inside a healthcare system approach for - Cleveland Clinic

RoundsThe laTesT news foR pRimaRy caRe physicians fRom cleveland clinicWinter 2011

inside

Heart Patients Benefit from Telehealth

Percutaneous Valves: Implanting an Alternative

Addison’s Disease Important to Recognize, Treat

Referring Patients Who Have Difficulties With Swallowing and Speech

Oncology Program Improves Treatment in Elderly Patients

Cleveland Clinic Children’s Hospital Opens a Neurocardiac Clinic

Cleveland Clinic’s Cerebrovascular Center integrates a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, neurointensivists and rehabilitation physiatrists to provide expert diagnosis along with advanced medical, endovascular and surgical management of all cerebrovascular conditions. Cleveland Clinic has five healthcare system hospitals that are Joint Commission-certified Primary Stroke Centers, providing consistent, high-quality stroke care and treatment throughout Northeast Ohio.

Integrated Model of Care

This uniquely integrated model of care ensures that you and your patients access to the appropriate specialists, who join in coordinating a customized treatment approach. Cleveland Clinic’s team has the resources and capability to meet your needs for referral and consultation, including:

• One of the highest stroke-related patient volumes in North America and a case severity index that ranks among the top 2.2 percent in the nation.

• A 22-bed Neurological Intensive Care Unit with 24-hour in-house neuro-intensivist staff coverage that treats more than 1,300 patients a year and has one of the nation’s highest acuity rates.

• Staff and equipment to provide the most advanced surgical and endovascular management of ischemic stroke.

• A dedicated pediatric stroke program for the evaluation and management of childhood stroke from birth to age 18.

• Direct coordination with Cleveland Clinic’s critical care transport team, which can be mobilized on the ground or in the air for transfer or urgent referral of a patient requiring emergency treatment.

expert Care, ConvenIent aCCess

Patients are seen by Cerebrovascular Center staff at Cleveland Clinic main campus; at Euclid, Hillcrest, Lakewood and Marymount hospitals; and at the Beachwood Family Health and Surgery Center and Wooster Family Health Center.

For more information, visit clevelandclinic.org/cerebrovascular. to refer a patient to the Cerebrovascular Center, call 800.553.5056. n

a healthcare system approach for cerebrovascular care

services for physicians

reFerring PhysiCian Center

For help with service-related issues, information about our clinical specialists and services, details about CME opportunities and more, contact us at [email protected], or 216.448.0900 or 888.637.0568.

CritiCal Care transPort WorldWide

Cleveland Clinic’s critical care transport team and fleet of mobile ICU vehicles, helicopters and fixed-wing aircraft serve critically ill and highly complex patients across the globe.

To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.379.Code (2633). For all other critical care transfers, call 216.444.8302 or 800.553.5056.

request For MediCal reCords

216.444.2640 or 800.225.2273, ext. 42640

traCk your Patient’s Care online

DrConnect offers referring physicians secure access to their patients’ treatment progress while at Cleveland Clinic. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

reMote Consults

Online medical second opinions from Cleveland Clinic’s MyConsult are particularly valuable for patients who wish to avoid the time and expense of travel. Visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext. 43223.

outCoMes data

View the latest clinical Outcomes book from many Cleveland Clinic institutes at clevelandclinic.org/quality/outcomes.

services for patients

MediCal ConCierge

Complimentary assistance for out-of-state patients and families

800.223.2273, ext. 55580, or email [email protected]

global Patient serviCes

Complimentary assistance for national and international patients and families

001.216.444.8184 or visit clevelandclinic.org/gps

General patient Referral

24/7 hospital transfers or physician consults

800.553.5056

On the Web at clevelandclinic.org

Stay connected to Cleveland Clinic:

Cleveland Clinic at Home, in partnership with the Cleveland Clinic Sydell and Arnold Miller Family Heart & Vascular Institute, integrates distance health monitoring with home-based cardiac rehabilitation. The program is offered to adult patients living in their own homes (or with a caregiver) who have decreased mobility, multiple morbidities and limited access to follow-up care.

“The program is designed to decrease 30-day readmission rates in this high-risk population and allow them to complete their post-acute recovery in the comfort of their own homes,” explains Cindy Vunovich, RN, BSN, MSM, Administrator of Home Health and Hospice, Cleveland Clinic at Home. In a three-month pilot, Heart Care at Home reduced readmission rates for post-MI and HF patients to 20 percent, 8 percent below the national average.

