December 1997 -- Vol. 6, No. 11
For more information about any of the following articles
or to request a telephone number for a contact,
please call the editor at (412) 624-2243.
Current Topics:
Fining process continues for incomplete
medical records
JCAHO: What you need to know
UPMC Health System News:
Future of health care centers around consumers,
employers
Bedford hospital to merge with UPMC Health System
The year 2000 'bug:' What UPMC is doing
Clinical News:
Pharmacy and Therapeutics Committee report
Coagulation testing procedure, values to change
Combined imaging methods pinpoint depression-associated
brain changes
Research studies
Research funding available
Interim lab information reports discontinued
CARTO study offers more accurate AF ablation
Caffeine may be an effective pain inhibitor
UPMC Programs:
Inpatient Rehabilitation earns high quality scores
In Brief:
Upcoming conferences and events
HSLS workshops
Survey response influences hospital ratings in national
magazine
Notes
On the move
Get your UPMC Health System gear
Correction: Hospital Code Team responds to codes at Falk
Information system change at Horizon
Fining process continues for incomplete medical records
At the Nov. 4 meeting of the Medical Executive Committee (MEC), medical record delinquency fining procedures were clarified. As of the meeting date, four UPMC Presbyterian physicians had been fined for incomplete medical records.
The medical record delinquency fining procedure follows:
- Physicians with incomplete medical records outstanding for a period of 30
days will be deemed to voluntarily relinquish their elective admitting staff privileges
and elective operating privileges.
- A fine of $50 per day wll begin accruing on the 31st consecutive
day that a medical record remains incomplete and will continue to accrue until the
physician completes such medical record documentation.
- Upon completion of the medical record, any fines that have begun to
accrue will cease accruing but will remain due and payable to the medical staff fund.
- Elective admitting staff privileges and operating privileges will remain voluntarily relinquished until the outstanding fines are paid by the physician to the medical staff fund.
These procedures were presented at a meeting of the Joint Conference Committee (JCC) of the UPMC Presbyterian Board of Directors Nov. 13. Carol Rose, MD, chairman, Medical Records Committee, further clarified with this group that physicians would reclaim admitting staff privileges for elective services only after completing overdue medical records and paying the full fine. Both the MEC and the JCC supported the proposal to have the names of physicians who do not pay their fines printed in UPMC Presbyterian Physician. Physicians have the option of appealing their fines to the MEC in person.
For more information, call Dr. Rose.
UPMC Presbyterian, including UPMC Montefiore, Eye & Ear, Western Psychiatric Institute and Clinic and related facilities, will be surveyed from Monday, Dec. 15, through Friday, Dec. 19. A special edition of UPMC Presbyterian Physician was distributed last week to help physicians prepare for the upcoming survey. The special edition provides brief information about "hot" topics. Information about problematic areas and identifying abuse follow.
Problematic areas
The following standards assessed by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) proved to be the most problematic for
hospitals surveyed so far in 1997:
- Special Treatment Procedures — Standard area: The hospital must
define specific time limits for restraint and seclusion orders.
- Assessing Competence — Standard area: The hospital must assess an
individual’s competence based on job description.
- Medication Use — Standard area: The hospital must control the
preparation and dispensing of medications.
- Management of the Environment of Care: Implementation — Standard
area: The hospital must conduct fire drills regularly.
- Patient-Specific Data and Information — Standard area: The hospital
must make entries in the medical record in a timely manner. Additionally, all orders must
be signed; verbal orders must be signed within 4 hours.
- Special Treatment Procedures — Standard area: Documentation in
medical records must reflect an organization’s policy.
- Special Treatment Procedures — Standard area: A licensed independent
practitioner must order restraint and seclusion.
- Medication Use — Standard area: The hospital must have mechanisms
that address emergency medications.
- Patient-Specific Data and Information — Standard area: Medical
staff rules and regulations must identify individuals qualified to accept verbal
orders.
- Management of the Environment of Care: Design — Standard area: Hospitals must comply with the Life Safety Code.
Recognizing abuse
As part of the upcoming JCAHO survey, physicians and staff
members may be asked about UPMC Presbyterian’s policies relating to reporting child
abuse, domestic abuse, and elder abuse.
The UPMC policies can be found in the UPMC Policy Manual — No. 4009 (child abuse), No. 4010 (spouse abuse), and No. 4012 (elder abuse). All instances of suspected child abuse, domestic violence, and elder abuse involving medical-surgical and psychiatric patients should be referred to the appropriate social worker at UPMC Presbyterian, UPMC Montefiore, or Western Psychiatric Institute and Clinic (WPIC), as appropriate. Medical record documentation should include objective physical findings, patient statements, and/or clinical observations, as appropriate, as well as medical and psychosocial treatment recommendations. No accusations of abuse or neglect or conclusions that abuse or neglect occurred should be made by UPMC personnel either verbally or in writing.
