Trilogyâ„¢ Revolutionizes Radiation Oncology

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					                                                                                                                    September 2006




                         Physician
                                                   W A S H I N G T O N H O S P I TA L C E N T E R                            vol. 12, no. 8




                                                                               News for Medical Staff, Residents, Fellows and Alumni




Inside…
Talking SBAR
 ..........6
                                                                    Trilogy™
Asssessing
Surgical
                                                                    Revolutionizes
Skills
 . . . . . . . . . 12
                                                                    Radiation Oncology
                                                                                                                      by Catherine Avery
New Chief of
Cardiology
. . . . . . . . . .15




                                                                                                                                              (Photo by Rick Reinhard)
                         Dr. Pamela Randolph-Jackson,
                         chair of the Department of
                         Radiation Oncology, shows off
                         the Trilogy system to Chief
                         Medical Officer Dr. Janis



                                                                                      W
                         Orlowski and Foundation                                                 ashington Hospital Center added a
                         Board Chairman John Sargent.                                            third state-of-the-art linear accel-
                                                                                                 erator to its radiation oncology
                                                                                      armamentarium in April, extending radiation
                                                                                      therapy applications and improving patient

                    Microsoft                                                         flow. Varian’s Trilogy™ Stereotactic System
                                                                                      presents a new direction in cancer care, with

                    Purchases Azyxxi                                                  power, precision and versatility that revolu-
                                                                                      tionize radiation therapy.

                    Giant’s First Foray into                                          “The Trilogy enables the department to offer com-
                                                                                      prehensive radiotherapeutic options to patients, with
                    Industry Applications                                             both stereotactic radiotherapy and radiosurgery,”

                    by Catherine Avery                                                                              continued on page 10




                   S
                         oftware giant Microsoft Corporation has chosen
                         MedStar Health’s AzyxxiTM health information
                         system as the cornerstone of a new health strat-
                   egy and its first-ever venture into industry-specific
                   applications.
                                                         continued on page 8
      Chief Medical Officer

Making the Hand Off Safe
Using SBAR
by Janis M. Orlowski, MD



I
   n recent months we have had two               To respond to the new JCAHO requirement,
   significant situations in which the transfer   the Clinical Improvement Committee at
   of patient care from one service to           Washington Hospital Center has charged the
another—what is known now as “the hand           ad hoc team, the Hand Off Performance
off”—did not go well.                            Improvement Task Force, comprised of
                                                 physicians and nurses, to develop a protocol
In reviewing these cases, miscommunication       to assure that the transfer of patients goes
between medical personnel was at the heart       smoothly. Details of that protocol are in the
of the medical error.                            article on page 6.
The good new is we know how to prevent           The health care industry is borrowing a pro-
this from happening. It’s called “effective      cedure developed by the United States Navy
communication.” And it takes great team-         known as SBAR: The SBAR technique pro-
work to make it work.                            vides you with a framework for communi-
                                                 cating the most critical information about a
We know from our own experiences and in
                                                 patient’s condition.
studies done by organizations such as the
Joint Commission on Accreditation of             ■   Situation
Healthcare Organizations and the University      ■   Background
HealthSystem Consortium that ineffective
communication is the most frequently cited       ■   Assessment
category of sentinel events.                     ■   Recommendation
This year, JCAHO added a National Patient        We are in the process of teaching physicians,
Safety Goal requiring organizations to           nurses, and house staff to use SBAR commu-
“implement a standardized approach to            nications so that you receive accurate infor-
‘hand off ’ communications, including an         mation about a patient’s care, treatment and
opportunity to ask and respond to questions.”    services, current condition, and any recent or
                                                 anticipated changes. This information must
In a recent report by the UHC titled “Best       be accurate to meet the patient safety goals.
Practice Recommendation: Patient Hand Off        And, it doesn’t matter whether the hand off is
Communication,” best practice for patient        for a brief moment or permanent.
hand off communication emphasizes what is
the equivalent of the Hippocratic oath of        Ultimately, we must look at our strengthened
professional communicators: “Effective com-      teamwork and communications from a
munication, which is timely, accurate, com-      patient safety perspective.               ■
plete, unambiguous, and understood by the
recipient, reduces error and results in
improved patient/client/resident safety.”                                                          WASHINGTON HOSPITAL CENTER
In other words, if the recipient doesn’t
understand your message it has the same          Dr. Orlowski is senior vice president, Medical         June Statistics
result of not being delivered at all. In the     Affairs, and chief medical officer at Washington
                                                 Hospital Center. She can be reached at (202)                             2006 2005
health care industry, unfortunately, mis-
takes due to miscommunication can be             877-5284 and Janis.M.Orlowski@MedStar.net.        Inpatient Admissions   3,962 3,788
tragic. We must be proactive in improving
communication.                                                                                     Outpatient Clinic Visits 8,124 8,413
                                                                                                   ED Visits              6,398 5,951
                                                                                                   ED Admissions          1,604 1,532
                                                                                                   Average Daily Census     697    694
                                                                                                   Births                   382    336

–2–
      Insider

State of the System
MedStar Health President/COO Presents Healthy Outlook
for Organization
                                                                                                      Preparedness Planning Workgroup that is

                         A
                                 t the June       When it comes to capital spending, MedStar
                                 Department       this year expects to spend more than $125           comprised of leaders from across the system
                                 Head meet-       million on its hospitals, which is up from the      who will be tasked with developing a corpo-
                         ing, MedStar Presi-      $115 million spent on capital expenses in           rate crisis management plan that collaborates
                         dent and Chief           FY05. Samet confirmed that MedStar will              with and supports individual site disaster
                         Operating Officer         need to continue to spend around 125 per-           plans. The work group will facilitate a table-
                         Kenneth A. Samet         cent of depreciation each year on strategi-         top exercise for all hospitals this fall.
                         presented his semi-      cally planned and routine capital expenses to
                                                  continue to build and maintain the health           “We have to make certain that we are sharing
                         annual “State of the                                                         best practices and content knowledge, and
Kenneth A. Samet,        System” update to        care system.
                                                                                                      that we are optimally organized to respond
COO, MedStar Health Washington Hospi-
                                                  Mentioning how important it is that MedStar         with all system resources if a system compo-
                         tal Center managers                                                          nent is impacted by an extraordinary disaster
                                                  employees work to gain the public’s trust,
and department chairmen. The forum pro-                                                               situation,” said Samet.
                                                  Samet outlined the system’s plan for working
vided Samet the opportunity to share cur-
                                                  with insurers and third party payers who
rent information about MedStar’s financial                                                             Additionally, the MedStar leadership team has
                                                  reimburse the organization for care provided.
performance in the current fiscal year,                                                                developed a council and five task forces
                                                  He stressed that while MedStar does try and
patient satisfaction scores and the details of                                                        focused on moving the system from “Good to
                                                  collect legitimate bills within charity care/dis-
several system-wide initiatives. He closed                                                            Great” by further creating a culture and
                                                  count policies, MedStar hospitals never deny
the meeting with a “MedStar in the News”                                                              organization that is deeply committed to clin-
                                                  anyone life-sustaining care based on their
compilation of television video clips high-                                                           ical excellence, world-class service and being
                                                  ability to pay.
lighting all seven MedStar hospitals.                                                                 an Employer of Choice. This effort was for-
                                                                                                      mally launched with the system’s senior man-
Financial Performance                             Patient Satisfaction                                agers in June. Already this year, MedStar has
                                                  Samet reviewed current patient satisfaction         proven its workforce excellence by being
MedStar stood in an overall positive position
                                                  survey data from all MedStar hospitals,             named to the lists of Best Places to Work in
as it closed out FY06. “While the Emergency
                                                  proudly noting that the trend line for three-       both the Washington Business Journal and
Department volume system-wide has
                                                  year mean scores shows that patients receiv-        Baltimore Business Journal.
increased, we have seen a slight decrease in
                                                  ing care within the system are stating they are
overall admissions,” said Samet. The system is                                                        By pointing out that MedStar hospital depart-
                                                  more satisfied than ever. The trend lines were
0.7 percent behind budget in the fiscal year—                                                          ments contributed almost 1,700 action plans
                                                  especially gratifying, when compared to hos-
and, for the first time in three years, has seen                                                       after the 2004 Employee Satisfaction Survey,
                                                  pitals in other urban settings’’— showing that
no statistically demonstrated “market                                                                 Samet emphasized the importance the system
                                                  MedStar is ranking above similar hospitals
growth.” Overall, MedStar expects to finish                                                            places on employee feedback. He then enthu-
                                                  when it comes to patient satisfaction.
the fiscal year with net revenue of about $2.7                                                         siastically shared that he and other system
billion, and employees can feel very positive     Managers also received an overview of the           leaders look forward to the 2006 Employee
about contributing to a system turnaround of      upcoming Hospital Consumer Assessment of            Satisfaction Survey, which will be conducted
over $200 million during a four-year period       Health Providers and Systems (HCAHPS)               this September.
in a difficult market.                             survey being implemented by CMS, the
                                                  agency that administers Medicare/Medicaid.          “The single most sustainable, competitive
Samet attributes the softness in admissions                                                           advantage for MedStar Health is our 23,000
                                                  Beginning in October, HCAHPS will “go live,”
in part, to a decrease in cardiac patients at                                                         employees,” said Samet, when detailing the
                                                  and hospitals will collect patient satisfaction
some MedStar Health hospitals—in line with                                                            upcoming Employee Survey. “The survey will
                                                  data and submit their results to CMS. Such
general industry trends. He said the system                                                           be available the entire month of September,
                                                  scores will likely impact future Medicare reim-
must seek the right mix of activity across the                                                        and MedStar’s system-wide goal is to achieve
                                                  bursement, and will include public reporting
system, given capacity issues, including                                                              85 percent participation. We value the input
                                                  of patient satisfaction data. The first public
focusing on outpatient treatment and con-                                                             from each and every employee, and we look
                                                  reporting of hospital performance will be
tinuing to build public trust in the MedStar                                                          forward to giving all 23,000 employees the
                                                  available online in late 2007 or early 2008.
name and to seek to capture all revenue owed                                                          opportunity to share their opinions and to act
to the hospitals. Samet noted that all Med-                                                           on their feedback.”                         ■
Star hospitals continue to be successful, and     System Initiatives
Georgetown University Hospital and Wash-          MedStar currently has underway several sys-                               — Rachel Christoferson
ington Hospital Center have continued their       tem-wide initiatives, including an Emergency
aggressive turnarounds.

