Below are the June Medical Staff Updates. As a reminder, all providers must complete the attestation at the bottom of this page by June 30.
Medical Leadership Message
Kaleida Health continues to have a positive trend. From physicians’ point of view, we like to follow numbers, and ours are looking great.
The organization reviews indicators in quality and safety, patient satisfaction, length of stay (LOS) as well as the financial numbers, and we are seeing positive trends in all these areas.
The leadership team is most proud of the reductions in healthcare-associated infections that we have been able to achieve. We set robust goals for these infections, and it is only through a working collaboration between nursing and the Kaleida Health Medical/Dental Staff that we will be able to hit our targets. There are plans underway to improve how we address Foley and central line placement and care. In addition, there will be an aggressive hand hygiene campaign to further reduce MRSA and C. difficile infections.
Kaleida Health’s patient satisfaction scores have been up and down but are generally trending up.There are more domains over the 50th percentile than ever before, and we will continue to expand on our efforts to further these trends. LOS and costs per case now rival that of systems across the country that we are compared against, and the organization’s revenues remain strong.
When you look at all of the numbers, you will ultimately see – we are seeing more patients than before, sicker patients than before, performing more efficiently than before and with improved outcomes. This is what makes Kaleida Health a successful healthcare agency and the leader in health care in Western New York.
This success is directly attributed to you, the Kaleida Medical/Dental Staff, who provide the leadership and direction in the daily care of our patients. Thank you for all that you do.
David Hughes, MD, MPH
Chief Medical Officer
Kaleida Health
Kenneth Snyder, MD, PhD
Vice President, Physician Quality
Kaleida Health
Colin McMahon, MD
Chief Medical Officer
Buffalo General Medical Center
David Pierce, MD, FACEP
Chief Medical Officer
Millard Fillmore Suburban Hospital and DeGraff Memorial Hospital
Stephen Turkovich, MD
Chief Medical Officer
Women & Children’s Hospital of Buffalo
Kamil Alpsan, MD
Site Medical Director
DeGraff Memorial Hospital
Message from the President of the Medical/Dental Staff
At the May Medical Executive Committee (MEC) meeting, Andrew Curtis, MD, MBA, from the Greeley Company provided an orientation for new MEC members (which also served as a refresher for the experienced members). Greeley specializes in medical staff organizations, and Dr. Curtis is one of their regular speakers. I have had the opportunity to attend a number of Greeley seminars and am certified through them as a Medical Staff Leader (CMSL). Dr. Curtis covered a range of topics, including how the MEC relates to the Kaleida Health Board of Directors and management, how the MEC can help improve physician performance, the role of the Peer Review and Credentials Committees, and many others. He reviewed some of the key roles and responsibilities, including:
- The president of the Medical/Dental Staff and the MEC has responsibility for the organization and conduct of the medical staff
- The chiefs of service and chief medical officers oversee and improve (i.e., manage) the quality of care and professional conduct of individuals granted privileges and assigned to their department
- The chief executive officer and management are responsible for implementing effective processes (including patient care, human resources and financial management), ensuring adequate physical plant and technology, and meeting board-approved quality, financial and operational targets
Dr. Curtis also emphasized that there is a critical interdependence among the board, Medical/Dental Staff and management. These entities must be aligned around a shared vision that provides for the triad of good patient care, hospital success and provider success. The Medical/Dental Staff is a key partner in this alignment, and I and the other Medical Staff officers will continue to work closely with Kaleida Health’s board and management to achieve our mutual goals.
Peter Winkelstein, MD, MS, MBA, FAAP
Medical/Dental Staff President
Kaleida Health
Hospital-Acquired Conditions: Surgical Site Infections
Kaleida Health’s top quality and patient safety priorities in 2016 focus on reducing hospital-acquired conditions (HAC). One of the top five HAC across Kaleida Health is surgical site infections (SSI), and Kamil Alpsan, MD, site medical director at DeGraff Memorial Hospital, is leading the reduction and prevention efforts.
SSI are the second most common healthcare-associated infection (HAI). SSI rates are disproportionately higher among patients following colorectal surgeries. Resulting SSI are known to have significant patient complications with adverse clinical and economic impact. Preventing colorectal SSI is a complex problem with multiple variables specific to patients and patient populations, institutional factors, surgical practice and process.
Based on the evidence, surgeons and anesthesia across Kaleida Health agreed upon the colon bundle in efforts to reduce colon SSI rates. The best practices include:
- Ertapenum within one hour of incision
- Skin preparation with antiseptic agent with alcohol
- Fascial wound protector
- Gown and glove change before fascial closure
- Dedicated wound closure tray
- Maintenance of normothermia
- Maintenance of euglycemia
- Increased perioperative oxygenation
We continue to incorporate evidence-based medicine into our practices to reduce colon SSI. In the first quarter of 2016, Kaleida Health’s infection rate was 3.9 percent (state average is 6.6 percent). If you have any questions, please contact Mark Falvo, MD, or Dr. Alpsan for more information.
New Consent Process Effective July 1
To truly lead with CARE, it is everyone's responsibility to ensure the safety of each and every patient by following the appropriate guidelines established by Kaleida Health's regulatory agencies. 
Kaleida Health is required by the Department of Health, Centers for Medicaid and Medicare Services (CMS) and DNV to include certain information on our consent forms. In the past, DNV cited Kaleida Health for failing to have proper control over consent forms and for using outdated forms.
To ensure that the up-to-date language mandated by our regulatory agencies is on our consent forms, Kaleida Health will begin using only forms marked with a version number to indicate if the form is current.