At discharge, participants are equipped with a transmitter and wireless devices for recording weight, blood pressure, heart rate and blood oxygen saturation. Patients are responsible for recording and transmitting their information daily to the Heart Care at Home nurse, who is a cardiovascular-trained nurse working at Cleveland Clinic’s home care office. The nurse partners with a hospital-based nurse practitioner and a cardi-ologist to manage patients and optimize the plan of care.

“If a patient exceeds his or her established parameters, the nurse intervenes by a phone call and consultation with the patient’s physician, if needed,” Vunovich says. The Heart

Care at Home nurse also delivers patient education on spe-cific topics such as medications and side effects or diet and lifestyle changes via a two-way transmitter.

Daily monitoring and recording of vital signs reinforces the importance and impact of following medication and diet regimens. In many instances, medication management is a tremendous challenge for patients. Telehealth nurses instruct patients and families in medication schedules and actions. Additionally, dietitians educate patients on how to read food labels and teach food-modification techniques that meet the patient’s dietary recommendations. Providing patients with the tools they need to track their progress reinforces the patient’s self-confidence, which ultimately results in better outcomes and quality of life for patients.

The comprehensive cardiac rehabilitation program includes home visits by a physical therapist, a dietitian and, for some patients, a home health nurse. The desired length of service is limited to between 30 and 40 days post-discharge.

Garnering both clinical success and high patient satisfac-tion ratings, Heart Care at Home will be expanded from the current 100 patients to 250 during the next 18 months.

For more information about Cleveland Clinic’s heart Care at home, visit clevelandclinic.org/homecare, or call 216.444.hoMe (4663) or 800.263.0403. n

Heart Patients Benefit from Telehealth

a combination of specially trained home care nurses and the latest communications technology is reduc-ing the readmission rate for frail elderly patients following hospitalization at cleveland clinic for myocardial infarction (mi) or acute decompensated heart failure (hf).

clevelandclinic.org/rounds 3

each year, athletes at all levels of competition in the United states suffer more than 1 million concussions. although the injury is common in sports, the public only recently has recognized its potential to cause serious, long-term damage. as awareness grows, clinicians and investigators from cleveland clinic’s neurological institute, orthopaedic & Rheumatologic institute, pediatric institute and lerner Research institute are collaborating to improve understanding, diagnosis and treatment of this traumatic brain injury.

testIng guIdes treatMent

Cleveland Clinic Sports Health fields a dedicated team of orthopaedic sur-geons, primary care sports medicine physicians, physical therapists, athletic trainers, nutritionists, radiologists and exercise physiologists that evaluates and manages concussion.

Because conventional imaging tech-niques do not detect concussion, sports health physicians use leading-edge computer technology known as Immediate Post-concussion and

Cognitive Testing (ImPACT) to make a more precise sports-related concussion diagnosis.

Ideally, ImPACT testing starts even before an athlete steps onto the playing field. Cleveland Clinic experts adminis-ter the half-hour test to gather baseline data on the athlete’s memory, reaction time and other cognitive functions.

If the athlete then sustains a concussion, another ImPACT test is administered. Comparing these results with baseline, physicians can determine the severity

An intense interdisciplinary research effort, focused in part on improving safety in helmet and equipment design, is under way across Cleveland Clinic.

n the spine research laboratory, part of the Neurological Institute, has developed a wireless, MEMS-based Intelligent Mouthguard that measures in-game head impact dynamics in contact sports such as football and boxing. With Bluetooth® technol-ogy, data from mouthguard sensors are transmitted to a computer on the sideline to measure head orientation, position, and velocity and accelera-tion of impact. The data are used to

assess real-time and post-competi-tion neurological outcomes and to assist with rapid diagnosis of injury. Ultimately, the information should be useful in equipment design.

n on another front, the Spine Research Lab has partnered with Rawlings, a well-known manufacturer and retailer of sports equipment and apparel, to test protective headwear and accessories for baseball and foot-ball. Rawlings has donated research

promising Technology will improve safety

Concussion Concerns drive efforts to protect athletes, manage Brain injury

cleveland clinic RoUnds4

of the concussion and design an appropriate treatment plan. If neces-sary, the athlete undergoes concussion rehabilitation. ImPACT testing may be repeated later to help in deciding when the athlete can safely return to play.

Even when the physical symptoms of a blow to the head have disappeared, the brain may not be healed. Cleveland Clinic Sports Health accepts referrals for evaluation of suspected athletic concussion, diagnosis and comprehen-sive management of confirmed cases.

eduCatIon Is Key

Inadequate response to concussion can have serious, even deadly, con-sequences. Cleveland Clinic Sports Health is reaching out to parents, coaches, athletic trainers and athletes to ensure that they know the symptoms and act appropriately when athletic concussion is suspected.

