Community Health Network, in partnership with Healthcare Performance Improvement (HPI) hosted the 2008 Safety Summit this week. The conference theme, Navigating toward Safer Outcomes, provided an opportunity for more than 250 health care leaders from around the country and the network to gather and discuss ways to advance the culture of safety. Speakers shared best practices and lessons learned at this two-day conference from their safety culture journeys.

“With the annual safety summit taking place right here in Indianapolis the network had the opportunity to send many leaders, safety coaches and others, who have been and continue to be instrumental in the culture of safety journey,” shared Trudy Hill, network safety officer.

“Topics included integrating human error science into process improvement methods; internal transparency; a system approach to culture transformation; giving new meaning to rapid response teams; and inspiring behaviors for a culture of safety.

“I know all those who attended are inspired to continue on this transformational journey with renewed urgency,” said Trudy. “I have been humbled by the commitment of all who participated and look forward to the continuing journey of the entire network.”

From: PEDIATRICS (doi:10.1542/peds.2008-2449)

Recommendations have been expanded to include all children ages 6 months to 18 years of age.  Household members and out-of-home care providers for all children at high risk, adolescents, and all children under 5 years of age should also be immunized.  Also, as usual, health care professionals and pregnant women should receive the vaccination.

The number of vaccine doses is age dependent.  Children over the age of 9 who have never received an influenza vaccine only need one dose in their first season of being immunized.  Any child under 9 years of age, receiving an influenza vaccine for the first time, should receive a second dose, four weeks after later.  Children under 9 who received only one dose in previous seasons should receive 2 doses in the following season.  This only applies “to the influenza season that follows the first year that child younger than 9 years receives an influenza vaccine.”

Efforts to immunize patients should begin at the onset of flu season and continue through May 1st as there can be multiple peaks of activity in one season.

In accord with Community North Hospital’s desire to offer regular Pediatric Grand Rounds, another session is scheduled for November 5th, 2008.  Our next speaker is Chris Belcher MD, with Infectious Disease of Indiana.  Dr Belcher is a pediatric infectious disease specialist, who supports physicians in our area on childhood infectious disease matters.  He will be providing a lecture titled “Vaccination Update 2008”. 

Again, these sessions are provided monthly and are eligible for CME.  We will provide these offerings on the 1st Wednesday of each month at 7:30 am, in the multi-service conference rooms on the 3rd floor of the professional building.  Breakfast refreshments will be served.

If you have any questions about this, you can contact Dr Robert Lindeman at Community North’s pediatric unit 317-621-5474.

Last week Community Health Network hosted our annual Best In Class Showcase, featuring exceptional and innovative work being done across Community Health Network.

Representatives from all parts of the network gathered to share their latest ideas and best practices, hear operational updates and a motivational address from former local news anchor Anne Ryder. And they honored winners of the network’s first annual Leadership Excellence Awards.

Check out this episode of "Community News" for more.

There has been a lot of news recently about a national health record being able to display a patient record for the clinicians if someone appears in a hospital.

The example that is cited the most is someone appears unconscious at an emergency room at a hospital when they are out of town.  The system pulls up their medical records even though they haven't been there before.

This scenario depends on three factors occurring:

1. The patient is out of town.
2. The patient has an event that causes them to go to the emergency room.
3. The patient arrives unconscious and without family or without some sort of medical information on them.

While I’m sure this example does happen, it would not be the norm; it would be an aberration.  I would think that patients who have serious conditions like heart problems would take some medical information with them when they travel in case something happens.  Or at least they would be with family members who know what their medical issues are.  They would probably have their medications with them when they travel even if they don’t have them in the emergency room.

This scenario is very dramatic and compelling but would not occur often enough to justify the expense the time and effort to create these systems.  The scenario that should be targeted to improve would be the day to day flow of medical data in a health system.  Patients are asked to complete similar paperwork with similar pieces of data each time they visit a new location in a health care system, physician office, emergency room, surgery, etc.  Fixing this problem would save more expense and improve more patient care than the unconscious patient appearing in a out of town ER.

Community’s first eCycling event was a partnership involving the network’s green team, Computer Experts Inc., Keep Indianapolis Beautiful, Virtual Scavengers and 1-800-GOT-JUNK. A team of volunteers processed donations during the 10-hour event in the Community North parking lot.

The event sought old electronic products—such as used computers, VCRs, DVD players, cell phones and televisions. Disposing of such items through regular trash pickups is not considered safe, due to hazardous materials they may contain. Equally important, in many cases these used electronics still have some good life left in them.