WPIC has a Child Abuse Committee that meets on a monthly basis to review reports of abuse that have been filed since the last meeting. Members of the committee also serve as consultants to faculty and staff at WPIC when the filing of a report appears to be indicated. The consultation process is set forth in the WPIC Child Abuse Policy and Procedure. The committee chairpersons also routinely provide education and training on issues of abuse for WPIC faculty and staff, including house staff.
Physicians and staff also should know that state law governs the reporting of certain types of abuse. Those who are obligated to report child abuse are those who, in the course of practicing their profession, have reason to believe, based on their training and experience, that a child coming before them in the context of their work is an abused child. This reporting is mandated by the Pennsylvania Child Protective Services Law, which protects those under age 18 who exhibit evidence of serious physical or mental injury that cannot be explained by available medical history as being caused by accident. Types of child abuse include physical injury, physical neglect, sexual abuse, or emotional maltreatment.
Currently, Pennsylvania has no state law regarding mandatory reporting of domestic violence. However, a victim can request a protection from abuse order or press criminal charges. Social workers can discuss these options with victims. Domestic abuse is defined as abusive behavior that coerces the victim to do whatever the abuser wants him or her to do without regard for his or her physical and emotional self. It is characterized by physical violence, sexual violence, psychological violence, or even financial abuse.
Elder abuse is a complex and serious problem that is underreported. The elderly person is frequently isolated and dependent on the abuser. The abuser may cause the elderly person to be fearful or embarrassed. Elder abuse also may include other forms of psychological abuse as well as physical abuse, neglect, exploitation, and abandonment. In accordance with the Adult Protective Srvices Law, which covers those age 60 and older, the social worker must report instances of suspected elder abuse if the victim consents. In cases where the patient’s capacity to provide consent is an issue, UPMC legal counsel should be consulted as appropriate.
Questions about the policies regarding reporting child abuse, domestic abuse, or elder abuse may be directed to Mary Ellen Cowan, MSW, Collaborative Case Management Questions regarding policies at WPIC may be directed to Elaine Buzzinotti, JD, or Mary Greaves, MSEd.
For more survey information
To learn more about the upcoming JCAHO survey, call John
Harper, MD, associate medical director, or Juliet Jegasothy, MBBS, assistant medical
director.
Future of health care centers around consumers, employers
As managed care evolves in the Pittsburgh region, consumers and employers will play a larger role in determining health care costs and in defining what services they receive, says Jeffrey Romoff, president, UPMC Health System. Insurers and third party payers now control what consumers pay for health care and, to a large degree, what services they receive. But insurers will see their roles diminish as more of these controls shift to consumers, employers, and health care providers in coming years, he says.
Mr. Romoff offered his forecast on the future of health care in Pittsburgh at a recent Health Policy Institute lecture at the University of Pittsburgh’s Graduate School of Public Health (GSPH). "During the past five years, insurers replaced providers as the dominant player in health care," he says. "But the balance of power is continuing to shift from providers and third party payers to employers and health care consumers because they ultimately are the ones paying for and receiving services."
UPMC Health System is in a strong financial position in western Pennsylvania’s health care market. Although nonprofit, the system has grown to be a $2 billion-a-year enterprise and is the largest nongovernment employer in western Pennsylvania with a workforce of more than 21,000. The Health System and its affiliates now have nearly 6,000 staffed beds, compared to about 1,200 at Allegheny General Hospital and 1,250 at St. Francis Health System, Mr. Romoff says. UPMC Health System also is strengthened by its network of nearly 3,000 physicians, and merger talks continue with numerous community hospitals throughout the region.
But UPMC is more than a network of hospitals and physicians. In addition to its physician practices and tertiary, specialty, and community hospitals, the organization includes insurance products, rehabilitation services, in-home services, retirement living options, a mail order pharmacy, technology transfer ventures, and international initiatives, such as a transplantationhospital being built in Palermo, Italy.
"Creating a pre-eminent integrated delivery system is not just about being large; it’s about functioning with a clear sense of purpose and striving to deliver high-quality health care services at a low cost," Mr. Romoff says, adding that UPMC Beaver Valley, UPMC South Side, and UPMC Braddock were finan-cially troubled when joining the Health System and are now becoming financially healthy institutions.
Mr. Romoff expects that the regional and national health care markets will increasingly become buyers’ markets with employers forming coalitions to purchase health care, that providers and insurers will undergo greater regulatory scrutiny, and that the balance of power and choice will continue shifting to consumers. He reminded the audience that although media reports portray UPMC Health System as a big business enterprise similar to some for-profit industries, UPMC, as a nonprofit organization, invests all of its revenues back into health care research, academic training, community programs, and development of diversified services. This is all for one primary reason, he says. "We are building this integrated delivery system because we believe that western Pennsylvania health care should be run by western Pennsylvanians," Mr. Romoff says.