For more information, or to refer a patient, contact Cleveland Clinic sports health at 877.440.teaM or visit sports-health.org. n

equipment, including a linear impac-tor for helmet testing and a baseball air cannon. It will be housed at the newly named Rawlings Performance Laboratory at Cleveland Clinic Lutheran Hospital.

n in the lerner research institute, another team of researchers is develop-ing a blood test to determine whether the blood-brain barrier has been breached, thus indicating which patients may need further evaluation. This simple test could spare less severely injured patients the radiation exposure from an unnecessary, costly CT scan.

promising Technology will improve safety

percutaneous valves: implanting an alternative

Aortic stenosis patients who are deemed inoper-able or at a very high risk for standard open heart surgery could be candidates for a less invasive option: transcatheter aortic valve implantation (TAVI).

The procedure involves transporting a synthetic valve to the heart through a small incision in the groin or chest. It can be compared to placing a stent or performing balloon angioplasty.

“For many years, we have been exploring ways to solve this problem of life-limiting aortic stenosis in high-risk populations,” says Murat Tuzcu, MD, Vice-Chairman of Cardiovascular Medicine at Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute.

“TAVI is a very exciting, innovative way of helping these people.”

TAVI is still investigational in the United States and can only be implanted within the context of the PARTNER clinical trial at participating sites, includ-ing Cleveland Clinic. In September, results from part of the trial focusing on patients who were deemed inoperable were released. “TAVI now is a proven solution for patients who cannot be operated on because of their comorbidi-ties,” Dr. Tuzcu says, noting that the results of TAVI on high-risk patients will be reported in the spring.

In the patient population with aortic stenosis who were deemed inoper-able, those treated by TAVI compared to standard therapy had an absolute risk reduction of 20 percent. That translates to a mortality rate of one in five patients, which is significant compared to the mortality rate of 50 percent in patients who received traditional therapy.

Patients who have severe, symptomatic aortic stenosis and are deemed too high-risk for open heart surgery can be considered for TAVI under the U.S. FDA’s Continued Access Clause. Candidates must meet requirements of the PARTNER trial. Exclusion includes dialysis treatment, an extremely weak heart (ejection fraction of less than 20 percent) and other forms of severe valvular heart disease. It is possible to include patients who are high-risk with an SDS score of >10, provided they do not meet exclusion criteria.

For more information on the Partner trial, visit clinicaltrials.gov. to refer a patient for tavi consideration, call 800.553.5056. n


Case presentation. A 24-year-old Caucasian female with type 1 diabetes presented to the ED following two days of abdomi-nal pain, nausea, vomiting and dizziness. She reported fatigue and frequent hypoglycemia for two months and used no mealtime insulin because she could not tolerate food. Her serum glucose was 135 mg/dL; she was diagnosed with viral gastroenteritis, given IV hydration and discharged home.

Her symptoms persisted for two more days; she used no insulin because of low blood sugars. She presented to the endocrinologist with a heart rate of 120 and blood pressure of 90/54. She appeared tanned, with areas of vitiligo. An ACTH stimulation test showed a baseline plasma cortisol level of 0.1 µg/dL and a 60-minute stimulated cortisol level of 3.4 µg/dL. She was diagnosed with adrenal insufficiency and started on hydrocortisone. Her symptoms resolved within 24 hours.

addison’s disease highly prevalent. Autoimmune destruction of the adrenal glands (Addison’s disease) accounts for about 65 percent of the adrenal insufficiency in the industrialized world. Both glucocorticoid and mineralocorticoid secretion are decreased and, untreated, may be fatal. Addison’s disease may be part of two distinct autoimmune polyglandular

syndromes: a childhood syndrome involving hypoparathyroid-ism, adrenal insufficiency and mucocutaneous candidiasis, and a typically adult syndrome involving Graves’ disease or Hashimoto’s thyroiditis, insulin-dependent diabetes and Addison’s disease.

Signs of adrenal insufficiency. Adrenal insufficiency com-monly presents as weight loss, increasing fatigue, vomiting, diarrhea or anorexia, and salt craving. Abdominal pain, muscle pain and postural dizziness may also occur. Increased pigmentation, particularly on the extensor surfaces, palmar creases and buccal mucosa, often occurs due to increased ACTH production by the pituitary. Lab tests may show hyponatremia, hyperkalemia, hypercalcemia, azotemia, hypoglycemia and eosinophilia.

