting

Only three months after receiving anew heart, William Wichess has aspring in his step again.

Wichess was 43 when he had his firstheart attack, the same age his motherwas when she died of cardiac arrest.His father died of a heart attack at 58.In the past 12 years, Wichess has beenhospitalized more than a dozen times.

“His heart was failing in every way,”says Mitchell Saltzberg, M.D., directorof the Heart Failure Program.

Until last summer, Wichess wouldhave had to travel from his home inNewark to a regional center inBaltimore or Philadelphia to deter-mine if he was candidate for a hearttransplant. But Christiana Care’s HeartTransplant Evaluation Program

room of the Heart Failure Program,where he greeted Cathy Johnson, RN.

“My neighbor didn’t believe I had aheart transplant,” he tells her. “I haveto show people my scar to convincethem.”

These days, Wichess is walking atleast three miles a day and has startedjogging. He spends time at CivilEngineering Associates inMiddletown, where he is a partner.

Long-term care at homeBecause Christiana Care provides hislong-term medical care, Wichess doesnot have to travel to Baltimore orPhiladelphia for follow-up tests orevaluations. “Mr. Wichess is a truesuccess story, an example of the waythe system works.” Dr. Saltzberg says.

In 2007, about 30 patients from areasserved by Christiana Care went tohospitals in Philadelphia or Baltimorefor heart transplants. But that numberrepresents only a fraction of the peo-ple with advanced heart failure evalu-ated at Christiana Care each year forpossible transplant.

Most of these patients are treated withmedications and never have to leavehome. If a transplant will improve apatient’s chance of survival, however,staff coordinates care with regionaltransplant centers so patients spend aslittle time as possible away from theirfamilies and doctors.

Heart Failure Program Medical Director Mitch Saltzberg, M.D., listens toWilliam Wichess’s new heart while his case manager, Cathy Johnson, RN, takeshis pulse. Marine Corps veteran Wichess had a heart transplant Jan. 7 at theHospital of the University of Pennsylvania and receives long-term care atChristiana Care’s Center for Heart and Vascular Health.

Heart Transplant Evaluation Program offers better logistics

CLINICAL NEWS

4 ● F O C U S A p r i l 2 3 , 2 0 0 9

Focus on Excellence – Best Practice Review

Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly reviewimportant topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staffto better articulate our safety practices during an unannounced survey.

PCA PUMPS

Q. Who is authorized to activate the PCA dosing button?

A. The patient is to push the PCA button to receive pain medication. However, Registered Nurses in the Critical Care &Diagnostic Areas are also authorized to activate the dosing button only if the patient meets criteria.

Q. What criteria must be met in order for an RN in Critical Care & Diagnostic areas to activate the dosing button ofa PCA?

A. An RN in the Critical Care or Diagnostic Area can activate the button only if the following two criteria are met:

1. The button is out of reach for the patient.

2. The patient verbalizes that he or she is in pain and requests pain medication.

Q. If an RN is not available, is there ever an instance when a non-licensed employee can activate thedosing button?

A. No. The only other qualified person would be a physician. If neither is available, the patient’s primary care RN mustbe called to activate the dosing button.

To ask questions, contact the content expert: Gwen Ebbert, RN, SDS 733-3052. To reach the Safety Hotline, call SAFE(7233) from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further informa-tion is available in the Archives of Best Practices. From your portal, choose Focus on Excellence, Joint Commission

M.D. Anderson Cancer Center, whochairs the committee, notes, “our goalis to ensure the highest quality med-ical education symposia and coursesavailable to breast specialists in theUnited States.” Society Executive Director BrookeBreslow adds, “The addition of Dr.Dickson-Witmer’s perspective,through her involvement with theCommission on Cancer and her lead-ership role in a multidisciplinarybreast center, will help the Society ful-fill its mission.”

Diana Dickson-Witmer, M.D., associ-ate medical director of the ChristianaCare Breast Center at the Helen F.Graham Cancer Center, will join theAmerican Society of Breast Disease’s(ASBD) Education ProgramCommittee for a three-year term.As a member of the EducationProgram Committee, Dr. Dickson-Witmer joins a national panel of breastcancer experts to oversee the develop-ment of U.S. and international medicaleducation programming that promotesmultidisciplinary breast health care.Aman U. Buzdar, M.D., professor ofmedicine at the University of Texas

A p r i l 2 3 , 2 0 0 9 F O C U S l 5

C L I N I C A L N E W S

normal behavior of stem cells—howthey behave and grow,” Sikes says.Testing one’s idea against an audi-ence of fellow researchers canimprove the quality of the workdone at member institutions, Sikesadds.

“If you’re only going to live in yourdark box, there’s never going to beany light shed on anything.”

Partners on grant applications Dr. Boman, who published innova-tive research for identifying colonstem cell markers in the New EnglandJournal of Medicine April 15, 2009,says the new working group alsoshould lead to more applications forjoint research grants.

“The hope is this will enhanceresearch within the region and bringin grant award dollars and philan-

Cancer researchers led by BruceBoman, M.D., Ph.D., director of

Cancer Genetics & Stem Cell Biologyat Christiana Care’s Helen F. GrahamCancer Center, meet monthly to sharetheir knowledge and understanding ofadult human stem cells.