UPMC Health System at a glance
UPMC Health System has four operating divisions, each led by a senior vice president who
reports to Mr. Romoff and John Paul, executive vice president. The divisions are Physician
Services, Hospital Services, Diversified Services, and Insurance Services. The operating
divisions are supported by services that function across the system.
Loren Roth, MD, MPH, is senior vice president, Physician Services, which includes physician acquisition activities, management services organization (MSO) operations, physician practices, and UPMC Health System’s freestanding same-day surgery centers, which will be located in Monroeville and the South Hills and potentially in the North Hills and Moon Township. The MSO operations encompass the University Services Organization and the MSOs of Shadyside and St. Margaret. In his role as chief medical officer for the system, Dr. Roth also has responsibility for medical management, practice standards, and physician credentialing.
The Hospital Services component encompasses all of the merged and acquired hospital facilities — UPMC Presbyterian, UPMC Shadyside, Western Psychiatric Institute and Clinic, UPMC Beaver Valley, UPMC Braddock, UPMC South Side, UPMC St. Margaret, and UPMC Passavant. The presidents of each hospital report to the senior vice president of this division, a position that is being filled on an interim basis by Mr. Paul.
Insurance Services, led by Dean Eckenrode, senior vice president, includes UPMC Health System’s 100 percent ownership of UPMC Health Plan as well as Community Care Behavioral Health Organization, which is a behavioral health managed care product that is a partnership between UPMC Health System and St. Francis Health System. In addition to UPMC-owned insurance companies, UPMC Health System and physicians are major components of Tri-State Health System.
The Diversified Services division includes the Health System’s other related health care businesses. Michele McKenney is senior vice president, Diversified Services. The division’s initiatives include ventures in rehabilitation services; technology transfer; international business opportunities; in-home services; pharmacy services; emergency medicine management; and assisted living, retirement, and subacute facilities, among others.
Bedford hospital to merge with UPMC Health System
Memorial Hospital of Bedford County officials announced Nov. 25 that the hospital will become part of UPMC Health System, effective Feb. 1, at which time the hospital’s name will change to UPMC Bedford Memorial. This 59-bed acute care facility will be the seventh community hospital to become part of UPMC Health System.
Because of dramatic changes occurring in health care delivery, Memorial Hospital of Bedford County began negotiations to find a system relationship that could best ensure the future presence of the hospital in Bedford County, said James Vreeland, president and chief executive officer.
"Out of an initial field of seven potential partners, we determined that UPMC Health System has both the financial ability and access to advanced medical technology that will not only maintain but also enhance the fine services we have provided to the citizens of this area," Mr. Vreeland said.
According to John Blackburn Jr., chairman of the Bedford hospital’s board of directors, the merger with UPMC will benefit the community in many ways. It will enable the purchase of new medical equipment and augment physician manpower in the area through recruitment of more physicians.
Some of the clinical areas that will be developed include psychiatric services, cardiology, pulmonary medicine, and critical care medicine. Other areas that will be targeted for the future are colorectal surgery, geriatrics, and reproductive endocrinology.
Mr. Blackburn said that UPMC and Memorial Hospital of Bedford County also will establish a charitable foundation that will fund projects to benefit the health and welfare of the community for future generations.
Jeffrey Romoff, president, UPMC Health System, said, "The board of directors, medical staff, and administration of Memorial Hospital of Bedford County are to be commended on their unified and thoughtful approach in analyzing the current health care environment and making a decision that will ensure the continuation of their tradition of providing high-quality care. We are pleased to welcome UPMC Bedford Memorial to our network of hospitals."
UPMC Bedford Memorial will continue to be locally run and operated. Two-thirds of the board will be from the current board and one-third will be from UPMC Health System. There will be a Bedford representative on the system board along with medical representation.
The year 2000 'bug:' What UPMC is doing
UPMC Health System is developing a strategy to identify and eradicate the year 2000 "bug." The year 2000 bug was caused by the use of two digits to represent the year in computer programs. When computer systems calculate the year, they append or assume that the firsttwo digits for the year are 19, as in 1997. When the calendar changes from 12/31/1999 to 1/1/2000, these computer programs will assume the date is 1/1/1900. This assumption by computer programs will cause many problems, depending on each computer’s use of the date. An example of a serious error would be the calculation of someone’s age to be a negative age. In many computer systems, use of a negative age will cause the computer program to stop running. If this program is performing a critical function, such as admissions, then the function will be stopped and no more admissions information can be accessed or entered until the program is corrected.
To avoid these problems, UPMC has performed an assessment of its existing computer systems and hired a person to manage the effort. UPMC Health System is continuing with assessments for each of its business units and is generating project plans to track progress toward correcting the problem. A database has been created that captures the Health System’s inventory of systems and determines whether the applications are year 2000 compliant. UPMC has contacted numerous vendors and requested the most current compliant version of their software packages.
You can help identify computer systems that may not be year 2000 compliant by contacting the software vendor for software used in your area. Check any programs that you have written to see if they will continue to work. Upgrade your personal computer’s software to the current version. For example, Microsoft Windows 3.11 is not compliant, but Windows 95 and Windows NT are compliant.