The consent forms that Kaleida Health will be using are:
- Consent for Medical and/or Surgical Treatment – KH00049 and all of its subsets KH00049-xxx
- Consent for Bedside Procedure – KH24803
These consent forms will be available for use as of June 1, 2016, and we encourage all providers to use the updated forms with the version number printed in the bottom right corner.
Consent forms without the version number printed in the bottom right corner will be accepted until July 1, 2016.
After July 1, 2016, only forms with the correct version number will be accepted.
The current version number is v1, which can be found on the bottom right corner of the forms.
It is Kaleida Health’s expectation that all physicians, nurses and office staff are aware of the current version number and only use those forms with the current version number present.
To make sure staff and providers are aware of what version is the most current, there will be a button on the homepages of KaleidaScope and InfoClique that displays the appropriate version number. Everyone should regularly check the button to be familiar with the current version number.
When completing a consent form, the physician performing the procedure should discuss the name and description of the procedure with the patient and receive the patient's consent before proceeding with the procedure. The physician or proceduralist signing the attestation must also make sure that the form is the correct version.
If a consent form is presented that is not the current version, the consent will be considered invalid, and the proper form must be executed prior to proceeding with the procedure and/or treatment.
The consent forms will be available on Forms on Demand, which allows staff to print the consent form at the time the patient will be signing their consent for the procedure. By printing consent forms as needed from Forms on Demand, users can be assured they are using the most up-to-date version.
If and when the version number changes due to a change on the form, staff must destroy all outdated forms to ensure they are no longer used. Kaleida Health will notify staff of a change to the version number via email as well as a notice in OneVoice.
By standardizing and streamlining the consent process across Kaleida Health, everyone will be better able to control documents and provide a safer environment for our patients.
Provider to Provider Communication
Provider to provider communication between referring providers is a key provision for best medical practices at Kaleida Health. Gaps in provider to provider communication are key findings in our root cause analyses. To this end, the Medical Executive Committee (MEC) has endorsed a policy of provider to provider communication. This is a culture change for all of us and key policy changes, to be implemented in June 2016, are listed:
- Providers will be required to contact consulting providers directly
- Orders and order sets for referrals will no longer have a choice for “floor to contact.” Simply, nurses and secretaries will no longer contact providers for consults
- Options for contacting other providers:
- Direct contact by phone or in-person
- Contact by pager or phone using on-call search
- Contact by secure texting (Imprivata Cortext)
- Your usual means, such as practice answering service
We are working on several processes to improve ease of communication, including:
- Consulting directly through the Electronic Medical Record (EMR) (You can build a consult list)
- Providing forwarding options in the secure texting environment
- Providing a secure texting application that allows sharing of PACS images
Anyone with ideas for improving the communication process or having difficulty with the referral process is encouraged to contact Robert Sawyer, Jr., MD, by email (Rsawyer@kaleidahealth.org) or by secure texting.
“Two Midnight Rule” PowerChart Certification
The “Two Midnight Rule” certification will be removed from PowerChart effective June 15, 2016, because it is no longer required by the Centers for Medicare and Medicaid Services (CMS). The certification created several issues that will also be eliminated by its removal, such as the inadvertent cancellation of inpatient orders and the fact that verbal inpatient admission orders could not be entered into PowerChart by a nurse. Physicians must be sure to document medical necessity and the plan of care for all those admitted as inpatient. Lack of sufficient medical necessity documentation is the basis for payment denial by all payors, including Medicare.
Electronic Medical Record Update for Kaleida Health Clinics
Kaleida Health has contracted with Cerner to transition all Kaleida Health clinics on paper to the Electronic Medical Record (EMR) as well as to optimize Kaleida Health clinics currently on EMR to model state (more user-friendly workflows and improved functionality).
The goal of this project is to keep the patient at the center of care by partnering with clinicians and using technology to support high quality care.
This project will:
- Facilitate the delivery of efficient care across the entire organization. Records from all Kaleida Health clinics will be readily available each time the patient is in a different clinic, the Emergency Department or admitted to the hospital
- Improve patient outcomes, improve the patient experience, and once fully implemented, reduce the cost of delivering high quality care
- Improve provider and staff job satisfaction
Clinical Research: Cystic Fibrosis Foundation Therapeutics Development Center
The Cystic Fibrosis Foundation-accredited Therapeutics Development Center, one of 82 in the country, has both adult and pediatric programs. The Center was the first site to enroll subjects in the international, pivotal phase 3 trial of ivacaftor (Kalydeco), a mutation-specific drug for a less common Cystic Fibrosis (CF) mutation, G551D; thus, a person from Western New York has been taking this medication longer than anyone else in the world. Ivacaftor dramatically changes the clinical course of CF for individuals with G551D and is now FDA-approved for use in children as young as two-years-old and others with rare mutations.
The Center has also been involved in studies of the combination of ivacaftor and another drug, lumacaftor for treatment of people with the most common CF genetic make-up, two copies of F508del. That drug combination (Orkambi) is FDA-approved for individuals down to age 12. The Center was instrumental in generating data to lower the age eligibility, some of it through use of a new lung function test that measures lung clearance index.
The Center is currently involved in a range of studies to explore the next improved small molecules and to extend the age range down to young children. The Center is also the national coordinating center of a study using a new biomarker to study CFTR’s role as a regulator of intraluminal pH through its role in bicarbonate secretion.
The CFF Therapeutics Development Center staff include Carla Frederick, MD, Danielle Goetz, MD, and Drucy Borowitz, MD; coordinators Nadine Caci, Christine Roach and Beth Cahill; and administrator Rosanne Johnson.
Medical Staff Attestation - June 2016
By submitting this attestation, I confirm that as a member of the medical staff I have read and understand the information included in this email from Kaleida Health in accordance with Kaleida Health policy MED.41 as approved by the Medical Executive Committee.
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