A plasma cortisol level >18 µg/dL rules out adrenal crisis, whereas a value <18 µg/dL in the setting of shock is con-sistent with adrenal insufficiency. In patients with chronic symptoms, a one-hour ACTH (cosyntropin) test should be performed: 0.25 mg of cosyntropin is given intravenously and plasma cortisol is measured at 0, 30 and 60 minutes. A normal response is a plasma cortisol level >18 µg/dL at any point.

lifelong management. Patients with Addison’s disease require lifelong replacement with both glucocorticoids and mineralocorticoids. During illness and physical stress, the glucocorticoids dose must be increased. All patients should wear medical information bracelets and know how to inject emergency hydrocortisone intramuscularly.

dr. li-ng, endocrinologist in Cleveland Clinic’s department of endocrinology, diabetes and Metabolism, may be reached at 216.444.1949 or [email protected]. n

addison’s disease important to Recognize, Treat by Melissa li-ng, Md


Cleveland Clinic’s Vestibular Rehabilitation Program offers a comprehensive, multispecialty approach to the diagnosis and treatment of vestibular disorders and balance problems. Patients with vestibular disorders who do not demonstrate a spontaneous resolution of symptoms within six months of onset may significantly benefit from vestibular rehabilita-tion. Patients with acute or abrupt loss of vestibular function, or those who have surgery for unresolved vestibular problems, will benefit from rehabilitation designed to help compensate for their disorders.

Cleveland Clinic’s team of specialty-trained physi-cians and certified vestibular physical therapists treats patients who report symptoms of:

• disorientation • lightheadedness

• dizziness • spinning

• falls • vertigo

• imbalance • wooziness

Vestibular disorder treatments are individualized to meet your specific patient’s needs but could include:

• gait and balance training

• gaze stabilization exercises

• habituation exercises

• joint mobilization, stretching and soft-tissue massage

• neck exercises

• positional testing/repositioning

• strengthening

After treatment with the proper combination of therapies, patients often return to full functional-ity. Expected vestibular rehabilitation outcomes include decreased dizziness and fall risk; increased balance, gaze stabilization and strength; and return to prior level of movement or function.

vestibular rehabilitation services are available at several Cleveland Clinic locations through-out northeast ohio. to refer a patient, call 216.445.8000. n

vestibular disorders Benefit from multidisciplinary approach


The advent of mid-urethral synthetic slings has revolutionized vaginal sling surgery for stress urinary incontinence (sUi). This surgery, the type most commonly performed in the United states for sUi, offers a high success rate along with a minimal amount of pain and time off work.

The Glickman Urological & Kidney Institute’s Center for Female Pelvic Medicine and Reconstructive Genitourinary Surgery has developed a com-prehensive postoperative care pathway that has aided in rapid and safe discharge home after vaginal sling surgery, along with high efficacy rates. These procedures are now performed almost exclusively on an outpatient basis unless in combination with vaginal prolapse surgery. In patients with SUI and no prolapse, average operative times in our most recent series is approximately 22 minutes, and time from preoperative arrival to discharge from the ambulatory surgery centers is less than 140 minutes. Short- and long-term studies show quality-of-life improvements after vaginal sling surgery of 80 to 90 percent, and the need for repeat or additional interven-tions in appropriately selected patients is quite low.

The center recently published a care pathway to management of postopera-tive Foley use in patients undergoing solitary mid-urethral sling surgery. In this large series of prospectively enrolled patients, 90 percent went home without the need for a Foley catheter and none required replacement of the catheter due to complications in voiding. The development of postoperative urinary tract infections within the first month after surgery in this subgroup of patients was less than 8 percent after single-dose antibiotic therapy.

Most patients can resume most normal activities within one to two weeks after surgery and, depending on the nature of the patient’s work, can get back to work within one week or less after surgery.

to arrange for a consultation or to refer a patient to the glickman urological & kidney institute’s Center for Female Pelvic Medicine and reconstructive genitourinary surgery, call 216.444.5600. n

Ultrasound-Guided interventions provide more Targeted pain Relief

Cleveland Clinic now offers patients who are suffering from musculoskeletal and orthopaedic disorders, injections administered with the use of ultra-sound guided imaging. This technique gives physicians enhanced visualization and real-time guidance of the muscles, joints and tendons so that medication can accurately be injected into the affected area.

This type of image-guided injection can give patients a more accurate treat-ment alternative over a blind injection in which medications could erroneously be administered to the wrong target area. In addition, the use of ultrasound images does not expose patients to the radiation inherently found in many other methods of imaging.