If you have questions, call Guy Dalessandro, Information Services Division, at 647-3356. You can send your questions or concerns by e-mail to this address: D’Alessandro, Guy (on Microsoft Exchange).
Pharmacy and Therapeutics Committee report
The following report includes information about actions taken at the October meeting of the UPMC Presbyterian Pharmacy and Therapeutics (P&T) Committee. Questions may be directed to the Drug Information and Pharmacoepidemiology Center.
Sevoflurane added to formulary
Five volatile anesthetics are approved for use in the
United States. Three of these agents are on the UPMC Presbyterian formulary: isoflurane,
enflurane, and halothane. Two newer agents are desflurane and sevoflurane. Desflurane has
a blood gas coefficient lower than that of sevoflurane and as a result, desflurane allows
for more rapid induction and emergence than sevoflurane. However, because of the high
incidence of laryngospasm and coughing related to its use, desflurane is not recommended
for induction in pediatric patients, which limits its usefulness. Sevoflurane has been
studied in pediatric patients and has proved to be a safe and effective agent in this
population.
The committee recommended that sevoflurane be added to the formulary but restricted to use at the Ambulatory Surgical Center, that enflurane be removed from the formulary, and that halothane remain on formulary. Agents for mask induction should be limited to halothane and sevoflurane. In addition, the committee recommended that soflurane be the preferred inpatient anesthetic agent.
Controlled Substances Task Force
Some of the procedural aspects of the new Controlled
Substance Policy proposed by the Controlled Substances Task Force were discussed. The
policy is designed to integrate all controlled substance procedures at UPMC Presbyterian
that previously were the responsibility of different departments. The discussion included
regulation of prescription pads and how to tell if the patient has actually gotten the
drug prescribed. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
has looked at this in inspections of other institutions. The committee recommended that
the policy be approved.
24-hour stop orders for heparin
The committee recommended that heparin orders be changed to
a "soft-stop" policy, meaning that the physician will be notified to review the
order and rewrite it, but the drug is not stopped. If a patient goes to surgery, the usual
procedure is that all orders are stopped. The committee discussed that the current policy
regarding resuming pre-op orders would cause an inadequate check of the orders, unless the
patient comes back to the same team. It was suggested that the wording be changed with
exceptions for the ICU and MAC units. If the patient is going to be with the same ICU or
MAC team, the order will not have to be rewritten. The policy was approved with the
suggested changes.
Coagulation testing procedure, values to change
The Hematology Division of the Automated Testing Laboratory announces that by Feb. 2, changes in the procedures for determining prothrombin time (PT) and partial thromboplastin time (PTT) will be instituted. Changes will involve updated instrumentation and use of more sensitive and more reproducible recombinant thromboplastin reagent. Before the changes are implemented, laboratory staff will help to prepare physicians through Grand Rounds presentations, small-group tutorials, and other communications.
The changes will have a minor effect on the normal range but will impact abnormal values substantially. Patient test results that showed minor prolongation of prothrombin times with the old reagents will show greater prolongation with the new reagents. This will require an adjustment in the interpretation of values and their clinical significance.
Before the hange takes place, the laboratory will continue to report results using the present methodologies but will conduct parallel testing using the old and new procedures. Parallel testing will provide valuable information about the shifts in reaction times for the many clinical situations treated at UPMC Presbyterian. This information will be reported to physicians via e-mail and an upcoming edition of UPMC Presbyterian Physician. When the new procedure is instituted in February, new and old values will be reported for two to four weeks. After that time, test results will be reported using only the new values.
Questions may be directed to Sandra Kaplan, MD, medical director, Automated Testing Laboratory’s Hematology Division, at 647-6189 or pager 5127 or Darrell Triulzi, MD, medical director, Blood Bank, at 209-7304 or pager 2300.
Combined imaging methods pinpoint depression-associated brain changes
By combining complementary methods for imaging the living, thinking brain, two UPMC Health System studies have revealed what may be important causes of depression in both elderly and younger patients. The researchers presented their findings at the 1997 Society for Neuroscience Annual Meeting in New Orleans in October.
Computer-combined images using both positron emission tomography (PET) and magnetic resonance imaging (MRI) allowed a research team led by Wayne Drevets, MD, to pinpoint an emotion-associated area of the brain that is abnormally active in patients with depression or bipolar disorder. In a separate study, Carolyn Cidis Meltzer, MD, and colleagues used the same combination of brain imaging tools to show that another mood-associated brain system deteriorates with age — possibly explaining why older people have higher rates of depression.
Dr. Drevets’ study involved brain scans of 32 patients with major depression or bipolar disorder — disease involving periods of depression and periods of "wired" overstimulation — and 15 volunteers without either disorder. The scans revealed high levels of metabolic activity in an almond-sized brain center called the amygdala in the patients, but not the healthy subjects.