The Stem Cell Working Group pro-vides a forum for researchers andclinicians from Christiana Care, theUniversity of Delaware,Nemours/Alfred I. duPont Hospitalfor Children and the DelawareBiotechnology Institute to discuss theirwork, listen to feedback from otherscientists and collaborate on jointresearch projects.

They started meeting in January 2009because, while a number of scientistsat the member institutions wereengaged in stem cell research, “therewas no mechanism for people to inter-act and share their research,” Dr.Boman says. “Ultimately, what wewant to do is translate stem-cell target-ed therapies to clinical practice.”

Testing ideas“We’re trying to figure out problemsinherent to cancer from a stem cellperspective,” says Robert Sikes, Ph.D.,associate professor of biological sci-unces at the University and associatedirector of the Center for TranslationalCancer Research (CTCR). The CTCR isa research partnership that includesthe Helen F. Graham Cancer Center,UD and Nemours. “We also want toknow more about what regulates the

Researchers, clinicians establish monthly stem cell working group

thropic dollars and support from othersources,”Dr. Boman says.

Dr. Boman and Deni Galileo, Ph.D.,another associate professor with UD’sdepartment of biological sciences, areseeking a grant from the newlyformed Delaware Health SciencesAlliance to fund joint research intowhat causes normal colon stem cells tomutate into colon cancer stem cells.The Alliance is a new partnership thatfosters closer research and clinical tiesamong Christiana Care, UD, Nemoursand Thomas Jefferson University (seeFOCUS April 9 issue cover story).

Dr. Boman says the Stem CellWorking Group also wants to expandmembership to include representativesfrom area pharmaceutical and biotechcompanies, which have the capacity todevelop lifesaving medications fromthe discoveries made in the lab.

Researchers and clini-cians from ChristianaCare, the University ofDelaware,Nemours/Alfred I.duPont Hospital forChildren and theDelaware BiotechnologyInstitute meet monthlyat the UD as part of theStem Cell WorkingGroup.

Physicians, scientists conduct open forum to share and develop ideas

6 ● F O C U S A p r i l 2 3 , 2 0 0 9

or concerns.“Kudos to our nurse managers formaking this patient-focused project apriority,” says Staff DevelopmentSpecialist Carmen Pal, RN, PCCN.“The cushions allow patients with

Therapeutic Notes

The Joint Commission (JC) NationalPatient Safety Goal (NPSG) 3E aims toreduce the likelihood of patient harmwhen therapeutic (as opposed to pro-phylactic) anticoagulation is used. TheNPSG, issued in 2007, introduced ele-ments of performance and expectationsof implementation to be met on a spec-ified time line throughout 2008.

The scope of the goals is broad,encompassing both inpatient and out-patient areas wherever unfractionatedheparin, low-molecular weight heparinand warfarin are used.

To this end, two new tools have beendeveloped: (1) a revised heparin pre-printed order sheet that will be rolledout in June (MD5613), and (2) a com-prehensive warfarin order sheet(MD5605). This article will introducethe warfarin order sheet and how ithelps to meet NPSG 3E goals. In a laterissue of FOCUS the revised heparinorder sheet will be discussed.

Required element of performanceThe primary requirements, with respectto warfarin, address the need for appro-priate monitoring. A current baselineInternational Normalized Ratio (INR) isavailable for all patients starting orreceiving warfarin therapy. A currentINR is available and is used to monitorand adjust therapy.

Christiana Care requires an INR currentto the present admission for all patientsbefore warfarin therapy can commence

(with the exception of confirmed DVTor suspected/confirmed PE, in whichcase the baseline lab is ordered concur-rent with administration of the firstdose). Pharmacists and nurses review-ing warfarin orders are required to veri-fy there is a current INR and to clinical-ly evaluate the result prior to dispensingor administering the first dose.

Order sheet MD5605 is in useThe preprinted order sheet streamlineswarfarin dosing, ordering of the associ-ated labs, and appropriate follow-up ona single sheet.

The prescriber can quickly and easily:■ Order a baseline INR.■ Initiate follow-up INR schedule.■ Select from a number of dose methods

specific to patient need and prescriber preference.

The Warfarin Therapy (MD5605) ordersheet used to initiate therapy willimprove patient care by:■ Meeting NPSG 3E requirements for

warfarin therapy.■ Streamlining the process for

prescribers, pharmacists and nurses.■ Improving the clarity of orders and

communication of the goals of therapy.■ Preventing unnecessary delays in

initiation of therapy.

Comments or questions should bedirected to Medication Safety SpecialistDean A. Bennett, RPh,dbennett@ChristianaCare.org.

Nursing and OccupationalTherapy are making majorprogress at improving patients’skin integrity by using specializedseat cushions to fight hospital-acquired sacral pressure ulcers andtissue shearing.

“Seven to 33 percent of patients inacute care develop pressure ulcers,yet insurance no longer coverswounds acquired during hospitalstays,” reports Patricia Poet,MOTR/L, OTD, OccupationalTherapy supervisor and programcoordinator.

Health systems now assume thosecosts, which the Institute ofHealthcare Improvement estimatesat $1.3 billion per year.