                                                                                                                                              –3–
                                     News & Notes

                                                                                                                      LATEST ULTRASOUND
                                   MEDICATION SAFETY INITIATIVE                                                       TECHNOLOGY
                                                                                                                                      Hospital Center has
                                                                                                                      W ashingtonthe latest in 9, providing
                                                                                                                           acquired
                                                                                                                      technology, the GE LOGIQ
                                                                                                                                                 ultrasound

                                                                                                                      physicians with the smallest details with
                                                                                                                      stunning clarity about their patients’
                                                                                                                      conditions. If you compare previous
(Photos by Annamarie G. DeCarlo)




                                                                                                                      technology to taking photographs, this
                                                                                                                      new system can be compared to filming
                                                                                                                      a movie. And, because so much detail is
                                                                                                                      obtained during the ultrasound test,
                                                                                                                      physicians can “rescan” a patient by
                                                                                                                      reviewing the raw data they have
                                                                                                                      obtained – long after the patient has left
                                                                                                                      the exam room. This system can be used
                                                                                                                      for scanning virtually any part of the
                                   C   hief Medical Officer Dr. Janis Orlowski made medication safety rounds on
                                       two units recently to followup on the adherence to the zero tolerance policy
                                   regarding non-compliance on order writing. Left, she reviews charts with Nurse
                                                                                                                      body. For more information call Dr.
                                                                                                                      Michael Smith at (202) 877-6030.

                                   Practitioner Judy Cunningham on 3C. Right, she answers a question posed by
                                   Clinical Nurse Chidi Ifeandu, 3D.
                                                                                                                      NEW ADMINISTRATIVE
                                                                                                                      RESIDENT
CALL TO INCREASE DIABETES FUNDING                                                                                     Z   al Damkevala
                                                                                                                          has joined
                                                                                                                      Washington Hos-
D   r. Wayman Cheatham and Dr. Michelle Magee of the MedStar Research and
    Diabetes Institutes participated in the American Diabetes Association’s “Call to
Congress” on June 9. They joined a group of 500 diabetes advocates in calling on
                                                                                                                      pital Center as its
                                                                                                                      administrative res-
congressional members to increase NIH spending for diabetes research by five percent,                                 ident for 2006–
CDC funding for diabetes education and prevention by $20.8 million and in support of                                  2007. During this
embryonic stem cell research. Dr. Cheatham serves on the National Board of the ADA                                    one-year appoint-
and Dr. Magee is president of its Mid-Atlantic Affiliate.                                                             ment, Damkevala
                                                                                                                      will work closely
                                                                                                                      with hospital administrators to gain insight
                                                                                                                      on how large hospitals are managed. He
                                                                                                                      recently received his Master of Health
                                                            RUIZ A WHITE HOUSE FELLOW                                 Administration (MHA) degree from Penn
                                                                                                                      State University. Among his graduate proj-
                                                                              a
                                                            Dr. GeorgeaRuiz,withcardiologist specializing in treat-
                                                               ment of adults     congenital heart disease, has
                                                            been named White House Fellow for 2006-2007.
                                                                                                                      ects were developing strategies to improve
                                                                                                                      patient flow and developing a project
                                                             Dr. Ruiz has been with the Washington Adult Congen-      management toolbox for hospital adminis-
                                                             ital Heart Center, an affiliation between Washington      trators. Prior to attending Penn State,
                                                             Hospital Center and Children’s National Medical          Damkevala worked on the clinical side of
                                                             Center, since 2005.                                      medicine in his home country of India,
                                                             He is one of just 14 “exceptional young men and          where he earned a Bachelor of Medicine
                                                             women” nationwide selected for the program, which        and Bachelor of Surgery (MBBS) degree
                                                             was founded in 1964 by President Lyndon B. Johnson,      from the University of Mumbai in Bombay.
                                   according to the White House news release. The program offers the fellows
                                   first-hand experience working at the highest levels of the Federal government.      Megan McKeown, last year’s resident,
                                   White House Fellows typically spend one year working as full-time, paid special    has accepted a position at MedStar
                                   assistants to senior White House Staff, Cabinet Secretaries, and other top-        Health’s corporate offices.
                                   ranking government officials. Fellows also participate in an education program
                                   consisting of roundtable discussions with leaders from the private and public
                                   sectors, and trips to study U.S. policy in action both domestically and abroad.


–4–
                                 W A S H I N G T O N                                 H O S P I T A L                     C E N T E R
                                 OFFICE               OF      CONTINUING MEDICAL EDUCATION
                                                   SEPTEMBER 2006 — HIGHLIGHTS
                              Upcoming CME Events Sponsored by Washington Hospital Center • www.WHCenter.org/CMEOffice

