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New Form Required for DNR by ahu93919

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									                                   ArnotHealth

                                   INSIGHT
News and Information
for Physicians and
Medical Professionals




September 2006
                                   New Form Required for DNR
In this Issue:

• New MOLST form
  Page 1

• Hyperbaric Oxygen Therapy
  Page 4
                                                                                                           As of
                                                                                                           September 18,
Departments / Issues:                                                                                      the new
                                                                                                           MOLST form is
• Laparoscopic Bariatric Surgery                                                                           the only form
                                                                                                           recognized by
• 64-Slice CT Scanner                                                                                      Arnot Health
                                                                                                           for DNR.
• Hospitalist Medical Director


New Appointments:

• Adolfo Llanos, M.D.

• Taseer Cheema, M.D.              MOLST, or the Medical Order for Life-         preferences. Depending on these wishes, a
                                   Sustaining Treatment, is a physician order    physician order for DNR, DNI, and/or
• Robert Cole, M.D.                used to ensure that patient wishes are        other life-sustaining treatment can be
                                   honored regardless of healthcare setting.     designated on the MOLST. Supplemental
                                   The MOLST program is in its pilot phase       forms for minors and those who lack
• Douglas McKane, M.D.
                                   in New York State, but will soon become       capacity are available and should be
                                   state law. Arnot Health began using the       attached to the form when applicable.
                                   form September 18, and it is now the          Physicians should still strongly encourage
                                   only form recognized for DNR and life-        patients to fill out Healthcare Proxy and
                                   sustaining treatment.                         Living Will documents, and work with the
                                                                                 patient to make sure the documents are
                                   New York State has adopted the program        not contradictory.
                                   to unify advance directive information into
                                   a single, easily recognizable document that   MOLST forms should be filled out for
                                   functions as an actionable medical order.     patients who reside in a long term care
                                   The form transitions with a patient           facility, might die within the next year,
                                   through all healthcare settings, while        reside in the community and need long
                                   reducing contradictory and repetitive         term care services, and those who want
                                   documentation.                                to avoid some or all life-sustaining
                                                                                 treatments.
                                   The MOLST form contains brief, summary
                                   information on a patient’s treatment          The MOLST form is hot pink in color so
                                                                                                   continued on Page 3 -
                                             Quality Healthcare Close to Home