Earlier studies had shown that the amygdala plays a crucial role in controlling emotional responses to sensory stimuli, and that drugs that improve and prevent depressive episodes also reduce amygdala activity, states Dr. Drevets, associate professor of psychiatry and radiology. But this was the first study to demonstrate that people with depression or bipolar disorder actually have an overactive amygdala.
"What we now know suggests that if we can develop drugs that more effectively reduce metabolism in this structure, we may be able to better treat or prevent depression as well as mania," says Dr. Drevets.
Dr. Meltzer’s research team used the PET/MRI combination to show that, in 18 volunteer subjects between the ages of 18 and 76, the brain system called the serotonin system declines with age. The researchers’ PET scans revealed that a particular kind of receptor protein that allows nerve cells to respond to the brain-communication chemical serotonin was 55 percent more scarce in the oldest (ages 60 to 76) than the youngest (ages 18 to 31) volunteers.
Serotonin-sensitive nerve cells are an important target of antidepressive drugs like fluoxetine hydrochloride (Prozac); this suggests that decline in the serotonin system may underlie higher levels of depression in the elderly says Dr. Meltzer, assistant professor of radiology and psychiatry and acting medical director, PET Facility, UPMC Presbyterian.
The combination of PET and MRI was crucial for both groups to make their findings, the researchers agree. In Dr. Drevets’ study, the fine anatomic detail produced by MRI allowed the researchers to positively identify the hyperactive brain region shown on the PET images — which are by nature blurrier — as the amygdala.
In Dr. Meltzer’s study, anatomic MRI information allowed her team to correct for normal age-related changes in brain anatomy that might otherwise be mistakenly labeled as changes in activity on the PET images.
Department of Neurology seeks diabetic subjects for neuropathy
study
The Department of Neurology is conducting a study of
individuals with diabetes who are experiencing signs of neuropathy. Diabetic volunteers
ages 18 to 74 are needed to participate in the study to evaluate an investigational drug
that may prevent or treat nerve damage. Physical examinations, laboratory tests, EKGs, and
neurological testing will be provided at no cost to study participants, who will be
required to complete 16 outpatient visits over a 13-month period.
Contact Maureen Geary, clinical coordinator, Department of Neurology, at 648-1948 to refer patients or for more information.
Psychiatry SRC funds
Departmental funds are available from the Services Research
Committee (SRC) for the support of pilot research efforts by Department of Psychiatry
faculty, postdoctoral fellows, and residents interested in studying the delivery of mental
health services. These limited funds are allocated to encourage new pilot research
proposals that are promising in terms of larger-scale development and external funding.
Proposals must follow SRC guidelines and meet the deadline for submission. Remaining
submission dates for Fiscal Year 1998 are Monday, Jan. 5, and Monday, April 6. For more
information, call Diane Comer at 692-7842.
American Liver Foundation funds
The American Liver Foundation has announced that $850,000
in research funds will be made available in 1998. These awards include six to eight new
liver scholar awards, 10 to 12 postdoctoral research fellow awards, and eight to 10
student research fellowship awards. The application deadline is Thursday, Jan. 15. For an
application and guidelines, write to the American Liver Foundation, Research
Department, 1425 Pompton Ave., Cedar Grove, NJ 07009 or call (973) 256-2550,
Ext. 230.
CMRF applications available
Applications for research project funding through the
Competitive Medical Research Fund (CMRF) are available through the Office of Research in
the Health Sciences, University of Pittsburgh. Completed applications are due by 4 p.m.
Monday, Feb. 16. Awards will be announced by June.
The fund provides support for new research in its early stages; the goal is to enable researchers to obtain preliminary data to successfully support further research. Grants of up to $25,000 for one to two years of research will be awarded. Individuals not currently receiving funds from other sources will receive priority.
Junior faculty up to and including the rank of associate professor in the schools of the health sciences are eligible to apply for funds.
To request an application form or more information, contact Iris Lowe, CMRF coordinator, at 692-2759 or loweie@msx.upmc.edu or visit the health sciences’ Web site at www.pitt.edu/~oorhs.
Small cancer research grants available
Small cancer research grants are available through the
American Cancer Society-George Heckman Memorial Institutional Grant for Cancer Research,
which has been awarded to the University of Pittsburgh and is administered by the
University of Pittsburgh Cancer Institute. Applications will be accepted through Monday,
Feb. 2.
The grants provide seed money to permit investigators to initiate promising new projects or novel ideas in cancer research. Awards will be made only to junior faculty (assistant professor and instructor) and will be given for scientific merit and perceived need. Applications for research pertaining to cancer in the economically disadvantaged are encouraged.
To request an application form or more information, contact Iris Lowe, CMRF coordinator, at 692-2759 or loweie@msx.upmc.edu.