                                                                           REGULARLY SCHEDULED CATEGORY 1 CONFERENCES
 THIS MONTH’S                 All activities listed are approved for
                                 AMA PRA Category 1 Credit.
                                                                        ANESTHESIOLOGY                         NEUROSURGERY
 PHYSICIAN                        Category 2 activities are self-
                              reporting, effective October 2002.
                                                                        Anesthesiology Clinical                Neurosurgery Conference
 BLOOD-DONOR                                                            Conference
                                                                        Weekly, Tuesdays, 7:00 a.m.
                                                                                                               Weekly, Tuesdays, 7:30 a.m.
                                                                                                               CTEC Board Room–6th Floor
 SUPER HERO                  OCTOBER 15 – 18, 2006
                                                                        Room G-200
                                                                        1 AMA PRA Category 1 Credit TM
                                                                                                               1 AMA PRA Category 1 Credit TM
                                                                                                               (202) 877-5580
                             CareScience National Confer-               (202) 877-7500
                             ence — Quality in Motion: From                                                    OBSTETRICS/GYNECOLOGY
                             Innovation to Collaboration                CARDIOLOGY/CARDIOVASCULAR              OB/GYN Grand Rounds
                                                                        Cardiac Catheterization                Weekly, Tuesdays, 8:00 a.m.
                             Jointly Sponsored by Washington Hospital
                                                                        Conference                             5B–3 Conference Room
                             Center & CareScience, Inc.                 Weekly, Wednesdays, 7:30 a.m.          1 AMA PRA Category 1 Credit TM
                             Richard Bankovitz, MD – Activity           True Auditorium                        (202) 877-6054
                             Director                                   1 AMA PRA Category 1 Credit TM
                             Portofino Bay Hotel, Orlando, Fla.         (202) 877-8574                         ONCOLOGY Presented by the
                             (215) 387-9401                                                                    Washington Cancer Institute (WCI)
                                                                        Updates in Cardiovascular
                             20 AMA PRA Category 1 Credits TM           Medicine Lecture Series                Gastrointestinal Oncology
                                                                        Dates TBD                              Case Presentations
                             DECEMBER 8, 2006                           District, Maryland and Virginia Area   Bi-Monthly, 2nd & Last Fridays,
                             Thyroid Disorders: Recent Clinical         Restaurants                            8:00 a.m. – 10 :00 a.m.
                                                                        2 AMA PRA Category 1 Credits TM        Surgical Classroom – Room G-270
                             Advances                                                                          2 AMA PRA Category 1 Credits TM
                             Presented by Washington Hospital Center    (202) 877-2992
                                                                                                               (202) 877-3908
                             & the Division of Endocrinology            Echocardiography Conference
                                                                        Weekly, Thursdays, 7:45 a.m.           Multidisciplinary Breast Cancer
                             Kenneth Burman, MD – Activity Director
W    hy John K. Kilcullen,
     MD, surgical critical
 care, donates blood:
                             True Auditorium
                             Washington Hospital Center
                                                                        Cath Lab Conference Room (5th Flr)
                                                                        1 AMA PRA Category 1 Credit TM
                                                                        (202) 877-7853
                                                                                                               Treatment Conference
                                                                                                               Weekly, Wednesdays, 7:30 a.m.
                                                                                                               Siegel Auditorium
                             (202) 877-8206                                                                    1 AMA PRA Category 1 Credit TM
                             9 AMA PRA Category 1 CreditTM              EMERGENCY MEDICINE                     (202) 877-7937
“My parents lived
                                                                        Emergency Medicine                     OPHTHALMOLOGY Presented by
 through World War II                                                   Grand Rounds                           Washington National Eye Center
 when blood donation                                                    Monthly, Third Thursdays, 7:00 a.m.
 was a part of life. They                                               Emergency Department Conf. Rm.         Saturday Morning Lecture Series
                                                                        1 AMA PRA Category 1 Credit TM         Weekly, Saturdays, 8:30 a.m.
 brought me to neigh-                                                   (202) 877-9191                         True Auditorium
 borhood blood drives                                                                                          2.5 AMA PRA Category 1 CreditsTM
                                                                        Emergency Medicine Continuous          (202) 877-6159
 as a teenager and I've                                                 Certification (EMCC) Literature
 been donating regularly                                                Review                                 ORTHOPAEDICS
                                                                        Monthly, Last Thursdays, 7:30 a.m.     Orthopaedic Grand Rounds
 ever since.”                                                           Emergency Department Conf. Rm.         Monthly, 1st Monday
                                           Log on to                    1 AMA PRA Category 1 Credit TM         7:45 a.m. – 9:15 a.m.
                              www.DiabetesRoundtable.com                (202) 877-9393                         3 NW Conference Room
                               for CME learning modules, slide          Emergency Medicine Faculty             1.5 AMA PRA Category 1 Credits TM
                              library, eGrand Rounds, literature        Development Series                     (202) 877-8150
                                 update and daily news feed             Dates TBD
                                                                        Emergency Department Conf. Room        OTOLARYNGOLOGY
                                                                        1 AMA PRA Category 1 Credit TM         Multidisciplinary Head and Neck
                                                                        (202) 877-9393                         Tumor Board Conference
                                                                                                               Weekly, Thursdays, 4:00 – 5:00 p.m.
                                                                        MEDICINE                               Siegel Auditorium
                                    New Era of Medicine                                                        1 AMA PRA Category 1 Credit TM
                                                                        GRAND ROUNDS
                               Conference —2006 Highlights              Weekly, Wednesdays, 12:30 p.m.         (202) 877-9403
                                       “Management of                   True Auditorium
                                                                        1 AMA PRA Category 1 Credit TM         SURGERY
                              Hyperglycemia in the Hospital”
                                                                        (202) 877-3109 or (202) 877-6749       General Surgery Orange Team
                                available as a web module on                                                   Teaching Conference and Lecture
                                  SitelMS—Online Learning               NRH Medical Grand Rounds               Weekly, Thursdays, 8:00 a.m.
                                 Management System. Go to               Weekly, Fridays, Noon                  General Surgery Conference Room
                               www.whc.sitelms.org to register          NRH Auditorium                         2 AMA PRA Category 1 Credits TM
                                                                        1 AMA PRA Category 1 Credit TM         (202) 877-9847
                              and create your personal account          (202) 877-1660
                                                                                                               Surgery Grand Rounds
                                                                        NEONATOLOGY                            Weekly, Tuesdays, 8:00 a.m.
     Call                                                               Visiting Lecturer Series
                                                                        in Perinatal Pediatrics
                                                                                                               True Auditorium
                                                                                                               1 AMA PRA Category 1 Credit TM
202-877-5250                  William M. Steinberg’s Board
                              Review in Gastroenterology—
                                                                        Bi-Monthly, 1st & 2nd Tuesdays
                                                                        12:30 p.m.
                                                                                                               (202) 877-6426
                                                                                                               UROLOGY
for an appointment              Audio, Video & DVD sets                 5B–3 Conference Room
                                                                        1 AMA PRA Category 1 Credit TM         Urology Academic Series
                               40 AMA PRA Category 1 Credits TM                                                Weekly, Tuesdays, 8:00 a.m.
                                                                        (202) 877-6527
                               Call 1-800-283-1997 to order                                                    Siegel Auditorium
                                                                                                               1 AMA PRA Category 1 Credit TM
                                                                                                               (202) 877-3968

                                                                                                                                                   –5–
    Feature

Situation–Background–Assessment–
Recommendation
Precise Language Gets Point Across Quickly

H
        ealth care providers are taking a        The Joint Commission on Accreditation of          hand off situations are described as includ-
        page from the United States Navy by      Healthcare Organizations established a new        ing, but not limited to: physicians transfer-
        adapting its tried-and-true SBAR         National Patient Safety Goal this year that       ring complete responsibility for a patient;
communication tactic to the hospital setting.    requires hospitals to “implement a standard-      physicians transferring on-call responsibility;
Situation-Background-Assessment-Recom-           ized approach to ‘hand off’ communications,       temporary responsibility for staff leaving the
mendation is the framework a care giver uses     including an opportunity to ask and respond       unit for a short period of time; anesthesiolo-
to transfer the most critical information        to questions.”                                    gists reporting to the post-anesthesia recov-
about a patient when handing off a patient to                                                      ery room nurse; nurse and physician hand
another care giver. The goal of SBAR is to                                                         off from the emergency room to inpatient
organize information about a patient and                                                           units, different hospitals, nursing homes, and
present it in a way that gives the listener(s)       The goal of SBAR is to                        home health care; nursing shift changes; and
the facts quickly and coherently.                organize information about a                      critical laboratory and radiology results sent
“In recent months we have had two
                                                 patient and present it in a way                   to physician offices.
significant situations in which the transfer of     that gives the listener(s) the                  The Hospital Center’s Clinical Improvement
patient care from one service to another—         facts quickly and coherently.                    Committee charged the Hand Off Perfor-
what is known now as ‘the handoff’—did                                                             mance Improvement Task Force, comprised
not go well,” said Janis M. Orlowski, MD,                                                          of physicians and nurses, to develop a proto-
senior vice president of Medical Affairs and                                                       col for training physicians, nurses, and House
chief medical officer.“The SBAR technique is      In a white paper released this year by the Uni-   Staff to the SBAR system, and education has
in place to assure that these tragic incidents   versity HealthSystem Consortium, titled           been underway this summer.                  ■
do not happen.”                                  “UHC Best Practice Recommendation:
                                                 patient Hand Off Communication,” patient                             — Annamarie G. DeCarlo