                                             New Appointments                            Continued from page 1 -

   S
64-Slice CT Offers Enhanced                  Adolfo Llanos, MD, has joined the team      it is easily identifiable in case of an
Capabilities                                 at Arnot Health specializing in             emergency. Do not, however,
                                             Neonatology.                                assume that a hot pink form
In CT imaging, each X-ray                                                                automatically signifies a DNR. In the
measurement lasts just a fraction of a       Dr. Llanos completed his medical            MOLST form, section A, patients are
second and represents a "slice" of an        training at Universidad del Norte,          given a choice of DNR or CPR (no-
organ or tissue. As recently as last year,   Barranquilla, Colombia, and pediatric       limitations). MOLST forms are
the technical gold standard was 16-          residency training at Universidad del       designed to travel with the
slice, requiring patients to hold their      Rosario, Bogota, Colombia, and              individual between care settings.The
breath 25 to 40 seconds in the time it       Maimonides Medical Center, Brooklyn,        form should be kept in the front of
took to perform the scan. Arnot              NY. Dr. Llanos is certified by the          the patient’s medical chart when in
Ogden Medical Center's 64-slice, high        American Board of Pediatrics and the        a facility; when they are transferred,
speed, high resolution CT scanner, the       American Board of Neonatal-Perinatal        a copy of the form should be made
only one of its kind in the region, can      Medicine. He is an American Academy         on hot pink paper and kept in the
provide thousands of three-dimensional       of Pediatrics Fellow.                       chart, the original being sent with
images per minute and completes a full                                                   the patient. Photocopies and faxes
rotation in just 1/3 of a second, with a     To schedule an appointment or for           of the form are legal and valid.
significantly lower dose of radiation–all    more information, call 607-737-4543.
in an 8- to12-second breath hold.                                                        To be valid, a MOLST form must be
                                                              _____                      signed by a licensed physician.Verbal
Its advanced technology improves                                                         orders are acceptable with a follow-
imaging of the heart and other organs,       Taseer Cheema, MD, has joined the           up signature by a physician in
making the diagnosis of certain diseases     Hospitalist Program at Arnot Ogden          accordance with facility policy.
faster, easier and potentially more          Medical Center.                             Completing all four pages of the
accurate.The extended coverage of                                                        form is advised; incomplete sections
anatomical areas and more detailed           Dr. Cheema completed his medical            indicate full treatment for that
images provided by this technology is        training at Allama Iqbal Medical College,   section.
key in clinical applications such as early   Lahore, Pakistan, and residency in
tumor detection.The 64-slice scanner's       Internal Medicine at Woodhull Medical       Primary care physicians may
capabilities also include:                   Center, Brooklyn, NY.                       complete the MOLST form with
                                                                                         their patients prior to admission.
• Vasculature evaluation of the head,        To schedule an appointment or for           Physicians should update and sign
  neck, abdomen, pelvis and                  more information, call 607-737-7770.        the document every 90 days for
  extremities using CT Angiography.                                                      outpatients, every 60 days for long-
                                                              _____                      term care patients, and weekly for
• Evaluation of osteopathic and                                                          inpatients. A new form is not
  traumatic alterations of bone surface      Robert Cole, MD, and Douglas                necessary each time it is revised;
  using 3-dimensional imaging.               McKane, MD, have joined Arnot               updates can be recorded in the
                                             Medical Services, specializing in           appropriate section of the form.
• Diagnosis of specific regions of           Bariatric Surgery at 100 John               The order remains valid even if it
  interest including heart scans, lung       Roemmelt, Drive, Horseheads.                has not been revised within the
  scans and virtual colonoscopies.           Formerly the Bariatric Surgery              appropriate time period.
                                             Associates, their practice is designated
Appointments may be arranged for             a Center of Excellence by Excellus          The MOLST will be available as a
your patient through Arnot Ogden             Blue Cross Blue Shield and the              stock form from supply at Arnot
Medical Center Radiology Scheduling at       American Society for Bariatric Surgery.     Ogden Medical Center. If you have
607-735-4646.                                                                            any question concerning the
                                             To schedule an appointment or for           MOLST form, contact Medical
                                             more information, call 607-796-5936.        Social Work at 607-737-4132.
                                                                                                                                   3
ArnotHealth
INSIGHT                                                                                 September 2006




    Hospitalist Program                                                                 Department News

    New Hospitalist Program Medical          care for patients transferred to Arnot     Arnot Health Will Offer Laparoscopic
    Director Appointed                       Ogden Medical Center from other            Bariatric Surgery
                                             facilities in the region for specialized
                                             care, as well as patients who do not       Laparoscopic Bariatric Surgery has recently
                                             have a primary care physician or are       come to the forefront of surgical weight
                                             admitted through the emergency             loss options with its appealing shortened
                                             department.                                recovery time, decreased post-operative
                                                                                        discomfort, and significantly lessened
                                             Arnot Health Hospitalists know the         scarring compared to traditional invasive
                                             facility intimately, and therefore have    bariatric surgery.
                                             the knowledge and expertise to
                                             arrange the best possible plan of          The laparoscopic approach employs a fiber
                                             action. Because they work on-site at       optic laparoscope introduced into the body
    Bharathi Thuraisamy, MD was recently     the hospital, patients or family           through a series of small incisions of less
    appointed to the role of Medical         members can always get a prompt            than half an inch in length.The patient's
    Director of the Hospitalist Program      answer to questions about their care,      muscles are separated to enter the
    at Arnot Ogden Medical Center. Dr.       and by carefully coordinating              abdomen, and plastic ports are introduced
    Thuraisamy received her medical          treatment and facilitating the flow of     through the incisions. Carbon dioxide gas
    degree from Rajah Muthiab Medical        patient information, Hospitalist care      is pumped through a channel to facilitate
    College, Annamalai, India, and           can shorten the length of hospital         expansion, creating a space for
    completed her residency in Internal      stays.                                     instrumentation. Images from inside the
    Medicine at Woodhull Hospital,                                                      abdomen are transmitted onto a television
    Brooklyn, NY.                            Primary care physicians can contact a      monitor, and patients undergo the
                                             Hospitalist before their patient’s         procedure under general anesthesia.
    As Medical Director of the               hospital stay begins, and the              Laparoscopic bariatric surgery is intended
    Hospitalist Program, Dr. Thuraisamy      Hospitalist can streamline the             to be the most effective and least invasive
    will be responsible for the daily        admission process. When it is time         type of bariatric surgical methods.
    operation of the growing Hospitalist     for a patient to be released,
    Program at Arnot Ogden Medical           Hospitalists coordinate discharge and      The overall outcome following laparoscopic
    Center, ensuring compliance with         follow-up care and relay in-patient        weight loss surgery appears to be
    JCAHO standards, facilitating            information to the primary care            comparable to that following an equivalent
    development and implementation of        physician, ensuring patients receive       open procedure. However, not all patients
    continuous quality improvement           the best and most coordinated care.        are suitable for laparoscopic weight
    programs, and guiding strategic          For more information about                 reduction surgery, and in some
    planning on issues pertinent to the      Hospitalist care at Arnot Ogden            laparoscopic cases, conversion to an open
    success of the Hospitalist Program.      Medical Center, call 607-737-7770.         bariatric procedure is sometimes necessary.