Promotes wound healingChristiana Hospital’s pulmonarystep-down unit (3D) piloted thecushion last year, and now it is asystemwide program. In oneexample, a 48-year-old maleachieved dramatic improvement ofa 9 x4 cm, stage-II sacral wound.

Initially able to sit in a chair foronly 30 minutes at a time, withinthree weeks of using the special-ized, high-profile cushion he wasable to sit for two hours at a time.With two months, the woundshrank to 2 x 2 cm.

Cushions available sys-temwideEach nursing district maintainsthree to five reusable cushions.Nearly 750 nursing, laundry, main-tenance and rehabilitation servicesstaff are trained in their care, useand maintenance. Five cushionstyles enable nurses to meet indi-vidual patient needs. Wound osto-my nurses and occupational thera-pists are a resource for questions

Specialized cushions help hasten healing of pressure ulcerseven stage III or IV wounds to get out ofbed and promote wound healing.” Formore information or questions, callPatricia Poet, MOTR/L, OTL or ClaudineWujcik, MS, OTR/L at 302-733-1071.

A p r i l 2 3 , 2 0 0 9 F O C U S ● 7

E D U C A T I O N N E W S

The 2009 Scientific Paper Awardsreception April 2 at the Ammon

Education Center marked the close ofEducation and Research Week atChristiana Care.

President and CEO Robert Laskowski,M.D., welcomed about 150 honoreesand guests, telling them: “Education atChristiana Care is key to our ability toserve our neighbors with excellence. Icongratulate all of my fellow educa-tors at Christiana Care for inspiringand leading our organization toexcel.”

Vice President, Academic Affairs andResearch Brian Little, M.D., Ph.D.,observed that “True transformationcomes about through willingness tolearn and change.”

Leadership built on spirit“With the spirit shown by our educa-tors and the promise of the DelawareHealth Sciences Alliance, we canbecome a true model for educationalinnovation and leadership for ourregion and the country.”

Rosa M. Colon, Ph.D., vice presidentof System Learning, said “This year’sEducation and Research week allowedus to come together as a multidiscipli-nary learning community to explorenew ways to enhance how we learn,change our culture, and leveragelearning technologies to enable trans-formation.”

Colon congratulated more than 800individuals who participated in theweeklong events that included educa-tional workshops, expos and learningneeds surveys. “It is exciting and pow-erful for us all to connect like a bigthink tank to learn new ways to col-laborate with each other and servebetter our patients.”

Here are some highlights of the2009 Scientific Paper Awards:The Lewis B. Flynn Award and BestFellow’s Paper went to cardiology fel-lows Vinay R. Hosmane, M.D., MPH,and Nowwar Mustafa, M.D., for theirstudy of 98 patients at the Center forHeart and Vascular Health, publishedFeb. 3 in the Journal of the AmericanCollege of Cardiology, which showedthat patients resuscitated from cardiacarrest in the early stages of a heartattack have a good chance of survivaland full neurological recovery follow-ing emergent coronary angiography.

The Paul Shaw Memorial Award wento preliminary year Internal Medicineresident Omer Awan, M.D. for his casereports documenting the successfuluse of endovascular stents to repairabdominal aortic aneurysms inpatients with unfavorable anatomies.

The Medical-Dental Staff BestAbstract Award went to Tequa Salehi-Rad, D.O., a MED-PEDS fourth-yearresident, for her long-term study ofchildren with perinatal HIV exposure.Her study of electronic patient recordsat Nemours/Alfred I. duPont Hospitalfor Children, showed babies withmaternal HIV exposure in the wombsubsequently experienced more chaot-ic living conditions with more parentalsubstance.

The Best Case Report went to MED-PEDS resident Cherilyn Hall, M.D.,for diagnosing a case of dermatitisresulting from a four-year-old’s misad-ventures with a box of chocolate laxa-tives. Her case report is slated for pub-lication in the Journal of EmergencyMedicine.

The People’s Choice Award for BestPoster went to a Respiratory Careteam led by Joel Brown II, BS, RRT.The poster illustrates how VirtualEducation and Simulation Technology(VEST) can build both clinical compe-tency and confidence at bedside.

Key educators and contributors recog-nized at the event included more than45 volunteer educators for their dedi-cation and outstanding service in facil-itating learning programs in Nursing,Safety, and Quality, Team Training andSystem Learning; and program assis-tants who work with program direc-tors to support residency trainingamong Christiana Care’s many resi-dency programs.

See p. 17 for additional awards informa-tion from the 2009 Scientific PaperAwards reception.

Scientific Paper Awards cap Education and Research Week

“ E d u c a t i o n a t C h r i s t i a n a C a r e i s k e yt o o u r a b i l i t y t o s e r v e o u r n e i g h b o r sw i t h e x c e l l e n c e . ”– Robert J. Laskowski, M.D., MBAPresident and CEO, Christiana Care

8 ● F O C U S A p r i l 2 3 , 2 0 0 9

During a Health and Society LectureSeries and Grand Rounds presentationon April 1, one of medicine’s mostinnovative thinkers challenged hisaudience to commit to changing theway medicine is practiced in the U.S.