   The following scenario has been used in role playing exercises to      A: The surgeon should have readily available the
   practice the SBAR method.                                                   patient’s background information such as age, gender,
                                                                               date admitted, basic past medical history, date of last
   SAMPLE PHYSICIAN “HAND OFF”                                                 dialysis, allergies, and his/her current assessment of the
                                                                               patient’s condition.
   Case: Mrs. Jane Doe is a 56-year-old female with end stage
   renal disease who is admitted to the surgical floor for a pro-         Q: How should the surgeon communicate this information
   cedure. At 10 a.m. on Thursday, laboratory personnel call                   to the nephrologist?
   Mrs. Doe’s surgeon to report a critical potassium level of 6.8.        A: Through the SBAR technique: Situation, Background,
   Q: After receiving the critical results what should the                     Assessment, and Recommendation. Formulate Jane
        surgeon do?                                                            Doe’s situation using the SBAR method.
   A: The surgeon should READ BACK the critical result to                 Situation: Mrs. Jane Doe is a 56-year-old female with end
        laboratory personnel with the following statement:                stage renal disease and a critical potassium of 6.8.
        “Mrs. Jane Doe has a potassium of 6.8.”                           Background: She has a past medical history significant for
   Q: What is the responsibility of the laboratory personnel              hypertension and was admitted yesterday for a surgical
        reporting this critical result?                                   procedure, having missed dialysis two days ago. She has no
                                                                          allergies to medications and is a full code.
   A: The personnel reporting this critical result should record
        that a READ BACK has taken place.                                 Assessment: Clinically she is in no distress with stable vital
                                                                          signs. The EKG shows manifestations of hyperkalemia.
   At 10:05 a.m., the surgeon assesses the patient and
   calls Mrs. Jane Doe’s nephrologist.                                    Recommendations: I recommend that we get a STAT
                                                                          dialysis because the EKG shows signs of hyperkalemia.
   Q: What information should the surgeon gather prior to
                                                                          Appropriate medications have been administered for
        calling/paging the nephrologist?
                                                                          hyperkalemia and the patient needs emergent dialysis.         ■



–6–
   Feature


In the Aftermath of
Hurricane Katrina

D
        orothy Jacques died in the aftermath      She began working over the phone with a         Ms. Davis got in touch with Medicare and
        of Hurricane Katrina. The 87-year-        woman from FEMA who was collecting              found out where the surgery had been done.
        old New Orleans native was on life        historical information in an effort to iden-    She then began tracking down the doctor,
support in a nursing home that first lost its      tify bodies.                                    who had moved out of state. She got in touch
electricity to the winds and then saw its gen-                                                    with the office manager of the clinic where
                                                  “For example, my mother was on a feeding        the surgery had been performed and the
erators fail.
                                                  tube, she had a hip replacement, she had long   woman, miraculously, remembered Mrs.
She died September 1, 2005 but it took until      hair and a colostomy—these were the kinds       Jacques.
September 9 for FEMA, the Federal Emer-           of characteristics they would use to identify
gency Management Agency, to notify                remains,” Beverly Anderson relates. “I argued   Dr. Anderson picks up the tale: “This whole
Jacques’s family. It then took until the end of   at the time—I was about fed up with             thing was something that God solved,
November for the body to be identified.            FEMA—I said, ‘Well, I really want to use        because we as human beings could not put all
                                                                                                                   this together.”
The identification was
done by her son-in-law Dr.                                                                                          The office manager in
Ronald Anderson, an oph-                                                                                            New Orleans said she
thalmologist who is a 32-                                                                                           would do everything she
year veteran of Washing-                                                                                            could to locate the
ton Hospital Center.                                                                                                records. “The manager
                                                                                                                    went to the clinic; the
In the confusing, awful                                                                                             files were on the second
days after the storm, Dr.                                                                                           floor,” continues Beverly
Anderson’s wife, Beverly,                                                                                           Anderson. That is, they
fielded calls from her fam-                                                                                          were dry. “She was able to
ily members, who had scat-                                                                                          get my mother’s file like
tered from New Orleans.                                                                                             nothing had happened.
She became the communi-                                                                                             She mailed the original
cations center, creating a                                                                                          file to my husband.”
phone book of who was
where. On CNN, she saw                                                                                           The lenses themselves
her brother Alvin Jacques                                                                                        already had been removed
being rescued by helicop-                                                                                        from the body and mailed
                                Dr. Ronald Anderson and daughter Montina with a photo of Dorothy Jacques at      to Dr. Anderson. “I sat
ter from a roof, as well as a   her memorial services. (Family photo)
sister and her child taking                                                                                      down and had a prayer,”
shelter at the Astrodome in                                                                                      he says. “I looked at the
                                                 some objective data. A lot of old people have records and evaluated the lenses and they
Houston.
                                                 feeding tubes and [artificial] hips.’”         matched.”
Dr. Anderson left the job to his wife. “I kind
                                                 Then her sister reminded her that their It was an enormous relief for Beverly Ander-
of stayed aloof from it,” he says.
                                                 mother had had intraocular lenses implanted son and her family. “The body was not rec-
Beverly Anderson (who is president of the in 1996.                                             ognizable, so how were we to know?” she
Auxiliary to the National Medical Associa-
                                                 At this point Dr. Anderson got involved. “I says. “I couldn’t be comfortable until we had
tion) says that from August 29, the day the
                                                 said, ‘Beverly, tell them that I can I.D. her something objective.”
storm struck, until September 9, when she
                                                 through the intraocular lenses.’”             The funeral was held on December 15.
was notified by FEMA, she had no idea of her
mother’s whereabouts or condition.               But first he had to know what kind of lenses Dorothy Jacques had found her family. ■
                                                 —the brand, type and power— his mother-                                     — Hope Keller
                                                 in-law had implanted. He put his office
                                                 manager, Wana Davis, on the case. “She’s
                                                 dynamic,” he says.




                                                                                                                                         –7–
    Feature


MICROSOFT PURCHASES AZYXXI
continued from page 1




Historically, Microsoft has avoided providing industry-specific soft-
ware, instead supplying the operating system and development tools,
and encouraging outside developers and end users to develop their
own applications. The strategic alliance between Microsoft and Med-
Star Health was announced July 26 at a joint press conference at
Washington Hospital Center.
“In acquiring Azyxxi, we believe in the vision of its founders,” said
Peter Neupert, Microsoft’s corporate vice president, health solutions
group. When it comes to the deployment of information technol-
ogy, “Health care is behind other industry segments,” Neupert
noted, citing the anticipated benefits of increased productivity,
improved outcomes and enhanced patient safety. “Azyxxi can                Accordingly, Kenneth A. Samet and Joy Drass, MD — the Hospital
deliver these benefits today.”                                             Center’s president and senior vice president for clinical services at the
                                                                          time — recruited Mark Smith, MD, to the Hospital Center as chair
Azyxxi (rhymes with “Trixie”) represents a quantum leap in health         of emergency medicine, a position he still holds today. Craig Feied,
intelligence software, bringing a patient’s current and past medical      MD, joined the Hospital Center at the same time as an ED physician
information to the clinician’s fingertips at the click of a mouse. It      and to serve as director of medical informatics. Both physicians are
captures, integrates and displays patient care data from wherever it is   exceptionally skilled in information technology, with a deep, on-the-
generated. What started in the Hospital Center’s Emergency Depart-        job understanding of how technology can enhance clinical practice.
ment a decade ago is now used throughout all MedStar hospitals.           Fidrik Iskandar, who came to the Hospital Center along with Smith
In 1995, leadership at Washington Hospital Center had a vision for a      and Feied, also has been a key member of the development team.
future in which information technology could transform the prac-          The result is Azyxxi, which was built from the ground up using
tice of medicine. Of equal importance at the time, new leadership         Microsoft development tools. Designed by doctors for doctors, it
was required for the Hospital Center’s Emergency Department (ED).         incorporates many different types of patient data elements from a