Interim lab information reports discontinued
Two recent surveys showed that, in nearly all instances, extensive use of online inquiry has supplanted interim clinial lab information system reports for patient management at UPMC Presbyterian, UPMC Montefiore, and Western Psychiatric Institute and Clinic. As of Nov. 24, interim reports were discontinued, except those going to specific units that indicated they are actively using the Microbiology reports. If you have questions, call Carol Lidiak, systems analyst, at 647-3991.
CARTO study offers more accurate AF ablation
UPMC Health System cardiologists are leading a multicenter clinical study of an innovative catheter navigation system for treating atrial fibrillation (AF). The system, called CARTO, utilizes ultralow magnetic fields to precisely localize an ablative catheter without radiographic imaging.
"Until now, there has not been an effective nondrug treatment for the cure of atrial fibrillation," says David Schwartzman, MD, assistant professor of medicine and director, Atrial Fibrillation Consultation and Advanced Therapies Center, UPMC Presbyterian. Worse, he adds, drug inefficacy, adverse side effects, and disease progression all contribute to limiting the utility of pharmacologic treatment as well. The CARTO system, he explains, promises precise radiofrequency ablation of atrial tissues initiating fibrillation.
In the CARTO system, three microtesla magnetic generators under the operating table provide a frame of reference for a catheter with a magnetic sensor at its tip. The catheter, which is also an electrophysiologic probe, can be used in conjunction with intracardiac echocardiography to map out both the anatomic movement of the affected atrium and the propagation of its electrical activity. Once these two maps are constructed, electrophysiologists can locate the source of the aberrant heart rhythm and ablate it with a radiofrequency generator in the probe.
Ongoing studies in Europe have indicated that this system can provide submillimeter precision in identification and treatment of aberrant electrical activity, says Dr. Schwartzman. In these trials, catheter ablation produced suppression of AF in approximately 75 percent of patients.
The electrophysiologic study and treatment procedure generally lasts for three to five hours, explains Dr. Schwartzman. Patients undergo the procedure under sedation and are subsequently monitored overnight and discharged in 24 to 48 hours.
Patients who are candidates for the study include those with paroxysmal or persistent AF that is resistant to one or more antiarrhythmic agents.
For more information about this or other studies of new therapies for AF or to refer patients for assessment, call Dr. Schwartzman at 647-2762 or 647-5019.
Caffeine may be an effective pain inhibitor
According to a study by Daniel Myers, DDS, associate professor of oral medicine and pathology, University of Pittsburgh School of Dental Medicine, moderate doses of caffeine may inhibit muscle pain. The study, published in the November issue of the journal Headache, evaluated ischemic muscle pain — the type of pain experienced during a heart attack — in seven healthy people. Each person in the study was given either a 200 milligram caffeine pill — equivalent to approximately two cups of strong coffee — or a pill with no caffeine. One hour after the pills were given, subjects raised their arms to drain the blood and blood pressure cuffs were used to prevent blood flow back into the arm. The participants then did wrist curls while holding a small 5 gram weight. "These actions simulated ischemic muscle pain," Dr. Myers explains. Participants then rated pain after 15, 30, and 45 seconds of wrist curl exercises.
At 15 seconds, the mean pain rating in participants given caffeine was half that of people given the pill with no caffeine, Dr. Myers says. The trend continued at the 30- and 45-second ratings.
"The implication is that there is a rationale for the use of caffeine in the treatment of muscle pain when blood flow is reduced," says Dr. Myers. The effectiveness of caffeine in this study may be related to its ability to block adenosine receptor function. "It has been theorized that adenosine, a common biochemical substance in the body, plays a role in causing muscle pain, and if caffeine blocks the adenosine receptors, muscle pain could be blocked as well." Caffeine is used in several effective over-the-counter and prescription pain medications.
Inpatient Rehabilitation earns high quality scores
UPMC Presbyterian’s Inpatient Rehabilitation Unit, located at Montefiore, 11-east and west, recently received impressive quality scores in a report comparing the unit’s outcomes to those of other facilities in the region and across the nation.
The report from the Unified Data System (UDS), a national database that evaluates quality and outcomes in rehabilitation medicine, ranked the UPMC Presbyterian unit in the 90th percentile for overall performance compared to facilities across the nation and in the 86th percentile compared to the region (Pennsylvania, West Virginia, Virginia, Maryland, Delaware, and the District of Columbia). The report was based on data for the year that ended June 30.
"These numbers are especially impressive when you consider the type of patients we tend to see," says Michael Munin, MD, medical director of the unit. "As a tertiary care facility, UPMC Presbyterian tends to treat patients who are sicker or have more complicated injuries than other facilities typically see."
UDS bases its evaluations on assessments like patients’ improvement in functional independence measure (FIM) scores, lengths of stay, and whether they are discharged to long-term care or go home. Over the past year, Presbyterian’s Rehabilitation Unit discharged 87 percent of patients to the community, compared with 83 percent regionally and 81 percent nationally, and only 4 percent to long-term care, compared with 10 and 11 percent for the region and nation, respectively.