Darrell G. Kirch, M.D., president andchief executive officer of theAssociation of American MedicalColleges, delivered “Can We Believein Health Care ‘Change’?” to an audi-ence of about 200 at the John H.Ammon Medical Education Center.

Capping off Christiana Care’sEducation & Research Week, whichconcluded on April 2, Dr. Kirch’s talkwas also broadcast to an audience atWilmington.

Changing the cultureDr. Kirch says the current culture inwhich physicians work autonomously,without communicating with oneanother about their patients, needs tobe replaced by a new patient-centeredmodel built on collaboration “a culturein which we all teach and learn.”

According to Dr. Kirch,“We’ve got tohave the courage to say ‘I am commit-ted to trying to change the culture.’” He is a psychiatrist and neuroscientistand former dean of the medical schoolat The Pennsylvania State Universityand CEO of the Milton S. HersheyMedical Center at Penn State,

Need more than justmoney and strategyTo build revenue, he says, we needsomething more than money andstrategy. “The answer is culture.”

Given the wide-spread dissatis-faction with thecurrent system,change of somekind isinevitable, saysDr. Kirch.The U.S.devotes 16 per-cent of its grossdomestic prod-uct to healthcare, far morethan otherindustrializedcountries. Yet,many patients are unable to find a pri-mary care doctor or afford healthinsurance.

“Virtually everybody in America isunhappy about some aspect of healthcare,” Dr. Kirch says.

Focusing on patients and physiciansThe new culture needs to be not onlymore patient-focused, but also moreaccommodating to a new generationof physicians, whose personal andprofessional aspirations are differentfrom those of earlier generations,Kirch says.

Rethinking education and the current dialogueHe notes that a growing number ofphysicians will, at some point in theircareer, take a break from the practiceof medicine in order to raise childrenor care for aging parents.

Creating a new culture will also

require rethinking the traditionalmodel of medical education in whichstudents go in lockstep from

premedical courses through their resi-dency—an educational process Kirchcalled “the most discontinuous contin-uum that man ever invented.”

And inventing a health care modelthat reduces the disparities in howhealth care is dispensed in this coun-try will also mean changing the cur-rent dialogue, Kirch says. “Are wewilling to talk not about what wewant but about what we’re willing togive up to create a more just system?”

AAMC President Darrell Kirch, M.D., urgeschanging current culture of U.S. medical practice

Darrell G. Kirch, M.D., pres-ident and chief executiveofficer of the Association ofAmerican Medical Colleges,spoke about transformativechange in health care April 2at the John H. AmmonMedical Education Center.

A p r i l 2 3 , 2 0 0 9 F O C U S ● 9

On April 8, the largest group ofgraduates (25) completed the

Achieving Competency Today (ACT):Health Care Quality, Cost, Systems, andSafety course. The 12-week, graduate-level course teaches systems-basedpractices and collaborative team skillswhile promoting the learners’ role asadvocates for quality and safety inpatient care.

To-date, 120 Christiana Care nurses,residents, attending physicians, phar-macy residents and allied health pro-fessionals have taken the course.Joining the graduates was Teri Foy,MEd, RRT, the seventh ACT coursefacilitator to complete the facilitatortraining program.

THE PROJECTS

Still need that central line?Talk about it!This project was intended to decreasecentral line bloodstream infection (CL-BSI) through raising team awarenessof the need for daily assessment of theongoing need for central venouscatheters with prompt removal whendeemed no longer necessary. Postintervention, 97 percent of the clini-cians surveyed intend to evaluate on adaily basis whether a central line isstill necessary.

Safety First: Increase near-missreporting through educationOne team focused on increasingnear-miss (also called ‘close calls’)

reporting through the Safety FirstLearning Report System as a way toidentify system issues before theycause harm. Based on survey data thatidentified a lack of knowledge, theteam created two education strategies:1) an educational module for residentphysicians, and 2) an interactive Web-based ‘frequently asked questions’(FAQ) for all employees, which is nowembedded within the current report-ing system.

“Who ya gonna call?”: Reportingcritical microbiology results fordischarged patientsIn a small number of instances, identifying a licensed, responsiblecaregiver to contact when critical

results are found after apatient is discharged is dif-ficult. Our multi-discipli-nary group found supportfrom an unexpected sourceby following the ACTprocess. Our developmentof a secondary fail-safemechanism gives theMicrobiology Laboratoryaccess to a source to helpidentify a caregiver whocan receive the results andinform the patient thattreatment may be needed.

An ounce ofprevention . . .

The aim of the project wasto increase rates of preventive healthcare delivery in the ambulatory settingwith the introduction of a screeningtool. Goals were to increasepatient/physician dialogue about therole of prevention in health care and

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to provide an efficient means for physicians to quicklyassess the preventive health status of each patient.Most importantly, the tool provides an opportunity forthe provider to initiate a collaborative partnership byinviting patients to be members of the health care team.

Web site shares resources

MORE ACT INFORMATIONThe next ACT course begins on Sept. 16 and runs toDec. 9, 2009. Applications—due by July 31—are avail-able through the Academic Affairs Office, ChristianaHospital, Suite 2A00 or by e-mailing Theresa Fields,TFields@christianacare.org.