   AZYXXI — REAL-TIME VALUE
   A patient comes into the Emergency Department (ED) at a MedStar Health hospital. The admission clerk takes the informa-
   tion and generates an electronic chart. The pertinent information— chief complaint, room assignment — is displayed on a
   Master List for all ED physicians to view.
   The physician then looks at the patient’s past visits to MedStar EDs, past admissions to MedStar hospitals and past
   outpatient visits to a MedStar facility, to establish a context for the workup. Tests are ordered and results are available elec-
   tronically, along with relevant graphs. All MedStar-generated images, static and dynamic, are available for viewing. All
   medications prescribed by MedStar physicians are retrievable to round out the picture. And, if a test result merits immediate
   attention— elevated cardiac enzymes, for example — the doctor’s pager is alerted.
   If the patient is admitted to the hospital, patient care units have access to the same information to track the patient’s
   progress. All new tests and therapies become part of the record. The system tracks patients systemwide to detect any infec-
   tious outbreaks or anomalies that merit attention.
   The result— all the necessary data elements are instantly available so physicians can hone in on the correct diagnosis and
   formulate an individualized treatment plan, and hospital administrators can improve patient care and enhance safety. All the
   necessary information— one mouse click and one-eighth of a second away. That’s Azyxxi in a nutshell. And, thanks to the
   strategic alliance with Microsoft, the future promises information availability beyond the MedStar Health system, to every
   hospital and every physician, for the benefit of every patient.                                                            ■
                                                                                                                           — Catherine Avery



–8–
                                                                             AZYXXI NEWS CONFERENCE




wide variety of different sources, making all the data instantly avail-




                                                                                                                                            (Photos by Allison O’Brien)
able through a single interface. Putting information into the appro-
priate context improves clinical decision-making and enables physi-
cians to fine-tune treatment choices. Azyxxi also improves patient
flow through hospital departments, helps nurses coordinate care in
patient care units, and tracks infection patterns and trends in med-
ication usage. The Azyxxi team now consists of some 40 profession-
als who are dedicated to enhancing and deploying Azyxxi applica-             Dr. Mark Smith and Washington Hospital Center President
tions throughout MedStar.                                                    James F. Caldas chat before the news conference.
“It’s an honor for all those throughout MedStar who have worked to
develop, support and improve Azyxxi that Microsoft has chosen our
product,” Samet notes. “I am very proud of what we were able to
accomplish internally over these last 10 years. However, moving
Azyxxi’s development to a more significant and lasting platform
requires a major development partner, and that is certainly a role for
Microsoft.”
For Smith, the alliance is a dream come true. “Azyxxi helps our clini-
cians save lives by enabling them to deliver care better, faster and
safer,” he says. “When we showed Azyxxi to former Gov. Tommy
Thompson (former U.S. Secretary of Health and Human Services),
he asked, ‘Why can’t this system be in every hospital in the country?’
I am delighted to be able to answer him, ‘Well, now it can.’”
Feied has lived and breathed Azyxxi for the past 10 years. “Clini-
cians historically spend 60 percent of their time looking for infor-
mation,” he notes. “Azyxxi helps solve that problem. This is like an
air traffic control system for hospitals. It’s an easy to use, fast and       Microsoft's Peter Neupert, Dr. Craig Feied, Dr. Mark Smith,
comprehensive system that incorporates 12,000 data elements and              and MedStar Health President Kenneth A. Samet share a
makes them all available in real time. It makes finding a needle in a         laugh after the news conference.
haystack routine.”
The strategic alliance aims to take Azyxxi to the next level of func-
tionality, with the goal to make it widely available to health care insti-
tutions across the country and around the world. Feied, Iskandar and
the development team will be employed by Microsoft, but most will
remain based at Washington Hospital Center. Although the financial
terms of the alliance were not announced, Samet commented that it
allows MedStar to recoup its financial investment in the software
development and reduce its operating expenses, and provides seed
money for a new patient pare tower as part of the Hospital Center’s
campus development initiative.
But all agree that the greatest benefit to the alliance is that it enables
Azyxxi to realize its full potential.“Our hospital is contributing to the
advancement of patient care everywhere,” says James F. Caldas,
Washington Hospital Center president.                                  ■

                                                                             Dr. Craig Feied talks to Washington Post reporter Susan
                                                                             Levine.




                                                                                                                                           –9–
    Feature

TRILOGY IMAGE-GUIDED RADIATION THERAPY SYSTEM
continued from page 1




                       says Brian McCagh,          reducing the effects of tumor motion. It also     Similarly, the Trilogy is highly effective for
                       vice president, Oncol-      enhances patients’ comfort with shorter           the treatment of small tumors or recurrent
                       ogy Services, at Wash-      treatment times.                                  tumors previously treated with radiation
                       ington Cancer Insti-                                                          therapy, where precision is vital. It also will be
                       tute at Washington          “The Trilogy increases our arsenal of cancer-     useful for lung and abdominal tumors, where
                       Hospital Center. “This      fighting tools,” says Pamela Randolph-Jack-        respiratory gating can account for tumor
                       clearly puts us at the      son, MD, interim chair, radiation oncology.       movement within these areas. Fiducial mark-
                       leading edge of tech-       “With this new technology, we will be able to     ers can be placed within the prostate gland,
                       nology for radiation        deliver higher radiation doses with fewer side    optimizing image-guided radiation therapy
                       therapy in the DC           effects, and hopefully this will translate into   for prostate tumors that require repeated
                       region.”                    higher cure rates.”                               image verification.
                      The Hospital Center’s        The Trilogy offers the latest technologic         The Trilogy can supplement the Gamma
                      Trilogy is the only          advances, designed to broaden applications        Knife by using stereotactic radiosurgery in
                      such system in Wash-         and improve results. These include:               the treatment of tumors located in specific
                      ington, D.C. The Can-        Image guidance technology — Locates               areas of the brain. It is especially well suited
                      cer Institute also has       tumor precisely with sub-millimeter accu-         for the treatment of low lying cerebellar
two other state-of-the-art Varian 2100 linear      racy, using on-board imaging that verifies         brain tumors and tumors located laterally or
accelerators, along with a dedicated three-        positioning at each session.                      at the base of the brain, due to the unique
dimensional CT simulator, a Varian Eclipse                                                           geometry of the device. It also can be used to
treatment planning system and a Varian Varis       Respiratory gating — Synchronizes dose            treat tumors in multiple locations within the
verification system. In addition, Washington        delivery with the patient’s breathing cycle to    brain, accomplishing the required imaging in
Hospital Center has a Gamma Knife, another         ensure accuracy and reduce radiation to           one planning session and allowing targeted
kind of radiosurgery device utilizing Cobalt-      healthy tissue.                                   treatment for multiple lesions in one treat-
60 radioactive sources, which is used to treat                                                       ment session.
patients with primary and secondary brain          Imaging adaptability — Offers adapt-
tumors as well as vascular disorders.              able modes of operation, including radi-          “We’re excited to offer this new modality to
                                                   ographic, cone beam CT and fluoroscopic for       area residents who are facing the fight against
“Our goal is to provide the best radiothera-       maximum flexibility.                              cancer,” Randolph-Jackson concludes.
peutic technology in the region,” says
Lawrence Lessin, MD, medical director of the       Intensity-modulated beam delivery —               The radiation oncology suite is located on
Cancer Institute. “Image-guided radiation          Calculates dose distributions that conform to     the ground floor of the Cancer Institute. It
therapy is the new gold standard, because it       the three-dimensional shape of the target,        recently completed an extensive renovation,
delivers the highest optimal dose to tumor         including concave and complex shapes.             adding nearly a third more space to accom-
tissue while minimizing exposure—and                                                                 modate the new Trilogy device. The Wash-
                                                   Stereotactic radiosurgery — Treats                ington Cancer Institute delivers radiation
thus injury—to normal tissue.”                     tumor with surgical precision, both cranially     therapy to some 1,000 patients each year,
The Trilogy incorporates an on-board imag-         and extracranially.                               during 25,000 visits. The staff includes four
ing and respiratory gating system that tar-        Perhaps most exciting, the Trilogy makes          radiation oncologists and three radiation
gets tumors precisely, synchronizing radia-        radiation therapy an effective treatment          physicists, supported by a team of radiation
tion with the patient’s breathing and              option for more patients. “It increases our       therapists, dosimetrists, nurses and adminis-
“gating” radiotherapy to organs that move          capacity to treat patients and do more com-       trative staff.
with respiration, reducing exposure to nor-        plex cases,” Lessin says. “It adds an improved
mal tissue. Its tightly focused beam delivers                                                        For additional information about the
                                                   dimension for radiation therapy, extending        Trilogy system or to refer a patient for
highly conformal doses, allowing higher            the therapeutic index by maximizing benefit
doses of radiation. It operates at least 60 per-                                                     radiation treatment at the Washington
                                                   and minimizing harm.”                             Cancer Institute at Washington Hospital
cent faster than conventional accelerators,
                                                   Randolph-Jackson sees particular applica-         Center, please call the Physician Consult
                                                   tion for tumors located in hard-to-treat areas    Line, 1-877-877-DOCS (3627), or visit
                                                   of the body because of normal tissue toxici-      www.whcenter.org/cancer.               ■
                                                   ties. Retroperitoneal tumors are especially
                                                   amenable, because tight field arrangements
                                                   spare radiation to adjacent major organs.