Virtual Scavengers, for example, reconditions old PCs, printers and monitors—or disassembles them for parts—and helps provide low-income families with low-cost technology and training. Donated items that were determined to have no potential for reuse were taken away for safe disposal by partner 1-800-GOT-JUNK. The preliminary weight total of objects that were e-cycled at the September 5 e-Cycling event was 27,292 pounds.

“I want to tell you how wonderful the whole event was for us. You work with an incredible group of people. The volunteers worked long, hard hours with enthusiasm and humor. We were also deeply touched by the enthusiasm of your donors; they were obviously genuinely excited by the knowledge that their ‘babies’ were going to remain in use and benefit other families," says John Crooks, executive director of Virtual Scavengers.

To see a video of the day's events, click here.

Looking for something to add flavor -- and a little kick -- to your salads, sandwiches, and grilled chicken? Nilima Mondal, cook at Community Hospital East, shared her recipe for spicy tomato ginger chutney:

1 c + 2 T cider vinegar
1 c + 2 T sugar
¾ c red wine vinegar
¼ c fresh ginger root, peeled & minced
1 T whole mustard seed
2 tsp Kosher salt
¾ tsp black pepper
1 tsp crushed red pepper flakes
¼ tsp ground cloves
1 ½ pounds plum tomatoes, diced ½ inch
½ pound fresh red peppers (sweet), seeded & diced ½ inch

In a heavy bottom non-reactive pan over medium high heat, bring all ingredients except tomatoes and diced red peppers to a boil. Let boil 8 to 10 minutes. Add tomatoes and fresh red peppers. Bring back to a boil. Reduce heat. Simmer 45 minutes to 1 hour, stirring often until most of liquid is evaporated and sauce coats the back of a spoon. Cool. Store in refrigerator covered for up to 3 weeks. (Makes 2 cups)

The chutney is a nice complement to ham, turkey, grilled chicken, or grilled portobello mushrooms. To make a salad dressing, whisk some additional oil and vinegar into the finished chutney. Bon Appetit!

If you don't want to do the cooking yourself, you can enjoy Nilima's creations at the Community Hospital East cafeteria daily, 7 a.m. to 7 p.m.

Community Health Network will host a bike rodeo for kids ages 7 to 12.

Saturday, September 27
10 a.m. to noon
Community Hospital North

The rodeo will be held in the parking lot on the south side of the hospital campus, just east of Community Regional Cancer Center. Participants should bring their bicycle and a helmet, if they have one. The event will include a helmet fitting station to ensure riders are receiving maximum benefit from their safety gear. Kids will also have the chance to visit three skill stations that will teach them how to stay safe, while having fun, on their bike.

“We are offering this free event as a public service to our local community,” says Tom O’Daniel, bike patrol coordinator and field training officer. “Young cyclists are encouraged to join us, rain or shine.”

Quality indicator data for Q2 2008 has been posted at eCommunity.com/quality.

The data reflect Community's high quality patient care for indicators in three categories:

• Heart attack
• Congestive heart failure
• Pneumonia

Community's quality data are compared against national hospital averages and are provided for all network hospitals: Community Hospitals North, East, South and Anderson, and The Indiana Heart Hospital.

More information, including national averages for hospital quality data, can be found at http://www.hospitalcompare.hhs.gov

The FDA has issued a Health Information Advisory urging U.S. consumers to avoid all infant formula from China, after several brands sold there may have been contaminated with melamine, a chemical used in plastics. Although sales of infant formulas from China are illegal in the U.S., FDA officials are concerned that some formula from China may be on sale at ethnic grocery stores here. The FDA stresses there is no risk of contamination to the U.S. Domestic supply of infant formula. Melamine is known to cause kidney stones and other serious kidney conditions.

For more information, please go to the FDA Web site.

Football season is upon us, and although concussions occur year round, this seems like an appropriate time to briefly discuss concussions. Athletes who suffer a concussion during the season are at increased risk of recurrence during the same year. Studies have demonstrated a decrease in cognitive function in association with repeated head trauma. There are also concerns regarding second impact syndrome, but because of the very small number of documented cases, the diagnosis is controversial.

Data is not readily available to guide decisions about the timing of return to sports after concussion. However, conservative recommendations reflect concern regarding second impact syndrome. Sideline evaluation generally includes tests of mental function and coordination and provocation of symptoms such as headache, dizziness or unsteadiness with exertion.

Review the AAP/AAFP practice parameter on Acute Evaluation of Concussion

Review the 1997 American Academy of Neurology Practice Parameter

 I am proposing a waiting period for new! cool ideas.  Like there is for buying guns.  