Did you know that more than 70 physician assistants (PAs)work side by side with physicians in nearly every majorspecialty at Christiana Care?

Like an extra pair of hands for our doctors, PAs improveboth quality and continuity of patient care. And they assistwith student and residency training as well as promotecontinuing professional education.

Certified PAs must be graduates of an accredited PA pro-gram and pass the national exam administered by theNational Commission on Certification of PhysicianAssistants (NCCPA). To continue working, PAs must passthe exam again every six years.

Clinical rotations

In their 50 weeks of clinical training, students fromHahnemann Hospital’s PA Program at Drexel University,the Philadelphia College of Osteopathic Medicine (PCOM)and Arcadia University do their clinical rotations and pre-ceptorships at Christiana Care.

“Most of the 16 full-time and 8 part-time PAs in theEmergency Department rotated here as students,” saysWill Paynter, PA-C, of Christiana Care’s EmergencyMedicine Department.

Teaching

During Education Week, March 30-April 2, ChristianaCare’s Academic Affairs team recognized PAs for theirroles as teachers and mentors in supporting excellence inacademic medicine. “Doing the prep work to teach othershelps me keep current with the knowledge and skills Ineed to deliver the highest level of care to our patients,”says Paynter, former PCOM faculty member.

In the Medical ICU, teaching mostly takes place in the con-text of managing patients. Students from area medicalschools, including Jefferson Medical College, pair with oneof two teams consisting of a PA, an attending physicianand one or two upper-year residents and interns.

Chief Surgical PA Joe Allison, PA-C, says that in hisdepartment PAs are ideal teachers and mentors because

Physician assistants learnthe ropes at Christiana Care

A p r i l 2 3 , 2 0 0 9 F O C U S ● 1 1

Christiana Care’s Basic HealthMinistry and Parish Nursing ProgramChristiana Care’s Basic HealthMinistry and Parish Nursing Programis to be offered again in 2009. This pro-gram is sponsored as a collaborativeeffort between the Helen F. GrahamCancer Center at Christiana Care andNeumann College.

The vision of this program is to gener-ate new ministries and thus promotehealthy communities. It prepares reg-istered nurses, licensed practical nurs-es and lay health ministers to beginministering in their congregationsusing the curriculum developed bythe International Parish NurseResource Center.

The Friday/Saturday weekend ses-sions are May 29-30, June 5-6 and June12-13. Friday sessions are 4:30-9 p.m.Saturday sessions are 8 a.m.-5 p.m.

they provide continuity for surgicalPA students rotating through the pro-gram.

Continuing Medical Education

Allison also sits on the PA EducationCommittee chaired by Michele Kelly,PA-C, that works with AcademicAffairs to develop programs for anNCCPA-approved Category 1Continuing Medical Education lectureseries for all Christiana Care PAs.

“The opportunity to be part of theeducational process promotes per-formance excellence as well aslongevity for our profession,” he adds.

G E N E R A L N E W S

Education FIRST (Fostering IndividualResponsibility Starting Today), a pro-gram partnering Christiana Care’sCenter for Community Health andDelaware Technical and CommunityCollege, has opened a clinic at thecollege’s downtown Wilmingtoncampus.

Christiana Care’s Center forCommunity Health provides repro-ductive health services, mental healthcounseling and navigation services.

Helping students stay focused on their education The National Campaign to PreventTeen and Unplanned Pregnancyawarded Delaware Technical andCommunity College grant designed tohelp students focus on their educationand avoid the additional responsibilityof an unplanned pregnancy.

The grant for the $98,000, two-yearproject supports efforts to increase stu-dent awareness of the consequences ofunplanned pregnancy, improve facultyand staff communication skills on thesubject and provide free or low-costcounseling, referral and reproductivehealth services for students at theclinic.

Call Center for Community HealthManager Kathy Cannatelli at 302-428-6557, for more information.

New clinic opens at DTCC in WilmingtonChristiana Care provides reproductive, mental healthand referral services

All sessions will be held at the HelenF. Graham Cancer Center.

Participants must attend all threeweekend sessions to be eligible toreceive continuing education contacthours. The cost for the program is$125 and is due with registration.Scholarship funds are available.Seating is limited.

For more information or to register,contact LaVaida Owens-White, RN,Christiana Care Health System HealthMinistries Coordinator at 302-765-4557or Nora Katurakes, RN, MSN, OCN,Christiana Care Health SystemCommunity Health Outreach Managerat 302-765-4161.

CHRISTIANA CARE’S

COMPLIANCE HOTLINE

Christiana Care’s ComplianceHotline can be used to report aviolation of any regulation, law orlegal requirement as it relates tobilling or documentation.

The hotline will be answered 24hours a day, seven days a week.All reports go directly toCompliance Officer Ronald B.Sherman. Callers may remainanonymous.

The toll-free number is

877-REPORT-0 (877-737-6780).

To learn more about CorporateCompliance, review the CorporateCompliance Policy online or con-tact Sherman at 302-428-4503.