– 10 –
    Feature


Surviving and Thriving:
National Cancer Survivors Day
Sugarbaker, Bowen-Ross, Vinh Among Award Recipients

M
           ore than 400 cancer survivors, fam-    Foundation, which is dedicated to igniting a                             2006 Washington Hospital Center Physician
           ily members and caregivers gath-       global response to cancer. Her husband,                                  Magazine). Together they provided gyn-
           ered at the Washington Cancer          Joseph Simone, continues to lead the Founda-                             oncology screenings, education, diagnostic
Institute at Washington Hospital Center June      tion on its mission.                                                     tests and even surgery for hundreds of at-risk
4 for a joyous National Cancer Survivors Day                                                                               women over a seven-day period. Susan is a
celebration.                                      Washington Cancer Institute                                              patient advocate at heart and is beloved by
                                                  Employee Ambassador Award                                                those in her care.
Cancer Survivors Day also is a fitting time to     Susan Bowen-Ross, RN, Gynecology
present the third annual Living Well with         Cancer Care Coordinator                                                  Volunteer of the Year Award
Cancer Awards. This year’s awards honored         A native of Grenada, Ms. Bowen-Ross                                      Christine Vinh, Assistant Vice
the Hospital Center’s Dr. Paul Sugarbaker,        recently returned from a mission trip to that                            President, Medical Affairs and
director, surgical oncology; Susan Bowen-         impoverished island, which she coordinated                               Quality Assurance
Ross, RN, gynecology-oncology; Christine          with Cancer Institute physician, Dr. Jonathan                            Thanks to her thoughtfulness and talent, Ms.
Vinh, assistant vice president, Medical Affairs   Cosin. (See cover story of the July/August                               Vinh, together with her friends in Alexandria
and Quality Assurance, and two affiliated                                                                                     Quilters, helped to create a welcoming,
organizations for donating their time, talent                                                                                hopeful atmosphere in the Washington
and compassion to improve the lives of                                                                                       Cancer Institute by creating unique quilts
people living with cancer throughout the                                                                                     with personalized squares made by patients
Washington region.                                                                                                           and family members.
During the celebration, Hospital Center                                                                                      Philanthropic Partners Award
chaplain Yvonne Gilmore-Essig blessed
three new “Quilts of Hope,” made from                                                                                        Four Seasons Hotel,
quilt pieces that bear hand-written mes-                                                                                     Washington, D.C.
sages of encouragement and love to cancer                                                                                    Thanks to the support of the Four Seasons
survivors from people throughout the                                                                                         staff, which has raised more than $250,000
Washington region. Men, women and                                                                                            in the past five years to fund cancer
children wrote poems, drew pictures and                                                                                      research, a wide range of clinical studies
created positive sayings for the quilt pieces                                                                                have touched — and saved — the lives of
at various health events the hospital spon-                                                                                  hundreds of patients at the Washington
sored during the past year. The quilts are        Dr. Anita Aggarwal and patient Natasha                                     Cancer Institute.
permanently displayed in the Cancer               Edwards, who read one of her poems
                                                  during the program.                                                        John J. Lynch Community
Institute.
                                                                                                                             Outreach Award
Merium Ann Simone                                                                                                            Archdiocesan Health Care
Distinguished Service Award                                                                                                  Network, Catholic Charities of the
Paul H. Sugarbaker, MD, Director                                                                                             Archdiocese of Washington
of Surgical Oncology, Washington                                                                                             This health care network often makes it
Cancer Institute                                                                                                             possible for the most vulnerable in our
Throughout his distinguished career, Dr.                                                                                     community to receive the cancer care they
Sugarbaker has been dedicated to expand-                                                                                     need as its staff tirelessly works to reach the
ing the oncology knowledge base, advanc-                                                                                     poor and homeless in the District. This
                                                                                                  (Photos by Max Taylor)




ing research and ultimately, providing                                                                                       award was named for Dr. John J. Lynch,
treatment options to cancer patients who                                                                                     who shared his vision and leadership to
often have no other place to turn. His lead-                                                                                 shape the Washington Cancer Institute.
ership in the field has benefited thousands                                                                                    Now retired, Dr. Lynch still devotes count-
of people in the Washington region, the                                                                                      less hours in the community, working to
nation and the world. This award is pre-                                                                                     expand cancer education and services in
                                                  Dr. Luis Zappa accepts the Merium Ann
sented in the name of the late Merium Ann                                                                                    Washington and beyond.                       ■
                                                  Simone Distinguished Service Award from
Simone, co-founder of the Spirit of Life          Brian McCagh, vice president, oncology                                                                 — So Young Pak
                                                  services, on behalf of Dr. Paul Sugarbaker.