Ultrasound-guided injections are offered as an outpatient procedure to the hip, shoulder and ankle joint; carpal tunnel and subachromial space; bicep tendon; and greater trochanteric bursa. Same-day appointments are available.

to refer a patient or for more information, call 216.445.0096 or 800.223.2273, ext. 50096. n

vaginal sling surgery for stress Urinary incontinence: new care pathway speeds discharge home and Maintains High Efficacy


The Section of Cardiovascular Imaging includes eight physicians, two medical physicists, three researchers, and a team of technologists and nurses, whose combined expertise supports the work of Cleveland Clinic’s world-renowned Sydell and Arnold Miller Family Heart & Vascular Institute. In 2010, U.S.News & World Report ranked Cleveland Clinic No. 1 in the nation for heart care for the 16th consecutive year.

The Cardiovascular Imaging Lab is equipped with the most advanced com-puted tomography (CT) and magnetic resonance imaging (MRI) equipment. The staff is expert in diagnosis and treatment planning for conditions that include acquired cardiac disease in adults and congenital heart disease in children and adults. Specific disorders that patients may present with include chest pain with exercise, leaky heart

cleveland clinic’s cardiovascular imaging lab: Skilled Staff, Superior Technology, Low-Dose CT

Cleveland Clinic’s Cardiovascular Imaging Lab (CVIL) is one of only a few centers in the country offering imaging of the cardiovascular system by a team of cardiologists, radiologists and technologists specially trained in cardiac imaging.

valves, hypertrophic cardiomyopathy, and defects in the size and shape of the heart.

Ct: exCellent IMage QualIty, MInIMal exposure

The CVIL is equipped with multiple superior-quality CT scanners to expertly handle the imaging needs of your cardiovascular patients. The lab’s CT equipment provides excellent image quality even in patients with high heart rates.

With each patient, our staff is com-mitted to using the procedure that is least invasive and reduces radiation exposure to the minimum. The CT scanners in the CVIL are state of the art and extremely fast, allowing for smaller contrast injections than typically used for similar CT scans performed elsewhere. In addition, the CVIL CT scanners incorporate “step-and-shoot”

technology, which results in the lowest radiation doses possible with today’s technology.

These new techniques individualize the examination and adjust the radiation dose to the body type and body organ examined, providing patients and their physicians with quality images while lowering the dose between 30 and 70 percent compared with traditional CT imaging techniques.

Imaging reports are generated in real time, and images are interpreted by our physicians and provided to refer-ring physicians within 24 hours of a study’s completion.

expert Care, ConvenIent aCCess

same-day appointments are available. For more information, visit clevelandclinic.org/Cvil; call 216.445.7050 to schedule a patient exam. n


Referring Patients Who Have Difficulties With swallowing and speech

by Michael l. huband, dds, Cleveland Clinic head & neck institute

If the tongue has lost tissue volume or mobility due to congenital or acquired defects, traumatic brain injury, or scarring and fibrosis, a palatal augmenta-tion prosthesis may prove beneficial in improving or restoring function.

During the oral phase of swallowing, the tongue comes in contact with the hard palate and is braced against the roof of the mouth during movement. This allows the tongue to act as a plunger, forcing the bolus of food poste-riorly. When the tongue can no longer adequately move to contact the hard palate, a palatal augmentation prosthesis can be used to create an artificial palate that is positioned to bring the level of the palate down to contact the tongue during function.

Similarly, during speech the tongue contacts the anterior portion of the palate or the teeth during “T” and “TH” sounds and contacts the posterior area of the palate when forming “K” and “G” sounds.

To construct a palatal augmentation prosthesis, a functional impression is generated while the patient repeats a series of words. From this impression, the desired shape of the prosthesis is generated and produced in acrylic resin. For dentate patients, the prosthesis is retained by placing clasps on the teeth in a manner similar to an orthodontic retainer. If the patient is edentulous, it may be added to an existing denture.

A quick screening to determine whether your patient would benefit from a consultation includes the following questions:

• Is the tongue tethered or does it deviate during protrusion?

• Is the problem with moving a bolus during the oral phase of swallowing?

• Is the patient unable to produce a crisp and clear sound during the produc-tion of “T,” “TH,” “K” and “G” sounds? An easy test is to have the patient repeat aloud, “Go get Gary because Kit Kat is tip-top.”