1 2 ● F O C U S A p r i l 2 3 , 2 0 0 9

When Sgt. Adam Ringle of theWilmington Department of Policeresponded to a Delaware State Policerequest last year to assist during abomb threat in Milford, State Policefortunate to have him.

Ringle is the first police officer in thehistory of the Wilmington Departmentof Police trained as a paramedic toprovide emergency care to injuredofficers.

The Milford incident lasted 25 hours.Weary bomb technicians dismantledeight dangerous pipe bombs that day.While no one was injured, Ringle pro-vided care to stressed technicians.

Thanks to Christiana Care, theDelaware State Police and theWilmington Department of Policewere able to create a first-of-its-kindprogram in the state to train tacticalparamedic police officers. The trainingallows officers to respond quickly tohigh-level emergencies even whenagency and police jurisdictionsoverlap.

In recognition of the program, severalphysicians and staff members fromChristiana Care received aDistinguished Community MemberAward from the Wilmington PoliceDepartment on March 31.

“Our role was to help plan and over-see Sgt. Ringle’s education in conjunc-tion with the Delaware Office ofEmergency Medical Services and theState Police,” says Linda LaskowskiJones, RN, MS, vice president of

Emergency, Trauma and AeromedicalServices at Christiana Care.

“Together, we’ve established a modelfor ongoing training and support ofthis initiative,” she says.

The Distinguished CommunityMember Award nomination reads:“This agreement saves time andresources, and demonstrates how lawenforcement agencies and emergencymedical service agencies can worktogether to truly provide homelandsecurity the way it was intended.”

from left to right): John Madden, M.D.; Linda Laskowski Jones, RN, MS, ACNS-BC, CEN; Karen Toulson, RN, MSN, CEN, NE-BC; Sgt. Adam Ringle, WPD,NREMT-P; Heather Orkis, NREMT-P, FTO; Carol Faedtke, RN, MJ, CFRN; RossMegargel, D.O.

Those receiving an award fromChristiana Care and their role:

Ross Megargel, D.O., overall programsupervisor.

John Madden, M.D., medical direc-tion.

Brian Levine, M.D., medical direction.

Linda Laskowski-Jones, RN, MS,vital hospital resources.

Carol A. Faedtke, RN, MJ, supervi-sion.

Heather Orkis, NREMT-P, FTO, fieldtraining supervision.

Karen Toulson, RN, MSN, ED rota-tions coordinator.

Congratulations to all!

Unique program trains police as tactical paramedics

A p r i l 2 3 , 2 0 0 9 F O C U S ● 1 3

The Christiana Care Department ofEmergency Medicine showcased

Christiana Care’s prowess in medicaleducation and the facilities at the JohnH. Ammon Medical Education Centerin sponsoring the Mid-AtlanticRegional Society for AcademicEmergency Medicine (SAEM).

More than 160 attendees representingthe Delaware Valley, Baltimore,Philadelphia, Louisiana StateUniversity Health Sciences Center, theMedical University of South Carolinaand the University of California SanFrancisco, attended the 12th annualevent.

Preconference activities included

ultrasound skills and advanced air-way sessions, a roundtable discussionabout medical education for medicalstudents and a talk from Temple’s JoeLex, M.D., on the assassinations offour U.S. presidents.

The conference featured 62 presenta-tions—five Plenaries and 57 orals—in10 breakout rooms. Keynote speakerAmal Mattu, M.D., from theUniversity of Maryland, discussed“Becoming a Great Leader inEmergency Medicine.

Award-winning presentations madeby Christiana Care physicians includ-ed David Cook, M.D., for Best inSession and Best ResidentPresentation, and Joel Schofer, M.D.,

Emergency Medicine team hosts SAEM Mid-Atlantic regional conference

From left, Emergency Medicine Program Director Neil Jasani, M.D., Emergency Medicine Resident DavidT. Cook, M.D., Emergency Ultrasound Fellow Joel Schofer, M.D., and Emergency Medicine AssociateProgram Director Michael Breyer, M.D. , with SAEM awards.

for Best in Session.

Christiana Care residents shinedbrightly through participating in theoral sessions, volunteering to assist forthe break-out sessions and taking vis-iting attendees on ED tours.

Special thanks is due to the planningcommittee and to all the moderators,abstract reviewers, research nursesand support staff at the AmmonCenter.

In addition, Christiana CareEmergency Medicine and the SAEMare grateful to Melissa Bollinger, man-ager, Emergency Medicine Research,and Sherrill Mullenix, EmergencyMedicine executive assistant, for theircommitment to making the meeting asuccess.

1 4 ● F O C U S A p r i l 2 3 , 2 0 0 9

When the norovirus struck atWilmington Hospital’s reha-

bilitation unit in mid-March, quickthinking helped stem the number ofpeople sickened and enabled newpatients to receive care quickly.

According to Sharon Kurfuerst,Ed.D, OTR/L, FAOTA administra-tive director of RehabilitationServices, 11 patients and 19 staffwere affected by the virus. “Within48 hours we knew we had a prob-lem,” she says.

The rehab unit closed to new admis-sions. Within 36 hours, the Nursingand therapy departments opened atemporary unit for new admissionson 6D at Christiana Hospital.