                                                                                                                                                                    – 11 –
    Feature


Assessing Surgical Skills
Technology Advances Training

      eft surgical skills are paramount to

D
                                                The departments of obstetrics and gyne-       In addition to these devices, residents
      successful outcomes, whether              cology, and general surgery have recently     have lab models they can use to practice
      those skills are used for the most        added high-fidelity virtual reality trainers   targeting, knot tying and suturing,
minor removal of a skin tag or to trans-        to teach specific laparoscopic applica-        autonomously or with supervision. The
plant multiple organ systems. But how           tions, such as camera navigation and          models are connected to television moni-
does a hospital ensure that its surgeons        suturing. Specifically for the ob/gyn resi-    tors for viewing. The ob/gyn department
are up to snuff?                                dents, the simulator can imitate gyneco-      also will be getting an anatomic model to
Solid surgical skills start with solid train-   logic procedures, such as tubal ligation or   practice tubal ligation and basic laparo-
ing. Washington Hospital Center main-           removal of an ectopic pregnancy.              scopic skills.
tains a general surgery residency and fel-      The surgical resident training program        The obstetrical simulator is an anatomic
lowships in surgical subspecialties in such     has the same virtual reality simulator as     model that is mechanized to perform
areas as trauma, transplant, cardiovascu-       ob/gyn, says surgeon Frederick C. Finelli.    vaginal delivery. The goal is to demon-
lar and neurological surgery. In                                                                      strate that simulation training
addition, many other specialties                                                                      drills in shoulder dystocia
require surgical expertise, such as                                                                   improves the physician’s per-
obstetrics/gynecology, dermatol-                                                                      formance during this situation,
ogy and ophthalmology.                                                                                leading to a favorable outcome for
Residents and fellows receive                                                                         mother and infant. This model
hands-on training in the operating                                                                    can be used as a tool in risk man-
room, under the tutelage of expe-                                                                     agement strategies because it can
rienced surgeons, says John Butler,                                                                   be used to rate technical skills and
MD, a general surgeon who                                                                             behavioral performance during
trained at the Hospital Center and                                                                    the management of emergencies
now is chair of the surgical practice                                                                 such as shoulder dystocia and
committee. “Technical skills are                                                                      postpartum hemorrhage. In addi-
open to subjective opinion,” he                                                                       tion, the simulator equipment
notes. “But attending physicians                                                                      can be used to train the nursing
rate residents assigned to their                                                                      and ancillary staffs in other
team quarterly.”                                                                                      obstetrical emergencies and criti-
                                                                                                      cal care scenarios.
Now, thanks to technology, resi-
dents can practice surgical skills on                                                                  “This gives us objective points to
                                         Dr. Frederick C. Finelli:      Dr. Briana Robinson-Walton:
anatomic models and in simulators Virtual Reality gives trainees Sees a new wave of training           look at and assess, so we can eval-
before they ever approach their feedback.                                                              uate residents and post grads on
                                                                        and assessing skills.          specific parameters,” Robinson-
first patient with a scalpel. This
new technology promises to take                                                                        Walton explains. Further, the
some of the worry out of perform-                                                                      novice surgeon’s efforts can be
ing surgical procedures for the first time.      “We have eliminated the animal lab por-                videotaped, so he or she can pro-
                                                tion of surgical training in favor of the vr vide self-feedback and also receive feed-
Washington Hospital Center has added system,” he said. “One of the beauties of back from others.
training devices that allow residents to the vr system is that it gives the trainee
refine surgical skills, much in the same feedback on errors as they are made, via “We need to train residents and post
way a pilot perfects aviation skills.“This is the screen display.”                             grads to do new procedures safely with-
the new wave of learning and assessing                                                         out impacting patient safety or out-
surgical skills,” says Briana Robinson- Finelli notes that residents can learn even comes,” she adds. “There can be a major
Walton, MD, associate residency director if the attending is not present. “This is a impact from minor mistakes.”
for ob/gyn. She is in charge of the simula- big advantage over traditional kinds of
tion program for ob/gyn residents.              simulation where the instructor (usually
                                                the attending) had to watch every move-
                                                ment for the trainee to get feedback. The
                                                vr system stores the results and you can
                                                see what needs improvement.”
– 12 –
Down the road, she would like to create a
multidisciplinary lab, where all surgeons
can practice skills. “The focus of the lab
would be on technique, skills set assess-
ment and, finally, procedure. We’re in the
infancy stage of the program now, but it
is pretty exciting. This is a step in the
right direction for the future in training,
evaluation and possibly credentialing.”
However, for attending physicians, there
is no standardized program to assess sur-
gical skills. Outcomes are the best meas-
ure of surgical competence, Butler notes.
“We pay very close attention to out-
comes,” he explains. “If we notice a trend
of more complications [associated with a
particular surgeon] that is consistent, that
will trigger a review of the surgeon’s tech-
niques or practice.”
The Hospital Center has policies in place
to safeguard patients. Credentialing
requirements ensure that surgeons have
training and experience performing
specific procedures. “Credentialing is
key,” Butler says.“We look at the surgeon’s
training program, case log, licensing and
board certifications.”
For new surgical applications, surgeons
cannot post a case unless they have
demonstrated proof that they have been
trained appropriately. Training typically
requires completion of a course in that
procedure and a specified number of
proctored cases.
But Butler points out that surgical skills
are only part of the equation for surgical
competence.
“Technical skills are important, but good
surgical judgment is also very important.
A surgeon has to know when to operate
and how to manage a patient appropri-
ately pre- and post-operatively.”      ■
                         — Catherine Avery




                                               – 13 –
    Chief Resident


Chad Friedman, DPM
On Solid Footing



S
      ince Dr. Chad Friedman began his             “We also rotate to different hospitals—
      residency in podiatry three years ago,       Georgetown, Union Memorial, Children’s—
      nearly 1,000 people have walked out          that serve different age groups and people
of the podiatric clinic at Washington Hos-         with different problems.”
pital Center after seeing him, which means
he’s doing exactly what he set out to do:          “Plus we have 20 different attendings,” he
“Podiatry appealed to me because often             says. “I like having so many because I learn
you can treat patients when they first come         something unique, something different,
into your office, usually solve their prob-         from each one of them.
lems and have them walk away happy,” says          “We also have plenty of opportunity to do
the chief resident.                                research and be published in many
“I knew I wanted to go into medicine in            different journals and magazines.” He has
high school. I liked science and was good at       had two articles published in the Diabetes
it and I always enjoyed watching television        Watch column of Podiatry Today, one in
shows about medicine.” Dr. Friedman holds          May 2006 describing the use of silver in
a degree in biology from Penn State                wounds; and one in July 2006 discussing
University. A lover of pick-up basketball and      gastric bypass surgery for diabetics. He’s
a Philadelphia Eagles fan, his interest in         most excited about a third article,
sports also fueled his desire to practice          coming out next year in Clinics in
podiatry. “Podiatrists also treat many sports      Podiatric Medicine and Surgery about
medicine injuries. Running injuries, like          the use of antibiotics in podiatry.
cracked metatarsals, strains and other foot        “Everyone’s bodies take a toll on their
problems respond to conservative treat-            feet, considering the number of miles
ments such as stretching exercises, and            we walk a day,” he says. “As a
physical therapy.                                  podiatrist I can also recommend the
Raised outside of Philadelphia, Dr.                right shoes and design orthotics that
Friedman came to Washington Hospital               help keep serious foot problems,
Center from Temple University School of            such as bunions, at bay for a while.”
Podiatric Medicine. “I had a few residencies       When orthotics, exercise and
to look at,” he says. “I liked that the Hospital   therapy can no longer help,
Center was out of the Pennsylvania area            however, “Podiatry offers me the
because I wanted to explore a city different       opportunity to eliminate foot
from Philadelphia.” He lives in D.C. just          problems like bunions through
outside Georgetown.                                surgery.”
The Hospital Center also came highly               Dr. Friedman was raised in
recommended. “During the last year of              Bensalem, Pa., where his
podiatry school some graduates who had             mother, a homemaker, and
done residencies at Washington Hospital            father, a controller in the
Center came to Temple to talk about how            plumbing and heating
         .
great this program was compared with               industry, still live. His brother, Scott, is an
others,” he says. “I’m glad I came here to do      optometrist working in New Jersey.                “Of course, I’m looking to create a successful
my residency,” he reports.                                                                           private practice,” he says. “But I hope to also
                                                   Engaged to Jamie, a school counselor from         continue working at a teaching hospital like
“We have a high volume of patients at the          Philadelphia, he plans to return to Penn-         Washington Hospital Center, to teach other
clinic, which gives us a variety of experience     sylvania in 2007, where he hopes to put his       doctors what I’ve learned here.”             ■
with a diverse patient population, from            clinical skills and all that he’s gained at
diabetic foot problems to breaks and fractures     Washington Hospital Center into practice.                                        — Carol Casey
to surgeries to correct foot abnormalities.



– 14 –
  Spotlight On…

Leslie W. Miller, MD
Chief, Cardiology

F
     or someone who has spent his career delving into heart
     failure, Leslie Miller, MD, has no failure of heart. He brings
     a singular passion to his practice of cardiology, incorporat-
ing a surprising multiplicity of skills.
Effective August 1, Dr. Miller assumed a unique role that inte-