Another area where UPMC excelled was in length-of-stay efficiency, which is calculated by dividing patients’ change in FIM score by their lengths of stay in the hospital. The UPMC unit was close to regional and national numbers in almost all categories but was rated much more efficient in treating patients with neurologic syndromes and orthopaedic patients.
Dr. Munin attributes part of the department’s success to good data management. "UDS ony requires us to submit FIM scores at admission and discharge, but we have a computerized database where our therapists enter that data every week," he points out. It not only simplifies record keeping, but allows the care team to track progress more efficiently and quickly address setbacks.
"We keep records of therapy time attended for each patient," Dr. Munin explains. "Our goal is a combined average minimum of three hours a day of physical, occupational, or speech therapy for each rehabilitation patient. This system makes it easy to keep track of who’s on target and where there might be problems." The software was developed especially for the unit by UPMC’s Information Services Division.
But Dr. Munin is quick to point out that data keeping is not the sole reason for the unit’s success: "Of course, we have an excellent staff," he says.
Dr. Munin is interested in sharing their successful methods, especially with other rehabilitation units across the UPMC system. For more information, contact him at muninmc@msx.upmc.edu.
Upcoming conferences and events
ADRC Topics at Noon
Thursday, Dec. 11, noon to 1 p.m.
UPMC Montefiore, 4-south, ADRC conference Room
"Alzheimer’s Disease: Neuropsychiatric Symptoms and
Caregiver Impact" will be presented by Daniel Kaufer, MD, assistant professor of
psychiatry and neurology.
MGB Seminar
Thursday, Dec. 18, 3:30 p.m.
1295 Biomedical Science Tower
"Use of Highly Virulent Molecular Clones of EIAV for Studies
of Lentiviral Pathogenesis" will be presented by Susan Payne, PhD, Department of
Biology, University of Texas at Arlington. Presented by the School of Medicine’s
Department of Molecular Genetics and Biochemistry. Refreshments will be served.
The Health Sciences Library System (HSLS) offers the following classes; those marked with an asterisk (*) are now being offered for CME credit. To register for classes held at Falk Library, contact the Reference Desk at 648-8796 or medlibq+@pitt.edu. To register for classes held at WPIC Library, call 624-1919 or send e-mail to wpicref+@pitt.edu.
PowerPoint for Presentations
Wednesday, Dec. 10, 9:30 to 11:30 a.m.
Falk Library, MMC, Windows Classroom
ProCite for Windows
Thursday, Dec. 11, 8 to 10 a.m.
Falk Library, MMC, Windows Classroom
Getting Started With Netscape and the WWW
Thursday, Dec. 11, 3 to 4:30 p.m.
Falk Library, MMC, Windows Classroom
Survey response influences hospital ratings in national magazine
U.S. News and World Report annually rates America’s best hospitals using results of a National Opinion Research Center survey. UPMC physicians who received this survey in the last few months are urged to complete and return it by mid-December to help increase UPMC Health System’s rating in the 1998 edition.
In 1997, UPMC Health System ranked among the best hospitals in the country in six specialty areas. The ranking of specialty areas is based on three factors: hospital reputations based on a survey of board-certified physicians, mortality data, and hospital service capabilities.
Questions may be directed to Sandra Danoff, director, Planning and Marketing, at 647-7658.
Noteworthy items about UPMC Presbyterian physicians follow. To contribute an item, contact Beth Geisler, Public Relations, at 624-2243.
- Fredric Jarrett, MD, clinical professor of surgery, is president-elect of the Eastern Vascular Society, the largest regional society in the United States. He will assume office in May 1998.
Anatomic Pathology, Hematopathology
In November, UPMC Presbyterian’s departments of
Anatomic Pathology, including Cytopathology, and Hematopathology, including the Bone
Marrow Laboratory, moved to Presby, sixth floor, C-wing, or other areas occupied by
Anatomic Pathology. The departments moved from Montefiore. Following are new office and
telephone numbers:
- Cytopathology main office, C-600, 647-8200 Bone Marrow Laboratory, C-605,
647-0263
- Samuel Yousem, MD, C-620, 647-3238; secretary Jackie Lynch, C-600,
647-6193
- Steven Swerdlow, MD, C-606, 647-0267; secretary Agnes Zachoszcz, C-606,
647-5191
- Lydia Contis, MD, C-602, 647-0264
- David Bahler, MD, PhD, C-604, 647-8504
- Sheldon Bastacky, MD, C-622, 647-9612; secretary-residency coordinator
Diana Winters, C-618, 647-0236
- Paul Ohori, MD, C-616, 647-3478; secretary Barbara DeFrancesco, C-600,
647-9843
- Uma Rao, MD, A-607, 647-0372
- Diane Lape, A-609, 647-1633
- Nancy Sulanowski, C-626, 647-0202
- Kimberly Miller, A-519, 647-9044
- Peggy Whigham, C-612, 647-5291
All other calls should be directed to 647-3720.