At Wilmington, patients who wereill or exposed to the virus remainedon the unit. Nurses and therapistsrestricted visitors and provided“gown and glove” care to patientsin their rooms.

Janice E. Nevin, M.D., MPH, seniorvice president/executive director ofChristiana Care WilmingtonCampus, has high praise for theteamwork that took the event instride.

“Everyone just rolled up theirsleeves and did what was necessaryto ensure patients were safe andreceived the rehabilitation servicesthey required,” says Dr. Nevin. “Inparticular, our leadership team,including Nurse Manager FelishaAnderson, SharonKurfuerst, andMedical DirectorKelly Eschbach,M.D., demonstratedthe flexibility, team-work and creativityrequired to run reha-bilitation services atboth hospitals.

“No one faltered,”says Penny Seiple,MSN, RN, NE-BC,FACHE, vice presi-dent of Patient CareServices, creditinginterdisciplinary teamwork withensuring their success. Physicians,nurses, therapists and case man-agers communicated away barriers.

“And the patients always camefirst,” Seiple says.

A p r i l 2 3 , 2 0 0 9 F O C U S ● 1 5

A Celebration for End of Treatment atthe Helen F. Graham Cancer Centertakes place Tuesday, May 5, 6-7:30p.m., in the Large Conference Room. All patients who have finished cancertreatment are invited to attend andlight refreshments will be served.Presentations include mind, body andspirit wellness, challenges of life aftertreatment, fatigue management, symp-tom management, nutritional needsand library resources. RSVP by April28 to 302-623-4700.The 2nd annual Great Place to Workcelebration during National Hospitalweek May 11-15 celebrate everyonewho contributes to making ChristianaCare a Great Place to Work. System-wide events include:Team posters and essays contest – Showcaseyour unit or department with a posterto visually display how we live ourcore values and work together to makeChristiana Care a Great Place to Work.A $200 gift card will be awarded fortop poster(s).Essays – Show off your writing talentby describing the impact our core val-ues have on creating a Great Place toWork. A $50 gift card will be awardedfor top essay(s). In addition, allemployees who vote online for their

favorite poster or essay will be enteredinto a drawing for prizes. Our cafeterias will feature a special KeyWest/Caribbean menu at ChristianaHospital on May 12 and at Wilmingtoncampus on May 13. Water ice will beserved at varioius locations. The Department of Medicine-spon-sored 4th Annual Roger B. ThomasMemorial Lecture is May 28 at 8 a.m.at the Ammon Medical EducationCenter main auditorium. LawrenceSmith, M.D., chief medical officer atNorth Shore-LIJ Health System in GreatNeck, N.Y., will present “Who’s inCharge?,” a lecture on the medical andcultural factors that cost physiciansownership of their patients’ care andoffers strategies to counter this problemand improve patient safety, quality ofcare and satisfaction.Free bus transportation to the Susan G.Komen Foundation Race for the Cureon Sunday, May 10, sponsored byChristiana Care Helen F. GrahamCancer Center and Delaware BreastCancer Coalition. Bus departs from theMedical Arts Pavilion 2 promptly at5:30 a.m. and from the Medical ArtsComplex at Riverside at 5:45 a.m., andleaves the Philadelphia Museum of Artat 11 a.m., returning to Delaware bynoon. Seating is limited. RSVP by May6 to 302-765-4161.The Implantable CardioverterDefibrillator (ICD) Support GroupSeries for those who have or plan toreceive an ICD, next two presentationsinclude:“Exercising with ICDs andPacemakers,” with Tim Parosky,Exercise Physiologist for CardiacRehabilitation at Christiana CareTuesday, May 12, 2009 6-7:30 p.m. “Eating Heart Healthy,” with DanielleJerome, Registered Dietitian atChristiana Care’s Eugene du PontPreventive Medicine & RehabilitationInstitute Tuesday, June 9, 6-7:30 p.m.Light refreshments provided. Call 800-693-CARE (2273) or 302-623-CARE(2273).

Celebrate Administrative ProfessionalsWeek April 20-24. Please remember totell the administrative professions inyour department about your apprecia-tion for all they do. All administrativeprofessionals are invited to a specialtea in their honor on Friday, April 24.Please register on the portal EducationCenter.National Medical LaboratoryProfessionals Week, celebrated April19-25, recognizes the dedication ofour lab professionals and calls atten-tion to the role of medical lab profes-sionals in patient care.National Volunteer Week, April 19-April 25, is a time to say a special“thank you” to some of our country’smost valuable assets–our volunteers.This special week recognizes the gen-erous contributions of more than 1,000volunteers across our health system,from volunteers ranging in age from 14(our Summer VolunTEEN Program) towell into their 90s,. Last fiscal yearthey donated more than 126,000 hoursas compassionate listeners, helpingwith inhospital deliveries of flowersand mail; responding to patient needs,supporting departments with clericalskills, and much more.

1 6 ● F O C U S A p r i l 2 3 , 2 0 0 9

■ “Thrombopoietin in Infants Born toMothers with PreeclampsiaCompared to Those with IUGR,” byTiffany LaBella, M.D., Amy Mackley,RNC, Kelly Zook, M.D., StevenMcKenzie, M.D., Ph.D., and DavidA. Paul, M.D.