If the answer to any of these questions is “Yes,” then referral to a maxillofacial prosthodontist is appropriate.

to make an appointment with a maxillofacial prosthodontist in Cleveland Clinic’s head & neck institute, call 216.444.6907 or 800.223.2273, ext. 46907. n

Impression for adding palatal augmentation

A palatal augmentation added to existing denture


TOPS answers the need for the specialized treatment approach these patients require to achieve the best possible outcomes, says oncologist Dale Shepard, MD, PhD.

He co-directs the geriatric oncology program with oncologist Abdo Haddad, MD.

They form the core of a multidisciplinary team that includes palliative medicine specialists, geriatric social workers, pharmacists, physical therapists, nutritionists, radiation oncologists and bioethicists.

Every TOPS patient undergoes a medical and functional assessment at the first visit that becomes a part of the patient’s electronic medical record.

This comprehensive assessment for geriatric syndrome includes evaluation for polypharmacy, nutritional status, fall risk, mental status and multiple medical problems.

The results of this assessment form the basis for referrals within the team and to other Cleveland Clinic specialists and are essential to individualized treatment planning for that patient. Integrating a comprehensive geriatric assessment like this into cancer treatment for the elderly is a new approach practiced at only a handful of cancer centers nationwide, says Dr. Haddad. He believes a pre-treatment assessment is essential to effectively treating this population.

oncology program improves Treatment in elderly patients

“Underlying problems will affect how the patient will toler-ate treatment and must be addressed prior to treatment to maximize the patient’s condition. If they are not addressed, problems will surface after the first cycle of chemotherapy,” he says. Untreated comorbidities can contribute to treatment side effects and are a common cause of discontinuing treat-ment in older cancer patients after a single cycle, he adds.

To manage problems that are identified during the assess-ment, patients are referred to a specialist on the geriatric oncology team or to specialists in Cleveland Clinic’s Center for Geriatric Medicine if necessary. The electronic medical record makes patient assessment results easily accessible to team members and physicians outside of TOPS and facilitates col-laborative intervention.

“Our team has the support and resources to resolve any prob-lems that may result and to make adjustment to treatment when necessary,” says Dr. Shepard. “Every patient is treated with curative intent and the goal of prolonging survival.”

In addition to comprehensive cancer care, TOPS offers functional assessment and consultation services to referring physicians for patients over 75 years of age with gastrointes-tinal, genitourinary, lung and breast tumors.

to refer patients to toPs, call 216.444.7923 or 866.223.8100. n

The Taussig oncology program for seniors (Tops) in cleveland clinic’s Taussig cancer institute addresses the unique needs of patients 75 years of age and older who are diagnosed with cancer. The program, launched in July 2009, has a dual goal of improving clinical care for and conducting research specific to elderly patients undergoing chemotherapy for solid tumors.


cleveland clinic children’s hospital opens a neurocardiac clinic

by neil Friedman, Mb, Chb, and gerard boyle, Md

Cleveland Clinic Children’s Hospital has created a comprehensive, dedicated Neurocardiac Clinic as part of our Neurocardiology Program, to address the unique needs of children with complex congenital heart disease (CHD) who develop neurodevelopmental disabilities.

Advances in cardiac surgery over the past three decades have led to earlier repairs, yet neurological morbidity remains the major extracardiac manifestation of CHD and includes stroke, seizures and neurodevelopmental disabilities.

Increasingly, problems such as learning disabilities, language delay, behavioral difficulties (ADHD, executive dysfunction), visual-spatial dysfunction and coordina-tion (fine motor, oromotor) difficulties have emerged. Approximately 30 percent to 50 percent of children who have had surgery under cardiopulmonary bypass for complex CHD will require remedial school services, and 15 percent will need full-time special education.

The importance of identifying neurodevelopmental problems early is critical to allowing each child to reach his or her full potential and to minimize disability.

In our comprehensive Neurocardiac Clinic, specialists in pediatric cardiology, neurol-ogy, developmental pediatrics, behavioral health and psychology provide coordinated, compassionate care alongside speech, occupational and physical therapists.

For more information about the neurocardiac Clinic, contact dr. Friedman, Center for Pediatric neurology and neurosurgery, at 216. 444.6772 or [email protected]; or dr. boyle, Chairman of the department of Pediatric Cardiology, at 216.444.3083 or [email protected]. n

large multidisciplinary Team offers advanced pediatric heart care

Cleveland Clinic’s Center for Pediatric and Congenital Heart Diseases offers advanced pediat-ric cardiovascular catheter-based interventions, and sophisticated, innovative surgery for all forms of congenital and pediatric heart disease, including circulatory support with both ventricular assist devices and ECMO heart-lung bypass for newborns and young patients. The team also has performed more than 100 heart transplants. Two cardiothoracic surgeons, 15 board-certified cardi-ologists and four pediatric cardiac anesthesiologists staff the center.

to refer a patient, please call 216.445.5015. n


acute care service offers 24/7 coverage

Cleveland Clinic’s General Surgery Department has estab-lished a new acute care service to provide timely consults around the clock.