                                                                                                                                          (Photo by Cynthia Miller)
grates the strengths of MedStar’s Washington, D.C. hospitals. He
is chief of cardiology at Washington Hospital Center and chief of
cardiology at Georgetown University Hospital. He also is aca-
demic chair of cardiovascular medicine at Georgetown University
School of Medicine, where he holds the Walters Family Chair.
The Hospital Center/Georgetown job offered him an opportu-
nity he could not resist. “Washington Hospital Center has one of
the largest, most respected cardiovascular programs in the coun-
try,” he notes. “It is now enhanced by the additional clinical          While Dr. Miller plans to promote all areas of clinical excellence,
strength of Georgetown University Hospital (GUH) and the aca-           the treatment of heart failure remains closest to his heart. “I’ve
demic and research strength of Georgetown University Medical            watched the evolution of therapies for 25 years now,” he explains.
Center (GUMC). This is an incredible opportunity to create the          “Washington Hospital Center already has a committed heart fail-
model of the future, combining academic research and educa-             ure program, along with mechanical assist devices and transplan-
tion with excellence in clinical care.”                                 tation. I plan to bring new faculty here and expand research stud-
Dr. Miller was well acquainted with the Hospital Center’s and           ies so we will have the most complete menu of treatment options
GUH’s clinical strengths. He has worked closely with cardiac            for patients with any severity of heart failure. With new drugs,
surgeon Steven Boyce, MD, over the years, and knows retiring            stem cell therapy and new mechanical assist devices, I want to cre-
cardiology chair Joseph Lindsay, MD, as well as other Hospital          ate the dominant heart failure program in the country.”
Center and GUH cardiologists.                                           In addition to promoting clinical excellence, the challenge of cre-
Dr. Miller wore several hats in his previous job, too. At the Univer-   ating a program that integrates clinical application with research
sity of Minnesota, he served as chief of cardiology, director of the    and educational excellence is a primary appeal. “If we align the
heart failure and transplant program, and director of the cardiol-      goals and strengths of the Hospital Center and Georgetown, we
ogy training program for nine years. During that time, he also          can create the nationally dominant cardiology program, so we
conducted research into the molecular mechanisms of cardiac             can build on each other’s strengths,” he says.
remodeling, mechanical assist devices and transplant immunology.        Dr. Miller has always sought a career in medicine. “I never had
But back to Dr. Miller’s multiplicity of skills…. He is well estab-     any other career aspirations,” he notes. “From childhood, I
lished as a cardiologist specializing in heart failure, since he        wanted to be a doctor. It provides an extraordinary opportunity
finished his fellowship training in Boston at the Peter Bent             to interact with and take care of people. It’s such a privilege.”
Brigham Hospital. He also completed three years of surgery res-         A native of St. Louis, he is excited about his move East. He hopes
idency, primarily at Washington University, before switching to         to buy a home in the District, convenient to both the Hospital
medicine and focusing on cardiology, where he could combine             Center and Georgetown. He will maintain offices in both centers.
medical and interventional approaches to treatment. So that             He and his wife, a photographer, have two children—a daughter
explains his knowledge of and interest in mechanical assist             entering medical school and a son entering college.
devices and transplantation for heart failure patients.
                                                                        When not working, Dr. Miller enjoys roller blading and ice skating,
Just prior to becoming chief of cardiology at Minnesota, Dr.            and loves sailing. “I have to say that access to great sailing helped
Miller completed a two-year sabbatical in transplant immunology         influence my decision to come here,” he notes with a laugh.
and vascular biology at the University of Alberta in Edmonton,
Canada. That experience provided him the focus on basic science         But his greatest passion is cardiology. “I have a sense of real
research along with extensive experience in clinical research.          excitement about coming here,” he concludes. “There is a clear
                                                                        standard of excellence here already. I’d like to bring another
Despite his experience as an administrator, researcher and edu-         internationally recognized program in heart failure and forge a
cator, Dr. Miller is clear about what aspect of medicine most           real integration of Washington Hospital Center with George-
appeals to him—hands-on patient care. “I’ve been intimately             town’s significant academic strengths, so we get the international
involved in patient care at Minnesota, and I will continue that at      recognition this program deserves.”                            ■
Washington Hospital Center and GUH.”
                                                                                                                        — Catherine Avery
                                                                                                                                                        – 15 –
    Feature                                                                                        CONTACT                    INFORMATION
                                                                                                                James S. Jelinek, MD
                                                                                                                 Editor • (202) 877-6088
                                                                                                               James.S.Jelinek@MedStar.net
                                                                                                                   Margo Smith, MD
                                                                                                            Associate Editor • (202) 877-7164

Center for Breast Health                                                                                      Margo.A.Smith@MedStar.net
                                                                                                         Annamarie G. DeCarlo, ABC
                                                                                                           Managing Editor • (202) 877-3118

Goes Totally Digital                                                                                       Annamarie.G.DeCarlo@MedStar.net


Selenia™ Digital Mammography System                                                                Washington Hospital Center Physician is an
                                                                                                   informative monthly publication for all the members of the
                                                                                                   Washington Hospital Center Medical and Dental Staff. It is a
Installed                                                                                          forum to report news of interest to the medical staff, disseminate
                                                                                                   information about what is going on in the hospital, introduce new
                                                                                                   providers and profile current ones, exchange ideas and opinions
                                                                                                   about subjects of interest and controversy, and recognize the



T
      he Center for Breast Health at Wash-      enhances visibility of the breast, particularly    professional and personal accomplishments of our practitioners.
                                                near the skin line and chest wall and among        Its overall goal is to help foster and celebrate a sense of commu-
      ington Hospital Center, one of the                                                           nity among the broad diversity of the Hospital Center physician
      busiest screening and diagnostic suites   women with dense breast tissue.                    membership. The newsletter is published by the editorial services
                                                                                                   division of Public Affairs for the Office of Medical Affairs.
in the region, now offers a filmless environ-
                                                The image quality itself is superior to film,       MISSION—Washington Hospital Center, a valued member of
ment with the installation of two Selenia™                                                         MedStar Health, is dedicated to delivering exceptional patient
                                                and images are available within seconds,           first health care. We provide the region with the highest quality
Digital Mammography Systems.                                                                       and latest medical advances through excellence in patient care,
                                                allowing the mammographer to confirm                education and research.
The Selenia system offers physicians and        proper positioning immediately.                    Washington Hospital Center, a private, not-for-profit hospital,
                                                                                                   does not discriminate on grounds of race, religion, color, gender,
patients several important advantages,
                                                The system comes with SecurView, a diag-           physical handicap, national origin or sexual preference.
according to Margaret Graves, MSM, director                                                        Visit the hospital’s Web page at: www.WHCenter.org.
                                                nostic workstation that allows radiologists to
of Radiology for Ambulatory Services and
                                                manipulate, magnify and annotate the
the Center for Breast Health.
                                                images on site, increasing efficiency and diag-        James F. Caldas, President, Washington Hospital Center
                                                nostic accuracy.                                                         Richard A. Weiss
                                                                                                        Chairman of the Board, Washington Hospital Center
                                                David Grant, MD, senior attending radiolo-                   John P. McDaniel, CEO, MedStar Health
                                                gist, notes that “another very practical advan-
                                                                                                           James Jelinek, MD                  Editorial Board
                                                tage of the digital mammogram systems is                          Editor                          Members
                                                the ability to reliably retrieve previous images           Margo Smith, MD                 David Downing, MD
                                                for yearly comparisons. No off site storage                  Associate Editor                Jeffrey Dubin, MD
Full field digital image, left, shows a small                                                       Annamarie G. DeCarlo, ABC                Cheryl Iglesia, MD
mass with calcifications (arrow). Notice that   and other potential avenues of loss of impor-               Managing Editor                Stephen Peterson, MD
mass is better demonstrated on the digital      tant data for diagnostic followup.”                     Jean Wilhelmsen-Exter               Michael Pistole, MD
image than on the standard film screen                                                                       Graphic Design
                                                                                                                                           Marc Schlosberg, MD
mammogram, right. This mass turned out          He added that “the interpreting radiologist            Frederick C. Finelli, MD
to be an invasive cancer.                                                                                       President,                   Thomas Stahl, MD
                                                also has the ability to incorporate computer-          Medical and Dental Staff              Guy Weigold, MD
                                                aided detection (CAD) with the digital mam-             Janis M. Orlowski, MD                 Larry White, MD
Its direct technology eliminates the image-     mogram systems and CAD has been shown                     Senior Vice President
degrading effects of light diffusion common                                                            and Chief Medical Officer            Contributing Writers
                                                to increase the detection of cancers during                                                   Catherine Avery
in systems that use indirect technology. This                                                                  Lisa Wyatt
                                                screening mammograms.”                             Sr. Vice President, Public Affairs           Carol Casey
helps to improve image sharpness, and                                                                        Christine Vinh                Rachel Christopherson
                                                For more information call (202) 877-9244. ■                Asst. Vice President                 Hope Keller
                                                                                                   Medical Affairs/Quality Resources
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