■ “White Matter Magnetic ResonanceSpectroscopy (MRS) of ExtremelyLow Birth Weight (ELBW) Infants isSimilar to Term Infants,” by Erlita P.Gadin, M.D., David A. Paul, M.D.,Amy Mackley, RNC, James C.Galloway, Ph.D., Kert F Anzilotti,M.D., and Karl Steiner, Ph.D., “Is ASmall Platelet Mass Associated withIntraventricular Hemorrhage in VeryLow Birth Weight Neonates?” byJody L. Kohut, D.O., Amy Mackley,RNC, and David A. Paul, M.D.

■ “The Allusion of the Best InterestPrinciple” was presented by KirsitieMarcello, M.D., Amy Mackley, RNC,John L. Stefano, M.D. They also pre-sented it at the Association ofPerioperative Registered Nurses’56th Congress, March 17 inChicago.

■ Medical/Dental Staff Clinical Award

■ Best Dental Paper Award

■ Best Oral Maxilliofacial SurgeryAbstract Award

Publishing

A p r i l 2 3 , 2 0 0 9 F O C U S ● 1 7

The Junior Board of Christiana Care’sannual Medicine Ball traditionally supports nursing and

allied health education scholarships, among numerous other programs.

lease support them with your gift today. It will make a differencein the lives of thousands of patients treated every day.

Contribute by May 8 to support the scholarshipsand help put Medicine Ball fundraising

over the $1 million mark!

Send your tax-deductible gift to support nursing and allied health scholarships today to:

GoldGold

AstraZenecaBetty and Jim Coker in

memory of Dr. I. Lewis Chipman, Sr.

Endo Pharmaceuticals

SilverSilver

The Glenmede Trust Company Mason Building Group, Inc.Wilmington Trust Company

BronzeBronze

Rocco & Mary Abessinioc/o Abessinio Family

Foundation Action CoffeeBancroft Construction Co.Bayada NursesDuPont Five Star Senior Living Peter D. Furness Electric Co. Vincent N. Greggo Hatzel & Buehler, Inc. Helen F. Graham Cancer CenterLankford SYSCO LBI PropertiesPeninsula United

Methodist HomesPNC Bank Skanska USA Building

PewterPewter

Ameriprise Financial ServicesBlood Bank of DelmarvaCavan Construction Co.Christiana Care Center for

Heart & Vascular HealthConner Strong CompaniesEast Coast ErectorsW. L. Gore & AssociatesLincoln Financial GroupMarvin & Palmer AssociatesMedAssetsMid-Atlantic Realty CompanyMitchell AssociatesNason ConstructionPatterson Schwartz Real EstateSentinel Self StorageSmith Barney,

Randall L. RenneisenSpinnaker Medical, LLC Synthes SpineTalley BrothersYoung Conaway

Stargatt & Taylor, LLP

FriendsFriends

Associates Graphic ServicesB’s Shuttle ServiceBassett, Brosius & Dawson Chandler Funeral

Homes & Crematory Craft-Way Kitchens Doctors for Emergency ServiceElkton FloristFinancial House, Cliff Berg First State Women’s Care, P.A.Greenhills Salon/DK SpaGunnip & Company, LLPHardcastle’s Newark GalleryKerns Brothers

Tree Service & LandscapingNewspaper Support ServicesThe Old LamplighterParkowski, Guerke

& Swayze, P.A.Pratt InsuranceLeo Raisis, M.D.Robert Layton ReedTrilogy Salon and Day SpaValero-DE City RefineryWohlsen Construction Co.

In-Kind ContributorsIn-Kind Contributors

The Inn at Montchanin VillageSherif Zaki Salon

and The Oasis SpaTotal Wine & More

PRSRT STDU.S. POSTAGEPAIDWILMINGTON DEPERMIT NO. 357External Affiars

P.O. Box 1668Wilmington, DE 19899-1668

www.christianacare.org

P R I N T E D O N R E C Y C L E D P A P E R

Albert Rizzo, M.D., chief of the section of Pulmonaryand Critical Care Medicine at Christiana Care, testi-fied in March before the U.S .House ofRepresentatives’ Labor, Health & Human Services,Education and Related Agencies’ AppropriationsSubcommittee.

As the Speaker of the American Lung Association’sNationwide Assembly, Dr. Rizzo presented the healthorganization’s recommendations for public healthand research funding.

He explained that many lung diseases are chronicand place a huge burden in both human sufferingand medical care costs on our nation. He stressed theneed for a “renewed commitment to medicalresearch” not only for lung disease, but also acrossthe entire National Institutes of Health. He also rec-ommended sustained funding in prevention andwellness as a way to further reduce the toll of chroniclung diseases.

Dr. Rizzo is a long-time volunteer for the AmericanLung Association. His term as Speaker for theirNationwide Assembly runs through June.

Albert Rizzo, M.D., testifies before Congresson toll taken by chronic lung diseases

Albert Rizzo, M.D., section chief of Pulmonary and CriticalCare Medicine at Christiana Care, testified As the Speakerof the American Lung Association’s Nationwide Assembly inMarch before a congressional subcommittee about theburden of chronic lung disease on our nation.