You know, those ideas that come from IT news sources and press releases about the latest thing that’s coming out soon.

The minimum waiting period before making any changes or building something new because of a cool idea is two weeks.  Oh come on, with guns it is a month.

There could also be a sliding scale that depends on the size of the project.  Small one page application the waiting period could be a week.  A larger application or a new website should be a least a month.

The waiting period is to give the idea time to mature so that you don’t end up always chasing the LatestNewCool thing and never actually build something that works.  Or to let you cool down so that you don’t build something just for the sake of using the LatestNewCool thing.  Just like with guns.

And for all iPhone applications that waiting period must be three weeks.  Minimum.

Like more than a few people, I downloaded the new Chrome browser to see what it was like.  The most interesting thing about it is how it integrates into other Google services like Bookmarks and Web History.  It’s like Google had this browser in mind when they created those services.  Right now I have those working in other browsers through the Google Toolbar, but they are built right into Chrome. As Spock would say, "Fascinating."

From PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1062-1068 doi:10.1542/peds.2008-0564

The AAP Committee on Nutrition has updated its 1998 statement on the use of soy protein–based formulas in infant feeding.

In term infants, the few indications for use of soy formula in place of cow milk-based formula are: (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred. 
Note:
1) For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.
2) Most previously well infants with acute gastroenteritis can be managed after rehydration with continued use of human milk or standard dilutions of cow milk-based formulas. Isolated soy protein-based formulas may be indicated when secondary lactose intolerance occurs.
3)Isolated soy protein-based formula has no advantage over cow milk protein-based formula as a supplement for the breastfed infant, unless the infant has one of the indications noted previously.
4)Soy protein-based formulas are not designed for or recommended for preterm infants.
5)The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness.
6)Infants with documented cow milk protein-induced enteropathy or enterocolitis frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula. They should be provided formula derived from hydrolyzed protein or synthetic amino acids.
7)The routine use of isolated soy protein-based formula has no proven value in the prevention of atopic disease in healthy or high-risk infants.

Community North hospital will be providing monthly Grand Rounds with CME on pediatric topics effective October 1,2008.  We will provide these offerings on the 1st Wednesday of each month at 7:30 am, in the multi-service conference rooms on the 3rd floor of the professional building.  Breakfast refreshments will be served.

Our first speaker will be Community’s new pediatric neurologist, Dr Deb O’Donnell, who will be speaking on the Epidemiology of Seizures.  This will be a great opportunity to meet Dr O’Donnell and learn more about pediatric seizures.  If you have any questions about this, you can contact Dr Robert Lindeman at Community North’s pediatric unit 317-621-5474.

Community Health Network's e-Business team and staff at Community Regional Cancer Center launched the network's new myCommunity Express Check-In system Friday, August 29th, with much success. 

The clinic is closed on Tuesday afternoons.  Contrary to public expectation, nobody is golfing.  Except maybe Chris.  We have a "dedicated" didactic block for the residents to attend lectures on pertinent topics in family medicine.  For me, being on medicine service for the past month, "dedicated" means make it when you can.  For everyone else, Tuesday afternoons are a great time to catch up with all the residents.  
    I caught up this past week in August.  The meeting was at the Community Rehab and Sports Medicine center across from CHE.  We got to see for ourselves where our patients go and what they experience when we send them for PT/OT.  Coming from training as an Osteopathic Physician, my philosophy on health is that the body is an integrated whole with an inherent ability for self healing. We are taught appreciation for the body's interrelation of structure and function.  I've used musculoskeletal manipulation of various forms to optimize the physiology of my patients.  At the rehab center this approach to healthcare happens daily.
The clinicians at Community were dedicated and impressive.  The treatment plans are very well thought out, and outcomes of each encounter are measured to improve overall care and to show objective results. The training facility is first rate. The talented people there complement our work in the clinics and give patients the consistency many chronic problems require.  Thanks for lunch and the impressive tour, your work is vital.

    Next, we returned to CHE for an interactive lecture on sleep apnea.  We were introduced to the various CPAP masks and machines.  It was a real eye opener (and nostril opener). 
    The day ended with an earfull of information from  Dr. Matthew O'Malley a neurotologist who recently joined the Midwest Ear Institute and specializes in ear, hearing, and balance disorders. He honored us with his expertise in this area and we are all grateful.  Welcome to Indianapolis.
     It felt good to meet up with everyone again, (there are actually eight of us interns!) I enjoy these Tuesday afternoons - they are a breath of fresh air.