The program ensures that a general surgery staff member is on-site 24/7 for consults in the emergency department and inpatient units and to provide oversight and teaching of general surgery residents, says Michael Samotowka, MD, director of the new five-member service.

to learn more about Cleveland Clinic’s general surgery program and acute care service, call 216.444.5405. n

sleep disorders centers expand

Cleveland Clinic’s Sleep Disorders Center has expanded regionally, extending its reach by joining Medina and Hillcrest hospitals’ sleep programs. For patient comfort and conve-nience, the Sleep Disorders Center now offers overnight sleep studies at nine regional locations, including six hotels, where sleep studies are performed for adults and children age 12 and older.

For more information, visit clevelandclinic.org/sleep. to refer a patient, call 866.588.2264. n

vascular lab locations added

Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute has added locations in Fairview Park and Medina Hospital to better serve your patients.

Cleveland Clinic’s entire network of conveniently located vas-cular labs on its main campus and throughout Northeast Ohio provide timely and detailed noninvasive vascular studies to help determine the best plan of care for patients with arterial and venous disease.

The labs are among the busiest in the country and are run by knowledgeable and well-trained vascular technicians, all of whom are committed to the highest standards of quality patient care and monitoring.

locations:

Cleveland

Cleveland Clinic - Main Campus 216.444.4420

east

Beachwood Family Health and Surgery Center 216.839.3800

Hillcrest Hospital 440.461.1150

West

Fairview Park 440.356.1009

Lorain Family Health and Surgery Center 440.204.7400

Elyria Family Health and Surgery Center 440.204.7400

Westlake Family Health Center 440.899.5555

south

Marymount Hospital 216.587.4280

Medina Hospital 330.721.5700

Strongsville Family Health and Surgery Center 440.878.2500

new! healthcare executive education programs

Don’t miss this opportunity to acquire insights into the business of healthcare excellence necessary to lead your organization. Two-day and two-week programs are open to English-speaking healthcare executives, including physicians, nurses and administrators.

visit clevelandclinic.org/executiveeducation. n

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Cleveland Clinic’s Infertility Program has broadened its reach with loca-tions throughout Northeast Ohio, most recently offering appoint-ments at the Twinsburg Medical Offices. James Goldberg, MD, Head of Reproductive Endocrinology and Infertility, will continue to see patients in Solon and at the state-of-the-art Beachwood Fertility Center as well as in Twinsburg.

He’ll move into the new Twinsburg Family Health and Surgery Center when it opens in June.

Cleveland Clinic’s Infertility Program offers a full range of ser-vices for the diagnosis and treatment of infertility, including in

vitro fertilization. Patients are seen in a caring environment, where the major emphasis is not only technological excel-lence, but also accessibility, personal attention and emotional support. Cleveland Clinic’s IVF laboratory and associated research laboratories create a unique environment for clini-cal care and cutting-edge technology. The labs encompass approximately 1,200 square feet and contain the latest equip-ment for micromanipulation, cryopreservation, cell fusion, and image analysis of gametes and embryos. The clinical labora-tory has 16 incubators and three micromanipulation stations. The strong link between the research and clinical labs in the Fertility Center has been instrumental in developing high-tech solutions to improve clinical IVF outcomes.

to refer a patient for treatment of infertility, call 216.444.6601. n

infertility expert sees patients in Twinsburg

With the opening of a state-of-the-art radiation oncology suite at the Strongsville Family Health and Surgery Center, a full complement of Cleveland Clinic cancer services is more accessible to patients south of the city. Cleveland Clinic Strongsville has added more than 2,000 square feet of space to house exam and treatment rooms for patients undergoing radiation therapy.

Cancer patients now can have all treatments, from surgery to chemotherapy and radiation therapy, in one convenient location, provided by oncologists from the top-ranked cancer program in Ohio – recently ranked in the top 10 in the nation by U.S.News & World Report. And because the Strongsville facility is tied in with the Taussig Cancer Institute, informa-tion can be shared with oncologists at Cleveland Clinic’s main campus if necessary.

“Our goal is to give the patient the best experience that we can. Every room here has electronic medical records. We share information constantly. I don’t know of any field in medicine that has as much technology as radiation oncology,” says radiation oncologist Andrew Vassil, MD, who began seeing patients in the new suite in early December.