Important instructions regarding use of pneumatic
tube stations
Take note of these instructions for the pneumatic tube stations that opened at 6A Presby
on Nov. 26. Specimens going to Cytology and Hematopathology for evaluation should be sent
to the 6C tube station. Do not send Cytology or Hematopathology specimens by tube after
4:30 p.m. weekdays or anytime on weekdays.
If you work in the Montefiore Operating Rooms, please take note of these instructions for the pneumatic tube station opening at 6A Presby on Monday, Dec. 8. Sed frozen section specimens from the Montefiore Operating Rooms by tube to the station on 6A Presby after calling the frozen section pathologist at 647-3720. Please do not send frozen section specimens by tube after 5 p.m. weekdays or anytime on weekends. For frozen section specimens after 5 p.m. or on weekends, contact the pathologist on call.
CPCDS
The Center for Psychiatric and Chemical Dependency Services
(CPCDS) of Western Psychiatric Institute and Clinic moved Nov. 14 to 3501 Forbes Ave.
(Oxford building) in Oakland. CPCDS is part of the new substance abuse service line. The
new clinic number is 383-2700, the new fax number is 383-1268, and the new drug and
alcohol research number is 383-2740. The new telephone number for Dennis Daley, director,
is 383-2710; for Howard Moss, MD, medical director of the substance abuse service line,
383-2720; and for Ihsan Salloum, MD, medical director of CPCDS, 383-2740.
CPCDS offers outpatient services to patients with primary substance use disorders in addition to those with dual diagnoses (substance use plus mood, anxiety, personality, or adjustment disorders). Health care professionals should send referrals for the primary substance abuse program and dual diagnosis program to Marlene O’Leary, admissions coordinator. A new referral form will be available and distributed in the near future. Call CPCDS if you have questions about services.
11F Neuro ICU to Unit 4F
UPMC Presbyterian’s Unit 11F (Neuro ICU) moved to
Presby’s fourth floor Nov. 21 to occupy a newly renovated space. The new unit is
called Unit 4F (Neuro ICU). The telephone number for Angel Hoffman, MSN, unit director, is
647-7697; the telephone number for Becky Mitchell-Perry, RN, primary nurse, is 647-5176.
The new interoffice mailing address is Neuro ICU, Presby, Unit 4F.
Referral Communications Center
The Referral Communications Center moved in mid-October
from the Presby lobby to F-1301 Presby. Telephone numbers remain the same. The fax number
is 647-7890.
Get your UPMC Health System gear
F.L. Haus Co., in cooperation with UPMC Health System, is selling Tshirts, sweatshirts, golf shirts, sports bags, and other items emblazoned with the UPMC Health System logo. UPMC staff and faculty may purchase these items directly from F.L. Haus through Wednesday, Dec. 31. For an order form, call Public Relations at 624-2500.
In this issue | UPMC Presbyterian Physician index | Information for Faculty and Staff
Correction: Hospital Code Team responds to codes at Falk
For conditions A (arrest) or C (medical emergency) staff at Falk should call 647-3131 to alert the Hospital Code Team. The team responds to these codes in the hospitals and at Falk but not at the Kaufmann Building or health care satellites. Staff at these locations should call 911. This information was not provided accurately on page 7 of the special JCAHO edition of UPMC Presbyterian Physician.
Information system change at Horizon
UPMC Health System and Horizon Hospital System have announced an agreement that will serve patients and physicians through the most modern system of medical records available. Horizon, located in Mercer County, and UPMC Health System signed a contract in late October that strengthens the affiliation of the two providers by making Horizon part of UPMC’s information system.
UPMC Health System and Horizon Hospital System view information technology as a strategic asset and initiative, says Dan Drawbaugh, chief information officer, UPMC Health System.
J. Larry Heinike, president and chief executive officer, Horizon Hospital System, adds that the new system will bring Horizon’s patients and physicians into a new era of convenience and access to vital health information with a new lifetime medical record for each patient. In addition, Horizon will save $6 million over a five-year period.
UPMC Presbyterian Physician is published to keep medical staff members abreast of medical staff issues, administrative activities, and health system programs and to report significant actions taken by medical staff committees. We welcome your suggestions on topics of concern and interest and encourage you to bring them to the attention of the editorial consultants or to contact the editor at 624-2243 with questions or comments. UPMC Presbyterian Physician is produced by Public Relations.
Editorial Consultants: Marshall Webster, MD; Thomas Horn, MD; Terence Starz, MD
Editor: Beth Geisler
Contributing Writers: Adam Burau, Ken Chiacchia, Alice Rudolph
The institutions of UPMC Health System prohibit and will not engage in discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam era. Further, the institutions will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC Health System programs and activities. This is a commitment made by the institutions of UPMC Health System in accordance with federal, state, and/or local laws and regulations.
© 1999 UPMC Health System