    The Hospitalist Program at Arnot                                                    The Arnot Health Bariatric Surgery
    Ogden Medical Center is staffed by                                                  Program, with new surgeon Dr.Taesun
    internal medicine physicians who                                                    Moon, who specializes in bariatric
    specialize in the care of hospitalized                                              procedures, will soon offer this approach to
    patients. Arnot Health Hospitalists                                                 weight loss surgery. Dr. Moon joins Drs.
    partner with primary care physicians                                                Cole and McKane, becoming part of a
    to communicate patient needs and                                                    program named a Center of Excellence for
    information while in the hospital and                                               Bariatric Surgery by Excellus Blue Cross
    coordinate with specialists, surgeons,                                              Blue Shield and the American Society for
    nurses and the rehabilitation program                                               Bariatric Surgery. For more information on
    to design a successful plan of action.                                              the bariatric surgery program at Arnot
    Hospitalists also admit and provide                                                 Health, contact 607-796-5936.

2
                                                                                          Quality Healthcare Close to Home
ArnotHealth
INSIGHT                                                                                   September 2006




Hyperbaric Oxygen Therapy                   actinomycosis, gas gangrene, arterial
                                            insufficiency ulcers, venous stasis ulcers,    ArnotHealth

                                                                                           INSIGHT
Every year, chronic wounds caused by        osteoradionecrosis, osteomyelitis,
diabetes, poor circulation or other         crush injuries, complete or partial limb
conditions affect three to five million     amputation, air embolism, carbon
Americans. Hyperbaric Oxygen                monoxide poisoning, cyanide
Therapy, offered at Arnot Health's          poisoning, decompression sickness,
Center for Wound Healing, can               preservation of compromised skin
                                                                                                                         b
                                                                                          Arnot Health is a community-based,
enhance medical and surgical                graft, and diabetic foot ulcer (Wagner
                                                                                              f p
                                                                                          not-for-profit healthcare system
methodologies available for patients        grade III wound with no improvement
                                                                                          operated for the public benefit.
with chronic wounds and related issues.     in 30 days of normal treatment).
                                                                                          Contents may not be reproduced
                                                                                          in whole or in part without written
Hyperbaric Oxygen Therapy with              For patients suffering chronic wounds
                                                                                          permission. 607-737-4100 /
aggressive wound healing protocols          who may benefit from Hyperbaric
                                            Oxygen Therapy, the multi-disciplinary        www.arnothealth.org
has been shown to be cost effective in
reducing morbidity and mortality from       medical team at the Center for
non-healing wounds, below the knee          Wound Healing can work directly with
amputations, incapacitating surgical        the primary care physician to carefully
revisions to wounds and life                evaluate patient condition and medical
threatening infections. Medical             history and develop a correct, specific
practitioners recognize the positive        and individualized plan to treat wounds
results and referral networks will          and subsequent complications.
continue to grown to the existing           Hyperbaric Oxygen Therapy facilitates
Hyperbaric Oxygen hospital based            the experience of a positive healing
facilities. Recent retrospective research   outcome. After any treatment at the
by Medicare has reinforced this,            Center for Wound healing, patients
increasing reimbursement for these          are returned to their primary care
services and expanding recognized           physician with progress notes.
indications for Hyperbaric Oxygen
Therapy.                                    For more information or to schedule
                                            an appointment for your patient
Medicare approved diagnosis for             contact the Center for Wound
Hyperbaric Oxygen Therapy include:          Healing at 607-737-4584.


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