The Strongsville Family Health and Surgery Center is now home to an ARTISTE linear accelerator that is the first in Ohio linked to a CT scanner. It offers uncompromised efficiency

cleveland clinic strongsville adds Radiation oncology

and functionality – right in the treatment room. For the comfort of patients, the exam tables are heated; a large conference room is designed so that family members can sit, view and discuss their loved one’s treatment in a comfortable setting; and the entire building is Wi-Fi enabled for those waiting for a family member.

The new radiation oncology suite offers:

• Custom-designed treatment plans as unique as each patient

• Real-time imaging to ensure pinpoint accuracy in radiation delivery

• Latest-generation technology that safely delivers powerful treatment to the tumor

• Less radiation to healthy tissue, meaning fewer side effects

• Shorter treatment times

For more information or to refer a patient, call 440.878.2500. n

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coming events — www.clevelandclinicmeded.com

CMe opportunities: live and online – Cleveland Clinic’s Center for Continuing education’s website, ccfcme.com, offers convenient, complimentary learning opportunities, from a virtual textbook of medicine (disease Management Project) and a medical newsfeed refreshed daily to myCMe, a system for physicians to manage their CMe portfolios. Many live CMe courses are hosted in Cleveland, an economical option for business travel.

may 11-13, 2011

health care Quality innovation summit

oPtiMizing value & seCuring a Future oF innovation and quality

interContinental hotel & Conference Center Cleveland, ohio

The Cleveland Clinic Health Care Quality Innovation Summit is devoted to exploring novel strategies for improving the assessment and delivery of quality healthcare. This multidisciplinary confer-ence brings together the major stakeholders in this process for in-depth discussions of the shared and sometimes competing visions through which health quality metrics can be used to advance healthcare outcomes.

For more information and to register online, visit ccfcme.com/quality11.

may 22-24, 2011

patient experience summit

transForMing healthCare through eMPathy and innovation

interContinental hotel & Conference Center Cleveland, ohio

This unique summit will provide insights and solu-tions to transform the patient experience. The 2010 Patient Experience Summit initiated a global discus-sion of patient experience and what it means to the future of healthcare. This year’s event will feature presentations, debate and candid discussion of key patient experience issues that are essential to the future of healthcare delivery but also applicable to any discipline where excellent customer service is the key to success.

For more information and to register online, visit empathyandinnovation.com.

Upcoming summits – mark your calendar

four recent developments related to the use of electronic health record (eHr) technology are important to practicing physicians:

June 18: The Department of Health and Human Services issued a final rule outlining how organizations can become Office of the National Coordinator Authorized Testing and Certification Bodies (ONC-ATCB).

July 13: The Department of Health and Human Services issued the “Standards, Implementation Specifications and Certification Criteria for Electronic Health Records,” which is the list of technical capabilities an EHR must meet in order to be certified by an authorized testing organization.

July 28: The Centers for Medicare & Medicaid Services (CMS) issued a ruling that defines the minimum “meaningful use” requirements that physicians must meet through their use of a certified EHR to qualify for incentive payments.

oCt. 7: The ONC announced the first 36 electronic health record products to be certified as capable of meeting

“Meaningful Use Stage One Criteria.”

As physicians prepare to select an EHR product, it is impor-tant to keep the meaning of “certification” in this context in mind. ONC-ATCB-certified EHR systems have been tested and proven capable of allowing a provider to do the things spelled out in the CMS “meaningful use” final ruling. EHR

The Cleveland Clinic Foundation 9500 Euclid Ave. / AC311 Cleveland, OH 44195

meaningful Use starts with a Certified EHR

RoUnds | winTeR 2011 | The laTesT news foR pRimaRy caRe physicians fRom cleveland clinic

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certification does not, in itself, mean that purchasing a partic-ular EHR system automatically makes a physician meaningful use compliant. A certified EHR system is the starting point at which a physician becomes eligible for the program. To be eligible for incentive payments, physicians will need to use a certified EHR system to fulfill the meaningful use criteria outlined by CMS.

As you consider which EHR would be right for your prac-tice, please include the MyPractice Community EHR system (powered by Epic Systems, an ONC-ATCB certified solution) among your choices.

to learn more about the MyPractice Community, and for a link to a list of ONC-ATCB-certified EHR solutions, please visit clevelandclinic.org/mpc. to speak to a MyPractice Community representative, please call 216.738.4617. n

Documents

inside a healthcare system approach for - Cleveland Clinic